Table Of ContentGet ahead!
The Situational
Judgement Test
Nishanthan Mahesan MBBS BSc (HonS)
Foundation Trainee, North East Thames
Foundation School, UK
Sirazum M. Choudhury MBBS BSc (HonS)
Foundation Trainee, North Central Thames
Foundation School, UK
Janice Rymer MD FRcoG FRAnZcoG FHEA
Dean of Undergraduate Medicine and Professor
of Gynaecology, King’s College London
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Foreword
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Medical education has undergone enormous changes over the last two e
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decades. Gone are the days of didactic lectures. Teaching is now more F
student-centred with an emphasis on students taking on the responsibility
of advancing their own education with self-directed and problem-based
learning. The teaching methodologies have changed, not only to give the
students a more intellectually stimulating experience but also to reflect
the changing practice of medicine. Patients are now more involved in
decisions about their own treatment and are more questioning about their
medication, often asking for the evidence base on which these decisions are
made. On top of this, with faster travel across the world, the actual practice
of medicine has changed with diseases becoming more global and, with
the inevitable movement of people across countries, a richer mixture of
different cultures within societies. Thus new doctors have the challenging
task of not only having the appropriate medical knowledge but will also
have to meet difficult scenarios which will test their professional and
personal attributes, attitudes and preconceptions. A very challenging task!
The General Medical Council (GMC) and medical schools work towards
producing curricula that are more focussed and appropriate for the
populations we serve. It is therefore inevitable that as the curricula change,
the actual methodology for assessment of students needs to be addressed
to reflect these innovations.
One such assessment tool is the Situational Judgement Test (SJT), which
has been designed to examine the awareness and response of trainees
to these difficult scenarios. It is more objective in assessing the desired
attributes of a safe and competent doctor, removing the bias involved in
previous forms of assessment.
This book is intended for medical students and foundation trainees. It is
designed as a revision book to help the trainee through a set of intellectual
mental processes in order to reach a correct answer. In difficult situations
there are often no correct answers but those that involve a balance of ethics,
judgement and professionalism. It is all about assessing and balancing a
situation to reach the most suitable answer to the dilemma posed. The
book is based on the views of experienced clinicians. It contains plenty of
questions covering a wide array of professional dilemmas. I found these
most testing but also fun to do!
The book also contains several dedicated chapters containing tips
for trainees to assist them in answering the SJT questions. It gives some
background information on GMC guidance and references on difficult
ethical issues encountered in the daily duty of a doctor such as consent,
capacity and confidentiality.
This book will be very useful for the trainee and the more senior medical
student. The SJT will be taken by all final year medical students and the
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results will count towards the allocation of foundation posts. It will also
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foundation trainees who have experienced the examination as well as
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o experienced clinicians. I am sure it will be an excellent new addition to
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books that help us to revise for different examinations.
Professor Parveen J Kumar CBE BSc MD FRCP FRCPE
Professor of Medicine and Education, Bart’s and the London School
of Medicine and Dentistry, Queen Mary, University of London
President of the Royal Society of Medicine
Co-author of Kumar and Clark’s Clinical Medicine
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Preface
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Medical students will only have had limited exposure to the Situational r
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Judgement Test (SJT) until this crucial juncture in their medical careers.
The results of this examination carry a great deal of significance and
contribute towards what ultimately determines where they will work as
doctors.
Rather than being a test of clinical knowledge or technical skills, this
test aims to elicit the essential attributes of a successful foundation trainee
by presenting challenging and realistic scenarios that assess various
professional competencies. Proponents of this examination highlight
that such a test cannot be revised for; indeed, clinical experience is key
to developing the skills and attitudes required to answer these questions.
This book is intended as a preparatory tool for the SJT and offers an
organised and focused study of the aspects of clinical practice that are to
be assessed. The initial chapters are a compilation of basic ethical concepts
and GMC guidance on the most commonly encountered scenarios, and a
log of prerequisite knowledge that will assist with answering these types of
questions.
