Success in the Situational Judgement Test (SJT) can be a deciding factor in whether you are allocated your first choice on the foundation programme – so it's important to be well prepared and know what to expect.
Rather than assessing your clinical knowledge, the questions ask you to respond to various scenarios in ways which reflect the abilities and attributes of an FY1 doctor. The test covers five core domains – commitment to professionalism, coping with pressure, effective communication, patient focus and working effectively as part of a team.
The MDU offers the following advice to students preparing to sit the SJT:
- Make sure you're familiar with the person specification for a foundation doctor on the UKFPO website.
- Review the GMC's core guidance, Good medical practice (2013).
- Get to know the format of the test and how the scoring works.
- Complete practice questions, like the ones below, under exam conditions so you understand the time constraints and get used to the format.
Part one: rank in order the following actions in response to the situation (from most appropriate to least appropriate).
Q1) You're an FY1 on a general medical ward covering the acute take. You have taken bloods from a patient and mislabelled them in error. The lab won't allow you to come and re-label the blood tubes and request a fresh sample.
A Take the repeat blood sample and say nothing about what the samples are for, asking for consent for more blood tests.
B Explain the problem to the patient, apologise and take the sample with consent.
C Ask a colleague to take them to avoid embarrassment.
D Collect the tubes from the lab, transfer the blood to new tubes and re-label them.
E Hand over the request for a new sample to the next shift.
Q2) On the consultant ward round the medical consultant, who is renowned for his impatience and fiery temper, asks you for the patient's ECG and the cardiac enzyme results.
A You hand over the admission ECG but can't remember the blood results, but are pretty sure that they were okay, so say they were normal.
B You give the ECG, offering the opinion that there are no acute changes. You apologise that you can't remember the blood results offhand and go to the computer to check them.
C You are not sure that the ECG has been done, but find an unnamed and undated ECG in the notes and pass that to the consultant.
D You respond that Dr X, who clerked the patient in, failed to arrange for the cardiac enzyme bloods to be taken and inform the consultant that you spotted the error this morning and are awaiting the results.
E You tell the consultant that the ECG should be filed with the notes and the bloods should be written in the clerking pro-forma if he wants to check them.
Q3) You are approached by the mother of a 15-year old girl. The girl lives with her father and has been admitted with abdominal pain. The mother wants to know about her daughter's recent medical history as 'she doesn’t hear from her daughter these days'.
A Ask the patient if she wants you to disclose the information.
B Assess the patient's capacity to decide on disclosure.
C Give her mother the details she wants.
D Call the patient's father and seek his perspective on the mother's request.
E Ask your registrar what to do.
Q4) As an orthopaedic FY1 you clerked a patient with a fractured ankle in A&E. A detective from the local police station contacts you and says he needs a statement today.
He explains he believes that the patient may have been involved in a burglary and injured himself jumping from an upstairs window. The patient has declined to consent to information being given to the police officer.
A Ask your consultant for guidance.
B Tell the policeman that there are no circumstances in which you would breach the patient's confidentiality without consent.
C Consider the request and whether it meets the threshold for disclosure in the public interest, declining to do so if you then feel that it does not.
D Provide the statement immediately, as consent is not required when the information may assist the police in their investigation of crime.
E Suggest the police officer contact the patient's GP for a statement.
Q5) You're an FY1 in a busy surgical team. The morning operating list has started and it has been noticed the third patient on the list, a complex elective GI procedure, has not been consented. Your senior registrar has rung you and told you to consent the patient.
A Explain that you would wish to assist but that you do not have sufficient experience to consent the patient, and ask that someone else be approached to do so.
B Search quickly on the internet for details of the procedure and then consent the patient.
C Contact the on-call SHO from the duty surgical team and ask her to consent the patient.
D Consent the patient immediately based on the limited knowledge you have of the operation.
E Ask the theatre sister to reschedule the patient's operation to the afternoon list, so that the senior registrar can consent the patient himself.
Q6) During a busy Saturday afternoon shift you are bleeped by a number of wards.
A Review the analgesia of a 17-year old oncology patient who slept badly last night due to pain and whose mother has arrived on the ward for visiting.
B A 72-year old post-operative female patient who is increasingly hypotensive and has become unresponsive.
