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Tips for getting ahead with your SJTs from the KUMEC team

Next week our final year students will be sitting their Situational Judgement Tests (SJTs). This article

from KUMEC is supplementary to and consistent with the advice and support provided by the School

to final year students and is intended for students in all years who might be curious about the tests

and want to know how to prepare in advance.

What are the Situational Judgement Tests (SJTs)? When you apply for your first training post (F1) there is a selection process that is based on

Educational Performance Measure (50 points) up to 43 points depending on which decile

you are in within your medical school ranking, with up to 7 points available for additional

degrees, publications or national-level presentations.

Situational Judgement Tests (50 points) this is a multiple choice examination designed to

test your professionalism; personal attributes such as using effective strategies to cope with

stress; your ability to communicate effectively with patients and colleagues; your patient

focus; and teamwork.

As the SJTs potentially count for as much as your medical degree, your intercalated degree, that

paper you published AND the presentation you gave at that national conference last year, you might

find it comforting to know that SJTs are actually well thought of and there are some very convincing

arguments about the validity and quality of these tests. They are supposed to be rather like

intelligence tests and be impossible to be coached for or to fake. That doesnt mean you cant

prepare for them.

Although this is a high stakes test, it is helpful to remember that most people, regardless of their

ranking, get offered an F1 post somewhere, and depending on the competition ratio for the post you

are applying for (see the application handbook available at www.foudationprogramme.nhs.uk) you

may not need to score brilliantly.

So how do I prepare? 1. Firstly, have a look at the SJT monograph which describes what they are and the attributes

that the foundation programme is looking for. Remember they are testing how you would

behave as an F1.

2. Have a go at a few questions on the practice paper on the Foundation Programme website

which includes answers and rationales so that you get an idea of how they intend to test

whether you have (or at least understand) the attributes that they are looking for.

3. Read, and re-read (including all the sub links and references) the GMC guidance on Good

Medical Practice. You may find it helpful to use the online version which has hyperlinks to all

the references and explanatory guidance rather than the paper version.

4. Deeply embed yourself into the culture and practices of the medical teams on each of your

rotations and learn from your F1 colleagues. What do they do in these situations? If their

consultant is consistently late for work, are they the best person to address it? If not, who

might they talk to?

5. Have another go at the rest of the practice paper on the Foundation Programme website

do you have a better grasp of how to answer? If yes great. If not dont ignore this. If the

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rationales given dont make sense to you, ask a friendly F1 to talk you through a few

questions and ask them to explain their thought processes.

What are the potential pitfalls?

Not knowing how F1s behave

It is not enough to know the GMC guidance on Duties of a Doctor (though this helps). Unless you are

familiar with the situations themselves, you will not know how these issues are dealt with in

practice. If you have spent your clinical years ensconced in the library or the Chantler skills centre,

you will not be familiar with who to turn to, or what actually happens in real life: at what point

should you as an F1 contact the GMC directly? Is there a protocol for raising concerns at your trust?

Thinking there is a rule book for doing well

It is tempting to think there is a protocol or formula for answering these questions perfectly. You

might develop your own check list to help you be systematic, but the clue is in the title judgement:

you are expected to use your common sense as much as your knowledge.

For example, your system might be

1. Is there a problem, if so, how bad/urgent is it?

2. What sort of problem is it? (e.g. communication, ethical, professional, legal, patient safety

etc.)

3. What needs to happen for this to be addressed, considering the GMC guidance?

4. How might an F1 approach this, considering their role within the ward team?

Taking the example of a late consultant:

Were they late only once with a reasonable excuse? (not a problem)

Are they late consistently leaving you and the team with too many jobs to get through in the

afternoon? (annoying but not putting patients at risk, a communication/negotiation issue)

Are they consistently late, arriving smelling of alcohol, and sitting alone in the doctors office

leaving their registrar to make all the decisions but available for advice (possible mental

health and dependency issue, needs addressing, patient care may suffer)

Arrives late only once but smells of alcohol and behaves erratically, and insists on personally

putting a chest drain into the first patient you see (patients at immediate risk).

In real life, how should these issues be addressed?

In the first example where the consultant is justifiably late, it would be inappropriate of you to raise

this as a problem we have all been unavoidably late at some point in our lives. In the other

instances something definitely needs to happen, but what and how?

If my consultant was continually late, as an F1 if I had a good relationship, I might address this myself

perhaps through banter. If this didnt work, I might ask someone with a good working relationship

with them (perhaps their registrar or the charge nurse) to mention the impact their lateness is

having on junior staff, and to try to negotiate a change.

If I suspected a mental health and/or dependency issue, then it would probably be inappropriate of

me as a junior doctor to assume I was the right person to help. I would be more likely to express my

concerns to a trusted senior colleague, and expect them to broach the issue and arrange for

appropriate care, communicating with the GMC as necessary (usually self-reporting).

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In the last instance, where a patients life is at immediate risk, it would be wrong to delay in anyway.

I would probably gather forces with whoever was at hand (e.g. charge nurse, other junior doctors,

registrar) and guide the consultant into a side room, staying with them until a senior colleague could

be brought in to address the more serious implications.

Relying entirely on crammer books for the SJTs

At some point you are likely Google the words SJT, and be bombarded with books or online courses

promising excellent results and fool-proof systems. It has been shown that students that apply these

systems rigidly, rather than applying their own genuine common sense and deeper thought

processes, do worse on average. By all means buy them and read them, but then put them away and

make sure you use your own deep thought processes.

Reading the wrong books on SJTs

SJTs are common tests in medicine: for example they are part of the selection process for application

to medical school and for applying for a GP training post. If you revise from the wrong books, the

answers may be pitched at the wrong level for example it might be more appropriate for a more

senior doctor to discuss mental health/dependency issues with a senior colleague.

Finally Dont panic. You will get a placement somewhere (probably). Anyone with special circumstances will

get a placement in the area they live in. If worst comes to worst, you might want to put an option

with a low competition ratio as one of your choices, so that you have a pretty good idea of where

you are likely to be sent if you dont score as highly as you had hoped; and be confident that the

time you spend as an embedded apprentice in your final year should give you a head start in these

tests.

Dr Kathleen Leedham-Green

KUMEC lead years 1&2