The Situational Judgment Test (SJT) is unique.
It stands apart from the other, academic sections of the UCAT, in that it tests your emotional intelligence.
The questions are a little daunting at first, but there are some fundamentals to getting ready for this section, which we explain below.
The UCAT is all about assessing your potential to be a competent doctor. A large part of that is critical thinking and academic skills, but there are other, more human qualities that are important for a doctor to embody.
If you haven’t yet heard of the GMC (General Medical Council), they are the body which regulates the whole medical profession. One of their key aims is to maintain a high standard of professionalism across the healthcare industry, and this forms the basis for much of the SJT.
The GMC regularly updates a publication known as ‘Good Medical Practice’. This outlines what they expect from the medical professionals. Read this document as part of your SJT preparation.
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Time: 26 minutes
To cover the SJT in depth, get Medify’s UCAT course, but here's a general overview of the structure:
The most common question requirement is to scale or rank statements, gauging the ‘appropriateness’ or the ‘importance’ of an action. For these questions, you are asked to select from four possible options with varying degrees of appropriateness or importance.
There are also a small number of 'drag and drop' style questions, where you will be given 3 options and must decide which 2 of these are the most and least appropriate respectively:
More recently, two option ‘appropriate or inappropriate’ questions have been added - these are the simplest to understand.
These questions may seem unusual at first, but with focus and effort, they become more natural as you start to recognise patterns. Whilst you will come across ranking questions most often, don’t disregard the others: getting good at these can mean easy marks from the exam.
Our free UCAT practice questions cover the SJT, so you can start to learn the format and presentation of the section. Don’t worry if you get things wrong at first; treat it as exploration.
The world of medicine is deeply integrated with ethics, and rightly so.
Not all SJT questions are ethics-based, but the topic is likely to come up often. It’s worth keeping in mind that medical ethics is an enormous topic, worthy of an entire career. Fortunately, premeds aren’t expected to get into this level of detail.
What you do need to know are the 4 pillars of medical ethics:
Autonomy - The duty to respect a patient’s right to self-determination
Beneficence - (i.e. ‘do good’). The well-being of the patient is a doctor’s top priority
Non-Maleficence - (i.e. ‘do no harm’). The duty to avoid harm to the patient, if possible
Justice - The duty to treat all patients with equity and equality.
The other key point to know is the importance of confidentiality. Doctor-patient relationships are strictly confidential - apart from in severe circumstances.
If an answer asks you to breach confidentiality, think carefully about whether it’s appropriate.
Jeremy is a medical student on placement in a paediatric ward. A junior doctor, Dr Edmund, has been observing. Dr Edmund arrives looking very unkempt and smelling strongly of alcohol. He is due to visit a young patient to conduct a blood test in one hour. Jeremy is concerned that Dr Edmund is not in a fit state to see patients. He asks him if he has been drinking, but Dr Edmund immediately dismisses his concerns without explanation.
Choose the one most appropriate action and the one least appropriate action that Jeremy should take in response to this situation.
Key things to note in the stem:
Clearly, this is a patient safety question.
Even as a medical student, you are bound by the code of ethics; in this case 'non-maleficence'.
We must attempt to avoid harm to patients, which may occur if we let a drunk doctor perform blood tests.
In these scenarios, it is usually best to go up the hierarchy (see our later tip on ‘knowing your role’). As the consultant is both in charge of the junior doctor and responsible for the patients on this ward, we must bring up our concern with him.
Even if Dr Edwards is not drunk, when we have concerns we must always make them known. For this reason, trusting him to carry out the blood test is the least appropriate option.
The appropriateness of a statement is sometimes hard to determine.
Whilst there are 4 possible answers, they consist of only 2 ‘sets’ of answers - they’re either appropriate or inappropriate, important or unimportant.
Once you have determined this, you can narrow down the correct answer. And if all else fails, it’s 50/50!
Choosing the correct ‘half’ of responses will still get you a partial mark.
For example, picking ‘Important’ instead of ‘Very important’ will still net you some credit, as opposed to marking something as ‘Not important at all’ when it should have been ‘Very important’.
In addition to medical scenarios, you may also be tested on general scenarios and dental scenarios.
Here’s an example dental scenario:
A 24-year-old patient, Sarah, presents to have a bridge put in. After the procedure, Sarah looks in the mirror and is clearly distressed. She complains that her mouth is ‘ruined’ and begins to cry.
