Situational Judgement Test
- Practice Paper -
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, Part One
1. Your consultant Dr Jackson has asked you to prescribe a second antibiotic for a patient who
has a chest infection which has been slow to respond to initial treatment. Later that day, a
pharmacist informs you that the new antibiotic is not in the hospital formulary. She tells you
that the new antibiotic should not be used because of the risk of clostridium difficile infection.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).
A. Prescribe what the pharmacist advises
B. Explain that Dr Jackson requested the antibiotic and he would be the best person to speak
to about the prescription
C. Agree to contact Dr Jackson to discuss the prescription
D. Ask your specialty trainee* to review the patient to enable an informed decision
E. Do not change the prescription and make a record in the notes of the pharmacist’s
concerns
Answer: CBDAE
Rationale: This question assesses your professionalism and how to manage your working
relationships. The most appropriate action to take would be to contact your consultant (C). As Dr
Jackson, your consultant, made the decision about the antibiotics, it is courteous and also in the
patient’s best interest to inform him of the pharmacist’s advice. It is preferable for you to contact
your consultant yourself (C) rather than expect the pharmacist to have to repeat the same
information to multiple members of the same team (B). The next most appropriate action would be
to ask a registrar/specialty trainee, who has more experience, to review the patient (D) as there
may be complexities surrounding the patient of which you and the pharmacist are not aware. A
review by a senior doctor may enable a more robust clinical decision. Option A suggests that you
do what the pharmacist recommends without further discussion with her, your consultant or any
other member of your team. It is Dr Jackson’s team (of which you are part) who are directly
responsible for the patient’s care and there needs to be clear communication about changes to the
management plan (A). Option E is not addressing the problem (E).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
C 4 3 2 1 0
B 3 4 3 2 1
D 2 3 4 3 2
A 1 2 3 4 3
E 0 1 2 3 4
,2. On the morning ward round, your specialty trainee* said that Mrs Anderson is medically fit
following her total knee replacement and could be discharged if Occupational Therapy* feel it
is appropriate. The occupational therapist has assessed Mrs Anderson and believes it is safe
for her to go home with a care package that has been arranged. It is now 4pm and the nurse
informs you that Mrs Anderson is demanding to see a doctor as she does not feel that she is
ready to go home yet. An elective admission is waiting in the day room for Mrs Anderson's
bed.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).
A. Ask Mrs Anderson about her concerns
B. Ask a senior colleague to speak with Mrs Anderson
C. Ask the bed manager if he can find another bed for the elective patient
D. Explain to Mrs Anderson that the bed has already been allocated and she has to go home
E. Ask the occupational therapist to come and speak to Mrs Anderson with you
Answer: AEBCD
Rationale: This question looks at your ability to cope with pressure but also maintain a patient
focus Your primary duty is to alleviate the concerns that Mrs Anderson has in relation to her
discharge and reassure her that it is safe for her to go home (A). Understanding her concerns will
be the first step to reassuring her that it is indeed safe for her to go home. The occupational
therapist is likely to have a greater experience in dealing with questions raised by patients who
have anxieties over the safety of discharge once it has been clarified that the patient is medically
fit for discharge (E), although your senior staff may be able to assist you in dealing with Mrs
Anderson’s concerns (B). Keeping her in hospital without addressing her issues may actually
increase the risk to Mrs Anderson of suffering a hospital acquired infection and is an inefficient use
of hospital resources (C). Whilst not your highest priority, you should always be aware of how
patients are being allocated to beds and if it is clear there could be a delay in discharging Mrs
Anderson, it would be appropriate to ask the bed manager to find a different bed for the elective
patient. Trying to coerce Mrs Anderson to go home by suggesting that she is depriving another
patient of a hospital bed is inappropriate as Mrs Anderson’s concerns remain central to the
management of this situation (D).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
A 4 3 2 1 0
E 3 4 3 2 1
B 2 3 4 3 2
C 1 2 3 4 3
D 0 1 2 3 4
, 3. You are working on a busy paediatric ward. Your shift was meant to finish at 7pm, but it is
now 9pm on a Friday, and you are still trying to complete some of your routine tasks from
the day. This has happened on a number of occasions in the last month and you feel
exhausted as a result. Your workload is also having a negative impact on your social life.
Rank in order the importance of the following considerations in the management of this
situation (1= Most important; 5= Least important).
A. The impact on your own wellbeing if you are not able to take time to rest
B. The risk to patient safety if working whilst tired
C. Your right to finish at the designated time
D. That your consultant may give you a poor reference if you are not completing your tasks
E. That you are repeatedly disappointing your friends by not attending social events with them
Answer: BACDE
Rationale: This scenario is about maintaining a good work life balance to work effectively and
provide good patient care. As a doctor, the care of the patient is your main concern (B). Your own
health has to be looked after in order to provide good patient care (A). Finishing on time is
suggestive of an appropriate and achievable workload and indicates good work life balance (C).
Getting a poor reference may be important personally but it should have no direct or immediate
impact on patient care (D). Disappointing your friends will be the least important consideration in
these options as it does not affect the level of patient care and should not influence your decisions
on the ward (E).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
B 4 3 2 1 0
A 3 4 3 2 1
C 2 3 4 3 2
D 1 2 3 4 3
E 0 1 2 3 4
- Practice Paper -
o
o
o
o
o
o
o
o
, Part One
1. Your consultant Dr Jackson has asked you to prescribe a second antibiotic for a patient who
has a chest infection which has been slow to respond to initial treatment. Later that day, a
pharmacist informs you that the new antibiotic is not in the hospital formulary. She tells you
that the new antibiotic should not be used because of the risk of clostridium difficile infection.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).