This book offers a logical approach to questions and details the sequence
to deriving the correct order of answers. Each answer is then backed with
justification drawn from official guidance.
The questions and answers included in this book are examples and
based on the expected style and content of the SJT examination. The
model answers and justifications are based on the authors’ interpretation
of current information and guidance on the relevant issues. As such, the
answers found in this book may deviate from the model answers in the
examination for similar scenarios.
We hope that this book offers you the preparation you require to succeed
in this examination.
On behalf of everyone involved in the production of this book, we
would like to take this opportunity to wish you the best of luck for this
examination and your future medical career.
Nishanthan Mahesan, Sirazum M. Choudhury and Janice Rymer
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© 2012 by Taylor & Francis Group, LLC
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Contents
1 Introduction 1
2 Analysis of SJT Questions 4
3 Common Topics in SJT Questions 9
4 Procedures and Protocols 21
5 Practice Questions 30
6 Practice Answers 91
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1: Introduction
THe SITuATIOnAl JudGemenT TeST
The practice of medicine is both rewarding and intellectually stimulating.
Doctors are placed in a unique position of enormous privilege, with
patients sharing their most intimate details, allowing the clinician to fully
explore the presenting complaint and address all aspects of their care.
Seeing a myriad of patients from all walks of life and a variety of cultures,
while treating each as an individual and acknowledging what is important
to them, continues to excite and challenge us. The daily activities of a doctor
are therefore highly variable, with novel cases presenting to even the most
experienced clinicians. Often challenging scenarios arise and guidance is
needed on the most appropriate way to approach them while upholding
the principles of the profession.
The Situational Judgement Test (SJT) is designed to highlight these
personal and professional dilemmas, and examine the response of
foundation trainees to these scenarios. The questions aim to portray
common situations that arise and test the essential attributes of a
foundation doctor. While the available responses to a given question may
not always be ideal, exploring the manner in which an individual prioritises
and assesses the suitability of particular actions can help paint a picture
of the level of understanding and intuition that the prospective doctor
has. The most challenging aspect of this assessment is demonstrating the
flexibility required to take the ethical considerations and guidance offered
by the General Medical Council (GMC), consider them, and then apply
them to a given scenario.
Since it has a more linear and objective basis of examination, the SJT
removes the bias associated with marking the forms of assessment that
had previously been used in this application process. While it is difficult
to prepare for such an examination, an awareness of a doctor’s priorities
in frequently encountered scenarios will aid in identifying the common
underlying themes and the accepted manner in which to deal with them.
Appreciating the nine domains of the successful foundation trainee, which
are visited in the next chapter, will further help to direct the doctor’s
attention to the more pressing actions in a scenario.
The SJT has recently been introduced to Foundation Training,
underscoring its increasing popularity in the medical profession as a tool to
assess the desired attributes of a safe and competent doctor. The questions
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in this book are broadly based on the authors’ own experiences as doctors.
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Others are extrapolated from important situations arising in the clinical
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cti colleagues with a specialist interest in the relevant field, in addition to the
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o guidance produced by the GMC and other professional bodies.
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nt The model answers in this book are based on the views and experiences
1: I of clinicians and providers of medical education, similar to those in the
formal examination. This book is intended as a learning tool to develop
the right thought processes in reaching the correct set of answers. As such,
memorising answers in each scenario is inadvisable as you are unlikely
to encounter precisely the same scenario and set of options in the actual
examination. Instead, understanding the justification for the correct
ranking of the possible responses, in light of the scenario and the other
options available, is likely to provide the best preparation for the SJT.
THe eduCATIOnAl PerFOrmAnCe meASure
In addition to the examination component of the application process, the
Educational Performance Measure (EPM) is used to allocate points that
are combined with the SJT score to produce an overall score that is used
to rank each candidate. The scoring for the EPM consists of three separate
parts:
1. Medical school performance, which provides a decile score. Applicants
at a given medical school are ranked against one another and given a
score depending on which group they fall into. The top 10 per cent will
be awarded the maximum mark for this section, and the points awarded
will decrease in increments with each subsequent 10-per-cent group.
