Medic Mind Situational Judgement

Situational Judgement UKCAT Course Book

Theory & Technique

Mock Questions

Step-by-Step Guide

Detailed Explanations

Table of Contents

Lesson

Page

Lesson 1: Introduction to Situational Judgement

3

Lesson 2: Appropriateness Questions

5

Lesson 3: Importance Questions

8

Lesson 4: Approaching the Scenario

11

Lesson 5: Knowing Your Role

14

Lesson 6: Timing Strategies

16

Lesson 7: Duties of a Doctor

18

Lesson 8: Knowledge, Skills and Performance

20

Lesson 9: Safety and Quality

23

Lesson 10: Communication, Partnership & Teamwork

25

Lesson 11: Maintaining Trust

29

Lesson 12: Tips from the Experts

32

Lesson 13: Situational Judgement - Test Day

33

Situational Judgement Mock

35

Answers and Explanations - Tutorial Questions

58

Answers and Explanations - Mock Test

64

What is Situational Judgement?

Introduction to Situational Judgement Lesson 1 Be able to recognise what the Situational Judgement section involves. Appreciate how it is marked, and why it is marked differently.

Introduction to Situational Judgement

• The test measures your capacity to understand real world situations and to identify critical factors and the appropriate behaviour in dealing with them. • It assesses the key traits of integrity, perspective taking and team involvement • SJTs are used widely in medical selection, including selection of Foundation Doctors, GPs and other medical specialties
 • Questions ask for the appropriateness of a response in a scenario or the importance of a factor in making a decision. These two will be explained below.

Why is it used? • Measures ability to assess real-life scenarios and choose correct response to a situation. • Used widely in medical selection, including in selection of doctors. • Helps to assess knowledge of ethics and the thinking process in making decisions.

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Introduction to Situational Judgement Lesson 1

Situational Judgement Marking The UKCAT answers are not as clear-cut as found in the other sections where the answers are either A, B, C or D. Here, different people may judge an item to be more appropriate or more important than other people. This means that they are subjective and can be interpreted in different ways. Because of this reason, the marking is based on 4 bands: Band 1 - Candidates in Band 1 performed well above average, showing similar judgment in most cases to a panel of experts. Band 2- Candidates in Band 2 performed above average, showing appropriate judgment for most cases, with many matching model answers. Band 3- Candidates in Band 3 performed lower than average, showing appropriate judgement for some questions, but significant differences from ideal responses for others. Band 4- Performance of candidates was low, with judgement differing greatly from ideal responses. This is decided by a group of doctors and medical professionals. However, it acknowledges the fact that you may not be far off the answer they deem to be correct. This is why there are partial marks in this section. This is because the consortium acknowledges that the test is subjective, and so awards partial marks if people are not far off the correct answer. • A and B represent one half of the answers, and C and D the other half. If you get the correct half, but not the specific answer, then you still score a half mark. • For example, if the answer is D, and you put C, you would get half a mark. If the answer is B, and you put C, you get no marks. 


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Appropriateness Questions Lesson 2 Be able to recognise Appropriateness Questions, and understand what the four answer options mean using examples.

Introduction to Appropriateness Questions For these questions you will be asked to rate the appropriateness of a series of options in response to a scenario. You have to select whether the response is: • • • •

A very appropriate thing to do Appropriate, but not ideal Inappropriate, but not awful A very inappropriate thing to do.

Example Scenario 1 Hector is an orthopaedics consultant. The time is 6pm and Hector is due to finish his shift at 6:30pm, and meet his wife for dinner. At 6pm, Hector was due to have a handover meeting with Abdul, a fellow orthopaedics consultant, where they would discuss the patient issues that are still outstanding and need to be dealt with by the incoming doctor. Abdul calls Hector to inform him that his son’s babysitter has only just arrived, and will be there around 7:00pm - more than 30 minutes after Hector’s shift finishes. How appropriate are each of the following responses by Hector in this situation? Leave at 6:30pm but go around and make detailed notes about patients that still have outstanding issues in their patient records so that when Abdul finally arrives he will be partially informed. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate 


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Appropriateness Questions Lesson 2

‘A very appropriate thing to do’ A very appropriate thing to do is a very good response which solves a key problem arising from the scenario. It means that at least one aspect but not necessarily all aspects of the situation are addressed.

Example of ‘Very Appropriate’ Response Response: A junior doctor is on an acute surgery ward and completes his work efficiently within the hours he is contracted to work. He does not find his work very challenging, and tends to have a lot of spare time. He asks the consultant doctor if he can spend the spare time that he has to help other junior doctors who are in wards that are busier than his. Explanation: This is a very appropriate thing to do. First of all this addresses a key issue in the scenario - he is currently using his spare time ineffectively, so by helping he is able to make better use of time. The response also has other benefits such as improving his overall experience on the wards and helping him learn more, as well as benefitting other patients and reducing the overall burden on hospital staff.

‘Appropriate, but not ideal’ Appropriate, but not ideal is a good response with some drawbacks. Although it can be done, it doesn’t necessarily mean it is a very good thing to do. It is not an optimal approach but there are few negative consequences.

Example of ‘Appropriate But Not Ideal’ Response Response: A medical student in clinics tells the consultant on a ward that she is overburdened and so is withdrawing from several cases effective immediately.

Explanation: Whilst it is normal for a student to be overburdened and indeed withdrawing might help, it is bad that the student did not even consider approaching the consultant to have a constructive discussion about withdrawing. Her action seems to have a feeling of imposing rather than creating a mutual understanding. The best action would be to ‘discuss’ with the consultant, rather than ‘tell’.

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Appropriateness Questions Lesson 2

‘Inappropriate, but not awful’ Inappropriate, but not awful is a poor response which is not disastrous. It should not be done but if it did occur there would not be many significant negative impacts.

Example of ‘Inappropriate But Not Awful’ Response Response: A junior doctor who has developed a fear of needles tells a senior consultant that he would be willing to carry out a lumbar puncture, but only if someone accompanied him in order to assist him if he panics. Luckily for him, he has chosen a future medical specialty which does not require him to use needles.

Explanation: Here the junior doctor is accepting that they may be a risk to the patient in case they panic and will ensure that the puncture takes place in a safe environment for the patient. However, the patient will not be put at ease if they see the junior doctor panicking. Additionally, the junior doctor will not be using needles very soon in his career so there is no immediate need to learn. He therefore could have asked the person who would has accompanied him to do it instead. This would be a safe alternative which would keep the patient at ease and also save time.

‘A very inappropriate thing to do’ A very inappropriate thing to do is a terrible response that definitely should not occur. It often can make the situation worse. There are potential negative consequences to patients or to public confidence in the profession.

Example of ‘Very Inappropriate’ Response Response: A medical student is with a chemotherapy patient who is panicking slightly whilst waiting for the results. To reassure the patient, he says that he thinks it was a success, when in fact he knows that it is likely that the treatment has not actually worked. Explanation: The medical student knows that the treatment was likely to have been unsuccessful and is therefore misleading the patient. The patient will eventually find out that the medical student was giving them the wrong information which will reduce the amount of trust the patient has in the medical team. This will make the situation worse. Misleading the patient is a very inappropriate thing to do. ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Importance Questions Lesson 3 Be able to recognise Importance Questions, and understand what the four answer options mean using examples.

