Situational Judgement

The situational judgement section of the UCAT tests a wide range of personal characteristics, specifically your integrity, ethics, ability to adapt to a situation, perspective, and responsibility. You will be given different scenarios, followed by actions/considerations for which you must determine the degree of appropriateness/importance. There are two types of questions: firstly, those where you are asked to judge how appropriate/important an option is, and, secondly questions where you must rank actions/considerations from the most to the least appropriate.

69 questions need to be answered in 26 minutes. These questions are separated into scenarios, each having up to six questions.

The Situational Judgement section is scored differently to other sections of the UCAT. Rather than being given a simple numerical result, results are instead banded (ranging from 1-4), where 1 is the lowest, and 4 the highest. Marks are awarded for how correctly you answer each question, with full marks being given for completely correct answers and partial marks for those ranking the options mostly, but not completely, correct. Once scored, this section of the test is not summed into your total UCAT score (the numerical score), but is instead is usually reported separately. Different universities place different emphasis on the result of the Situational Judgement score, as discussed in our UCAT Universities Guide.

The questions in this section may seem easily answerable at first glance. However, this section of the exam is based on ethical principles, many of which are based on the GMC good medical practice guide. While you do not necessarily need to memorise the GMC good practice principles, success in this section of the UCAT will depend on your answers being in close alignment with GMC principles, and so practice at answering these type of questions is recommended.

The key points are summarised below, with those most closely related to GMC principles in bold:

An extremely summarised version:
Good medical practice

1) Knowledge, skills and performance

– Ensuring you work within the limits of your ability
– Ensuring you keep you your knowledge up to date
– Making the care of the patient your main priority

2) Safety and quality

– Taking action if patient dignity, safety, or comfort is not being maintained
– Promoting the health of patients and the public

3) Communication, partnership and teamwork

– Work well with colleagues so you are able to prioritise the patients
– Work with patients in a partnership
– Respect patients and their right to confidentiality

4) Maintaining trust

– Never discriminate against patients or colleagues
– Never abuse the trust of patients or the public’s perception of the profession
– Be honest

Those were the basic principles in a very summarised form. We very much recommend considering these principles in great detail, however, so that you can not only reflect on GMC principles, but so that you have a better chance of scoring well in this section of the UCAT.

A more comprehensive summary of principles (again, with those most closely related to GMC expectations in bold):

1 – Knowledge, skills and performance

Developing and maintaining professional performance:

– Must be competent (this includes research, teaching and management)
– Must keep knowledge and skills up to date
– Must be familiar with guidelines (and any changes relevant to your field)
– Must follow the law, GMC guidance and other regulations

Apply knowledge and experience:

– Must only work in the limits of your competency (including having a good knowledge of English language)
– Must provide good care:

– Appropriately examine and interview the patient
– Provide appropriate advice, investigations and treatment
– Refer the patient on if this best serves their interests

When providing clinical care:

– Must only prescribe (drugs/treatments) when you have sufficient knowledge of the patient, their health and their needs
– Must relieve pain/distress when possible
– Must consult others when required
– Must respect wishes if a patient requests a second opinion
– When possible, don’t give medical care to anyone with whom you have a close relationship, or to yourself
– Must gain consent before any investigation/examination, treatment, teaching or research

Record your work clearly and accurately:

– All documents/notes must be clear and accurate, and must be made as soon as possible following the consultation/interaction/event

2 – Safety and Quality

Contributing to and complying with systems for protecting patients:

– Take part in regular audits and reviews of work, plus take steps to address any problems found
– You must (to keep patients safe):

– Report adverse incidents or adverse drug reactions
– Contribute to confidential inquires

Respond to risks to safety:

– Must promote a culture allowing you and your colleagues to be able to raise safety concerns
– Must act if you think patient dignity, safety or comfort is compromised:

– In the case of a colleague not being fit to practise, and where patients are at risk, seek advice from a college, defence body or the GMC. If concerns continue you must report this.
– If basic patient needs are not met, report to someone who can act immediately
– If a patient is at risk due to equipment or polices, raise the concern in line with guidance and workplace policy

– Must offer help if emergencies arise in clinical areas or in the community (this assumes you remain safe and your competence is adequate)

Risks posed by your health as a clinician:

– If you have an infectious condition or something clouding your judgement you must inform/consult colleagues
– You must be immunised

3 – Communication, partnership and teamwork

Communicate effectively

– You must listen to patients, and only respond honestly
– Only by giving patients information in ways they can understand can you achieve effective communication – you must aim to meet patients’ language and communication needs where possible
– You must remain accessible throughout your shift for any patient concerns or questions – this applies to patients’ relatives, too

Work collaboratively

– All colleagues should be treated with respect
– You must take up any post you have accepted and work contractual notice before leaving a job

Teaching, supporting and training colleagues

– You should contribute to teaching students and other doctors and provide mentorship if requested

Continuity of care

– When you delegate work you must ensure the person picking up that care has adequate skills and experience

Maintaining partnerships with patients

– You must always be polite and treat patients with respect
– You must respect patients’ beliefs and choices
– You must share with patients’ information they will need in order to make decisions about their health, such as the condition they have and its treatment/progression, your role in their treatment, and who is responsible for each element of their care
– Information about patients remains confidential, even after they die
– You must explain to your patient if you have a conscientious objection to a procedure, inform them of their right to see another doctor and not act in a way which implies any disapproval of their lifestyle or decisions

4- Maintaining trust

Show respect for patients

– You cannot pursue a sexual or emotional relationship with patients or their relatives
– You must not express your personal beliefs to patients
– Be open and honest with patients. If something has gone wrong, you must act to make it right, offer an apology and explain what has happened, including the effects of any error

Treat both colleagues and patients fairly

– Prioritise patients based on clinical need, nothing else, and not delay treatment, even when the patients’ actions have led to the condition
– You must provide treatment to a patient even if it puts you at risk
– You should challenge colleagues if their behaviour does not match these guidelines – if the behaviour amounts to denial of patient’s rights
– You must be honest and prompt in your response to complaints, and apologise when necessary, not allowing this to affect your future care of the patient
– You must end a professional relationship with a patient only if the trust has broken down to the extent that good care can no longer be given

Act with honesty and integrity

– Always be honest about your experience and qualifications
– When writing notes they must be correct with no relevant information excluded
– Use social media wisely

Legal proceedings

– You must inform the GMC if you have accepted a caution from the police, been criticised by an official inquiry, or if you have been charged with a criminal offence

Honesty in financial dealings

– You must be honest in financial dealings with all parties, and not allow financial interests to influence your practice
– You cannot accept any gift or hospitality

What is Situational Judgement trying to test?
The main ethical principles of medicine

All Situational Judgement questions draw on the general ethical principles underlying medicine. There are different ways of approaching these questions and identifying what it is the question is trying to draw out. In our explanation that follows, we have chosen the ‘four pillar approach’ to keep it simple and easy to remember in the stress of your exam day.

There are four main pillars of medical ethics:

– Beneficence

– The idea of only doing good for the patient

– Non-maleficence

– Ensuring you cause no harm to the patient

– Autonomy

– Enabling the patient to make their own, but informed, decisions about their health and care

– Justice

– Acting to ensure fairness is given to all patients

It is important to hold these four concepts in your head when approaching situational judgement questions, so that you can identify which principle each question is related to.

Each pillar or principle is explained more thoroughly below (and see our free blogs on the Cambridge Clinical website, many of which address these principles).

Beneficence
This ethical principle requires all doctors to act only in ways that ensure the best interests of the patient. In UCAT Situational Judgement beneficence questions, you need to choose the answer which prioritises the patient, not just medically, but also in terms of their expectations and wishes.

Questions you can ask yourself when considering beneficence in a situational judgement scenario include:

– Does the course of action you have chosen prioritise the patient and result in the best outcome for them?
– Does the course of action you have chosen result in the best scenario regarding the patient’s expectation of their treatment?
– Is the course of action you have chosen proportionate to the condition/illness the patient is presenting with?

Non- maleficence
You can consider non-maleficence as very similar to beneficence, but rather focussing on doing good for patients, this pillar of ethics states that you should do no harm to patients. While this may seem an obvious starting point, it is always important to ask yourself if the course of action you are considering aligns fully with the patient’s wishes. Related to this, it is also always essential to be certain that a proposed treatment will not cause more harm than good to a patient.

Similar to beneficence, you can ask yourself certain questions to ensure you are considering non-maleficence when answering situational judgement questions, including:

– Is the patient at risk due to the action you are taking?
– Does the good the action could result in outweigh the risk to the patient, and, importantly does the patient understand this cost-benefit analysis?
– If the patient is being treated with sufficient dignity to avoid accusations of non-maleficence?
– Are you, personally, capable of performing the treatment, or does the level of your training mean you are more likely to cause harm than if someone else treated your patient?

Autonomy
According to the principle of autonomy, the patient (with only a few exceptions, discussed below) has the right to decide their treatment, and the doctor must always act accordingly with the patient’s wishes. When considering autonomy, it is important to ensure the patient understands the proposed treatment, as it is only with this understanding that they can make an informed decision.

– The relevant exceptions are either if a patient is deemed not competent to make an informed decision, or if it is an emergency situation and it is not possible/practical to communicate with the patient (i.e. because they are unconscious).

– Deciding if a patient doesn’t have capacity is not always straightforward and, for the purposes of the UCAT exam, it will be explicitly stated if a patient lacks capacity, but, for information, some common examples of when capacity may be impaired are as follows:
– Patients with dementia
– Patients with severe brain injuries or with particular learning disabilities
– Certain mental health conditions can also limit capacity

– When considering capacity in an emergency, while the rule of thumb is to act to save life, it is still important to ask yourself if it is possible in any way to gain insight into the patient’s wishes. Any procedures beyond the bare minimum needed to save life should be paused until the patient can consent.

– When answering the Situational judgement questions, consider asking yourself the following questions, in order to ensure the patient’s autonomy is respected in the scenario:

– Have you fully explained to the patient the relevant information concerning their medical condition, or the decision being made?
– Do they know the advantages and disadvantages of the decision they are making?
– Has the patient explicitly provided consent for you to proceed with treatment?
– If you were to ask the patient to repeat to you what you have just told them, would they be able to do this (this is commonly used in clinical practice to check if a patient fully understands the information that has been given to them).

Justice
‘Justice’ is a complex principle, demanding consideration of the rights of the patient, of the doctor and of general societal fairness. You are not expected to know the finer details of associated medical law, but you are expected to be able to apply the basic principles of fairness to Situational Judgement questions.

Consider the following questions:

– Is the action/treatment you deem appropriate/important, legal (based on a basic and commonsense understanding of the law)?
– If this action/treatment occurs, would anyone’s rights be compromised, either patient or doctor (with a focus on the patient’s rights)?
– Does your action compromise the ‘fairness’ principle of our medical system, ie. is one person or group of people being prioritised over another?

A general strategy for Situational Judgement questions

1) Read the scenario that is given carefully, attempting to identify the key ethical issues/principles raised.

– You can try and separate the issues into a few areas – sometimes ‘chunking’ them up helps you pick out the key ethical question.
– Asking yourself what has gone ‘wrong’ in the given scenario may help you identify the ethical principle/s being questioned.

2) Once you have identified some ethical issues, attempt to order them in rank of importance (Top tip: anything compromising patient safety is likely to come top of your list).
3) Eliminate options: certain answers will be clearly not the most/least appropriate

– For questions that need to be ordered, eliminating options will mean you are left with fewer options, and it should hopefully be easier to rank what is left.
– For those questions where only one answer needs to be selected, eliminating options helps you to narrow down and select the most likely correct answer.

Common Situational Judgement scenarios
Certain scenarios occur on a regular basis. Some of the more common are listed below:

1) Medical student

– Key considerations: knowing your place and the extent of your competence. In a medical emergency, knowing how you should respond as a student (if no other help is available you should still act, but within your competencies).
– Further, knowing when to seek help, and at what stage, is key to answering some questions.

2) Patient’s involvement in their care

– Key considerations: the patient has a right to a role in their care, and, assuming they are mentally competent, they have the right to choose their care.

3) Patient refusal of treatment

– Key considerations: the patient’s need for treatment, alongside the parents right to refuse treatment (and the rights of the parents to refuse treatment for a child).

4) Unprofessional behaviour

– Key considerations: when there are possible consequences for reporting bad behaviour (i.e. the consultant may mark your placement badly) it is still the patient’s safety and well-being that are most relevant.

5) Honesty

– Key considerations: any response/ action that is based on dishonesty or misleading the patient will be inappropriate.

6) Bringing the medical profession into disrepute

– Key considerations: for any question which relates to inappropriate behaviour in or out of the workplace, the most appropriate answer will be the one that does not undermine the profession in any circumstances.

7) Confidentiality

– Key considerations: maintaining confidentiality is always of utmost importance

Examples of “very important” to “not important at all” questions:

1: Joe is a medical student on placement in an A&E department. Bill is a patient who is rushed into the hospital with severe injuries. It is late into a night shift and there are only a few doctors and nurses around, most of whom are dealing with their own patients all with their own injuries. A doctor wishes to perform a procedure on Bill and requests Joe’s help.

How important are the following considerations when Joe is deciding to help or not?

1) That all the other staff are all busy and not available to help.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

2) That the doctor who would be supervising has performed the procedure many times before.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

3) Joe’s competence in the situation.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

4) Joe doesn’t feel comfortable or happy performing the procedure.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

5) The procedure may offer a good learning experience for Joe.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

6) The nature of the procedure Joe is being asked to help with.

a) Very important
b) Important
c) Of minor importance
d) Not important at all

Answers:
1) C (Of minor importance)

While other staff being unavailable proves a practical challenge (hence D is not correct), in terms of ethical principles, patient safety is paramount. By considering just staff availability, patient safety may be compromised by allowing a possibly incompetent student to aid a procedure that they are not trained in. Hence for this answer, it is going to be either ‘not important at all’ or ‘of minor importance’, and due to the practicalities of the situation, it is ‘of minor importance’. It may be harder to find staff to help out, but this should be done if a patient is at risk.

2) B (Important)

If the doctor has the competence and experience to perform the procedure in question, this will prove important for Joe when deciding whether to offer to help or not. Working under a doctor who is confident performing this procedure makes this situation more ethical: the doctor can use their knowledge to judge if a medical student can help, as long as the medical student is being honest about their capabilities (as stated in the good medical practice guidelines). It is probably not ‘very important’, because Joe’s competence also carries some degree of relevance, but it remains ‘important’ as the competent doctor acts to mitigate the risk to the patient.

3) A (Very important)

As the GMC’s good medical practice guidelines lay out, an awareness of your own competencies as a medical professional is vital to acting ethically. The student must understand their competencies in order to work within their limits. This works in an overarching manner to keep patient safety as the top priority.

4) A (Very important)

Again, falling clearly within good medical practice guidelines, knowing your comfort levels as a medical student is akin to knowing your competencies. A lack of confidence may effectively reduce your competency in a given situation.

5) C (Of minor importance)

Patient safety is of primary importance, and hence the educational opportunity is of minor importance, ethically. The correct answer is not D as the possibility of gaining experience in this procedure may aid future competency as a doctor. This is a difficult question to know the answer to at first, with most students getting it wrong; next time you answer a question around learning opportunities, however, the answer is likely to be that it is ‘of minor importance’.

6) A (Very important)

Only by considering the nature of the procedure can the patient’s safety be adequately protected. If the procedure places the patient at high risk, then it is very possible that helping the doctor may put Joe in a position beyond his competence (i.e., if the procedure could cause a life-threatening situation that would require a better trained doctor to handle). This is a good example of a ‘very important’ answer: something that has a direct effect on patient safety is often going to take that top spot of importance.

2: A medical team has decided that a patient’s illness is no longer treatable and has informed their patient. However, the patient is very unhappy with this decision. The patient has gone away and researched a new and expensive treatment and is now insisting this should be the next step in his care.

How important are the following considerations for the consultant in charge of this patient’s care when deciding how to respond to the situation?