Deciles are allocated using local policy, which is determined by the
medical school that a candidate belongs to. Further information on this
may be sought from your medical school.
2. Additional degrees: This includes Bachelor’s, Master’s and Doctorate
degrees. Points are awarded for the classification of a degree, with more
points offered for a first-class honours degree than for a third-class degree.
3. Publications, presentations and prizes.
a. Publications: In order to gain points for publications, they must be
peer-reviewed and have a PubMed ID (PMID). Alternatively, a letter
of evidence to state that the work has been accepted for publication
and is ‘in press’ for an article that has a PMID is also acceptable.
b. Presentations: In order to gain points for presentations, they must
be oral or poster presentations given at a national or international
conference, and hosted by a recognised professional medical body.
c. Prizes: In order to gain points for prizes, they must be national or
international educational prizes which are awarded by an organisation
that is not student-led. Points are not awarded for bursaries,
scholarships, research grants, university prizes or elective awards. The
2 prize awarded must be the first prize.
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The precise scoring system for the EPM is likely to change each year and
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additional conditions for each component may also apply. The current o
criteria may be found from the latest ‘Foundation Applicant’s Handbook’. cti
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This, in addition to further information on the entire application process, o
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may be found on the Foundation Programme website. nt
1: I
THe FOundATIOn PrOGrAmme APPlICATIOn SySTem
As part of the Foundation Programme Application System (FPAS),
candidates are required to rank Foundation Schools in order of preference.
While the algorithm changes each year, the principle of allocating a
candidate to their preferred Foundation School remains the same.
Once analysed, the SJT and EPM marks are combined to provide an
overall score for each candidate. This score is ranked against every other
applicant involved in the process. The highest scoring candidates are
allocated to their most preferred choices. Once a particular Foundation
School’s vacancies have been filled, the algorithm is used to best-match
remaining candidates to their next highest ranking Foundation School.
Once allocated to a particular Foundation School, candidates are
required to undergo a local application process that is responsible for
assigning specific hospitals and rotations. This can once again be influenced
by a candidate’s mark from the combined SJT and EPM score, but may also
involve additional interviews or other assessments.
This entire application process usually occurs during the final year of
medical studies.
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2: Analysis of SJT Questions
The Situational Judgement Test (SJT) will comprise around 70 questions
to be taken in 2 hours 20 minutes. This allows for 2 minutes to be spent on
each question. Organisation and effective time management are therefore
vital during the examination.
Of the total number of questions, 60 will count towards the final score,
while the remaining 10 are pilot questions which may be used in future
years. The 10 pilot questions will be indistinguishable from the assessed
questions and are distributed throughout the paper.
The two possible question formats in the exam are:
1. Ranking questions: Rank five possible responses in the most appropriate
order. This type of question will account for two-thirds of the paper.
2. Multiple response questions: Select the three most appropriate responses
for the situation. This type of question will account for one-third of the
paper.
When presented with the same scenario, answers may differ slightly, so
partial deviations from the model answer may still be given credit. In
principle, the further someone deviates from the model answer, the less
credit their answer is given. The specific scoring system for each question
type is outlined below.
In general, the responses given for each question can be broadly arranged
as appropriate or inappropriate. You may be able to formulate two groups;
those that are appropriate, and those that are inappropriate. The ranking
questions inevitably take longer to consider given that comparisons have to
be made between each response, particularly within each of the two groups
that you have just created. In contrast, when considering the multiple
response questions, the inappropriate responses can simply be excluded.
You will be left to choose three responses out of the four or five remaining,
and comparisons between individual options need not be made with the
multiple response questions.
Particular attention should be paid to the underlying theme of each
question. Identifying the theme, or themes where more than one is
examined, is key to approaching the responses in the correct fashion.
Questions should always be screened for any threats to patient welfare, as
these are of overriding consequence. Other themes may also be present and
these must be ranked against one another, and the available options chosen
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accordingly. For instance, discussing a patient on the way to the car at the
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