SITUATIONAL JUDGEMENT TEST
The SJT examination, scheduled for the 5th December and 9th January is a new challenge for final year medical students. It is a bit of an unknown quantity and as such, getting practice at the type of questions you will be asked is important if you want to do well.
Situational judgement questions give you a clinical scenario and ask you to make judgements on what you would do. There are two formats, ranking questions and multiple choice questions. Ranking questions ask you to rank in order, your response to a situation (1 = Most appropriate, 5 = Least appropriate). Multiple choice questions ask you to choose the three most appropriate actions to take in a given situation.
In the exam there will be 70 questions, 60 of them count (40 ranking, 20 multiple choice) with the other 10 questions trials for future exams. You wont know which count therefore you should treat all 70 as if they do.
There are 2 minutes per question, and it is important to keep to time.
People have written to us asking whether they should run to a crash call or walk, or if its ok to leave work 30 minutes but not an hour late. It is unlikely they will test you on something as small print as this. Most of the questions will be based upon important real life scenarios that you will experience once you start as a doctor. Therefore, all questions should have reasonable scenarios with well thought out options to select from. There should be a correct answer that 90% of experienced doctors would agree on.
Our questions have been written by doctors at both SHO and registrar level. They have each been screened by our editorial team making sure that four specialty registrars agree on the correct answer. The scenarios have been designed to closely reflect the planned style of the SJT influenced by guidance from SJT question writers. The questions have then been thoroughly checked for accuracy by Consultants, including Mr Ramachandran the author of Secrets of Success: Getting Into Foundation Training.
The examples here are written by us based on the official mock exam:
Ranking Question
You are the colorectal surgical FY1. Your surgical registrar asks you to consent the patient for a simple incision and drainage of a subcutaneous abscess as he is scrubbed in theatre. You have never performed the procedure before.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A. Look the procedure and its risks up on the internet and consent the patient
B. Ask advice from your SHO
C. Call your consultant for advice and find out if it is appropriate for you to consent
D. Explain to the registrar that you are unable to take consent as an FY1 and you have never performed the procedure, therefore are not competent to do so
E. Ignore what the registrar has asked until you have finished checking all the bloods on the ward, and then talk to him about the consent process
Situational judgement questions give you a clinical scenario and ask you to make judgements on what you would do. There are two formats, ranking questions and multiple choice questions. Ranking questions ask you to rank in order, your response to a situation (1 = Most appropriate, 5 = Least appropriate). Multiple choice questions ask you to choose the three most appropriate actions to take in a given situation.
In the exam there will be 70 questions, 60 of them count (40 ranking, 20 multiple choice) with the other 10 questions trials for future exams. You wont know which count therefore you should treat all 70 as if they do.
There are 2 minutes per question, and it is important to keep to time.
People have written to us asking whether they should run to a crash call or walk, or if its ok to leave work 30 minutes but not an hour late. It is unlikely they will test you on something as small print as this. Most of the questions will be based upon important real life scenarios that you will experience once you start as a doctor. Therefore, all questions should have reasonable scenarios with well thought out options to select from. There should be a correct answer that 90% of experienced doctors would agree on.
Our questions have been written by doctors at both SHO and registrar level. They have each been screened by our editorial team making sure that four specialty registrars agree on the correct answer. The scenarios have been designed to closely reflect the planned style of the SJT influenced by guidance from SJT question writers. The questions have then been thoroughly checked for accuracy by Consultants, including Mr Ramachandran the author of Secrets of Success: Getting Into Foundation Training.
The examples here are written by us based on the official mock exam:
Ranking Question
You are the colorectal surgical FY1. Your surgical registrar asks you to consent the patient for a simple incision and drainage of a subcutaneous abscess as he is scrubbed in theatre. You have never performed the procedure before.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A. Look the procedure and its risks up on the internet and consent the patient
B. Ask advice from your SHO
C. Call your consultant for advice and find out if it is appropriate for you to consent
D. Explain to the registrar that you are unable to take consent as an FY1 and you have never performed the procedure, therefore are not competent to do so
E. Ignore what the registrar has asked until you have finished checking all the bloods on the ward, and then talk to him about the consent process
How the marking works for the Ranking questions
If the answer to a ranking question was CDBEA
Each question is scored out of 20, and for each of your 5 responses you can score up to 4 marks. If an answer should have ideally been ranked 1, C in the example table, and you ranked it 2 you will score 3 marks out of 4. If you ranked it 4 you’ll only score 1 mark.
You can see from this that you can score highly even if you rank two of the options the wrong way around.
Advice
This type of question lends itself well to situations where there isn’t just one correct answer but a range of possible solutions, where one is a better response than another. Often this is because one answer deals with the situation appropriately but perhaps fails to respect one of the principles of good patient care, or one answer ensures a task is completed better than another.
Don’t give the same rank to two answers as both will score 0. You see you score 3 marks if you are nearly right anyway, so if you’re not sure which of two responses is more appropriate then just pick one to be given the higher rank. Don't take too long deciding between two similarly appropriate responses as not finishing the paper will really hurt your score.
The importance of finishing all the questions and ensuring you don’t give any response the same rank (therefore scoring 0) can't be overstated. We predict that people who fail to finish the paper because of taking too long deliberating over an answer will score badly, therefore keep to the 2 minutes per question time limit, regardless of how difficult it is to make a decision between two answers - they'll probably both score 3 anyway if you get the order slightly wrong.
