Sample SJT ranking question
While working on a medical ward as an FY1 you are asked by a nurse to complete the discharge paperwork for a patient you are not familiar with. This includes a summary of the admission as well as drugs to be taken home when discharged. You are in a hurry and on the post-take ward round. The rest of the team is about to start discussing the next patient that was admitted overnight.
Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)
A - Ask the nurse what drugs the patient needs and the diagnosis, so you can quickly note this on the discharge paperwork and keep up with the ward round
B – Explain that you are busy at the moment but that you will come back and do it as soon as the ward round is complete
C – Sign the paperwork and ask the nurse to complete the summary and medication while you join the rest of the team
D – Check the patient’s notes and complete the paperwork with a summary of the admission and all required medication - you can catch up with the ward round later
E - Ignore the request. The nurse knows you are on the post-take round and can ask you later
This question is about effective communication with colleagues, working effectively as part of a team and ensuring patient safety. The best option is to communicate with the nurse so she is aware that you are currently busy, while reassuring her that you will give the jobs priority once the ward round is complete. This means that the nurse will not have to chase you, or someone else, while at the same time ensures that you are able to participate in the ward round, which is part of your job, but also ensures you are aware of the status of your patients from the ward round. By returning to do the discharge paperwork when you are less busy, you will be able to complete the paperwork without being rushed or pressured (B).Checking the patient's notes and completing the paperwork now with all the required information will help your colleague the nurse get on with their work and allow the patient to be discharged, but may mean that you rush to finish the job (so increase the chance of making errors) or that you miss the details of the next few patients from the ward round (D). This is not ideal as this is a post take ward round, so these will be new patients, and knowing the details of their diagnosis and the plans is important. This may also mean a senior colleague has to take notes on your behalf. At first reading, ignoring the request (E) sounds rude and unhelpful - it does not demonstrate good communication with colleagues. It does mean that the nurse can either contact you again later, or contact someone else to complete the paperwork correctly. By quickly noting the drugs and the diagnosis based on the nurse's suggestion (A) you may put the patient at risk - the nurse may provide incorrect information, and as this option suggests that you will "quickly note" the diagnosis and medication, you will not have time to double check the information is accurate. Just providing the diagnosis and drugs is also not ideal in terms of communication with the patient's GP - as this option does not mention a summary of the admission or any other key information such as tests to be followed up in the community after discharge. The worst option is to sign the paperwork and ask the nurse to complete the summary and medication (C). First, this shows a lack of professional integrity as you would be signing a document that you had not completed or checked. This also creates work for the nurse that is not part of her role and puts them in a difficult situation, and may lead to risks to the patient - if the nurse entered a dose incorrectly, or the wrong diagnosis, the GP may then act on this and this could lead to harm. This risk is greater in this option than in option A as if the nurse suggested a dose that sounded incorrect, you may pick this up and have an opportunity to ask for it to be checked.
Sample SJT selection question
You are an FY1 working in obstetrics and gynaecology. You see a lady on the labour ward who is having a massive postpartum haemorrhage. In the last few minutes she has become very unwell and is now unresponsive and continuing to bleed. From reading her notes you know she is a Jehovah's Witness and has signed a form in antenatal clinic stating she declines all blood products even if her life is threatened. The midwife looking after her states that she asked the lady a few minutes before she became unresponsive if she would accept blood products if her life was threatened and again she said no. Her husband is holding his new born daughter and states you must do everything you can to save her even if that means giving her blood.
Choose the THREE most appropriate actions to take in this situation
A. Give blood products as this is an emergency and they may be life saving
B. Do not give blood products even if it means she comes to harm
C. Put aside the patient’s wishes as her decision suggests a lack of capacity
D. Explain to the husband that you have to respect the patient’s decision
E. Ask the husband to give formal consent on behalf of his wife to give blood products
F. Do everything else you can to save the patient’s life
G. Do nothing else as she will inevitably die without blood products
H. Contact your consultant and ask them for permission to give blood products in the best interests of the patient
Do not give blood products even if it means she comes to harm
Explain to the husband that you have to respect the patient’s decision
Do everything else you can to save the patient’s life
This question is about coping with pressure, being focused on the patient and communication with relatives and colleagues. Explaining to the husband that you have to respect the patient's decision ensures that he is informed of your decision and that he understands the basis of your actions (D). In this scenario, you have both a written confirmation of the patient's advanced directive not to have blood products in exactly this scenario, as well as confirmation from a colleague involved in the patient's care that they had not changed their mind. In this situation, you should respect the patient's wishes and not give blood products even if she comes to harm (B). This is based on GMC guidance that states "If a patient lacks capacity and information about a written or verbal advance refusal of treatment is recorded in their notes or is otherwise brought to your attention, you must bear in mind that valid and applicable advance refusals must be respected." (GMC guidance on end of life care). Although this patient has refused blood products, you should still do everything else you can to save her life (F) as part of the core duties of a doctor include "You must make the care of your patient your first concern" (GMC Good Medical Practice).
Although giving blood products as they may be life saving may seem like a sensible option (A), in this scenario you have a written advance refusal as well as verbal confirmation from a colleague that the patient had not changed their mind, and so it would be wrong to go against the patient’s wishes. It is important that doctors respect patients' beliefs and decisions even if they may not seem logical to us- it would be wrong to infer a lack of capacity simply due to the fact that the patient's choice is different to a doctor's own beliefs (C). A husband cannot give consent on behalf of his wife (E) - where a patient is unable to make a decision, doctors should consider evidence on their wishes (e.g. the written advance refusal) or consult with a senior member of the team to consider the patient's best interests. In this case, as there is clear evidence of the patient's wishes, asking permission of your consultant (H) would not be helpful as they would also need to act on the advance refusal. This patient has not refused resuscitation, or any other form of help except blood products, so it would be negligent to do nothing else (G).
These questions have been developed by Emedica and have been adapted from our Online revision service for the Foundaton Situational Judgement Test exams. Dr Rahman will be teaching a revision course for the Foundation Programme SJT exam aimed at final year medical students: