SJT Secret For Success Dec 2018

SITUATIONAL
JUDGEMENT TEST
‘SECRET FOR SUCCESS’ WEBINAR
Mr Ahmad Moinie BMBCh (Oxon) MA (Cantab)
MRCSEd(ENT)
Floreo Associates t: 0203 617 1137

86-90 Paul Street e: sjt@floreo.co.uk
London EC2A 4NE www.floreosjt.co.uk
HISTORY OF THE COURSE
 First ran in November 2013
 Content devised in November

2012 and tested in the first cohort
to be assessed by SJT
 Consistently positive feedback
SJT: 'Secret for Success' Webinar 2

SCHEDULE
 BACKGROUND
 GENERAL STRATEGY
 TECHNIQUES FOR RANKING
QUESTIONS
5 minute break
TECHNIQUES FOR MCQs
 SAMPLE QUESTIONS
 Q&A
SJT EXAM
BACKGROUND

Why is the SJT so important?
 Situational Judgement Test. An assessment of your decision

making ability in various clinical situations.
 EPM may vary from 34-50 for any individual. SJT may vary from
0-50!
 Your result will determine where you work for the next two
years and the order in which you can pick your rotations in
your allocated deanery

What are the questions based on?
 FY1 Job Analysis
 Five professional target attributes

1 Commitment to Professionalism
 Issues of confidentiality
 Challenging inappropriate behaviour
 Commitment to learning

2 Coping with Pressure
 Knowing how to respond when you make a mistake
 Dealing with confrontation
 Seeking help when not sure of the correct procedure/best way of

doing things

3 Effective Communication
 Gathering information and communicating your intentions to

nursing staff or other colleagues
 Negotiating for a scan from radiology
 Listening and effectively communicating with an unhappy patient

or relative

4 Patient Focus
 Identifying that a patient’s views and concerns are important and

they should have input into their care
 Considering that a patient may have different needs from others

around them
 Spending time trying to understand a patient’s concerns and

empathising with them

5 Working Effectively as Part of a Team
 Recognising and valuing the skills and knowledge of nursing staff,

when faced with a disagreement about a patient’s care
 Consulting with colleagues about how to share workload fairly
 Offering assistance and support to colleagues when they are not

able to handle their workload

How is it scored?
 Each ranking question is marked out of 20, with 4 marks

available for each of the 5 positions.
 Lose 1 mark for every position you are out.
 If you get the best and worst correct then you will get a
minimum of 16/20 no matter what order you put the middle 3
in.
 MCQs have 3 right answers out of 8 (4 marks for correct

answer, 0 for wrong ones)

How are you ranked?
 All the scores are converted into an overall score from 0 to 50.
 Continuous distribution with a skew towards 50
 Majority (>95%)score between 30 and 45
 Much more variation in score compared to EPM

SJT EXAM
GENERAL STRATEGY

Know the Role of an FY1
If patient is sick then you
Seniors must ESCALATE. But first
You are the go between gather information
for other teams and your
seniors
Other teams FY1 Sick patients
Need to bat these

away by “exploring”
Patient/Nursing Concerns them

FY1 Can + Can’t
Can Can’t
• Consent for procedures
• Confirm deaths • Prescribe out of Hospital
• Sign death certificates (or prescribe new
• Prescribe anything (except medications not started in
cytotoxics) hospital)
• Discharge patients
• Make end of life decisions
• Break bad news

Know the roles of other Team
members
 Medical Team (FY’s, SpR’s, Consultant)= medical management plan
(including prescriptions/investigations/procedures)
 Nursing Team= bedside care, administering prescribed medications,

assessing care needs upon discharge and arranging district nursing etc.
 Pharmacists= checking prescription dosages, interactions, checking

admission and discharge medications correct, good source of drug info!
 Physiotherapists= mobilising patients
 Occupational therapists= assessing patients ability to complete activities

of daily living and organising any aids which may be required
Always address the concerns of all these team members and take them
seriously
Recognising phraseology
 Every word and sentence is there for a reason! Nothing is superfluous
 Active nearly ALWAYS better than passive
Active Passive
Request Inform
Ask Advise
Review Explain
Discuss
Reassure
Explore
Time is Tight!! Prioritise!!
 Don’t spend a long time fussing over ranking questions.
 Get the best and worst down, and then guess the middle 3 if
necessary.
 Make sure you have enough time for the MCQs, potentially lots
of marks to lose if not done/rushed.

“Doctoring theory test”
 Like driving theory test.
 Testing your response to various situations in order to

assess how well you understand the highway code
 BUT they haven’t given you a highway code (not explicitly)

Some are really obvious...

Some are easy to deduce...

Some need knowledge of cars...

Some need knowledge of the highway code...

SJT EXAM
RANKING Q’S

Best and Worst are often Obvious
 Due to how these are marked, at least 80% (16/20) of the marks
can be gained simply by getting the best and worst answers
correct.
 Don’t dither with the middle 3 options, just get something

down and move on!

Example 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, you
are contacted by a specialist trainee in microbiology who 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 microbiology trainee 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. Suggest that the microbiology trainee reviews the patient herself in order to be able to
make an informed decision
E. Do not change the prescription and make a record in the notes of the microbiology trainee's
concerns

Example 2
On the morning ward round, your registrar/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

Example 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

The UNOFFICIAL
HOSPITAL
CODE
Primum non nocere
 BUT, be sensible.
 Beware of over-reacting
when patient safety is not
really at risk
 Prioritisation!

Patient Centred Care
 Always act in the best interests of

the patient
 Even if it creates more work for you

Seeking advice
 If issue relates to medical

treatment then its good to ask
seniors
 If issue is
organisational/interpersonal
then asking seniors is never a
bad option
 BUT, it’s rarely the best.
 You’re expected to take initiative

Interacting with colleagues
 Address issue with requesting
senior (as stated in the question
stem)
 If unavailable...other seniors (or

relevant allied healthcare
professionals) within your own team
should be sought
 If unavailable...the relevant on-call

personnel

Covering yourself
 Consultant’s decision is definitive, unless HE/SHE reverses it. DO NOT

change patient care plans without discussing with them.
 Documenting decisions/recommendations/conversations is a good

thing to do in real life. But it doesn’t do anything to help patient care.

Handover
 Handover in person. To a
doctor looking after the
patient.
 Better a nurse looking after

the patient than a doctor
with no responsibility toward
the patient.
 Never leave notes/messages

if avoidable.
 If leaving a note, then better

in patients medical notes
than office/notice board

Emergencies
“On-call” people
are for out-of-
hours requests.
Or in an
emergency when
your senior is not
available.
Emergencies
 Crash call is for

arrest/non-responsive
patient only.
 If a patient deteriorates
acutely then review and
inform senior.
 Some hospitals have a

Medical Emergency
Team.

Interacting with patients/relatives
 FY1 should not be breaking bad news, discharging patients, consenting for ops or
prescribing outside of hospital.
 And no doctor should breach patient confidentiality without seeking the patients
permission
 Procedures= “see one, do one (supervised), teach one”

Addressing concerns
 Explore concerns before reassuring. And avoid ‘delegating’
reassuring to a nurse, or colleague.
 Always reassure/explain in the presence of the patient

themselves!

Prioritise
 There may be good options that solves a problem in the long term
or provide a learning opportunity.
 But it is more important to try to solve the problem there and

then!

You matter too!
 Your time and health are important.
 If not for yourself then for patient safety!!

When interacting with patients or
colleagues, DO NOT...
 do nothing/ineffective activity
 do something that may be unsafe to patient
 wait and see (but often better than a more extreme option)
 avoid the problem
 lie or be evasive
 break confidentiality (be aware of Caldicott guardian)
 be selfish
 have non-patient centred focus
 blame others

Raising concerns
 Address problem with the individual involved

Escalation
 First address them, then escalate in order of seniority
within the team

Escalation (cont’d)
 Seeking advice from

colleague is an okay option,
gossiping is not.
 And no telling tales!

 If somebody else is telling about an issue they have with

somebody then avoid getting involved directly.
(Advise them as above)

 If it is a confrontational issue then often its no use to try
to address the confronter as the ‘victim’.
 Escalate (or advise ‘victim’ to escalate).
 You should say something to the aggressor yourself if

you are an observer.
Escalation - the pit falls
 Do not escalate through their seniors (no snitching!), unless the

issue relates specifically to their role.
 Do not escalate to external organisations. Keep it in the family!

When raising concerns, DO NOT...
 do nothing
 run away from problem
 blame somebody else
 ‘inform’ or ‘complain’ (passive actions), be proactive!

Topical Issues
• Duty of Candour (GMC guidance 2015) = when a mistake is

made, the culpable person should own up and apologise to
those affected
• Surgical consent (Montgomery 2015) = informed consent

should include what a diligent patient would want to know,
not what a diligent doctor would tell them
• New JDC 2016: exception reporting to guardian

SJT EXAM
MCQ’S

1 Problem list
 Create a ‘problem list’ from the question.
 Ensure that all problems are addressed within your 3 answers.
 Remember- EVERY WORD/SENTENCE IN THE QUESTION IS THERE

FOR A REASON

48. You are an FY1 doctor working in the Emergency Department. A 48 year old
patient presents with an ankle injury. He is intoxicated, loud and demands immediate
medical treatment. There are four patients waiting ahead of him. He is upsetting the
other patients and at one point, threatens another patient with physical violence.
A. Ask one of the nurses to try and calm the patient down
B. Call security for assistance
C. Tell the patient that his behaviour is inappropriate and will not be tolerated
D. Arrange for the patient to be moved to a side room away from the other patients
E. Arrange for the patient to be treated as soon as possible
F. Tell the patient he will not be treated if he continues to behave in this manner
G. Ensure the other patients are not distressed by the situation
H. Ask the other patients if they would mind if this patient was treated before them
Example 1
48. You are an FY1 doctor working in the Emergency Department. A 48

year old patient presents with an ankle injury. He is intoxicated, loud
and demands immediate medical treatment. There are four patients
waiting ahead of him. He is upsetting the other patients and at one
point, threatens another patient with physical violence.

Problem List
1. Patient needs treatment
• You are an FY1 doctor working in the Emergency Department. A 48

You are an FY1 doctor working in the Emergency Department. A 48 year old
patient presents with an ankle injury. He is intoxicated, loud and demands
immediate medical treatment. There are four patients waiting ahead of him. He is
upsetting the other patients and at one point, threatens another patient with physical
violence.
You are an FY1 doctor working in the Emergency Department. A 48 year old patient
presents with an ankle injury. He is intoxicated, loud and demands immediate
Problem List
2. Abusive patient

You are an FY1 doctor working in the Emergency Department. A 48 year old
patient presents with an ankle injury. He is intoxicated, loud and demands
immediate medical treatment. There are four patients waiting ahead of him. He is
upsetting the other patients and at one point, threatens another patient with physical
violence.
Problem List
3. Wellbeing of other pts

50. You are on a busy colorectal team and regularly need to work late to complete all of your tasks.
Your FY1 colleague, Jenny, works on the breast team and usually finishes all her jobs by lunchtime.
You have 20 new patients this morning and a long list of jobs, including checking blood results.
You will need to work late in order to complete all of these tasks. You notice that Jenny is checking
her personal e-mails on the ward computer. Your registrar/specialty trainee is busy in theatre.
A. Ask Jenny if she would mind helping you today
B. Inform your registrar/specialty trainee in theatre that you are extremely busy and need some
help
C. Stay at work until you have completed all of your tasks
D. Talk to your consultant about the unequal workload between you and Jenny
E. Raise the issue of unequal workloads at the next departmental meeting
F. Explain to Jenny that it is not appropriate to check personal e-mails at work
G. Ask a medical student to assist you by requesting x-rays and scans
H. Hand over the remaining jobs to the on-call team at the end of your shift
Example 2
50. You are on a busy colorectal team and regularly need to work late
to complete all of your tasks. Your FY1 colleague, Jenny, works on the
breast team and usually finishes all her jobs by lunchtime. You have
20 new patients this morning and a long list of jobs, including
checking blood results. You will need to work late in order to
complete all of these tasks. You notice that Jenny is checking her
personal e-mails on the ward computer. Your registrar/specialty
trainee is busy in theatre.

Problem List
• You are on a busy colorectal team and regularly need to work late to
complete all of your tasks. Your FY1 colleague, Jenny, works on the
breast team and usually finishes all her jobs by lunchtime. You have
20 new patients this morning and a long list of jobs, including
checking blood results. You will need to work late in order to
complete all of these tasks. You notice that Jenny is checking her
personal e-mails on the ward computer. Your registrar/specialty
trainee is busy in theatre.

You are on a busy colorectal team and regularly need to work late to complete all of your tasks. Your
FY1 colleague, Jenny, works on the breast team and usually finishes all her jobs by lunchtime. You
have 20 new patients this morning and a long list of jobs, including checking blood results. You will
need to work late in order to complete all of these tasks. You notice that Jenny is checking her personal
e-mails on the ward computer. Your registrar/specialty trainee is busy in theatre.
Problem list:
• You’re always overworked
A. Ask Jenny if she would mind helping you today •You have too many jobs NOW
•Jenny’s chilling
B. Inform your registrar/specialty trainee in theatre that you are extremely busy and need some help

Problem list:

Problem list:

Problem list:

Problem list:

2 Overlapping answers
 The 3 answers are COMBINATION of actions you would take.
 Therefore do not put ‘overlapping’ answers
 HINT: Observing ‘overlapping’ answers means one of them

MUST be one of the 3 answers they’re looking for!!