Introduction to Importance Questions For these set of questions, you will be asked to judge how important a series of factors are when deciding upon the response to a scenario. You have to select whether the factor in hand is: • • • •

Very Important Important Of Minor Importance Not Important At All

Example Scenario 2 Vish is a new dentist at a dental practice and meets Firdous in the corridor during the lunch break. Firdous asks Vish to play a game where they have to tell each other gossip about their patients. Other colleagues join in on this game, but Vish is uncomfortable with the game and tells Firdous that he doesn’t like it as he feels it is a breach of confidentiality. Firdous disagrees with him and along with the other colleagues continues playing the game. How important is the following factor for Vish to consider when deciding how to respond to the situation? Vish is a new dentist, so the other colleagues may not listen to him. A. B. C. D. 


Very important Important Of minor importance Not important at all

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Importance Questions Lesson 3

“Very Important’ Very Important - this is something that is absolutely essential to consider.

Example:

Example of ‘Very Important’ Response

Scenario: A doctor is about to do a ward round in which he will be seeing many patients and running some very important consultations. Factor to consider: He is feeling very tired after a late party the night before, and barely able to keep his eyes open. Explanation: This is a very important point to consider. Patient safety should be valued at the utmost and if a doctor is tired they will make mistakes which will put the patient’s safety at risk.

‘Important’ Important - this is something that is important but not absolutely essential to consider. It is not vital but it may actually make a difference.

Example of ‘Important’ Response Scenario: A junior doctor receives a small gift of flowers as a form of gratitude for providing support during a difficult point in a patient’s life. Factor to consider: The doctor considers that the patient is a regular in the practice and the gift is linked to a particular situation. Explanation: It makes sense for a doctor to be offered a present as a thank you if they have made a significant difference to a patient. It wouldn’t make as much sense to receive a gift for a one-off routine visit. This means that the fact that the patient is a regular provides a sense of normality, and so does have a certain bearing on the decision that is made. The reason it is important and not very important is because it is not an essential consideration that is being made - they would not say no to the gift simply on the basis that they weren’t a regular patient. When it comes to gifts, doctors can at times accept gifts if they are not too large of value. ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Importance Questions Lesson 3

‘Of Minor Importance’ Of Minor Importance - this is something that could potentially be taken into account, but is not of huge significance. It is mildly relevant in decision-making process, and it is not a huge deal if you forget to take it into account, although it does have a certain level of importance.

Example of ‘Minor Importance’ Response Scenario: A junior doctor often neglects small tasks which he finds monotonous and uninteresting, and instead disappears to go to theatre sessions which he finds more intriguing. Factor to consider: The doctor says he will try to compensate for his absence by taking on more work later on during the year.

Explanation: The doctor is making an assumption that he will take on more work later on in the year, but whether he will actually do this is another question. Additionally, some tasks may need to be done now rather than later in the year. However, it is still a slightly important factor to consider, because if he is to compensate later in the year there may be more leeway for him to miss certain tasks.

‘Not Important At All’ Not Important at All - this is something that should definitely not be taken into account. It is completely irrelevant.

Example of ‘Not Important At All’ Response Scenario: A consultant is intoxicated during a ward round and a junior doctor notices this. Factor to consider: The consultant is a senior to the junior doctor, and it is likely to be the consultant’s word against theirs.

Explanation: Professionalism is a quality that has to be maintained no matter what stage of medical training you are at. Being more senior does not mean you can get away with poor behaviour more easily. The junior doctor has to report the incident. ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Approaching the Scenario Lesson 4 Understand the methods for the various question types, including Medic Mind’s 5 Domains of Response.

Should vs. Would 
 When you are answering UKCAT questions, never answer them based of how you yourself would react. This is not a personality test, or something that is trying to deduce how you would instinctively react. You should try and use your intuition to decide the most appropriate action in a professional setting. If you are given a non-medical setting such as a classroom, do not think from the viewpoint of a student at school. Instead, think using the medical principles of professionalism, integrity and respond accordingly. Approach the scenario logically and think, “what would a medical student do?” or “what would your GP do?”. Imagine that in the classroom one of your friends has cheated in an exam and has told you about it. If you put yourself in the position of a “friend”, you may neglect the action and are unlikely to report it. However, as a medical student it would be essential to report as it counts as unprofessional behaviour.

Judge It As An Independent Response Do not judge a response as if it is the only response that will occur. In one scenario there will be four or five different responses that you have per scenario. Do not look at the other responses when you are answering how to react to a response. We define a very appropriate thing to do as the “optimal approach” - however this does not mean that there is only one approach which is optimal. For example, if a GP wants to do a blood test there are several actions which could be classified as very appropriate. 1. Ask the patient for consent 2. Check the patient records for previous test results 3. Calm the patient down if they are scared of needles

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Approaching the Scenario Lesson 4 4. Log the results on the patient’s records 5. Prescribe appropriate drugs dependent on the results

5 Domains of Response When you read a response, do not consider that this is the only manner in which the medical student or doctor will respond. We can use 5 domains to categorise different possible responses. M istake Acknowledgement D ocumentation C linical Response C olleague Communication P atient Communication MDCCP

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My Doctor Can Cure Patients

Example Consider an example where a medical student hears about a fellow medical student accidentally breaching confidentiality. Here are five different responses: Domain

Response

Mistake Acknowledgement

Acknowledge the mistake you your colleague has made and ensure that he does not carry it out again by speaking to him.

Documentation

Write down and record the mistake that the medical student carried out.

Clinical Response

Ensure that this breach of confidentiality does not affect the clinical diagnosis and prognosis of the patient.

Colleague Communication

Report the breach of confidentiality to the consultant.

Patient Communication

Communicate with the patient, especially if they have heard about the breach and are upset.

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Approaching the Scenario Lesson 4 Some of these may be more applicable than others depending on the scenario. For example, the breach was by ‘accident’, so a simple word with your colleague (Mistake Acknowledgement) may be better than taking the situation to a higher level with a consultant (Colleague Communication).

Comparing different responses Remember, there are several responses that could be ‘a very appropriate thing to do’. This is why it is not useful to compare different responses across different questions relating to the same scenario.

Finding the Optimal Response in Each Domain 
 So, we have established that you should take each domain as a separate response. However, for each of the 5 domains listed above, the responses in each domain should only be taken as a very appropriate thing to do if they fit the optimal approach in that individual domain. In other words, a very appropriate thing to do has to be the best possible response involving Mistake Acknowledgement, Documentation, Clinical Response, Colleague Communication and Patient Communication. For example, if a junior doctor makes a mistake, in the domain of Patient Communication: • A very appropriate thing to do would be to apologise to the patient , reassuring them of their safety and then asking for consent to carry out the procedure again. • An inappropriate but not awful thing to do would be to immediately ask for consent to carry out the procedure again. Whenever a doctor or medical student makes a mistake, it is vital to apologise to the patient and reassure them of their safety. 
 


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Knowing Your Role Lesson 5 Appreciate that there are different players in each scenario, and each role requires different responsibilities and capabilities.

Different Players When faced with a scenario, you have to identify the status and profession of the person involved. This is essential in deciding the correct response. For example, the capabilities and responsibilities of a General Practitioner will be very different to that of a Medical Student.

Being A Medical Student According to the General Medical Council, medical students should be conscious of the fact that they are often acting in the position of a qualified doctor. Consider the view of a patient. They will treat a medical student with respect and potentially see them as an equal part of the medical team. This will often mean they confide in them which raises the issues of trust and confidentiality, something which doctors face daily. Medical Student: Responsibility Medical students have the responsibility to: • • • •

Follow the GMC guidelines on consent and confidentiality Dress in an appropriate and professional manner Be clearly identifiable as a student Respect and treat patients with dignity ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Knowing Your Role Lesson 5 Medical Student: Fitness to Practice In order to demonstrate that they are fit to practise, medical students should: • Respect patients and treat them with dignity • Be aware of ethical issues in their professional behaviour with patients • Be open and honest when dealing with patients, their carers, relatives, partners or anyone else close to them • Make sure that patients have consented to a student being involved in their care • Make sure they are clearly identified as students, dress in an appropriate and professional way and be aware that patients will respond to their appearance, presentation and hygiene • Make sure they follow the GMC’s guidance on consent and confidentiality

Finding A Direct Solution Whenever there is an opportunity, you should always try and resolve conflict directly and locally. If this fails, the next step is to escalate the problem to a higher level such as hospital management. For example, if you are a doctor and your colleague smokes directly outside the hospital instead of in the designated smoking area, you should technically report them. However, in this scenario a simple warning with your colleague would suffice. If he repeats the act, then you should definitely report it.

Example Response Response: A medical student sees a fellow medical student carry out an inappropriate action. They speak to the consultant who is supervising the medical student who has carried out the inappropriate action. Explanation: Here the medical student is involving other people who are not necessarily connected to the scenario. If you see this sort of question in the exam, recognise the role of the players and try and recognise that under certain conditions higher authority or other personnel can be avoided. This is a great example of such a case. Report to higher authorities or other medical professionals if it involves compromising Patient Safety, Patient Confidentiality or Data Handling.

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Timing Strategies Lesson 6 Understand how timing works in Situational Judgement, and learn Medic Mind’s Step by Step Timing Strategy

Timing Facts Number of Questions: 17 scenarios Questions per Scenario: 2 to 5 questions each (68 questions total) Timing: 26 minutes (30 seconds per scenario, then 10–15 seconds per question) In Situational Judgement, you are presented with a paragraph of between 50 - 150 words. Whilst for other sections we advise you to only read certain aspects of the text, a small detail in the situational judgement scenario could drastically alter how you should respond to it. Therefore you should real the whole passage.

Step by Step Timing Strategy Follow this step by step process: 1. Identify the main player in the scenario. Is it a medical student, junior doctor, nurse, consultant or someone else? This will help you decide how to react to the scenario. 2. Identify what the main problem at hand and how serious it is. The severity of the situation will let you identify the best possible way to respond, or the most important factor to consider. 3. Read the statement: When it is a question of appropriateness, deduce whether it is the: • Very appropriate - the optimal approach, the best possible way to react. • Appropriate but not ideal - a response that can occur but isn’t the best response. ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Timing Strategies Lesson 6

• Inappropriate but not awful - not a good approach, minimal potential negative consequences. • Very inappropriate - will make situation worse. When it is a question of importance, deduce whether it is: • • • •

Very important - something essential to consider. Important - important but not absolutely essential. Of Minor Significance - mildly relevant and it won’t hurt to take into account. Not Important - completely irrelevant.

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Duties of a Doctor Lesson 7 Appreciate the four domains of the General Medical Council Guidelines. A short introduction before analysis with examples later.

General Medical Council It is useful practice to read the General Medical Council (GMC) guidelines. Below we have compiled the most useful information from the official Good Medical Practice (2013) guide. We will go through each point in more detail in other tutorials.

Knowledge, Skills and Performance • • • •

Provide an adequate standard of practice and care Maintain your professional knowledge and skills up to date Recognise and work within the boundaries of your own competence Make the care of the patient your primary concern

Safety and Quality • •

Take immediate action if you suspect that patient dignity, comfort or safety is being compromised Ensure you promote and protect the health of patients and the public

Communication, Teamwork and Partnership •

Treat patients as individuals and respect their dignity

- Respect patients’ right to confidentiality. - Ensure you treat patients considerately and politely.

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Duties of a Doctor Lesson 7

•

Work in partnerships with patients

- Support patients in caring for themselves to improve and maintain their health. - Respect patients’ right to each decision about their treatment and care. - Give patients the information they need or would like in a manner that they are able -

to comprehend. Listen to and respond to patient concerns and preferences.

Maintaining Trust • Never abuse your patients’ trust in you or the public’s trust in the profession. • Never discriminate unfairly against patients or colleagues. • Make sure you are honest and open, and act with integrity. Citation: http://www.gmc-uk.org/guidance/good_medical_practice.asp

Whenever answering a Situational Judgement question, identify the main theme of the problem at hand. It is likely to be one of the four themes that are listed above. Trust, Communication, Teamwork and Partnership, Safety and Quality and Knowledge, Skills and Performance all require different but equally important skills that will be explained in future sections. We will now look at each section of the guidelines in more detail, with snippets from example questions. Bear in mind that in the actual exam you will be given a longer passage of approximately 50-150 words.

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Knowledge, Skills and Performance Lesson 8 Understand the GMC guidelines under this category, and how you can fulfill them both in your social and professional life.

Breaking Down the GMC Guidelines We will breakdown the guidelines from the 4 domains of the Good Medical Practice guide and give an example of a scenario which fits it.

GMC Guideline 1: Keeping Up To Date “Develop and maintain your professional performance” This guideline insists that you must be competent in all aspects of your work, which includes teaching, management and research. You need to keep knowledge about your current work up to date.

Example Scenario 3 A doctor who will specialise in a future degree not involving needles, has a phobia of needles. How appropriate is this response by the doctor in this situation? He refuses to take blood from a patient. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Knowledge, Skills and Performance Lesson 8

GMC Guideline 2: Knowing Your Skills “Apply knowledge and experience to practice” You should recognise and work within the limits of your competence. If you are in a clinical role, you should also provide effective treatments based on the best available evidence. It is also necessary to consult colleagues, or refer patients to colleagues when this is in the patient’s best interests.

Example Scenario 4 A junior doctor is taking long during a procedure, and potentially endangering the patient by doing so. How important is this a factor to consider for the junior doctor? The junior doctor is afraid that their consultant will get irritated at them if they keep asking them for advice on what to do with the patient. A. B. C. D.

Very important Important Of minor importance Not important at all

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Knowledge, Skills and Performance Lesson 8

GMC Guideline 3: Documentation “Ensure that all documentation formally recording your work is clear, accurate and legible”. Ensure that you make or review records at the same time as the events are documented or as soon as possible afterwards. You should also ensure that any documentation that records your findings, decisions, information given to patients is up to date and accurate. 


Example Scenario 5 A patient visits the dentist for a routine check up. The consultation ends, and only a day after, the dentist acknowledges that they forgot to record the details of the checkup. How appropriate is this response by the dentist in this situation? Trying to estimate or use recall to judge what their presentations would have been like. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Safety and Quality Lesson 9 Understand the GMC guidelines under this category, and think about how you can fulfill them both in your social and professional life.

GMC Guideline 1: Managing Systems “Contribute to and comply with systems to protect patients” Ensure that systems are in place where colleagues are able to raise concerns about risks to patients. You should also make sure that all the staff for whose performance you are responsible for, which can include students and locum doctors, are adequately supervised.

Example Scenario 6 A respiratory registrar is told by one of their medical students that they feel drained and burned out by the sheer level of work on the ward. How appropriate is this response by the registrar in this situation? The registrar tells the medical student that there is a lot of work at the moment, and to deal with the problem themselves. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

GMC Guideline 2: Responding To Risks “Respond to risks and safety” Report risks in the healthcare environment to your employing or contracting bodies. You should also take action when there is evidence that a colleague’s conduct, performance or health may be putting patients at risk. ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Safety and Quality Lesson 9

Example Scenario 7 A medical student sees a consultant, who they are shadowing, in the pub in the morning having 5 pints of beer before the first ward round. How important is this a factor to consider for the medical student? The consultant tells the medical student it was a one off, and that it is the consultant’s word against theirs. A. B. C. D.

Very important Important Of minor importance Not important at all

GMC Guideline 3: Your Own Health “Protect patients and colleagues from any risk posed by your health”. This includes making arrangements for accessing independent (non-self) medical advice when it is necessary. This would be a very inappropriate thing to do.

Example Scenario 8 A doctor has high blood pressure and they prescribe themselves a beta blocker. How appropriate is this response by the doctor in this situation? A. B. C. D.

A very appropriate thing to do. Appropriate but not ideal Inappropriate but not awful Very inappropriate

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Communication, Partnership & Teamwork Lesson 10 Understand the skills involved in Abstract Reasoning and be able to appreciate why it is tested.

GMC Guideline 1: Communicating Well “Communicate Effectively” Here you must listen to patients and respect their views about their health. You should treat those close to the patient considerately, and keep patients informed about the progress of their care. They should know when something has gone wrong, and you should always try to ensure that you respond to a patient’s questions.

Example Scenario 9 A patient is undergoing a procedure the next day and all the consultants have spoken to the patient about the procedure in detail, answered any questions they have had and have taken the patient’s consent for the procedure. A medical student is checking up on the patient and finds that they are sill anxious about some aspects of the procedure, and says that they want to speak to a doctor. Unfortunately the doctors have gone home. How appropriate are each of the following responses by the medical student in this situation? a) Inform the patient that the team the patient spoke to earlier are no longer available but that they will get another equally qualified doctor to answer their questions shortly. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

b) Inform the patient that the team of doctors from before are unavailable and that the medical student may be able to address some of the concerns, and will be able to get a doctor if some of the patient’s questions require more detailed input. A. B. C. D.

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Communication, Partnership & Teamwork Lesson 10

c) Tell the patient that the team is not available and that they themselves will be able to answer their questions. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate 


GMC Guideline 2: Working With Colleagues
 “Work with colleagues constructively and delegate efficiently” You must treat all your colleagues fairly and with respect. You should support colleagues that have problems with their performance, conduct or health.

Example Scenario 10 A junior doctor is prescribing a strong painkiller to an elderly patient, and an experienced nurse refuses to give the painkiller to the patient because they argue that they know the patient better than the doctor does. They are challenging the decision of the junior doctor. How appropriate are each of the following responses by the junior doctor in this situation? a) Cancel the prescription and prescribing another painkiller that would be more acceptable to the patient on the basis of the nurse’s advice. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

b) Ask the nurse why she disagrees with the prescription. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate
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Communication, Partnership & Teamwork Lesson 10

c) Tell the nurse that it is not up to them, but to the junior doctor to decide and so ordering the nurse to give the strong painkiller to the patient. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

d) Ask the nurse which painkiller she would be ready to give if the junior doctor prescribed it. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

GMC Guideline 3: Working With Patients
 “Establish and maintain partnerships with patients” You should encourage patients to take an interest in their health and to take action that improves it and maintains it. You should be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment or involve any patients in teaching or research. 


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Communication, Partnership & Teamwork Lesson 10 


Example Scenario 11 A patient is in a coma and is unable to communicate at all. Their kidneys are not functioning, and the doctor advises that the patient should have a kidney transplant. The doctor suspects that the next of kin of the patient, a very traditional lady, will reject the idea of a kidney transplant. He is also afraid to check the patient records for any special requests. How appropriate is the following action by the doctor? Carry out the kidney transplant based on his instinct on the correct treatment. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal Inappropriate, but not awful Very inappropriate

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Maintaining Trust Lesson 11 Understand the GMC guidelines under this category, and think about how you can fulfill them both in your social and professional life.

GMC Guideline 1: Respecting Patients “Show respect for patients”
 
 Here you must treat each patient fairly and as an individual. You should implement and comply with systems that ensure patient confidentiality. You should also be polite, considerate and honest, respecting a patient’s dignity and privacy.

Example Scenario 12 A patient is awaiting news on their chemotherapy. The doctor has just gone out of the room, and a medical student is speaking to the patient. The patient asks the medical student what the results are, and is aware of the fact that the medical student knows the results. How appropriate is this response by the medical student in this situation? Tell the patient that they are only a medical student and so are unable to reveal any information about the treatment, but reassuring them that the doctor is returning soon and will be able to answer any questions they may have. A. B. C. D.

Very appropriate thing to do. Appropriate, but not ideal Inappropriate but not awful Very inappropriate

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Maintaining Trust Lesson 11

GMC Guideline 2: Avoiding Discrimination “Treating patients and colleagues fairly and without discrimination, whilst acting with honesty and integrity” Here you have to respond promptly and fully to complaints. You should also provide care on the basis of the patient’s needs and the likely effect of the treatment that is going to occur.

Example Scenario 13 A medical student has strong views against leaving the European Union and is working with a cardiovascular surgeon who argues it was right to leave the EU. The medical student also finds the doctor arrogant and difficult to work with. One of the nurses asks the medical student to get a surgeon to give patient information on a heart operation they are going to have. How appropriate is this response from the medical student in this situation? The medical student is asked to find a cardiovascular surgeon on call in the hospital, but the only one he knows is the one he disagrees with. In order to avoid conflict, he approaches an orthopaedics surgeon instead. A. B. C. D.

Very appropriate thing to do. Appropriate, but not ideal Inappropriate but not awful Very inappropriate

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Maintaining Trust Lesson 11

GMC Guideline 3: Maintaining Integrity “Act with honesty and integrity” Here they should be honest in anything they report, and make clear the limits of their knowledge or competence.

Example Scenario 14 A medical student is speaking to a patient who is awaiting their results from a blood test. They are extremely anxious and the medical student has been asked to reassure and comfort the patient until the doctor returns. The medical student knows the results of the blood test, and the patient is aware of this and so asks the medical student what the results of the blood test are. How appropriate is this response from the medical situation in this situation? They say that they are unable to because they do not have the authority to as they are a medical student. They inform the patient that the doctor is returning soon and will be able to answer all the questions they may have. A. B. C. D.

Very appropriate thing to do. Appropriate, but not ideal Inappropriate but not awful Very inappropriate

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Tips from the Experts Lesson 12 Here is some advice from the Medic Mind Experts.

1. Use the GMC Guidelines as a Foundation “The rules written by the GMC is the best place to start to understand medical ethics” Every situational judgement question you are presented with will involve one of the principles that the Medical Council believed is necessary to be a good doctor. A lot of the scenarios will involve dental situations as well so regardless of whether you are applying for medicine or dentistry, it is important you get a good understanding of both. The more you read up on the principles and know them inside out the better chance you have of doing well in this section. Throughout your time doing questions you should write down principles you didn't know, forgot or found easy to forget. This means that on the day of your exam, you will be more able to remember these that you may have otherwise forgotten.

2. Read The Scenario Fully “Verbal Reasoning and Quantitative Reasoning had trained me to skip the passages in a question. The approach is very different for Situational Judgement, as I soon found out!” We recommend taking your time to read the scenarios. They will inform you of key details that you may potentially miss if you go straight to the statements. Unlike other sections, you should not skim read.

Tips from the Experts Lesson 12

If you are going through practice mocks and find that you are struggling for time, make use of the flagging technique. Go for the passages which are smaller and more straightforward in your eyes.

3. Questions Can Be Ambiguous “The half marking scheme is there for a reason!” There can sometimes be no correct answer. You must remember this. The SJT section can be very subjective and so it is important you think about what medical and dental professionals find appropriate and important, rather than your own beliefs.

4. Know Your Player “Your answer to a question can vary from one end of the scale to another dependent on who you are. If you are a medical student, you can’t do much!” Ensure you know the player. This will help put yourself in the shoes of the person who is giving the response. 


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Situational Judgement - Test Day Lesson 13 Here is some advice from the Medic Mind Experts on how to work through our materials ahead of test day.

When will this section be? Situational Judgement is the penultimate section of the UKCAT. It is usually less time pressurised than the three intense sections before it, so make sure to adjust to reading the passages carefully and thinking in detail.

Week by Week Plan • 4 weeks to go- consolidate the key principles of situational judgement by reading through the General Medical Council principles and going through Medic Mind’s guide on how to answer questions.

• 3 weeks to go- go through several scenarios which focus on a range of principles. Try and hone down on what differentiates an action which is appropriate and inappropriate as well as a factor that is either important or unimportant. Focus mainly on appropriateness as these questions come up more often.. • 2.5 weeks to go - begin working on timing by doing mini-mocks under test conditions. Use the official question banks on the UKCAT website as well to aid you. Begin writing down any principles you forget or find difficult to understand. • 2 weeks to go- start undertaking full situational judgement mocks. Ensure you are strict with timing, and follow our guide of knowing the player and putting yourself in the position of the character. • 1.5 weeks to go- go over the previous theory by rewatching our videos and the theory taught using the course booklet and online videos . • 1 week to go - have a go at the scenarios on the General Medical Council website. They may not be completely consistent with the UKCAT questions, but will give you a better understanding of what is expected. There is no harm in more questions! • 3 days to go - practice several situational judgement mocks back to back to develop your concentration skills for test day. • 1 day to go - consolidate the techniques briefly and then relax! • Test day - read over the summary

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UKCAT Mock Test Situational Judgement

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Situational Judgement Mock

Mock Scenario 1 Saima is a 5th year medical student on a GP placement and is asked to sort out the file records into an order which organises patient records by date of birth and age. The receptionist has asked Saima to do this for several hours and is becoming impatient with her, but Saima is finding it difficult to cope with the demands of the task, and would prefer to sort the patients by alphabetical order instead. How appropriate are each of the following responses by Saima in this situation? 1. Ask the receptionist for help on how to sort the information by both date of birth and age. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

2. Apologise to the receptionist, and tell her that she will make more of an effort now that she has raised the concern. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

3. Tell the receptionist that it will take him some time, and he will carry out the task at her own pace. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

4. Tell the receptionist that she prefers filing via alphabetical order rather than date of birth and age, and asks her to respect the fact that she prefers this. A. B. C. D.

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Situational Judgement Mock

Mock Scenario 2 Diego is a medical student and is currently on an acute surgery ward placement. He is asked by the consultant to take blood from the patient, as the patient urgently requires a blood test. Diego is usually very successful at blood-taking, and has not made a mistake on the several times he has carried it out, so the consultant feels that the procedure can be carried out without their supervision. Unfortunately, Diego finds that only a small amount of blood is drawn into the vial, and a lot less than what is required, and this is because he has missed the vein. To compound the problems, the patient is in agony and panicking. How appropriate are each of the following responses by Diego in this situation? 5. Apologise to the patient, and ask for their consent to take another sample of blood. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

6. Leave to fetch the consultant and ask them to take the blood instead. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate


7. Immediately try to take blood again, and try to seize the opportunity when the patient is not looking to take a second sample. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate


8.

Ask the patient if they would like someone else to take the blood instead.

A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 3 Safiya is a medical student who is currently on an orthopaedics ward. One of the patients has finished their treatment, and Safiya is escorting them out of the hospital. On the third floor, Safiya sees an elderly man who looks confused and lost. He doesn’t seem to have any guardian or relatives. 
 How appropriate are each of the following responses by Safiya in this situation? 9. After escorting the patient, speak to the elderly man and try to look for a relative or guardian, whilst reassuring and comforting him. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

10. Ask the receptionist to sort out the situation with the elderly man, because she has patients to deal with. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

11. Tell the patient that is being escorted out to wait there for a few minutes, and she will return to them as soon as she can, after she has dealt with the elderly man. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

12. Comfort the elderly man and reassure him that he is in the hospital and in capable hands. A. B. C. D.

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Situational Judgement Mock

Mock Scenario 3 cont. 13. Ask the patients and colleagues who are nearby if they know who the man is.
 A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 4 Sunita is a 6th year medical student who is on the tube to her placement at Royal Free hospital. The tube stops at Mornington Crescent station, and the driver makes an announcement that a passenger has fallen ill and asks for anyone of a medical background to come forward and help. Sunita is not yet a doctor, but has had a significant amount of medical training. The driver repeatedly makes the announcements, and Sunita assumes that there are no other passengers with a medical background on the train. Sunita is unsure whether she should respond to the announcement or not. 
 How important are the following factors to consider for Sunita? 
 14. The passengers are becoming extremely worried. 
 
 A. Very Important B. Important C. Of minor importance D. Not important at all `
 
 15. There could be other medical professionals on board, who may be more qualified than Sunita but have not yet come forward. 
 
 A. Very Important B. Important C. Of minor importance D. Not important at all `
 
 16. The tube driver now says that it is a medical emergency and paramount that someone comes forward. 
 A. Very Important B. Important C. Of minor importance D. Not important at all ` 
 17. Even if Sunita does go to the medical emergency, she may not be able to help as much as others might be able to. A. Very Important B. Important C. Of minor importance D. Not important at all `

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Situational Judgement Mock

Mock Scenario 5 Edward and Kar-Yeung are two medical students in a maxillo-facial ward. Edward sees Kar-Yeung taking selfies of herself while the consultant is speaking to the patient. Edward also sees KarYeung talking about a friend’s birthday party she went to, and observes that the patient is visibly annoyed even though the patient does not say anything. At this moment in time, Kar-Yeung and the patient are not aware that Edward has seen and heard these things. How appropriate are each of the following responses by Edward in this situation? 18. Monitor Kar-Yeung’s behaviour in order to see if she continues to display similar behaviour and misconduct. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

19. Speak to Kar-Yeung personally at the end of the consultation, and tell her that he has seen her actions, and remind her of the code of conduct for being a medical professional. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

20. Speak to Kar-Yeung during the consultation in front of the patient, and tell her that he has seen her actions, and remind her of the code of conduct for being a medical professional. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

21. Speak to the consultant who is supervising Kar-Yeung. A. B. C. D.

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Situational Judgement Mock

Mock Scenario 6 A junior doctor called Bhavik is on a night shift which is meant to end at 8am. At 7am, a consultant asks Bhavik to chase up on some CT scans from the radiology department that have been emailed to him. However, the IT is currently under security attack, so Bhavik is unable to access his e-mail. Bhavik has been working since 9pm, and acknowledges that he will be unable to analyse the CT scans before he leaves. So he asks Lisa, another junior doctor who is starting her shift at 8am, to follow up on the CT scans. Lisa refuses to agree to Bhavik’s request and tells him that he needs to stay beyond his shift and find the CT scans himself because she is preoccupied. Bhavik realises that this means that he will have to stay another 2-3 hours beyond his shift, and will mean he will not get a lot of rest before his next shift in the hospital.
 
 How appropriate are each of the following responses by Bhavik in this situation? 22. Remain in the hospital until the IT becomes fixed and he can access his e-mail. 
 A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate


23. Speak to the consultant managing Lisa to inform them of the situation, and tell them to make sure that Lisa checks the CT scans. 
 A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

24. Check the CT results the next morning on the next shift if Lisa has not already done so. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 6 cont. 25. Appreciate Lisa’s point of view and explain that this situation is a one-off and circumstantial, and ask her to reconsider her decision to help. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 7 A medical student called Dhruv is currently on a respiratory ward. One of his friends, Bethany, is the aunt of a child who is being treated on the paediatrics ward, and Bethany texts Dhruv to let him know about this. The child has a minor pyleoplasty. Bethany is anxious about her niece, and is unable to visit the ward today because she is at work. Bethany then texts Dhruv to ask how the pyeloplasty was, and to check if her niece is okay and if they needs anything. Dhruv visits the niece and it seems like she is recovering successfully. How appropriate are each of the following responses by Dhruv in this situation? 26. Text Bethany back letting her know the visit went well. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

27. Inform Bethany that he cannot say anything as he is not authorised to see the patient notes by his consultants. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

28. Inform Bethany that she is not the direct guardian and so without the parent’s consent she is unable to give any information away. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

29. Inform Bethany that she should speak to the paediatrics team themselves and that they would be better placed to update her on the situation. He tells her that he will arrange for a call to be made by one of the consultant doctors A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 7 cont. 30. Text Bethany back with the details of the patient records after finding them at the bedside. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 8 A junior doctor, Alex, is taking part on a ward round on the weekend, and it is especially busy today as a number of staff have called in sick. As soon as he enters the ward, a nurse from the surgeon team calls him to let him know that many of the surgeons are not available today. They inform Alex that he will have to explain to Jeffrey, one of the patients in Alex’s ward, that his operation will have to be delayed until the next day, and that he will be the first patient on the list. Alex knows that Jeffrey is having a colonoscopy and is extremely worried and anxious already that it is a risk to his life. However, delaying the operation by one day is not going to make a difference to Jeffrey’s safety. Alex plan to tell Jeffrey that his colonoscopy will not take place today. How appropriate are each of the following responses by Alex in this situation? 31. Alex explains to Jeffrey the reasons why his surgery won’t happen today. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

32. Alex tells a medical student who is doing the ward round with them to explain to Jeffrey the reasons why his surgery has been delayed to tomorrow. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

33. Promise to Jeffrey that Alex will manage to somehow turn it around and make the colonoscopy occur today. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 8 cont.

34. Tell Jeffrey that he can come back to him tomorrow with any questions he may have, instead of asking them right now, as he is extremely busy due to the shortage of staff. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

35. Speak to Jeffrey directly, and explain to him that having the operation one day later will not affect his safety or health. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 9 A group of junior doctors are celebrating finishing their first official week of being a doctor at a party, hosted by Konstantinos who has a few alcoholic beers. The next morning, Konstantinos is browsing social media and finds that his friend Tim, who is also a junior doctor, has posted a “snapchat story” which contains several pictures from the party. This includes ones of Konstantinos drinking alcoholic beers. This “story” is set to public, meaning anyone including patients and other colleagues are able to see them, and it is clear from the picture that it is Konstantinos. At the end of the party, Konstantinos and his friends, including Tim, went to drink inside their hospital office, and from the pictures it is clear that they were at the hospital. How appropriate are each of the following responses by Konstantinos to the scenario? 36. Text Tim and tell him that his Snapchat story is public, and that anyone can clearly identify the hospital from the pictures that have been taken. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

37. Block Tim from Snapchat. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

38. E-mail the hospital management team and inform them that the hospital’s reputation has been potentially been compromised. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 9 cont.

39. Start a debate at lunchtime with other junior doctors, consultants and medical students about the advantages and disadvantages of Snapchat. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 10 Sujinth is a junior doctor who has been asked to take a lumbar puncture by the consultant on a ward on a patient called Urvneek. The puncture is required for an extremely important examination. Sujinth is uncomfortable with this request because he has a fear of needles that he developed a couple of months ago on his elective where he accidentally pricked his own finger when he was taking blood from a patient in Peru. As a result of this, he is fearful of needles, and becomes anxious every time he sees them. The lumbar puncture procedure requires needles. Sujinth tells the consultant of this experience, and also tells them that his future area of medicine that he will specialise in after this placement does not involve needles. Despite this, the consultant tells him to carry out the lumbar puncture. How appropriate are each of the following responses by Sujinth in this situation? 40. Tell the consultant that it is unfair to ask him to do the procedure despite the fact that he told him that he feels uncomfortable to do so. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

41. Say sorry to the consultant because he does not want to do the procedure, and explain to the consultant that it might be better to find another doctor to carry out the procedure, in case something goes wrong if Sujinth panics. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

42. Explain to the consultant that he will try to do his best on the lumbar puncture, but once the consultant has left Sujinth will ask someone else to carry out the lumbar puncture. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 10 cont.

