Appropriateness questions

To answer Appropriateness questions with speed and accuracy, you must first:

• Learn the logic of the fixed-format answer choices.
• Practise applying this logic to specific scenarios in multiple-choice questions.
• Develop a technique to assess each response or factor according to the answer choice logic.

To achieve speed and accuracy then, you must master the answer choice logic so that it can guide your technique in Appropriateness questions as you practise Situational Judgement and get ready for Test Day.

Regular Appropriateness sets always have the same four answer choices:

A. A very appropriate thing to do
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to do

As you revise for Situational Judgement, you may find it is simpler to spot responses where the correct answer is A or D. These responses are ideal or terrible, respectively. With some practice, you can build your skills at recognising the best or worst responses to a given scenario. As always, this is contingent on the key issues facing the decider in that specific situation.

Remember that a set of questions can have multiple A or D answers.
Just because you’ve already selected one response as very appropriate, for example, this doesn’t mean the response that immediately follows can’t be very appropriate as well.

Not every set is guaranteed to have an A or D response, but sets with neither a single A or D are really rather rare.

In Appropriateness questions, the correct answer is A when the response provides a direct and local solution to the issue.

Direct = Immediately deals with the issue in a simple, straightforward way (i.e. without involving intermediate steps or unnecessary detours).
Local = Addresses the issue at the right context/level without escalating it unnecessarily, or including an unnecessary layer of seniority or bureaucracy.

For instance, if you have an issue with a member of staff, you should speak to that person rather than going to your supervisor or making a formal complaint.

Note, however, that it’s always appropriate for a medical student to get advice from a suitable senior person, such as someone responsible for their education or from a doctor supervising their placement. If the advice is essential for the student to directly resolve a key issue, then the response will usually be very appropriate.

Very inappropriate responses – with correct answer D – are awful and must not be done.

They often have serious repercussions, either for patient health, dignity or safety, for the decider’s career or team, or would reflect terribly on the profession as a whole.

If something strikes you as a really bad idea because it reflects poor patient care, unprofessional behaviour or a harmful or illegal act, it’s likely to be a D.

Answer B is correct in Appropriateness questions when the response is generally good but ‘misses the mark’ in some way.

Choose answer B if it is a response that has no bad element except that it:

• fails to address a key issue.
• addresses a key issue but only partially or ineffectively.
• suboptimally addresses a key issue.

If there is anything bad for patients or the profession in the response, B cannot be correct. Consider whether the answer is C or D.

Select B if the response is inferior for some reason – it’s not an ideal or optimal response – but without negative consequences for patients, for the profession or for academic integrity.

Responses that don’t address any underlying problem in a scenario but are otherwise positive or neutral in their effect on a patient or the staff, students or others involved, are likely to have B as the correct answer.

Inappropriate, but not awful responses – with correct answer C – have something bad in them, but any negative consequences from the response are minimal.

In other words, there is something in the response that the decider should not do.

However, the repercussions of the response would not be severe, either for patient health or safety, the decider’s career or team, or for the profession as a whole.

Sometimes in Appropriateness questions, a response is C rather than D because, although it would be a bad thing to do – for instance, because it is too blunt and displays a lack of sensitivity– it is factually true, meaning it is better than awful (so it isn’t D), but it is harsh or indelicate, meaning that it is less professional and therefore inappropriate (so it can’t be A or B).

Many official examples where C is correct for this reason are workplace interactions, so the harsh or indelicate response is to a colleague, not a patient or a relative.

Speaking harshly to a patient or relative is more likely to be D than C, as this behaviour impacts patient care and the public’s perception of the profession.

A small number of Appropriateness sets in a Situational section have responses that are things a decider might say. The responses are given in quotation marks.

You are told to ‘Assume that each of the following responses would be said politely’. This eliminates any unintended nuances in actual speech. You can consider each response as a straightforward statement in relation to the scenario.

The answer choices for Appropriateness with quotes sets are always the same:
A. A very appropriate thing to say
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to say

Notice that these are identical to regular Appropriateness answer choices in underlying logic. Only the last word of A and D has changed, from ‘do’ to ‘say’.

The only difference is that the answers are things the decider says rather than does. You can apply the same answer choice logic as in regular Appropriateness questions.

As always, start by reading the scenario carefully and identifying the key issue.

When answering Appropriateness with quotes questions, be particularly attentive to these key elements when evaluating each response:

• Whether the response addresses a key issue in the scenario locally, directly and optimally. If it does, this response is likely to be an A.
• Whether the response is blandly but indirectly supportive, or whether the response redirects the focus to a good but irrelevant consideration. In either case, the response is likely to be a B.
• Whether the response has a bad element, such as shifting focus in a self-centred way, or being too aggressive or not particularly constructive, but is at least an attempt to improve the situation and has minimal negative repercussions. In such cases, it is likely that C is correct.
• Whether the response is harmful or is likely to make matters a lot worse, for example, by worsening patient care, harming rather than helping or escalating a conflict between members of a team. If so, it could well be a D.
• Other responses will be inappropriate simply because they are too forceful or encourage bad behaviour. Whether it is C or D will often depend on context.