Decide if the following actions are appropriate or inappropriate:
A: Explain to Sarah the importance of her procedure regardless of cosmetic appearance
B: Allow time for Sarah to calm herself before discussing her feelings and options
C: Tell Sarah that she will get used to the bridge in time
D: Seek advice from your educational supervisor
E: Tell Sarah she should have gone to a different dentist
As you can see, despite the dental setting this question actually wanted to assess your level of empathy. Don’t be afraid of unfamiliar concepts; the SJT will never expect you to know anything above the level of a student. Work out what the question wants from you and focus on that.
Additionally, this question is quite an extreme example. Many questions will have broader and more familiar settings with situations that are easily comparable, such as references to the GMC (General Medical Council) and GDC (General Dental Council).
Some questions in the SJT are harder than others.
Should you miss questions if you’re short of time? Absolutely not.
As with any of the UCAT sections, there is no negative marking, so guess away.
The SJT comes after all other sections. Many students might be wiped out at this point - especially after the focus and effort needed for the rest of the UCAT. Don’t allow fatigue to affect your performance, as SJT score is an important criterion for some universities.
Practise maintaining your focus throughout the UCAT. Medify has Full UCAT Mocks available which will let you get used to the timeframe. Once you’ve done 10+ mocks, of the 21 or so we have, you will be used to getting over the finish line at full speed and with your grey matter still firing on all cylinders.
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You need to average ~22 seconds per question to complete all 69 questions.
The best way to practice SJT timing is to start with untimed practice to get familiar with the style, before trying timed practice, then Mini-Mocks and finally Full Mocks.
Learn about UCAT timing - the hardest part of the exam.
Whilst many questions in the SJT are universal, some scenarios put you in a role.
This is often the role of a student, but it could also be a junior doctor - or an even higher position. You need to adapt to the unique perspective of the role, so it’s worth having a basic knowledge of medical hierarchies, as well as the responsibilities of everyone involved.
Students, for example, would not be expected to deliver patient results - let alone prescribe medicine or perform procedures. Even for a Foundation Year 1 doctor (FY1) it would be rare to prescribe complicated or potentially dangerous medicines without a senior’s input, so think carefully if the question seems to expect a unilateral decision.
Read the question carefully - Scenarios can be several sentences long, and it can be easy to skim read and miss some potentially key points.
Be methodical - Once you’ve practised enough, you’ll understand how to move through at pace, whilst paying attention to the details. Don’t let the clock intimidate you into speed.
Be sure to go through each question and figure out what exactly it is saying and what the answers represent.
Is this a breach of privacy question?
Does it require an ethical decision?
Sometimes, the scenario will be ‘witnessing a colleague’s inappropriate behaviour’ and deciding how to respond. Don’t jump on your first thought; think about the feelings of everyone involved and be circumspect.
Adam is an FY1 (Foundation Year 1) doctor working in a busy hospital. The doctor in charge has asked Adam to complete a blood test for a patient, Mrs Jones, and send it to the lab that morning as it is very urgent. Adam has been rushed off his feet all day and has had many other urgent tasks to complete. Further, his best friend has invited him out for dinner that evening and has stressed that it is very important that Adam is not late. He is about to go home at the end of his shift when he realises that he has forgotten to do Mrs Jones’s blood test.
How appropriate are each of the following responses by Adam in this situation?
Key points in the stem:
This question concerns patient safety and taking responsibility for our mistakes.
By reading the stem carefully, we already have an idea about what the questions will be like and what our response should be.
In medicine, patient safety comes above all else - it is now Adam’s responsibility to attempt to assuage the potential harm caused by missing Mrs Jones’s blood test, regardless of personal commitments, like dinner parties. This should guide all your answers to the shown responses.
Sometimes, questions might touch on some complicated subjects.
For example, tourists are technically expected to pay for their treatment, but in reality, the scenario may be completely different. Remember, don’t answer based on what you believe to be morally right, or your existing knowledge, experience or assumptions. Answer based on what a doctor should do.
In most situations, this will mean getting help from a senior or involving a team. If in doubt during practice, go back to the GMC’s guidelines or use Medify’s feedback.
Sometimes, the choice between ‘important’ and ‘very important’ can be agonisingly difficult to pick.
Remember, the SJT answers are selected based on what a group of ‘Subject Matter Experts’ pick; and they may value completely different things to you.