Example
70. You share the responsibility for the patients on the Cardiology ward
with your FY1 colleague, Sam. He has previously confided in you that
he is finding his FY1 role very difficult. It is the end of Sam's shift and
he informs you that he has been unable to complete all his tasks and
once again passes them on to you to finish as you are on a late shift.

You share the responsibility for the patients on the Cardiology ward with your FY1
colleague, Sam. He has previously confided in you that he is finding his FY1 role very
difficult. It is the end of Sam's shift and he informs you that he has been unable to
complete all his tasks and once again passes them on to you to finish as you are on a
late shift.
A. Speak to your fellow FY1’s to see whether they think that his conduct is acceptable
B. Suggest to Sam that he may want to discuss his difficulties with his clinical supervisor
C. Advise Sam to inform his consultant that his workload is excessive and unachievable
D. Suggest to Sam that, on this occasion, you share the urgent jobs that need to be done
with another colleague
E. Delegate some of the tasks to your other FY1 colleagues
F. Discuss with Sam what he is finding difficult about his role
G. Inform Sam's clinical supervisor about the incident
H. Set some time aside to help Sam with his

SJT: 'Secret prioritisation
for Success' Webinar skills 74
70. You share the responsibility for the patients on the Cardiology ward with your
FY1 colleague, Sam. He has previously confided in you that he is finding his FY1
role very difficult. It is the end of Sam's shift and he informs you that he has been
unable to complete all his tasks and once again passes them on to you to finish as you
are on a late shift.
A. Speak to your fellow FY1s to see whether they think that his conduct is acceptable
H. Set some time aside to help Sam with his

SJT: 'Secret prioritisation
for Success' Webinar skills 75
late shift.
H. Set some time aside to help Sam with hisfor prioritisation

SJT: 'Secret Success' Webinar skills 76
late shift.
D. Suggest to Sam that, on this occasion, you share the urgent jobs that need to be
done with another colleague
H. Set some time aside to help Sam with hisfor prioritisation

SJT: 'Secret Success' Webinar skills 77
3 Eliminate answers
 Unlike Ranking Q’s some of the answer’s here can be

completely scored out and ignored
 Narrow down the options
 Then apply ‘Problem list’ and ‘Overlapping answer’

techniques

Example
58. You are working in the Emergency Department. Mrs Gersbach, a 65

year old female patient, is admitted with chest pain. This is her fifth
attendance with chest pain in the last two weeks. She has been
extensively investigated over this time, and a cardiologist has
documented that all investigations have been normal and that her
pain is not cardiac in origin. Today, nothing on examination or any of
the investigations suggest that her pain is a symptom of cardiac
disease. There are no other worrying signs or symptoms.

You are working in the Emergency Department. Mrs Gersbach, a 65 year old female patient, is
admitted with chest pain. This is her fifth attendance with chest pain in the last two weeks. She
has been extensively investigated over this time, and a cardiologist has documented that all
investigations have been normal and that her pain is not cardiac in origin. Today, nothing on
examination or any of the investigations suggest that her pain is a symptom of cardiac disease.
There are no other worrying signs or symptoms.
A. Admit Mrs Gersbach to the Acute Admissions Unit (AAU) for further
investigations
B. Write to Mrs Gersbach's GP, asking her to dissuade Mrs Gersbach from
attending the Emergency Department
C. Explain to Mrs Gersbach that there appears to be nothing wrong with her
D. Reassure Mrs Gersbach that her pain is definitely not a symptom of
cardiac disease
E. Ask a senior colleague to speak with Mrs Gersbach
F. Ask Mrs Gersbach if there is anything that she is worried about that might
be causing her pain
G. Arrange an outpatient exercise tolerance for Mrs Gersbach
H. Tell Mrs Gersbach that her attendance at the hospital is not the best use
of the Emergency Department's doctors' and nurses' time

investigations
cardiac disease
be causing her pain

investigations
cardiac disease
be causing her pain

investigations
cardiac disease
F. Ask Mrs Gersbach if there is anything that she is worried about that
might be causing her pain