C A 34-year old man in CCU with new onset jaw and left arm pain.
D A 64-year old woman who is awaiting a discharge letter and whose daughter wishes to leave soon to go to work.
E The husband of an 80-year old patient with dementia who has complained to the nurses about her care and that she has been more confused this afternoon.
Q7) You are on call for the ward cover and A&E. Prioritise these issues you have been asked to attend to.
A A patient threatening to make a complaint because he has not been prescribed night sedation.
B An 89-year old man in casualty with central crushing pain.
C A 24-year old man with a coffee ground vomitus and normal blood pressure and pulse on the ward.
D An 18-year old patient threatening to self-discharge following a paracetamol overdose.
E A patient wanting to discuss whether he can go on holiday as planned next month.
Q8) A colleague comes to you in a panicked state. He is concerned that he has just prescribed a 50-unit dose of insulin which was given in a syringe of 50% dextrose to treat hyperkalaemia.
The cannula that was in place has tissued and your colleague cannot gain IV access.
A Complete an incident form.
B Make sure you or your colleague contact a senior colleague for advice.
C Insert a cannula.
D Check the patient's blood sugar and potassium.
E Suggest your colleague get senior advice straight away, but try not to get involved as this could be a serious clinical incident.
Q9) You are the FY1 on the surgical on-call team. You have just clerked a 16-year old female patient with right iliac fossa pain.
After ultrasound and urine beta hCG, the diagnosis is an ectopic pregnancy. She is clinically stable and deemed competent and explicitly tells you not to tell her mother she is pregnant.
Her mother demands to know what is going on.
A Explain to the patient's mother that you are still in the middle of assessing her daughter and ask a nurse/HCA to take her to the relatives room.
B Take the mother outside the cubicle, try your best to calm her down, tell her that her daughter is currently stable. Suggest she chats to her daughter later.
C Refuse to talk to her.
D Tell the patient's mother the diagnosis.
E Ask her to wait outside and offer no more information. Tell her you'll be with her shortly.
Part two: Choose the THREE most appropriate actions to take in this situation.
Q10) Your consultant bleeps you to say a patient they saw earlier post-operatively is now fit to go home. He stresses the need for discharges as your ward is pushed for beds. The patient, however, has not had his post-op bloods.
A Complete a discharge letter asking for the GP to check bloods ASAP and discharge the patient.
B Call the consultant back and explain you are unable to discharge him as he has not had a blood test.
C Presume the consultant is aware of this fact and discharge the patient as requested.
D Take the bloods immediately and send them urgently to the lab. Complete a discharge letter so the patient is ready to leave if the blood tests return with normal results.
E Put out a phlebotomy blood test request for the following morning.
F Read the operation notes and post-op care plan to see if there are any instructions on post-op bloods. If there is no documentation of this, discharge the patient.
G Take the bloods and document in the discharge letter for the GP to chase the results.
H Take a blood test at the earliest opportunity. Hand over for the on-call team to chase and discharge the patient the following day.
Q11) You're an FY1 on a busy care of the elderly ward. It's a cold, wintry day and several of the nursing staff have called in sick. You're taking a quick lunch break in the hospital canteen when Mr Hawthorn, a patient's relative, comes over to your table and makes a complaint that you are enjoying a meal while his mother is being neglected on the ward.
He shouts at you and comes very close, angrily shaking his finger in your face. He alleges the care that his mother has received from the nursing staff has been dreadful.
A Tell Mr Hawthorn that you are on a break and refuse to speak to him.
B Ask Mr Hawthorn if he wishes to meet you on the ward when you have finished your lunch to discuss his concerns.
C Shout for hospital security.
D Look Mr Hawthorn directly in the eye and tell him you do not appreciate being spoken to in that way.
E Direct Mr Hawthorn to the PALs office so that he can make an official complaint.
F Gently but firmly explain that you are unable to discuss his mother's care in a public place and without her consent due to the importance of confidentiality.
G Ask Mr Hawthorn if he wishes you to accompany him back to the ward so he can discuss his concerns with the nurse in charge.
H Acknowledge his concerns and contact a senior colleague to speak to Mr Hawthorn.
Q12) A patient you saw in A&E with back pain dies the following morning after a serious GI bleed. You have been contacted by the trust and asked to prepare a report for the coroner and told that the family have made a complaint to them about his care.