1) This new treatment will give the patient hope moving forwards.

a. Very important
b. Important
c. Of minor importance
d. Not important at all

2) The medical team have already decided what they believe is best regarding the patient’s treatment.

a. Very important
b. Important
c. Of minor importance
d. Not important at all

3) The patient has a right to be involved in his own care and treatment plan.

a. Very important
b. Important
c. Of minor importance
d. Not important at all

4) The new treatment is expensive.

a. Very important
b. Important
c. Of minor importance
d. Not important at all

5) The consultant hasn’t heard of this treatment before.

a. Very important
b. Important
c. Of minor importance
d. Not important at all

Answers:
1) B (Important)

As it is important to prioritise the patient – their medical care, and also their mental wellbeing – to place this answer as anything less than ‘important’ would be against medical ethical principles. It is not ‘very important’, as not prioritising this would not fully compromise the patient’s care, but it would be advisable to attempt to maintain the patient’s hope, as this would generally be expected to improve their quality of life.

2) B (Important)

The medical team has made an informed decision and should not be ignored. However, it would not be correct to completely ignore the patient. Hence, while this is relevant, it is not classed as ‘very important’

3) A (Very important)

If the patient has the capacity (which should be assumed if not otherwise stated) then they should play a large role in their care and the decisions surrounding it. Hence, this is a ‘very important’ consideration (Top tip: this is a reoccurring theme, and patients having a role in decisions regarding their care is always regarded as being very important).

4) C (Of minor importance)

In this scenario, the expense of the new treatment should not be regarded as the primary concern of the team; the patient’s care and involvement in decision-making are usually regarded as being more relevant. The expense is, however, not of ‘no importance’, as medical ethics states that healthcare resources when limited should be shared in a fair way. While the mechanics of how this is done is up for debate, in practice it does that mean that very expensive treatments may not be licensed for use by the NHS. As such the expense of the treatment does need to be considered to some degree.

5) C (Of minor importance)

The consultant is likely to be very knowledgeable, and hence if he has not heard of the new treatment, this reduces the likelihood of it being a miracle cure. But it is important to recognise all doctors are fallible, so it is probably of little importance that the consultant has not heard of this. There is too much ‘medicine’ for just one person to know, so checking and looking into this new treatment is the only way to keep the patient as the main priority.

Examples of “Appropriate” to “very inappropriate” questions

1: You are a medical student on placement making polite conversation with a nurse on your ward. You are describing a new car you have been considering buying, but halfway through your conversation your colleague becomes suddenly upset and confides in you that they have recently lost a lot of their money gambling. In hindsight, you realise that by talking about buying a new car you have upset the nurse, who is clearly under financial stress.

How appropriate are each of the following responses by you as the medical student to the nurse?

1. “I don’t think it is appropriate to talk to me about this.”

a. A very appropriate thing to say
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to say

2. “I can help you speak to our seniors in order to help provide you with support.”

a. A very appropriate thing to say
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to say

3. “I am so sorry, I had no idea that you were struggling with these things.”

a. A very appropriate thing to say
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to say

4. “If you just stop gambling you will earn the money back and things will be better.”

a. A very appropriate thing to say
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to say

5. “Have you told anyone else about what has been going on recently?”

a. A very appropriate thing to say
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to say

Answers:

1. D (A very inappropriate thing to say)

By shutting down the conversation you are being rude to your colleague, possibly breaking down the respect of a working relationship and compromising patient care. Further, by shutting down the conversation you will not help the situation, and the nurse will likely continue gambling.

2. A (A very appropriate thing to say)

This response is very good as it provides direct help to your colleague, particularly given the very destructive nature of gambling, and the fact therefore that the problem is unlikely to get better without help. By offering to help the nurse speak to a senior you are not breaking any trust with your colleague by going behind their back (and possibly compromising patient care due to a lack of team cohesiveness), but you are also not ignoring the problem which, itself, may compromise patient care down the line if the nurse’s gambling problem worsens.

3. B (Appropriate, but not ideal)

This is a good response, as it addresses the fact that you have inadvertently upset your colleague, and as such it offers compassion and empathy in response. However, nothing you are saying helps your colleague and it is not, therefore, the best response possible.

4. D (A very inappropriate thing to say)

It will not help simply to tell the nurse to stop gambling and, further, you do not know the extent of the nurse’s gambling: they may be addicted and gamble at a higher rate than their earning supports, for all you know. Further, by brushing off and ignoring the problem that has been raised, you may again risk compromising patient care in the future.

5. A (A very appropriate thing to say)

This allows you to show concern for your colleague, and not just immediately shut the conversation down, while also ensuring that the nurse is left to deal with the problem on their own. If it emerges out that you are the only one to know about the gambling, this may change your future actions, with it then becoming more important to let others know about your colleague’s problems.

