Preparing for the Situational Judgement Test (SJT) exam can be quite daunting. It makes up 50% of your Foundation Programme application and thus has the largest weight of any one exam on your ranking. People will tell you that you can’t prepare for it or preparing will make you do worse. Some will advise their favourite textbook or course and you’re left anxious trying to prepare for a test you have no idea how to prepare for.

Whilst you can’t learn or cram knowledge in the conventional sense for the SJT, you can certainly prepare for it and in this article, we will talk about how.

What is the SJT and what does it involve?

The SJT is not a test of your knowledge or skills but rather a test to determine whether you have the attributes that are needed as a Foundation doctor. It covers the following attributes: commitment to professionalism, patient focus, coping with pressure, effective communication and teamwork.

The SJT is 2 hours and 20 minutes long, with 70 scenarios in total asking how you would respond to the situation. Questions have multiple formats including multiple choices selection and ranking.

• The multiple choice questions have 8 options and you need to select 3 options that make the best response to the question
• The ranking questions give you 5 options that you need to rank from best to worst.

How to prepare for the SJT?

You don’t prepare for the SJT in the conventional sense of memorising facts. This is because the questions are carefully worded where everything is highly contextualised. Slight differences in the wording or context of a question can really change what you do.

For example:

A 52 year old male patient is admitted with an NSTEMI. He requests a nicotine patch. In the past, he has been inconsistent with their use and has continued to smoke. Rank the following from most appropriate to least appropriate.

• Explain the dangers of smoking & do not prescribe
• Enquire about the difficulties he’s had with quitting or with patches before
• Insist he has a period of abstinence before you will agree to prescribing the patches
• Prescribe more patches and thoroughly explain how they should be used
• Suggest that nicotine replacement therapy is not suitable and other strategies should be considered

Now if we adjusted the wording slightly we could radically change the ranking. For example, if we changed the stem to state he’s been smoking on this occasion whilst on the ward despite having been prescribed patches, it now becomes a patient safety concern as he could start a fire on the ward. In a similar way, any of the options could have their wording slightly changed e.g. from explaining to scolding.

With this in mind, the trick is to understand the general principles behind how things are done in the UK and what regulations are in place. It requires a tricky balancing of commitment to professionalism, patient focus, coping with pressure, effective communication and teamwork. For example, you have to be kind to your colleagues but also you may need to be authoritative if patient safety may be compromised.

Several different resources are available that can be helpful when preparing for the SJT

1. GMC Good Medical Practice guidelines and Ethical guidelines

• Try to understand and get your head around the core material in this. The more familiar you are with these, the easier it is to rank against the guidance.
• You must understand capacity, ethical pillars of medicine, consent and other such important principles

2. Spend time on the ward

• Spending time on the ward observing doctors communicate with patients and relatives
• Seeing how the multidisciplinary team interacts is useful as you will familiarise yourself with the SJT scenarios that occur in the ward environment. The more you see, the easier it is to visualise the scenarios in the exam.
• This is helpful to understand what is practically possible within the constraints of a time pressued NHS. Without this, it is difficult to understand the difference between an educational supervisor and clinical lead.

3. Practice questions off the UKFPO website

• These are useful and should do them more than once. It is also important to read the rationale/answers as this will help you understand the GMC priorities.
• The trick is not to learn the answers, but really appreciate the nuances of how the question and responses are worded and how this impacts their ranking or selection

4. Practice the exam timings

• Not finishing or missing a question is the most common reason for why people do poorly at the SJT. Even the marks in one question can massively impact your ranking so scoring zero for a question can be the difference between landing your top choice or not.
• Work through an official practice paper and practice the timings.
• The exam is 2 hours and 20 minutes long for 70 questions.
• There are two sections in the SJT. You have 70 minutes to complete section 1 with 10 minutes of comfort break in between and 70 minutes to complete section 2. You cannot go back to section 1 after completing it.
• For section 1, there are typically 37 scenarios (19 multiple choice and 18 rating scenarios), each with several questions to respond to. For section 2, there are 38 scenarios, each with several questions to respond to.
• Make sure you do NOT wait until the end to trascribe your answers. Doing this is a sure way of failing.

SJT further information and statistics

• A yearly summary of the SJT and how many people were able to get their top deanery is published on the UKFP website.
• For far more detail, there are yearly technical reports which detail how they ensure the SJT is valid and how it is constructed. These are a helpful read just to understand how the SJT all works as well as detailed statistics in how well people do and how this translates into the jobs they get.
• As mentioned previously the SJT makes up 50% of your application.
• The other half is marked on educational performance measure (EPM). The EPM is made up of two elements; your medical school performance and educational achievements (only until the 2022 entry).
• The SJT and EPM contribute equally to your selection score.
• Every year very few applicants get a very low score. Most do reasonably well and actually there isn’t that large a distribution of scores (i.e. the standard deviation isn’t massive).

Please see the Health Education England Application Handbook for more detail on the areas scored/how they are equally weighted.

Top tips

• Start preparations early
• Do the practice paper questions
• Books and courses are not essential. More so than other exams, the best scoring applicants are those that put the time in on the wards & through reading and understanding the principles.
• Put yourself in the position of an F1 (remember the questions have been created using the F1 role as well as being mapped against the GMC guidelines)
• Always read the question more than once carefully paying attention to all key words
• In the ranking questions, make sure you read all the answers before making a decision
• In the selection questions, make sure your choices make sense when taken together
• Do not overthink the answers or make assumptions

Further reading

1. Geeky Medics – Top Tips for the Situational Judgement Test (SJT)
2. MDU – SJT Preparation
3. General Medical Council – Good Medical Practice
4. UK Foundation Programme. Applications Handbook. May 2020.

Edited by: Dr Akash Doshi (ST4) & Mudassar Khan (Y4 Medical Student) & Janice Yiu (Academic F1 Doctor)