Example SJT ranking and multiple choice

Example SJT – ranking 

Below you can find an example of an SJT ranking item. In this ranking item format, applicants must choose the three most appropriate responses to a given situation. Remember that the responses you select are discrete, and that in this particular item format they should not be considered to be in chronological order – but in the order of appropriateness. Note that there is a different item format that requires ranking the order in which the tasks should be undertaken.

You are working on a busy ward, completing some administrative tasks for your consultant, Dr Findlay. She has asked you to complete some discharge letters which should have been sent out a week ago. A new patient is admitted to the ward and the senior nurse asks you to assess him, as your colleagues are all busy completing other tasks. When you explain that you are currently completing the discharge letters for Dr Findlay, the nurse suggests that you ask the fourth year medical student on the ward to assess the patient instead.

Rank in order the importance of the following considerations in the management of this situation (1= Most important; 5= Least important)

A.  The medical student’s confidence to assess the patient independently
B.  The medical student’s level of clinical competence to assess the patient effectively
C.   The discharge letters should have been completed a week ago
D.   The urgency for the patient to be assessed is not yet clear
E.   The possible time delay before the senior nurse is able to find another available colleague to assess the patient

Answer: BAECD

Rationale: This question is about prioritisation. The medical student’s competence to assess the patient should first be established (B) as not only would it impact patient safety but the medical student’s initial findings could help you to establish the urgency for a full assessment of the patient. The medical student’s level of confidence is also
important although it is secondary to their competence (A). As all your colleagues are busy, there is a risk that the senior nurse may not find another available colleague to assess the patient soon enough (E) thereby risking clinical delay. The discharge letters do not constitute an urgent clinical priority (C). The urgency of the assessment required will only be determined by an initial assessment (D) which should happen with a minimum of delay.

Example SJT – multiple choice 

Below is an example of an SJT multiple choice item. Applicants should select the three most appropriate responses to tackle the dilemma in the scenario. Remember that these responses should not be viewed in isolation, but in combination.

You are on your way to take a break when you overhear an FY2 colleague breaking bad news insensitively to the relatives of one of your patients who has just been diagnosed with lung cancer. Anita leaves quickly. The relatives are looking extremely distressed.

Choose the THREE most appropriate actions to take in this situation

A.   Tell the nurses that the patient’s relatives look extremely distressed and may need some support
B.   Apologise to the patient’s relatives on behalf of Anita
C.   Speak to the Foundation Programme Director* about Anita’s communication skills
D.  Contact the hospital chaplain and ask that she comes and supports the patient and their family
E.  Approach the relatives and offer them the opportunity for further discussion
F.  Suggest to Anita’s clinical supervisor* that she may need further training in breaking bad news to patients and relatives
G.  Contact Anita and tell her that the patient and the patient’s relatives are upset
H.  Monitor Anita’s future encounters with patients

Answer: AEG

Rationale: You are not responsible for the oversight of your FY2 colleague’s performance but you have the duty to relieve any distress caused to the family. It is likely that the family will need support. Informing the nursing staff will ensure an empathetic approach in the wider team (A). You should offer to have further discussion with the family to help answer questions and alleviate their distress (E). You can apologise on behalf of the organisation for any unnecessary distress but not on behalf of your colleague without prior discussion (B). Informing Anita that the relatives are unhappy allows her to address the issue herself, apologise if necessary, and learn from the episode (G). It would not be appropriate to contact the clinical supervisor unless there is a pattern of behaviour (F). It would be the clinical supervisor’s responsibility to monitor Anita’s performance (H) and the Foundation Programme Director would only be involved if local resolution at the team level was not possible (C). The hospital chaplain should only be contacted after discussion with the patient or the patient’s relatives (D).

For the SJT practice paper, please visit the UKFPO website.