2: Fred is a 4th-year medical student working on a Care for the Elderly ward. He is interviewing a patient one day, when he realises that the patient’s medication, that was meant to be taken that morning, is still sitting on his bedside. Fred knows this is an important medication that the patient needs to take in order to get better. When Fred asks the patient about this, he responds with anger, telling Fred he doesn’t think the medication is doing any good and so there is no point in bothering to take it.

How appropriate are each of the following responses by Fred in this situation?

1. Tell the patient that he needs to take his medication.

a. A very appropriate thing to do
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to do

2. Ask the patient how long he hasn’t been taking his medication.

a. A very appropriate thing to do
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to do

3. Ask his supervisor to explain to Fred what the medication is for and why he needs to take it.

a. A very appropriate thing to do
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to do

4. Ask Fred if he understands what the medication does and why he needs it.

a. A very appropriate thing to do
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to do

5. As the patient is old, assume he does not have capacity to make the decision not to take his medication, and tell the patient he will be forced to take it.

a. A very appropriate thing to do
b. Appropriate, but not ideal
c. Inappropriate, but not awful
d. A very inappropriate thing to do

Answers:

This is an example of a question where which several different responses can all to a degree be appropriate.

1. B (Appropriate, but not ideal)

As the patient needs to take his medication to get better, this is an appropriate response (therefore you can cross out the two inappropriate answers). When deciding if this is ‘very appropriate’ or just ‘appropriate’, consider the effect this response will have on the patient. The patient is unlikely to respond well to simply being ordered to do something. Further, he has likely been told to take his medication before. Instead, a more appropriate thing to do would be to explore the reasons why he doesn’t want to take his medication.

2. A (A very appropriate thing to do)

This is a less confrontational approach than simply ordering the patient to take his medication, and, importantly, it keeps the conversation ‘open’. It is important to know how long the patient has not been taking his medication, as this will likely impact the dose he now requires (assuming he agrees to take the medication) and also may explain any stagnation in his healing (for example, if he hasn’t been taking the medication for several days). While admittedly it does not directly address the issue of the patient not taking his medication, it is still an important step in evaluating what to do next.

3. A (A very appropriate thing to do)

Fred can recognise the patient’s need to take his medication, and by involving a senior he is increasing the chances of the best approach being made in order to convince the patient to take his medication. Fred may not be wholly confident in his own ability or know all the facts about the medication and thus this response is very responsible.

4. A (A very appropriate thing to do)

This is a very good response. By exploring why the patient doesn’t think he needs the medication, and what he thinks the medication does, Fred can identify any misconceptions or genuine concerns and can attempt to explain the medical team’s reasoning for giving this medication. It is a less confrontational approach than just asserting that the patient needs the medication.

5. D (A very inappropriate thing to do)

Despite the patient’s age, it is never right to assume that they cannot make decisions about their care. This is in direct contradiction to several principles of medical ethics and the good practice guidelines. Further, by stating that he will be forced to take his medication, it will likely upset and anger the patient, damaging the patient-doctor relationship, and making it even less likely to be able to convince the patient to take the medication.

Top tips for answering ‘importance’ and ‘appropriateness’ questions:

• If the statement uses the words ‘may’ or ‘could’, the implication is that the scenario is not guaranteed to take place. As such, this is often not the most important thing to consider. The correct answer in such cases will often be the second down on the list: ‘important’ or ‘appropriate but not ideal’.
• For questions where you need to decide if an action is ‘important’ / ‘appropriate’ or not, it is perfectly acceptable to select the same level of ‘appropriateness’ / ‘importance’ for some or every subsection of the question, as demonstrated in the previous example. Do not be put off by this, as sometimes all the responses are ‘very appropriate’, even though it might seem like a trick question!
• You will be awarded partial marks if your answer is close to the correct answer. So, if you cannot decide between ‘very important’ and ‘important’, for example, try not to spend too much time procrastinating, as you will at least pick up some credit for being close, even if you don’t pick what has been decided is the most correct answer.