You have been approached by an FY1 colleague, James who has been on shifts with another FY1
doctor, Mark for the last two weeks. James tells you that Mark has become increasingly careless
in monitoring and documenting patients records. On three occasions, James tells you that he has
found Mark asleelpin the common room whilst on duty. You know Mark very well and have
never witness such behaviour when you have worked with him previously
A. Tell James that you have never witnessed such behaviour from Mark
B. Suggest to James that he speaks to Mark directly about his concerns
C. Advise James to document his concerns
D. Inform a senior colleague about what James has told you
E. Tell James you will speak to Mark about his behaviour
F. Ask other members of the team whether they have witnessed this
behaviour
G. Advise James to speak to a senior colleague about his concerns
H. Ask James whether he has any evidence that patient safety is being
compromised

behaviour
compromised

behaviour
compromised

Combining these Techniques
69. A 45 year old alcoholic is admitted in the afternoon with delirium

tremens after stopping drinking two days previously. During the night
you are called to see him as he has become very aggressive and is
demanding to be allowed home. As you arrive on the ward he
punches one of the nurses. He is confused, shouting and threatening
other patients.

A 45 year old alcoholic is admitted in the afternoon with delirium tremens after
stopping drinking two days previously. During the night you are called to see him as he
has become very aggressive and is demanding to be allowed home. As you arrive on
the ward he punches one of the nurses. He is confused, shouting and threatening other
patients.
A. Prescribe extra sedation for the patient
B. Ask the nursing staff to call hospital security
C. Attempt to talk to the patient to try and calm him down
D. Reassure the other patients in the ward that they are safe
E. Ask the nursing staff to help you restrain the patient
F. Ask the nursing staff to call the police
G. Inform the patient that his behaviour is inappropriate and will not be tolerated
H. Ensure that the nurse who was punched is not badly injured

patients.

patients.

patients.

patients.

SJT EXAM
SAMPLE QUESTIONS

RANKING Q1
One of the nurses working with you on the ward who you are friends
with asks if you could access her husbands chest X-ray and tell her
what it shows. He recently attended the GP with 3 month history of a
persistent cough. You are currently very busy with ward duties.
A: Give her your login so she can take a look herself

B: Agree to take a look at it now
C: Tell her you’re too busy right now, but you can talk to her later
D: Reassure her that his GP has followed this up appropriately and
should be contacted for the result
E: Ask her to let you talk to her husband to gain consent and then look
at the CXR

RANKING Q2
Your FY1 colleague, Frank, has been trying to swap their Friday night
on-call as they realised last minute that they have to catch a flight
before the end of the shift. He is unable to swap it in time. On the
day of the shift Frank calls in to the medical rota co-ordinator to say
he was in a car crash and is unfit to work. He returns to work 5 days
later with a very nice tan. What do you do?
A: Talk to Frank, find out what happened

B: Ask advice from your seniors
C: Tell Frank’s educational supervisor what he did
D: Report Frank to the Medical Director
E: Discuss Frank’s actions with an FY1 colleague

RANKING Q3
You are an FY1 doing Surgery. The nurse approaches you about a patient
on the ward who became unresponsive whilst she was taking bloods
from her, but she is now responsive. You notice on the board that the
patient is under the care of the Medics. What do you do?
A: Tell her to bleep the medical team to inform them

B: Tell her that she is not your patient
C: Treat the patient yourself without bothering the Medics
D: Review the patient and then after providing immediate care inform the
medical team
E: Tell her not to worry, the patient just fainted

RANKING Q4
You are the Surgical FY1 on-call overnight and haven’t eaten since
lunchtime. You are responsible for covering the ward. It is very quiet and
by 10pm all the ward jobs are done so you call your registrar to see if he
wants to hang out in the mess and watch Match of the Day. The registrar
is busy seeing new patients and says he will catch up with you later.
What do you do?
A: Go to the mess and watch MOTD

B: Ask the registrar if he could watch you clerking a new patient so you
can get a mini-CEX signed off
C: Ask if you could help the SHO with clerking
D: Take the opportunity to eat the dinner you brought in
E: Ask the medical FY1 if she would like a hand with ward jobs

RANKING Q5
You are an FY1 working at the nurses station, writing discharge

summaries at the computer. At the same time you are having an
entertaining conversation with some of the nursing staff. The tearful
daughter of a recently deceased patient complains to the ward clerk
about your behaviour. What do you do?
A: Request a doctors office on the ward so that discharge summaries can

be written in peace
B: Approach the relative and offer apologies for your insensitivity
C: Continue to work with the conversation toned down
D: Ignore the complaint
E: Suggest to the nurses that they should be more considerate and let
you get on with your work

MCQ1
You are an FY1 on surgery. In the morning ward round the consultant asked if a post-
appendicectomy patients bloods were normal, to which you absent mindedly
responded ‘Yes’. The patient was discharged. When you check your list again before
handover at 5pm you notice his inflammatory markers had in fact risen markedly.
What do you do?
A: Ignore the result