You did not examine the patient's abdomen but recall examining his chest, although you forgot to record this in his notes.
A Review the medical records and add details of the chest examination you performed.
B Prepare an honest and factual report of your involvement for the coroner promptly.
C Add details of a normal abdominal examination to the record to try and deflect any criticism.
D Ignore the request and hope it will not be followed up by the trust or the coroner.
E Discuss the case as soon as possible with your educational supervisor to identify any learning points.
F Write to the coroner saying that the workload in A&E is excessive and that you did not have time to fully examine the patient.
G Delay providing the report until you have attended a significant event review of the case.
H Provide a reflective response to the trust for the complaint investigation, offering an honest account of your involvement and an apology.
Q13) You have been an FY1 in orthopaedics for nearly two months. Your consultant frequently makes disparaging comments about patients when they are under anaesthetic, but no one in theatre appears to notice.
A Report him to the GMC.
B Keep a log of your consultant's comments for a month before deciding what to do.
C Discuss the matter with the clinical/medical director.
D Raise your concerns with senior colleagues, offering specific verbatim examples.
E Discuss your concerns with your medical contemporaries at the pub and see what they think you should do.
F Report your consultant to the BMA.
G Report your consultant to the MDU.
H Ignore your consultant's comments.
Answers and tips
Q1) B A E C D
- B is the only correct answer.
- A might be acceptable if you have to do more tests anyway.
- E might be acceptable if the shift is changing, but the patient should know what has gone wrong. You are required to apologise when something has gone wrong. The tests are required and you need to have informed consent prior to taking the blood.
- C is passing responsibility and lacks transparency.
- E is similar to C and the order is likely interchangeable.
- D potentially puts you and the patient at risk.
This type of question can be the most difficult – how to deal with errors and colleagues.
Q2) B E D A C
The theme of communicating with difficult colleagues is not uncommon; it's not always related to illness, but also to dealing with circumstances where you might work with people who are good at their job but perhaps 'difficult'.
- B provides the best answer; you demonstrate your knowledge of the ECG and provide a truthful response, and it indicates that you understand it's your responsibility to obtain the results and ensure that you are correct.
- E, although not necessarily incorrect, does not demonstrate the mutual respect you should have for colleagues.
- D may be seen as unsupportive of colleagues.
- C, A present potential patient safety concerns as results may be incorrectly attributed to the patient. C has the potential to present greater safety concerns.
Q3) B A E D C
This scenario relates to confidentiality.
- A 15-year old girl is likely to be Gillick competent and should be assessed for her capacity to provide consent for disclosure.
- Option A assumes she has capacity, but this needs to be formally assessed and documented.
- E might be appropriate if you are unsure, and it is better than getting it wrong. It can be helpful to seek the father's perspective just in case, however he cannot provide consent if the patient is competent, nor override her competent consent.
Q4) C A E B D
This question examines your knowledge of confidentiality and how to apply it when under pressure.
- C is the best answer. You should consider the request and whether the information ought to be provided in the public interest, but decline to disclose if it is not appropriate to do so.
- If you are unsure, you should seek the guidance of a senior colleague and therefore A is the next correct answer.
- B is not correct as there are circumstances in which information should be disclosed.
- E is also incorrect as this simply places the burden on a colleague who is no more able to decide matters than you.
- D is incorrect and the least appropriate choice, as you risk breaching patient confidentiality without justification.
Q5) A C B E D
This question requires you to consider how you approach being asked to do something outside your experience. As an FY1 you are unlikely to have the necessary knowledge of the operation to be able to consent the patient adequately.
- A is the most correct answer as it allows the person delegating the role to you to understand why this cannot be done safely and for them to find a more suitable person to assist.
- C is less appropriate as it is disruptive to another colleague outside your team, who will have their own workload pressures and who will not know the patient.
- B is the first wrong answer, but is in part mitigated by an attempt to obtain the knowledge needed.
- E is also wrong as it impacts directly on other patients and the efficient running of the department.
- D is the worst option, as it is the least safe. You should not consent a patient for a procedure where you do not have adequate knowledge.
Q6) B C A E D
This question simply asks you to prioritise in terms of clinical necessity.