Ranking-type questions
The final type of Situational Judgement question is one where you need to choose the most and least appropriate action from three options. You are effectively asked to rank the three options from the most to the least appropriate, and you will be required to drag and drop the options into the correct placing. In terms of how marks can be awarded, and unlike the previous questions in this section, with ‘ranking’ questions, you need to get the ‘most appropriate’ and the ‘least appropriate’ answers correct in order to be awarded any marks.

This specific type of question is relatively new, first appearing up in the 2022 UCAT. It is more time-consuming than the other types of Situational Judgement questions, but with good preparation, you should be able to master the technique required to answer these questions faster.

Top tips

• These questions can be tricky, and may require a little more time than others, so do not worry too much if you need to flag a question and come back to it later.
• Work on trying to identify quickly the key ethical principle/s the question is trying to test – this is often related to patient safety and colleague relationships.
• A helpful approach if you are unclear what the correct answers are is to try and identify the option that is neither perfectly good nor perfectly bad. Removing this option then leaves you (if you’ve correctly identified the middle option) with an obviously better and obviously worse option for the other two spots.

Examples

1: You are a final-year medical student in your last few months before becoming a junior doctor. While shadowing a consultant on the surgical ward round you notice that they tell the patient they can go back to work just one week after their surgery. You, however, are confident that the patient should be on bed rest for four weeks after the specific type of surgery they have had and, as such, shouldn’t be returning to work until at least one month post-operation.

Choose both the one most appropriate action and the one least appropriate action that you should take in response to this situation.

1. Tell the consultant that they are wrong, and the patient should have four weeks off work
2. During the ward round, confirm how long the consultant thinks the patient should have off after this type of surgery
3. After the ward round, find another doctor to tell the patient the correct amount of time off work

Answers:

The most appropriate action is 2.

This is the most appropriate because it opens the conversation up with the consultant in a non-confrontational manner, first giving the consultant the opportunity to correct themselves, and then if they insist on their original opinion, giving you the opportunity to gently question them. In this scenario, it is important that action is being taken, as incorrect advice could lead to potentially significant recovery problems.

The least appropriate action is 3.

By involving another clinician, you risk confusion, as well as undermining the consultant. Further, by waiting until the ward round is complete, you risk forgetting or being too busy to follow this up (which is important for patient safety). It is important to bear in mind that in these kinds of question, anything that involves going behind a colleague’s back is often regarded as the least appropriate action.

This leaves 1 as the middle answer.

This is not as inappropriate as going behind the consultant’s back, but is significantly more confrontational than option 2. It is not as preferable as approaching the consultant in a more questioning manner, as opposed to simply telling them they are wrong.

2- Two medical students, Harper and George, are on placement together. They are both meant to be shadowing a surgeon in the operating theatres. However, George becomes very nervous at the prospect of walking into surgery on his own, and asks Harper to meet him before to make him less nervous. Haper agrees. Harper, however, does not appear, as promised, and later sends George a message, apologising, and saying she felt ill. You are friends with both George and Harper, and later are told by Harper that she didn’t in fact forget, but that, because she thought it ridiculous that George needed her there, she made up a lie.

Choose both the one most appropriate action and the one least appropriate action that you should take in response to this situation.

1. Say nothing to Harper, as it is not your business.
2. Tell Harper to reorganise meeting George to help him go into surgery.
3. Tell Harper that she shouldn’t not turn up when she agreed to help George.

Answers:

The most appropriate action is 2

This is the most appropriate action because it allows George to go into surgery another day. As colleagues, Harper and George should be supporting and mutually respecting each other. Further, George ultimately needs to be able to go into theatre, which he is unable to do on his own at the moment, for the sake of future patient care. With Harper’s help, he will hopefully be able to enter theatre and will then then learn the skills to improve his clinical practice and become a better doctor, when he qualifies.

The least appropriate action is 1

Even as a student doctor, you are responsible for those in your team, and providing honest feedback is a key part of this. By ignoring this situation, Harper may never learn that she needs to support her colleagues. Further, by doing nothing, George may never get the opportunity to go into surgery, possibly compromising patient care in the future.

This leaves 3 as the middle answer

This answer, while not as bad as option 1, is more confrontational and does not necessarily help George in the long run. While it may help her learn some consequences, and may help her to understand the importance of supporting her colleagues, it is not as effective as action 2.