SJT Preparation Workshop

Laura Mackenzie King’s Careers & Employability

The session today: Outline: • Part 1 - Quick overview of the SJT exam • Part 2 - Small group discussion of sample SJT scenarios

Part I Approaching the SJT

The SJT Paper: Two separate sections: 1. Ranking all options 2. Selecting ‘best 3’

SJTs • Situational Judgement Tests

– Candidates to select most appropriate action based on given scenario

• Differences from previous FPAS a/form format: – Will be invigilated rather than in free time – 2 hours 20 mins (adjustments available) – completed on paper – Answers from given selection rather than self-generated

NB. Example Qs & rationales at: http://www.foundationprogramme.nhs.uk/pages/medical-students/SJT-EPM

What is the SJT designed to test?

The SJT is designed to assess … “your approach to work as a Foundation doctor as defined by the FP 2014 person specification.” The SJT measures … – Your understanding of situations that arise for a foundation doctor – Your judgement in differentiating between appropriate and

inappropriate responses, – Your ability to recognise the most important concerns in any

situation.

The SJT domains 1. Commitment to professionalism

– Responsibility, honesty, aware of ethical issues including confidentiality

2. Coping with pressure – Coping with ambiguity/uncertainty; resilient; seeks support when appropriate; deals

with mistakes

3. Effective communication – General; with patients; with colleagues; written

4. Patient focus – Patient safety; trust, empathy, respect, rapport; work with patient on their care

5. Working as part of a team – Aware of own/others’ roles;; can adapt own role;; notices when others struggling;;

contributes to team harmony; makes others aware of own workload

Answering the SJT Questions There will be two question formats: 1. RANK the five responses in the most appropriate order 2. Choose the three MOST APPROPRIATE responses from eight

NB. You should answer what you ‘should’ do in the scenario described, not what you ‘would’ do

Scoring – Ranking Qs

Ideal rank Applicant rank 1

Applicant rank 2

Applicant rank 3

Applicant rank 4

Applicant rank 5

B 4 3 2 1 0 A 3 4 3 2 1 D 2 3 4 3 2 C 1 2 3 4 3 E 0 1 2 3 4

Scoring based on ideal answer being ‘B-A-D-C-E’:

Marks given for how close you are to the ‘ideal’ response

Scoring – ‘Best 3’ Qs

A B C D E F G H 0 4 0 4 0 0 4 0

Scoring for questions requiring ‘best 3’ responses:

Marks only given for correct answers.

General tips I “As the SJT targets the professional attributes identified as important for an FY1, as

defined by the job analysis, it is important for applicants to be familiar with these five professional attributes:”

• Commitment to professionalism • Coping with pressure • Effective communication • Patient focus • Working effectively as a team

For full descriptors: http://www.foundationprogramme.nhs.uk/pages/medical-students/SJT-EPM For some GMP scenarios: http://www.gmc-uk.org/gmpinaction/v

General tips II • Focus on what is actually in each

scenario – Each scenario is carefully constructed to

provide the information needed to decide the best course of action

– Look out for ‘red flag’ words/context – Don’t over-interpret or add in extra info

General tips III Beforehand: • DO ... Read through the 5 SJT ‘domains’ (professional attributes)

• DO ... Complete the practice test available on the UKFPO website

• DON’T ... Try to memorise every possible scenario. Focus on keeping a clear head.

During: • Take time to read the scenario properly

• Stay calm and think about key principles (patient focus, confidentiality, patient safety etc)

• Think about what you would do in that situation as a foundation doctor

• Don’t spend too long on each question – avoid running out of time

FAQs • When selecting ‘best 3’ should they be viewed as

linked or in order chronologically/in terms of importance?

• Can we write on our question paper?

Part II Group Discussion of

Scenarios

SCENARIO 1

A nurse asks you to assess a patient who wants to self-discharge from the ward. The patient is still on the ward and has undertaken only part of the investigations he was meant to undertake for lung cancer. He is very agitated and anxious, and borders on aggressive, which is making the nursing staff feel threatened. Choose the THREE most appropriate actions to take in this situation. A - Spend some time listening to the patient's concerns. B - Tell the patient that you are sorry that he is upset. C - Tell the patient that you understand how he feels. D - Explain to the patient that it is

perfectly normal to be anxious

E - Explain to the patient that it is important that he completes all the tests. F - Explain to the patient that if he leaves he could be putting himself at risk. G - Offer the patient help for his anxiety.

SCENARIO 1 Best Answer: A, B, E Rationale: You will probably have found that more than 3 of the options appear reasonable; and it is indeed the case. However the aim is to determine which options are the MOST appropriate. the easiest way to handle the problem is therefore to eliminate those which you feel are unreasonable and, once you are left with 4 or 5 options, to compare them in order to determine which ones may be the most appropriate.