Approach to the ranking questions
We suggest you read the question, and try to imagine yourself actually in that scenario. Next read the answers from A to E and try to identify an answer that is the most correct and one that is obviously incorrect. Rank these 1 (most correct) and 5 (obviously incorrect). Finally decide on the relative ranking of the answers in between and rank them 2-4. If you're finding it difficult to decide on the order of two responses, and often it will be difficult, we recommend going with your first or gut reaction as its often the correct one.
Multiple Choice Question
The nurse on your ward comes to you with a drug chart telling you that you prescribed co-amoxiclav despite the chart saying the patient is allergic to penicillin. She has already given the drug.
Choose the THREE most appropriate actions to take in this situation.
A. Report the nurse to the ward sister as she has made a grave error in giving the drug
B. Assess the patient to ensure that they are not having an anaphylactic or allergic reaction
C. Inform your consultant of the error immediately
D. Shout at the nurse, and tell her she should not have given the drug without checking the patient's allergies
E. Inform the senior pharmacist of the error
F. Escalate the error to the medical director
G. Cross off coamoxiclav to ensure it wont be given again and seek advice from microbiology about what to prescribe instead
H. Ask your SPR for advice after assessing the patient and ensuring you have their recent observations available
You can see from this that you can score highly even if you rank two of the options the wrong way around.
Advice
This type of question lends itself well to situations where there isn’t just one correct answer but a range of possible solutions, where one is a better response than another. Often this is because one answer deals with the situation appropriately but perhaps fails to respect one of the principles of good patient care, or one answer ensures a task is completed better than another.
Don’t give the same rank to two answers as both will score 0. You see you score 3 marks if you are nearly right anyway, so if you’re not sure which of two responses is more appropriate then just pick one to be given the higher rank. Don't take too long deciding between two similarly appropriate responses as not finishing the paper will really hurt your score.
The importance of finishing all the questions and ensuring you don’t give any response the same rank (therefore scoring 0) can't be overstated. We predict that people who fail to finish the paper because of taking too long deliberating over an answer will score badly, therefore keep to the 2 minutes per question time limit, regardless of how difficult it is to make a decision between two answers - they'll probably both score 3 anyway if you get the order slightly wrong.
Approach to the ranking questions
We suggest you read the question, and try to imagine yourself actually in that scenario. Next read the answers from A to E and try to identify an answer that is the most correct and one that is obviously incorrect. Rank these 1 (most correct) and 5 (obviously incorrect). Finally decide on the relative ranking of the answers in between and rank them 2-4. If you're finding it difficult to decide on the order of two responses, and often it will be difficult, we recommend going with your first or gut reaction as its often the correct one.
Multiple Choice Question
The nurse on your ward comes to you with a drug chart telling you that you prescribed co-amoxiclav despite the chart saying the patient is allergic to penicillin. She has already given the drug.
Choose the THREE most appropriate actions to take in this situation.
A. Report the nurse to the ward sister as she has made a grave error in giving the drug
B. Assess the patient to ensure that they are not having an anaphylactic or allergic reaction
C. Inform your consultant of the error immediately
D. Shout at the nurse, and tell her she should not have given the drug without checking the patient's allergies
E. Inform the senior pharmacist of the error
F. Escalate the error to the medical director
G. Cross off coamoxiclav to ensure it wont be given again and seek advice from microbiology about what to prescribe instead
H. Ask your SPR for advice after assessing the patient and ensuring you have their recent observations available
How the marking works for multiple choice questions
12 points are available for each question, 4 for each of the 3 most appropriate answers. Everything else scores 0. This makes this type of question more discriminating, as getting one of the three wrong scores 8/12, whereas in the ranking question, misranking 2 answers may still score between 16-18/20.
Advice
Don’t select more than 3 as that will score 0 for the whole question even if the top three answers are chosen, and don’t choose just 2 as you’ll be missing out on 4 handy marks.
Approach
There is normally one answer that is definitely correct, one or two that are definitely incorrect and then a few that could all be appropriate. Try to choose what you should do over what you might actually do in the situation, as it will tend to be the correct response.
Like in the ranking questions, don't linger too long trying to decide between two answers, as it will mean you might not complete the test!
How to prepare
It's difficult not to worry about this exam - as your comments have shown us there's a lot of anxiety already out there. It is obviously very important as it could determine where your job will be, but worrying will not help. We advise you forget about it completely until around November, after you've had a decent break since submitting the form. Remember official advice is that you can't revise for this exam... however ...
- Read through the tips on how to approach the different questions above.
- Practice some questions early without checking what the answer is. We recommend you use the official mock exam for this.
Now go through the explanations for their answers to work out what the rationale behind the ideal answer is. No doubt at times you'll disagree with their rationale, we certainly did on around 5 occasions and we have the benefit of real life ward experience. However, it's important to get a feel for what they are looking for.
It's difficult not to worry about this exam - as your comments have shown us there's a lot of anxiety already out there. It is obviously very important as it could determine where your job will be, but worrying will not help. We advise you forget about it completely until around November, after you've had a decent break since submitting the form. Remember official advice is that you can't revise for this exam... however ...
- Read through the tips on how to approach the different questions above.
- Practice some questions early without checking what the answer is. We recommend you use the official mock exam for this.
Now go through the explanations for their answers to work out what the rationale behind the ideal answer is. No doubt at times you'll disagree with their rationale, we certainly did on around 5 occasions and we have the benefit of real life ward experience. However, it's important to get a feel for what they are looking for.