B: Alert your registrar and ask his advice
C: Admit to your consultant that you had given him false information on the round
D: Call the patient to return to the hospital
E: Add a note to the discharge summary for the GP to prescribe the patient antibiotics
F: Handover for the on-call doctor sort it out
G: Call the patient and tell him to return to hospital if he starts to feel unwell
H: Ask the consultant how he would like to treat the patient

MCQ2
Your consultant has requested his patient to have 2 units of blood overnight after she
lost a significant amount of blood intra-operatively. You have prescribed the blood
and it has been requested. You are bleeped by the nurse to come and see the
husband who is causing problems. He is adamant that his wife should not get any
blood as he is concerned about BBV’s (blood bourne viruses). She is quite happy to
receive the blood (she has capacity). What do you do?
A: Comply with husbands request as he has Power of Attorney

B: Do not give blood as per husbands request and prescribe iron instead
C: Explore the husbands concerns
D: Request security to remove the husband
E: Check her last haemoglobin to see if she really needs it
F: Tell them it can wait until the morning when the consultant can discuss it with him
G: Inform the husband that since his wife has capacity she is able to decide for herself
H: Give her the blood transfusion
MCQ3
You are surgical FY1 doing the ward round alone with your registrar who is a
foreign trained surgeon. He has a strong accent and one of the older patients is
struggling to understand anything he says. She calls you over after he has moved
on to ask if you could repeat everything he had said. This is the third time this has
happened on this ward round with elderly patients. What do you do?
A: Let your registrar continue without you whilst you re-do the consultation
B: Tell her you will come back and explain later
C: Summarise the consultation and then catch up with the registrar
D: Alert the GMC anonymously about the registrar’s poor English
E: Continue the ward round with the registrar
F: Tell your consultant that patients struggle to understand your registrar due to his
strong accent
G: Speak to the registrar after the round when you are in private to tell him that
older patients struggle to understand his strong accent
H: Tell her you need to go as there’s no one else to accompany the registrar
MCQ4
You are an FY1 on Surgery. After examining a Muslim patient on the ward round
who had sustained a burn to his hand the ward round moves on. Later the
consultant makes an Islamophobic joke about how he had likely been playing with
explosives. One of the medical students on the round is overtly Muslim and seems
to have become very upset. She doesn’t say anything at the time. What do you
do?
A: Alert the consultant that one of the students was upset by the joke
B: Tell the patient that a joke was made about them and apologise
C: Speak to the medical student and reassure her that you will say something
D: Discuss your concerns with your Educational Supervisor
E: Advise the medical student to discuss the issue with the consultant
F: Report the consultant to the GMC
G: Speak to the consultant privately to advise that the joke was inappropriate
H: Monitor your consultant over the next few weeks and escalate if it happens again
MCQ5
You are the FY1 on call for surgery overnight. It is a locum registrar covering the
on-call tonight. He tells you at 10pm that he’s taking the battery out of his bleep
and going to sleep and that if there’s any problems you are to bleep the Medical
Registrar on call. Meanwhile the SHO is busy seeing a sick patient in A&E resus.
Overnight a patient who had a bowel resection 5 days ago become very septic
and unwell. What do you do?
A: Ask the Med Reg to come and see the patient

B: Ask the surgical SHO to review the patient now
C: Bleep the surgical Reg and then document that he failed to respond
D: Provide supportive care and monitor until the morning when you can hand over
for the day SpR to review
E: Go to the on-call room and try to wake up the surgical Reg
F: Report the behaviour of the locum Reg to his locum agency
G: Report the behaviour of the locum Reg to the Consultant in the morning
H: Call your regular registrar on hisSJT:mobile and
'Secret for Success' ask him what to do
Webinar 103
RANKING Q1
One of the nurses working with you on the ward who you are friends
with asks if you could access her husbands chest X-ray and tell her
what it shows. He recently attended the GP with 3 month history of
cough and weight loss. You are currently very busy with ward duties.
D: Reassure her that his GP has followed this up appropriately and

should be contacted for the result
C: Tell her you’re too busy right now, but will find time to talk to her later
about her concerns
E: Ask her to let you talk to her husband to gain consent then look at the
CXR
B: Agree to take a look at it now
A: Give her your login so she can take a look herself

RANKING Q2
Your FY1 colleague, Frank, has been trying to swap their Friday night
on-call as they realised last minute that they have to catch a flight
before the end of the shift. He is unable to swap it in time. On the
day of the shift Frank calls in to the medical rota co-ordinator to say
he was in a car crash and is unfit to work. He returns to work 5 days
later with a very nice tan. What do you do?
A: Talk to Frank, find out what happened