Immediate life-threatening emergencies should be dealt with first, prior to attending a patient who has the potential to rapidly deteriorate. The relief of pain would be the next clinical priority, before attending to an individual who may have a medical cause for worsening of their confusion.
The final priority is to address the administrative task to allow a patient to go home.
Q7) B C D A E
This should be straightforward – the clinical priorities must come first. Our exam tip here is that irrelevant criteria, such as age of patient or disability, are put in to invite you to make the wrong call.
Q8) C D B A E
This situation might generate a medical emergency. Your colleague is in a panic and you should take control and take the immediately necessary steps to ensure the patient is safe.
This incident should be reported in the normal way and the patient advised of what has occurred, but this can wait until after the patient is safely treated.
Q9) B A E C D
Without the consent of a competent 16-year old, it is a breach of confidentiality to disclose information about the patient without her consent. The ideal situation would be to encourage the 16-year old to involve the mother in her care, particularly as she will require physical and psychological support going forward.
- B, A, E are clearly similar responses and simply more or less polite.
- D is legally and professionally unjustifiable and C is rude.
Q10) B D H
The patient should be at the centre of your concerns and bed pressure should not influence your decisions about treatment. In pragmatic terms, you should make sure that all the relevant paperwork is in place for an appropriate discharge as soon as clinically indicated.
Q11) G H F
This question examines your professionalism and communication skills. The priorities in this scenario are dealing appropriately with a complaint made in a public place and being open and honest with Mr Hawthorn, whilst also being mindful of not escalating his anger or placing yourself at risk.
- C – Shouting for security would seem to be an overly defensive reaction to the scenario, although if the incident had occurred in an isolated place and you had felt threatened by possible violence it would have been important to safeguard your own wellbeing.
- D – Making eye contact may escalate the problem and confronting Mr Hawthorn may have an inappropriately negative effect.
- A – Whilst you are entitled to a break, and being interrupted during a meal is frustrating, it may be unprofessional not to deal with some situations, such as this, as they arise.
- B – Inviting Mr Hawthorn to discuss the complaint with you on the ward after lunch does not offer a specific timeframe and might suggest to him that your lunch is more important than his wife.
- G – However, considering that his concerns are about the nursing care on the ward and you are the most junior member of the medical staff, it may be more appropriate for him to speak to the nurse in charge.
- H – It is important that Mr Hawthorn feels listened to, and contacting a senior colleague demonstrates that you recognise the seriousness of his concerns. It is likely a senior colleague will be appropriate to deal with the breadth of his issues.
- E – It is important to be aware of the hospital's complaints protocol and to be able to advise patients how to make an official complaint if they wish to do so.
- F – But in many situations a prompt, open and honest explanation, with an apology where appropriate, can resolve misunderstandings and frustrations at an early stage. Whenever you are in a place where you could be overheard, it is important to bear in mind patient confidentiality and to consider whether you may need the patient's consent to discuss the details of their care, and to explain this professionally to their relatives.
Q12) B E H
You are required to cooperate with investigations, including coroners' inquiries and complaints, and must promptly provide a full and honest account to both.
You should also reflect on the case with a senior colleague to identify any learning points arising from the incident.
Therefore B, E and H are the most appropriate answers. You should not ignore a request or delay your response, and should never alter the medical records in the manner outlined.
Q13) B C D
This question is about being able to focus on the needs of patients, despite perceived barriers to doing so.
- A – It would be important to consider whether your consultant's actions met the threshold for referral to the GMC. This would be difficult to determine in isolation based on the facts as presented.
- B – In the first instance, keeping a verbatim account of his comments, as the basis of a presentation of the issue you wish to raise, would provide valuable support for your concerns.
- C – Raising your concerns with a senior is an appropriate course of action.
- D – If you can offer specific examples, your concerns will be better highlighted.
- E – The venue for discussion is clearly inappropriate; furthermore, it is unlikely that your contemporaries will be better placed than you to advise you how to act.
- F – The BMA offers advice on contract and interprofessional issues, but is not an agency to report an individual to.
- G – We would refer you to the relevant GMC guidance to help you make a decision regarding the best course of action.
- H – The GMC requires you to put patients at the centre of your considerations, and the inappropriate behaviour illustrated requires further investigation.