A. Prescribe what the pharmacist advises
B. Explain that Dr Jackson requested the antibiotic and he would be the best person to speak
to about the prescription
C. Agree to contact Dr Jackson to discuss the prescription
D. Ask your specialty trainee* to review the patient to enable an informed decision
E. Do not change the prescription and make a record in the notes of the pharmacist’s
concerns
Answer: CBDAE
Rationale: This question assesses your professionalism and how to manage your working
relationships. The most appropriate action to take would be to contact your consultant (C). As Dr
Jackson, your consultant, made the decision about the antibiotics, it is courteous and also in the
patient’s best interest to inform him of the pharmacist’s advice. It is preferable for you to contact
your consultant yourself (C) rather than expect the pharmacist to have to repeat the same
information to multiple members of the same team (B). The next most appropriate action would be
to ask a registrar/specialty trainee, who has more experience, to review the patient (D) as there
may be complexities surrounding the patient of which you and the pharmacist are not aware. A
review by a senior doctor may enable a more robust clinical decision. Option A suggests that you
do what the pharmacist recommends without further discussion with her, your consultant or any
other member of your team. It is Dr Jackson’s team (of which you are part) who are directly
responsible for the patient’s care and there needs to be clear communication about changes to the
management plan (A). Option E is not addressing the problem (E).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
C 4 3 2 1 0
B 3 4 3 2 1
D 2 3 4 3 2
A 1 2 3 4 3
E 0 1 2 3 4
,2. On the morning ward round, your specialty trainee* said that Mrs Anderson is medically fit
following her total knee replacement and could be discharged if Occupational Therapy* feel it
is appropriate. The occupational therapist has assessed Mrs Anderson and believes it is safe
for her to go home with a care package that has been arranged. It is now 4pm and the nurse
informs you that Mrs Anderson is demanding to see a doctor as she does not feel that she is
ready to go home yet. An elective admission is waiting in the day room for Mrs Anderson's
bed.
Rank in order the appropriateness of the following actions in response to this situation (1=
Most appropriate; 5= Least appropriate).
A. Ask Mrs Anderson about her concerns
B. Ask a senior colleague to speak with Mrs Anderson
C. Ask the bed manager if he can find another bed for the elective patient
D. Explain to Mrs Anderson that the bed has already been allocated and she has to go home
E. Ask the occupational therapist to come and speak to Mrs Anderson with you
Answer: AEBCD
Rationale: This question looks at your ability to cope with pressure but also maintain a patient
focus Your primary duty is to alleviate the concerns that Mrs Anderson has in relation to her
discharge and reassure her that it is safe for her to go home (A). Understanding her concerns will
be the first step to reassuring her that it is indeed safe for her to go home. The occupational
therapist is likely to have a greater experience in dealing with questions raised by patients who
have anxieties over the safety of discharge once it has been clarified that the patient is medically
fit for discharge (E), although your senior staff may be able to assist you in dealing with Mrs
Anderson’s concerns (B). Keeping her in hospital without addressing her issues may actually
increase the risk to Mrs Anderson of suffering a hospital acquired infection and is an inefficient use
of hospital resources (C). Whilst not your highest priority, you should always be aware of how
patients are being allocated to beds and if it is clear there could be a delay in discharging Mrs
Anderson, it would be appropriate to ask the bed manager to find a different bed for the elective
patient. Trying to coerce Mrs Anderson to go home by suggesting that she is depriving another
patient of a hospital bed is inappropriate as Mrs Anderson’s concerns remain central to the
management of this situation (D).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
A 4 3 2 1 0
E 3 4 3 2 1
B 2 3 4 3 2
C 1 2 3 4 3
D 0 1 2 3 4
, 3. You are working on a busy paediatric ward. Your shift was meant to finish at 7pm, but it is
now 9pm on a Friday, and you are still trying to complete some of your routine tasks from
the day. This has happened on a number of occasions in the last month and you feel
exhausted as a result. Your workload is also having a negative impact on your social life.
Rank in order the importance of the following considerations in the management of this
situation (1= Most important; 5= Least important).
A. The impact on your own wellbeing if you are not able to take time to rest
B. The risk to patient safety if working whilst tired
C. Your right to finish at the designated time
D. That your consultant may give you a poor reference if you are not completing your tasks
E. That you are repeatedly disappointing your friends by not attending social events with them
Answer: BACDE
Rationale: This scenario is about maintaining a good work life balance to work effectively and
provide good patient care. As a doctor, the care of the patient is your main concern (B). Your own
health has to be looked after in order to provide good patient care (A). Finishing on time is
suggestive of an appropriate and achievable workload and indicates good work life balance (C).
Getting a poor reference may be important personally but it should have no direct or immediate
impact on patient care (D). Disappointing your friends will be the least important consideration in
these options as it does not affect the level of patient care and should not influence your decisions
on the ward (E).
Ideal Applicant rank Applicant rank Applicant rank Applicant rank Applicant rank
rank 1 2 3 4 5
B 4 3 2 1 0
A 3 4 3 2 1
C 2 3 4 3 2
D 1 2 3 4 3
E 0 1 2 3 4