B: Ask advice from your seniors
E: Discuss Frank’s actions with an FY1 colleague
C: Tell Frank’s educational supervisor what he did
D: Report Frank to the Medical Director

RANKING Q3
You are an FY1 doing Surgery. The nurse approaches you about a patient
on the ward who became unresponsive whilst she was taking bloods
from her, but she is now responsive. You notice on the board that the
patient is under the care of the Medics. What do you do?
D: Review the patient and then after providing immediate care inform the
medical team
C: Treat the patient yourself without bothering the Medics
A: Tell her to bleep the medical team to inform them
B: Tell her that she is not your patient
E: Tell her not to worry, the patient just fainted

RANKING Q4
You are the Surgical FY1 on-call overnight and haven’t eaten since
lunchtime. You are responsible for covering the ward. It is very quiet and
by 10pm all the ward jobs are done so you call your SHO to see if he
wants to hang out in the mess and watch Match of the Day. The SHO is
busy seeing new patients and says he will catch up with you later. What
do you do?
D: Take the opportunity to eat the dinner you brought in

C: Ask if you could help SHO with clerking
E: Ask the medical FY1 if she would like a hand with ward jobs
B: Ask SHO if he could watch you clerking a new patient so you can get a
mini-CEX signed off
A: Go to the mess and watch MOTD

RANKING Q5
You are an FY1 working at the nurses station, writing discharge

summaries at the computer. At the same time you are having an
entertaining conversation with some of the nursing staff. The tearful
daughter of a recently bereaved patient complains to the ward clerk
about your behaviour. What do you do?
B: Approach the relative and offer apologies for your insensitivity

C: Continue to work with the conversation toned down
E: Suggest to the nurses that they should be more considerate and let
you get on with your work
A: Request a doctors office on the ward so that discharge summaries can
be written in peace
D: Ignore the complaint

MCQ1
You are an FY1 on surgery. In the morning ward round the consultant asked if a post-
appendicectomy patients bloods were normal, to which you absent mindedly
responded ‘Yes’. The patient was discharged. When you check your list again before
handover at 5pm you notice his inflammatory markers had in fact risen markedly.
What do you do?
A: Ignore the result

B: Alert your registrar and ask his advice
C: Admit to your consultant that you had given him false information on the round
D: Call the patient to return to the hospital
E: Add a note to the discharge summary for the GP to prescribe the patient antibiotics
F: Handover for the on-call doctor sort it out
G: Call the patient and tell him to return to hospital if he starts to feel unwell
H: Ask the consultant how he would like to treat the patient

MCQ2
Your consultant has requested his patient to have 2 units of blood overnight after she
lost a significant amount of blood intra-operatively. You have prescribed the blood
and it has been requested. You are bleeped by the nurse to come and see the
husband who is causing problems. He is adamant that his wife should not get any
blood as he is concerned about BBV’s. She is quite happy to receive the blood (she
has capacity). What do you do?
A: Comply with husbands request as he has Power of Attorney

B: Do not give blood as per husbands request and prescribe iron instead
C: Explore the husbands concerns
D: Request security to remove the husband
E: Check her last haemoglobin to see if she really needs it
F: Tell them it can wait until the morning when the consultant can discuss it with him
G: Inform the husband that since his wife has capacity she is able to decide for herself
H: Give her the blood transfusion
MCQ3
You are surgical FY1 doing a round with your registrar who is a foreign trained
surgeon. He has a strong accent and one of the older patients is struggling to
understand anything he says. She calls you over after he has moved on to ask
if you could repeat everything he had said. This is the third time this has
happened on this ward round with elderly patients. What do you do?
A: Let your registrar continue without you whilst you re-do the consultation
B: Tell her you will come back and explain later
C: Summarise the consultation and then catch up with the registrar
D: Alert the GMC anonymously about the registrar’s poor English
E: Continue the ward round with the registrar
F: Tell your consultant that patients struggle to understand your registrar due
to his strong accent
G: Speak to the registrar after the round when you are in private to tell him
that older patients struggle to understand his strong accent
H: Tell her you need to go as there’s no one else to accompany the registrar 111
SJT: 'Secret for Success' Webinar
MCQ4
You are an FY1 on Surgery. After examining a Muslim patient on the ward round
who had sustained a burn to his hand the ward round moves on. Later the
consultant makes an Islamophobic joke about how he had likely been playing with
explosives. One of the medical students on the round is overtly Muslim and seems
to have become very upset. She doesn’t say anything at the time. What do you
do?
A: Alert the consultant that one of the students was upset by the joke
B: Tell the patient that a joke was made about them and apologise
C: Speak to the medical student and reassure her that you will say something
D: Discuss your concerns with your Educational Supervisor
E: Advise the medical student to discuss the issue with the consultant
F: Report the consultant to the GMC
G: Speak to the consultant privately to advise that the joke was inappropriate
H: Monitor your consultant over the next few weeks and escalate if it happens again
MCQ5
You are the FY1 on call for surgery overnight. It is a locum registrar covering the
on-call tonight. He tells you at 10pm that he’s taking the battery out of his bleep
and going to sleep and that if there’s any problems you are to bleep the Medical
Registrar on call. Meanwhile the SHO is busy seeing a sick patient in A&E resus.
Overnight a patient who had a bowel resection 5 days ago become very septic
and unwell. What do you do?
A: Ask the Med Reg to come and see the patient

