Wrapping up SJ

In regular Appropriateness sets, you must decide the relative appropriateness of responses in clinical or educational scenarios.

Responses can be judged as follows:
A. Directly addresses a key issue.
B. Generally good but fails to address a key issue.
C. Something bad in the response but has minimal negative consequences.
D. Negative consequences for patients or the profession.

You must infer a response in order to evaluate Importance factors.

But first, you must find the key issues in the scenario.

Practise applying the relative levels of the answer choices.

Factors can be judged as follows:
A. Must be considered; relates directly to a key issue.
B. Good to consider but not crucial; significant but less central to a key issue.
C. Okay to consider but tangential to the key issue.
D. Must not be considered; would cause negative consequences for patients or the profession.

In all scenarios, apply the key ethical and professional principles.

These include hard and fast rules such as:

• Treat patients equally, regardless of their life choices or beliefs.
• Do not break patient confidentiality.
• Respect patients’ rights, including to withhold consent or seek a second opinion.
• Act if a patient’s safety or dignity is at risk.
• If something goes wrong, be open and honest about it.

Some of the key principles that come up time and again in Situational Judgement include:

• Doctors and medical students must prioritise patient health, safety and dignity and act promptly whenever a patient’s health, safety or dignity are at risk.
• Doctors and medical students must not do anything to undermine public confidence in the profession, and must act promptly to address a situation in which public confidence in the profession is at risk.
• Doctors and medical students must never act or imply that they have knowledge, expertise or experience beyond their actual level of knowledge, expertise or experience.
• Doctors and medical students should seek advice from a colleague or supervisor if they are unsure of the best course of action.
• Doctors and medical students should seek local solutions to problems that arise wherever possible and practicable.

You can get a full sense of the range of principles of medical professionalism that you could encounter in the Situational section on Test Day by reviewing the booklet Achieving Good Medical Practice: Guidance for Medical Students.

Don’t waste time deliberating over any one response/factor.

You only have 10–15 seconds for each individual response/factor, so you can’t spend any longer than that in deciding its appropriateness/importance.

Force yourself to choose a side straightaway, and then choose the stronger/weaker answer on that side based on the context.

In Appropriateness, you may find it most challenging to decide between C and D. The key issue is whether the response is potentially so terrible that D must be correct, or if a mitigating factor makes it less bad but still unacceptable, so the answer is C.

In Importance, you are more likely to struggle deciding between A and B. In each answer, the factor is good to consider, but only essential factors – those that must be considered – will have A as the correct answer. Factors that are significant but less crucial to consider will be B rather than A .

From now until Test Day:

• Read the GMC’s Achieving Good Medical Practice: Guidance for Medical Students booklet.
• Always read answer explanations when practising.
• Stick to 30 seconds to read the scenario, 10 seconds to assess each response.
• Let yourself trust your judgement based on your SJ revision. Often, your initial ‘gut feel’ will be correct. You may need to adjust your answer if you notice a key detail in the scenario you overlooked, but you can refine your approach to limit these problems as you practise.