You may be able to pick up a feel for this, but in many cases, it simply isn’t worth the time spent thinking about it.
You may get half marks for a guess, or simply flag the question to return to at the end of the section.
Appropriate actions get to the source of the problem, they don’t deal with it at face value or ignore it.
If a colleague was acting in a way you perceived as unprofessional, for example, the first step would be to open communication with them to understand the root of the problem. If that failed, you could communicate with someone higher up.
You might find that the colleague had some extenuating circumstances, and your first reaction would have been too harsh. This can only be discovered through thoughtfulness and communication.
Inappropriate actions are often apparently obvious at first and don’t take much thought - they are knee-jerk reactions. Despite the time limit, train yourself to look beyond the obvious and deal with issues by finding the root cause.
Even with all the preparation in the world, the UCAT is still a stressful experience.
By the time you reach the SJT, you will have completed all the other sections. Even if you think they didn’t go so well, don’t panic. Focus on completing this section to the best of your abilities. The exam may not have gone as badly as you fear.
Preparing for the UCAT can be just as stressful as doing it, but remember, the key to successful working is a good state of mind.
Nowadays, everybody has some level of social media presence - and this can be useful when used in the right context.
However, the NHS and individual hospitals have strict policies when it comes to using social media.
It is now acceptable to identify yourself as a medical professional on a personal account, but there are constraints to how you behave online.
You should never post something that would be deemed unacceptable by a hospital’s policy. For example, many hospitals do not look kindly on posts involving drinking or any unprofessional behaviour if you have identified yourself as working with them.
This sort of scenario may very well come up in the SJT. Look through the NHS’s social media policy to determine if an action would be appropriate or inappropriate.
A few key points from this policy are:
Dr Ross is a consultant in orthopaedics at a General Hospital. Whilst on a ward round, he delivers good news to a patient he has recently treated. As he is leaving the patient’s room, Dr Ross is approached by the patient’s sister, another consultant at the hospital. She is keen to hear from Dr Ross about how her brother is recovering.
How appropriate are each of the following responses by Dr Ross in this situation?
Key points in the stem:
Remember, it is never appropriate to disclose information about a patient to someone who is not involved in their care; it does not matter that they are also a consultant, or that they are related to the patient. We do not know about the patient’s personal life - it’s easy to assume they are happy to share this information, but possibly they would prefer to keep it private. In any case, they can make that decision themselves - thus we should tell our colleague nothing.
By contrast, the second question asks how appropriate it would be to ‘encourage our colleague to look up the patient themselves on the hospital network’. This is highly inappropriate, and medical professionals have been struck off for such an offence. It is never acceptable to look up a patient's information without good medical reason (or at least their permission).
Any time spent in medicine will show you the value of teamwork and this is reflected in the SJT.
Keep these 4 tenets in mind:
This remains important despite your personal feelings about a colleague. Remember, patient safety comes above all else, regardless of if those feelings are positive or negative.
As we touched on earlier, trust is vital to the entire medical system. A key to this is the principle of ‘transparency’; doctors should aim to be as open and honest with patients as possible, keeping them informed about their care. It is extremely unlikely you will ever be in a scenario where it would be appropriate to lie to a patient.
In medicine, every action that affects a patient is supposed to have their informed consent.
This means two things:
A patient with late-stage Alzheimer’s, for example, may not be able to understand the necessary information to consent to their treatment.
As a medical student, you wouldn’t be expected to make the decision that a patient couldn’t provide informed consent - but understanding what this means is highly important.
A common feature of the SJT will be patients who may not be able to consent themselves or who are under a relative’s guardianship. In these cases, whilst the ‘guardian’ does have a large say in treatment plans, it is not final. Remember that you must always prioritise the patient’s best interests.
There are complex ethical issues regarding consent - some even leading to legal action - but it is highly unlikely this will come up in the SJT. In most cases, it will be enough to make sure the patient has as much agency and ability to consent as possible.
Most medical scenarios in the UCAT involve patients in some way, as patient safety should always be a consideration.
Professional behaviour is at the core of the GMC’s guidance on behaviour around patients. Doctors are meant to be respectful and considerate, build up trust with patients and do their best to help, providing they ‘recognise and work within the limits of [their] competence’.
Doctor-patient guidelines are highlighted in multiple segments of Good Medical Practice.
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Best of luck with your preparation!