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Questions and Scoring

Questions on the SJT draw heavily on the General Medical Council’s ‘Tomorrow’s Doctors‘ and its 2013 follow-up, ‘Good Medical Practice‘. It is also testing the appropriateness of students for their FP curriculum, so familiarity with all three documents is advisable.


Questions

The UKFPO reuse material from previous SJTs, so there are currently no official past questions available. However, SJTs usually follow the following formats:

Part I – Ranking Questions

You are a junior doctor in an emergency ward. You are speaking to the two parents of a young boy with multiple injuries requiring immediate blood transfusion. The parents’ religious beliefs are evidently at odds with this procedure, and they make their beliefs clear. After telling them that you believe their son will die if they do not consent, they agree to the procedure, and the boy survives. A few weeks later, your supervisor informs you that the hospital is being sued because the parents were coerced into believing the procedure more vital to their son’s survival than was the case.

Rank the below responses to the situation, where

1 = most appropriate            5 = least appropriate

A 1 2 3 4 5
B 1 2 3 4 5
C 1 2 3 4 5
D 1 2 3 4 5
E 1 2 3 4 5

A. Ignore the situation because you know you made the correct call, and wait for your supervisor to contact you.

B. Ask a fellow junior doctor for advice.

C. Discuss the situation with your supervisor.

D. Ask the ward clerk for the parent’s details.

E. Ask the nurses on shift on the night of the blood transfusion to write statements of support for you.

Part II – MCQs

You are a junior doctor working late on a care of the elderly ward when a patient calls for your help. The patient has been complaining of abdominal pain, and on their chart, are clear instructions for the nursing staff to record any changes to urine output. The patient tells you that they have been in agony for hours, following a visit to the bathroom. It is clear that multiple hourly checks have been skipped by the nursing team, and the patient now blames you for their condition.

Select the three most appropriate responses from the list below.

A. Immediately find the nurse in charge of the night shift, and get them to take charge of the patient.

B. Ensure the patient remains in their bed, and then leave to find a nurse.

C. Inform a senior member of staff about the incident.

D. Record the night’s events in the patient’s notes.

E. Explain to the patient that it isn’t your fault that they are suffering.

F. Tell the patient which nurse was supposed to check on them.

G. Call for a senior colleague and remain with the patient until someone more familiar with the case arrives.

H. Examine the patient.

Scoring

The candidate’s raw score is reviewed by subject matter experts, or SMEs, and evaluated against a set of ‘correct’ answers. Due to the focus on a candidate’s judgement, there is a wide range of possible responses – however, the SMEs will reach a consensus as to their preferences, and this will effectively become the perfect set of answers. This ensures that the scoring is standardised, and candidates’ results are easily compared.

The scoring system is not absolute, however, and candidates are able to earn points for ‘incorrect’ answers – or those deviating from the perfect answers decided by the SMEs. An example of the system is as follows:

Using this model, the ‘perfect’ answer of 1, 2, 3, 4, 5 would receive 20 points – four each for the five correct placements, but the worst possible answer – 5, 4, 3, 2, 1 – would still receive eight points. This is because number 3 is still in its ‘perfect’ position, and 4 and 2 are two places out – earning two points apiece. Only 1 and 5 earn zero points. There is therefore no negative marking on the SJT, and no reason to not answer every question. Even if the candidate is unsure as to what to do with many of the responses they are presented with, most will be able to identify at least one process they value as important, or a course of action they would prioritise.

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