Option A – Listening to the patient is a sensible thing to do. He is clearly anxious and it would help if you could determine what worries him so much. The tests are also not so urgent as to stop you spending time with the patient (in an emergency situation you may not have so much time to spend listening). Option B – Saying that you are sorry he is upset will help demonstrate empathy without sounding condescending and patronising. This is therefore also a viable option. Option C – On the surface, telling the patient you understand how he feels may sound like a good idea, and one which also helps demonstrate empathy; but the truth is that you don't really understand how he feels and it may come across as far more patronising that Option B. The patient may well come back with "No, you don't." So, Option C is a possible option but Option B would be more appropriate. Option D – Telling the patient that it is normal to be anxious is a sensible thing to do, but the mention of a possible diagnosis of lung cancer may well make things worse. Option E – Explaining the importance of completing the tests would be a very constructive approach and would also help steer the conversation away from the emotions. Your aim should be to focus on the end result (i.e. getting the patient to complete the tests) without being coercive. Option E achieves that. Option F – Telling the patient that he could be putting himself at risk if he leaves is only remotely true. There is no major emergency here and it would be perfectly possible to let the patient go home and then invite him back a few days later once he has had time to consider the situation in a calmer environment. Making such statement would be considered slightly coercive, verging slightly on emotional blackmail. Option G – The situation is what is causing the anxiety. Sorting out the immediate issue is therefore likely to resolve the anxiety. This may be appropriate if the patient suffers from anxiety generally speaking, but this would not be an immediate priority in this instance. .

SCENARIO 2 You are a foundation doctor in an NHS trust hospital. One of your patients is a general surgical consultant. He had an HIV test as he suffered a needle-stick injury a few months ago which has come back positive. However you note that although he has given up his NHS practice he still seems to be operating in the local private hospital. You raise the subject with him and he refuses to tell the private hospital the results of his test. Choose the THREE most appropriate actions to take in this situation: A. Your patient has a right to confidentiality and therefore

you are unable to inform the private hospital. B. You inform him that if he does not inform the private

hospital then you have no choice but to inform them as this would be in the public interest.

C. You would be breaching GMC regulations if you informed anyone about his HIV status.

D. Document your decision and actions in his medical notes

E. You inform him that you are unable to inform the private hospital but you strongly recommend that he does so in view of the risk he poses to patients.

F. Take no action as it’s really none of your business - the private hospital should have picked this up.

G. Inform the private hospital. H. Make a note in your diary in a week’s time to call him

up to check that he has informed the private hospital.

SCENARIO 2 Best Answers: B, D, G Rationale: The GMC states that: “disclosure of personal information without consent may be justified in the public interest where failure to do so may expose the patient or others to risk of death or serious harm. Where the patient or others are exposed to a risk so serious that it outweighs the patient’s privacy interest, you should seek consent to disclosure where practicable. If it is not practicable to seek consent, you should disclose information promptly to an appropriate person or authority. You should generally inform the patient before disclosing the information. If you seek consent and the patient withholds it you should consider the reasons for this, if any are provided by the patient. If you remain of the view that disclosure is necessary to protect a third party from death or serious harm, you should disclose information promptly to an appropriate person or authority.” As ever, it is always good practice to document any actions taken in the notes. You should also consider how to inform the private hospital, and it would be advisable to talk to your consultant about the best way of doing this (for example, the Medical Director of your NHS trust could inform the Medical Director of the private hospital).

SCENARIO 3 You see a 50 year old man with advanced lung cancer to discuss treatment options. After hearing about the benefits and burdens of chemotherapy he decides to decline treatment and says he has thought this through very carefully. His wife is shocked and requests you to ignore "the foolish man". RANK in order the following actions in response to this situation. (1= Most appropriate; 5= Least appropriate). A. Explain to the patient that you will need to take

into account the views of his family. B. Explain to his wife that he does actually have the

right to refuse treatment. C. Document in the notes all that has been explained

during the consultation. D. Empathise with his wife as this must be a difficult

time for them both, and suggest that you talk through the situation with her when she is ready.

E. Ignore the wishes of the patient as no rational person you have ever come across declines treatment.

SCENARIO 3 ANSWERS: D, B, C, A, E Rationale: D This is the best overall option. The lives of both husband

and wife have been turned upside down by recent events. They need support through this difficult time.

B Adult competent patients have the right to decide how

much weight to attach to the benefits, burdens, risks, and the overall acceptability of any treatment. They have the right to refuse treatment even where refusal may result in harm to themselves or in their own death.

C It is good medical practice to keep clear, accurate &

legible records of decisions made and information given to patients.

A Not true (see answer to B) E Doctors are legally bound to respect a patient's decision.

