Medication errors cause preventable patient harm with annual costs of USD$42 billion globally. In England, 237 million errors occur annually, accounting for 1700 deaths, with trainee doctors being responsible for the highest proportion of errors. The UK introduced the national Prescribing Safety Assessment (PSA) in 2013 to ensure prescribing competency. Imperial College School of Medicine (ICSM) sought to increase learning opportunities and reduce errors through a monthly Prescribing Practice Questions (PPQs) programme. PSA scores from 2020 (prior to PPQ introduction) to 2024 (first cohort to receive entire PPQ programme), the prescription writing skills (PWS) subsection and applied knowledge test (AKT) scores in 2020 and 2024 were analysed. 1505 students sat the PSA between 2020 and 2024. PSA fails significantly reduced from 2.51% in 2020 to 0% in 2024 (p=0.0054). Median PSA scores significantly improved from 78.5% in 2020 to 84.0% in 2024 (p<0.0001). Median AKT scores decreased between 2020 and 2024 (78.0% vs 74.5%, p<0.0001). Absolute increase in PSA scores from lowest to highest quintiles was 10 percentage points (pp), 7pp, 5pp, 4pp and 1pp, respectively, between 2020 and 2024. Median PWS scores significantly improved from 76.3 % (61/80) in 2020 to 87.5% (70/80) in 2024 (p<0.0001). Since introducing PPQs, PSA and PWS scores have statistically significantly improved, with progressively greater impact on students at the bottom of the performance distribution. Early, targeted and repeated opportunities for authentic prescribing activities, such as the PPQs, in undergraduate training may lead to significant improvement in prescribing competency as determined by the PSA.