B: Ask the surgical SHO to review the patient now
C: Bleep the surgical Reg and then document that he failed to respond
D: Provide supportive care and monitor until the morning when you can hand over
for the day SpR to review
E: Go to the on-call room and try to wake up the surgical Reg
F: Report the behaviour of the locum Reg to his locum agency
G: Report the behaviour of the locum Reg to the Consultant in the morning
H: Call your regular registrar on hisSJT:mobile and
'Secret for Success' ask him what to do
Webinar 113
Any questions?

Thank you for attending!
• Please fill out the feedback questionnaire which will appear

after this presentation is closed.
• Any queries, email sjt@floreo.co.uk or contact me directly at

moinie@floreo.co.uk

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SITUATIONAL

Floreo Associates t: 0203 617 1137

 Content devised in November

 Consistently positive feedback

SJT: 'Secret for Success' Webinar 2

SJT: 'Secret for Success' Webinar 4

 Situational Judgement Test. An assessment of your decision

SJT: 'Secret for Success' Webinar 5

 FY1 Job Analysis

 Five professional target attributes

SJT: 'Secret for Success' Webinar 6

 Challenging inappropriate behaviour

SJT: 'Secret for Success' Webinar 7

 Knowing how to respond when you make a mistake

 Dealing with confrontation

 Seeking help when not sure of the correct procedure/best way of

SJT: 'Secret for Success' Webinar 8

 Gathering information and communicating your intentions to

 Negotiating for a scan from radiology

 Listening and effectively communicating with an unhappy patient

SJT: 'Secret for Success' Webinar 9

 Identifying that a patient’s views and concerns are important and

 Considering that a patient may have different needs from others

 Spending time trying to understand a patient’s concerns and

SJT: 'Secret for Success' Webinar 10

 Recognising and valuing the skills and knowledge of nursing staff,

 Consulting with colleagues about how to share workload fairly

 Offering assistance and support to colleagues when they are not

SJT: 'Secret for Success' Webinar 11

 Each ranking question is marked out of 20, with 4 marks

 Lose 1 mark for every position you are out.

 MCQs have 3 right answers out of 8 (4 marks for correct

SJT: 'Secret for Success' Webinar 12

 Continuous distribution with a skew towards 50

 Majority (>95%)score between 30 and 45

 Much more variation in score compared to EPM

SJT: 'Secret for Success' Webinar 13

SJT: 'Secret for Success' Webinar 14

Other teams FY1 Sick patients

Need to bat these

SJT: 'Secret for Success' Webinar 15

SJT: 'Secret for Success' Webinar 16

 Nursing Team= bedside care, administering prescribed medications,

 Pharmacists= checking prescription dosages, interactions, checking

 Physiotherapists= mobilising patients

 Occupational therapists= assessing patients ability to complete activities

 Every word and sentence is there for a reason! Nothing is superfluous

 Active nearly ALWAYS better than passive

 Don’t spend a long time fussing over ranking questions.

SJT: 'Secret for Success' Webinar 19

 Like driving theory test.

 Testing your response to various situations in order to

 BUT they haven’t given you a highway code (not explicitly)

SJT: 'Secret for Success' Webinar 20

SJT: 'Secret for Success' Webinar 21

SJT: 'Secret for Success' Webinar 22

SJT: 'Secret for Success' Webinar 23

SJT: 'Secret for Success' Webinar 24

SJT: 'Secret for Success' Webinar 25

 Don’t dither with the middle 3 options, just get something

SJT: 'Secret for Success' Webinar 26

A. Prescribe what the microbiology trainee advises