SCENARIO 4

During a very busy shift, the relatives of a recently deceased patient want to see you to discuss "things". What do you do? Choose the THREE most suitable actions to take in this situation: A - Ask the nurse who knows the relatives to talk to them to get an understanding of the type of "things" that they want to discuss so that you can be fully prepared when you see them. B - Tell the nurse to let the relatives know that you are aware they are waiting,. C - Ask one of your juniors to talk to the relatives, D - Tell the nurse that you will grant the relatives 5 minutes only as you are busy. E - Inform your Registrar that you need to see the relatives and ask him whether he can cover for you. F - Tell the nurse to send the relatives to PALS as your involvement with the patient is over. G - Tell the nurse to find an excuse to send the relatives

SCENARIO 4 Best Answer: A, B, E Rationale:

A – You are using another team member appropriately; the nurse is already with the relatives and it makes sense that you may want to know more about the relatives’ request in order to ensure that you can have the relevant information ready when you do meet with them eventually. B – This may be a little inconvenient for the relatives as they would obviously prefer to get answers straight away. But you are being honest with them and there is a feeling that you want to get their queries resolved even if it is only on the phone. C – This is potentially placing your junior in a difficult situation and it also looks a little like you are trying to pass the buck. But this is a possibility. D – This places the nurse in a difficult position. It is also a fairly aggressive stance. E – Talking to your Registrar may help you identify a good way around the problem. Also, if you need to go and see the relatives, then this option will make the Registrar aware of the situation and the team will be able to deal with your temporary absence. F – PALS won’t be able to deal with the relatives’ queries. They will only encourage the relatives to contact you so it will defer the problem. It may sound like a good tactic in the short term but it is really unhelpful. In any case, you should consider it part of your duty to deal with the relatives, particularly if you have been dealing with the patient before his death. G – This is rude both to the relatives and to the nurse, whom you will place in a difficult position. There are therefore four possible candidates for the most appropriate actions: A, B, C and E. We need to eliminate one: it will be C because of the potential difficulty to which you will be exposing your junior colleague. The answer is therefore A, B and E. (Note that these do not need to be ranked.)

SCENARIO 5

You are very upset after your clinical supervisor was rude and undermined you in front of a patient during a mini CEX performance assessment. Choose the THREE most appropriate actions to take in this situation. A - Speak to your clinical supervisor about the way you feel. B - Apologise to the patient for your supervisor's behaviour. C - Wait until you are calmer to take any action. D - Speak to your programme director as soon as possible. E - Reflect on whether you can learn from the feedback. F - Discuss your supervisor's behaviour with your colleagues. G - Behave as normally as you can so that you supervisor does not see that you are upset.

SCENARIO 5 Best Answer: A, C, E Rationale: Here, you are dealing with a non-urgent situation, which seems to be a one-off event (otherwise the question would tell you that this has happened before). Option A – Since the supervisor caused an issue which upset you it would make sense to address it directly with her first. So this option is one of the most appropriate. Option B – although it would seem sensible to apologise to the patient, no harm has been done to the patient. It is possible that your apology would be interpreted as seeking to undermine the supervisor in the eyes of the patient. If anything, it should be the supervisor's responsibility to apologise to the patient rather than yours. Option C – Waiting until you are calmer is always a good option if there is no emergency, particularly when dealing with emotions. Option D – Speaking to the programme director might be needed further down the line if the problem persists; but after one event, you should address the issue with the supervisor first. The fact that the option contains the wording "as soon as possible" makes it far less appropriate. Option E – Despite the lack of tact shown by the supervisor, their behaviour does not take away your need to learn and improve and therefore reflecting on the feedback, however badly it was delivered, will be valuable. Option F – Discussing you supervisor's behaviour with your colleagues may help you put things in perspective, but this is not as immediately appropriate as some of the other actions, mainly because you would also undermine the supervisor in doing so. Option G – Ignoring the problem will not help.

SCENARIO 6

Your Consultant asks you whether you would be interested in doing an audit project. You are already doing an audit project for another Consultant and you know that you will not have enough time to do both. Rank in order the following actions in response to this situation. (1= Most appropriate; 5= Least appropriate). A. Agree you will do it as you don’t wish to say no but plan to drag it out until you leave. B. Refuse, saying that you are too busy with another audit project. C. Refuse, explaining that you have another project to do but you ask your colleagues to see if any are interested. D. Say you might be interested but you need some more time to think about it and then secretly hope he forgets about asking you again. E. Agree to do the project and mentally plan to give up your half days to complete it. This question tests communication skills, empathy & sensitivity, problem solving, coping with pressure and professional integrity.

SCENARIO 6 Best Answer: C, B, D, E, A Rationale: C. It can be difficult to say no to your Consultant especially as you may be needing a reference. However, she will respect you more if you refuse on the grounds that you already are doing a project but also that you will ask around to see if anyone might be interested. B. As above but not as good as you are not seeking a solution to the problem. D. A move not especially virtuous so hence is not as good as the first two options but better than the remaining two options. E. Making your own life a misery to please another person will only lead to resentment and unhappiness. Learn to say no. A. This is not being particularly honest nor trustworthy. If you agree to do something you must see the project through. The Consultant could have allocated the project to somebody else and the project may have been investigating something important.