43. Tell the consultant that he will only do the procedure if someone is there with them to support him during the lumbar puncture, and to help him in case he panics. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock 


Mock Scenario 11 Hector is an orthopaedics consultant. The time is 6pm and Hector is due to finish his shift at 6:30pm, and meet his wife for dinner. At 6pm, Hector was due to have a handover meeting with Abdul, a fellow orthopaedics consultant, where they would discuss the patient issues that are still outstanding and need to be dealt with by the incoming doctor. Abdul calls Hector to inform him that his son’s babysitter has only just arrived, and will be there around 7:00pm - more than 30 minutes after Hector’s shift finishes. How appropriate are each of the following responses by Hector in this situation? 44. Still leave 6:30pm but go around and make detailed notes about patients that still have outstanding issues in their patient records so that when Abdul finally arrives he will still be partially informed. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

45. Text his wife and tell her that he is going to be late A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

46. Speak to a junior doctor on the ward and tell them all the necessary information, to then tell Abdul when he arrives. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 11 cont. 47. Write down all the necessary patient test results and investigations which can be handed to Abdul when he arrives and so wait for his arrival. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

48. Before leaving spend 2 minutes jotting down the notes for Abdul. Also leave at 6:30. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 12 Roshni is a pupil in a Biology lesson when she hears her friend, Harveen, snoring and finds that she has fallen asleep midway during a tutorial. The teacher tells Harveen to wake up, and she becomes embarrassed and swears at the teacher. Roshni sees the teacher and Harveen then arguing, and hears the teacher make a racial slur towards Harveen. Roshni knows the teacher well, and so was extremely surprised to hear the racial comment. Roshni now sees Harveen crying because of the comment that has been made. How appropriate are each of the following responses by Roshni in this situation? 49. Report the teacher’s behaviour to the headmaster. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

50. Comfort Harveen and try and make her feel better. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

51. Understand that the teacher only reacted in the way he did because of the manner in which Harveen spoke to the teacher. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

52. Try to persuade Harveen to leave the room and immediately talk to the headteacher herself directly. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Situational Judgement Mock

Mock Scenario 13 A group of medical students are taking part in problem based learning (PBL), and are solving a case of a patient with acromegaly, where they are trying to find the best possible treatment for it. They are currently all having a group discussion and almost everyone is contributing to it, apart from Mark who is on his phone and is not really participating in the discussion at all. One of Mark’s friends, Raheem, knows that Mark is a big extrovert and that he can offer good ideas and is usually loud, but isn’t saying much today. How appropriate are each of the following responses by Raheem in this situation? 53. Telling the whole group that it is a group discussion and that everyone should take in turns to contribute ideas. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

54. Speak to Mark directly, and tell him that he should attempt to contribute more to the group discussion. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

55. Inform their professor that Mark is not contributing as much as he should. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

56. Not say anything because he is worried it will ruin the group dynamic. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Situational Judgement Mock

Mock Scenario 14 Nimby is a 4th year medical student working in a cardiovascular ward, where he is shadowing consultants, junior doctors and nurses. Nimby does not get along with one of the doctors, Dr Nawan. He finds her difficult to approach and believes she lacks work ethic. One day Nimby walks past the ward, and finds that one of the nurses is speaking to a patient who has just finished surgery, and overhears the conversation. The patient is angry that no doctor has come to see her, and hears the nurse telling the patient that she has asked Dr Nawan to see her, but feels that Dr Nawan is not attending to all her tasks. How important to take into account are the following considerations for Nimby when deciding how to respond to the situation? 57. That Nimby is a medical student, and he has less authority than the rest of the team. A. B. C. D.

Very important Important Of minor importance Not important at all

58. The patient knows Dr Nawan well, and Nimby feels that if he reports anything he will be shut down. A. B. C. D.

Very important Important Of minor importance Not important at all

59. If Nimby reports anything to the consultants, the patient may lose trust in the medical team. A. B. C. D.

Very important Important Of minor importance Not important at all

60. That Nimby is coming to the end of the placement, and will be in the neurology ward after. A. B. C. D.

Very important Important Of minor importance Not important at all

61. The team will look down on Nimby and will think he is trying to break the team dynamic. A. B. C. D.

Very important Important Of minor importance Not important at all ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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Situational Judgement Mock

Mock Scenario 15 Aké and Songo are about to sit their first year examination for medicine. Aké is extremely anxious about entering the exam hall, as he needs to pass this exam to progress to second year. Aké tells Songo that he does not want to sit the exam due to the pressure, and is about to walk away from the examination venue. How appropriate are each of the following responses by Songo in this situation? 62. Try to calm Aké down. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

63. Give Aké privacy and let him calm down on his own A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate


 64. Tell Aké to enter the venue and speak to the invigilators about his anxiety A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

65. Remind Aké that if he doesn’t pass this exam, he will not be able to enter second year. A. B. C. D.

A very appropriate thing to do Appropriate, but not ideal. Inappropriate but not awful Very inappropriate

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Situational Judgement Mock

Mock Scenario 16 Vish is a new dentist at the dental practice and meets Firdous in the corridor during the lunch break. Firdous asks Vish to play a game where they have to tell each other gossip about their patients. Other colleagues join in on this game, but Vish is uncomfortable with the game and tells Firdous that he doesn’t like it as he feels it is a breach of confidentiality. Firdous disagrees with him and along with the other colleagues continue playing the game. How important are the following considerations for Vish to consider when deciding how to respond to the situation? 66. Vish is a new dentist, so the other colleagues may not listen to him. A. B. C. D.

Very important Important Of minor importance Not important at all

67. That Vish is uncomfortable with the game
 A. B. C. D.

Very important Important Of minor importance Not important at all

68. That the other colleagues including Firdous do not find the game offensive A. B. C. D.

Very important Important Of minor importance Not important at all

69. If he reports this game, it could affect his relationship with the other dentists and colleagues A. B. C. D.

Very important Important Of minor importance Not important at all

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Answers and Explanations Tutorial Questions

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Tutorial Answers Answers and Explanations

Scenario 1 - C Hector is meeting his wife for dinner. This is not an urgent or unavoidable reason for missing work, whereas Abdul’s reason is because he cannot leave his son unattended. This means that there is no reason for Hector not to wait for 30 minutes, especially because it is a small duration and avoids the workload being burdened on other colleagues, including junior doctors who are likely to already be quite occupied. This makes it an inappropriate cause of action. Now we need to decide whether it is C or D. Although his reasons are not very reasonable, Hector is still leaving a record of notes and this may be sufficient even if it is not ideal. This makes it an inappropriate but not awful course of action. The answer is therefore C.

Scenario 2 - D The main issue to address here is that the game the dentists are playing is a huge breach of confidentiality and is very wrong. If a patient overheard then they would lose complete faith in the dental team. Indeed, the game is in the corridor, not even in a private enclosed office. It is irrelevant whether Vish is a nurse, an experienced dentist or a new dentist - he has to do something. 
 Scenario 3 - B
 Although having a phobia of needles is an acceptable reason why a doctor may refuse to take blood, the doctor should at least attempt to find a way to become competent in a skill that is essential in their medical career. This would therefore be an appropriate, but not ideal scenario. It would not be good for the doctor to take blood if he is uncomfortable because it can panic and unease the patient, and the best solution is to find an alternative doctor or nurse to perform the task. Scenario 4 - D 
 In this scenario you have to act in the patient’s best interests. The junior doctor should recognise that they may struggle because they are inexperienced and should therefore work within the limits of their competence, and consult colleagues. Indeed, it is the consultant’s duty to help junior doctors in situations such as this. The factor is therefore not important at all. 


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Tutorial Answers Answers and Explanations 
 Scenario 5 - D
 
 It is absolutely vital for a dentist to ensure they document all the necessary information about their patient, and that if they fail to do so they should not try and estimate or use recall to judge what their presentations would have been like. This would be a very inappropriate thing to do. A lack of accuracy on patient records could cause problems further down the line, so the best course of action is to speak to the patient and potentially re-do the appointment with any related tests. 


Scenario 6 - D
 This response by the registrar is dismissive, and could lead to the medical student making mistakes. In a hospital setting you must ensure that systems are in place where colleagues are able to raise concerns, and make sure all staff for whose performance you are responsible for are adequately supervised. It is a medical student being dealt with, not even a fully qualified doctor, so the registrar needs to be much more understanding. Even if the registrar cannot give time off, they should be understanding and at least offer moral support at the very least. 
 
 Scenario 7 - D The medical student should ensure that they take action when there is clear evidence of the consultant being unfit for practice. The consultant is putting patients at risk by turning up to the workplace intoxicated, and regardless of the status of the medical student relative to the consultant or the lack of evidence beyond witness, it must be reported. 
 
 Scenario 8 - B
 
 Surprising to many UKCAT candidates, self-prescribing is actually legal in the United Kingdom. Registered and licensed doctors are able to access any prescription drug they want, and can also purchase private prescriptions from pharmacies. However, the GMC advises that doctors should make arrangements for accessing independent medical advice when they can, and so should avoid providing medical care to themselves. 
 
 


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Tutorial Answers Answers and Explanations Scenario 9a - A
 Here the medical student is ensuring that they respond to the patient’s questions appropriately. They are also responding promptly and fully to the complaint, whilst avoiding going beyond the realms of their capabilities and training. 
 Scenario 9b - B This is appropriate because the medical student is trying to help the patient, but is also not promising anything they can’t deliver. However, the patient specifically asked to see a doctor and may not necessarily trust the medical student’s advice, so this is not ideal. Additionally, in practice it can be difficult to stop yourself answering questions which you may know the answer to but which you are not completely sure, so offering to answer questions can put the patient into an awkward situation. 
 Scenario 9c - D Here the medical student is providing a level of reassurance they may not necessarily deliver when the patient asks the questions. Although they are putting the patient at ease, they are creating a false sense of security for the patient and if they are unable to answer the question this will reduce the patient’s confidence in the team. It is very inappropriate, as they are also only a medical student and the patient asked to see a doctor. Remember, it is important to respect the patient’s views about their health.

Scenario 10a - B
 
 This is a good example a question where you have to consider each aspect of the scenario. The patient is being prescribed a painkiller, therefore a stronger or milder analgesic will only help relieve the symptoms and therefore will not play a major role in the patient’s immediate health. The nurse is more experienced with the patient, and therefore is likely to understand their needs better, which makes it an appropriate course of action. The statement involves the phrase ‘on the basis of’. This means that the nurse’s advice will be an important factor but not the deciding factor for the decision that is being made. The reason it is not ideal is because it seems like the doctor is going to cancel the prescription without having a considered discussion with the nurse or other colleagues, which could otherwise result in agreement over the doctor’s initial prescription. 


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Tutorial Answers Answers and Explanations Scenario 10b - A
 
 This is a very appropriate thing to do. The doctor is approaching the nurse directly and is not making any snap judgements. Colleague communication is always an important factor to consider, and it is good that the doctor is not ignoring the nurse. 
 Scenario 10c - D
 
 Here the doctor has approached the situation in a very hostile manner. There could be a perfectly reasonable justification as to why the nurse feels the painkiller is too strong. The doctor is correct in saying that it is up to them to prescribe the painkiller, however the nurse is a vital part of the medical team and so it would have been better to ask them why they felt it would be wrong to prescribe the painkiller. 
 Scenario 10d - D
 
 This is an inappropriate course of action, because the doctor is not asking for a reason why the nurse feels it is too strong. We have already established that the nurse feels that the painkiller should be milder, and so asking her for a specific painkiller will not provide any additional information as it is likely that the junior doctor already knows a milder painkiller to prescribe if need be. Also, while the nurse is an important member of the team, it is likely that the doctor has learnt more in their education about painkillers (e.g. in pharmacology), and so is likely to be better placed to understand the scientific side of the physiological effects of a painkiller on the human body. 
 Scenario 11 - D This is a very inappropriate thing to do by the doctor. He is completely dismissing the principle of Autonomy by not looking into the patient’s medical records to see if there is a special request for or against kidney transplants. Moreover, he is using discrimination to avoid the next to kin.

Scenario 12 - A
 
 Here the medical student is acknowledging the fact that they are unable to disclose such

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Tutorial Answers Answers and Explanations information due to their position, and is being honest and complying with systems. They are also being considerate and respecting the patient’s dignity by informing them that the doctor is returning soon. In this type of scenario, refusing to give any information and telling the patient to wait (without reassuring them) would be disrespectful.

Scenario 13 - D
 
 The medical student should not discriminate against the surgeon just because he has conflicting political views, or is difficult to speak to. You should treat colleagues fairly without discrimination and act with integrity, because at the end of the day the patient is the priority and nothing should come in the way of that. 
 Scenario 14 - A
 This is a very appropriate thing to do. They are acting within the limits of their competence, and they make it clear to the patient. This can sometimes be done in a brash way, but the fact that the medical student reassures the patient that the doctor is returning means that it is a very appropriate thing to do.

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Answers and Explanations Mock Test

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Scenario 1

Question 1 - A
 
 It is clear that Saima is struggling at this task, but she needs to make it clear to the receptionist, who may not be aware that she is finding it hard. Asking for assistance acknowledges the fact that the receptionist is becoming frustrated, and will hopefully make her less agitated. It could also improve the team dynamic, and in terms of the task the receptionist could give advice to make the task more efficient and reach task completion faster. 
 Question 2 - A
 
 First of all, Saima is acknowledging the fact that the receptionist is unhappy with her, and apologising to her is the correct thing to do. It is likely that the receptionist will now be more understanding, and it displays an important part of working in a team, as being able to admit your own faults shows humility and will help Saima when she becomes a doctor, as every doctor makes mistakes now and then. 


Question 3 - C
 
 The receptionist is frustrated with Saima for taking her time, and telling her that she will do it at her own pace does not resolve this issue, and could harm the team dynamic. It would be better for Saima to come to a compromise with the receptionist. It is not an awful course of action, as Saima has agreed to complete the task, but has just said that it will take slightly longer. 
 
 Question 4 - D
 
 The receptionist has already raised an issue with Saima about this, and the fact that she is going against what the receptionist has already said is significant, because Saima is not participating in a mutual discussion. If Saima had kindly asked if it would be possible to use this alternative method, it would have been appropriate. But here in the response Saima is dismissing the receptionist’s preference.

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Many responses in Situational Judgement involve a lack of discussion, and this immediately makes the response inappropriate because it is always important to attempt a mutual agreement when two parties disagree. Do not forget that the receptionist is very important to the GP practice, and her complaints should be regarded earnestly. 


Scenario 2 
 Question 5 - A
 
 Ideally mistakes should not happen in medicine because they can potentially compromise patient safety. However they inevitably do occur, and therefore it is understandable that Diego was unable to take blood successfully here, as long as he learns from his mistake and tries to work to prevent it from occurring again. Apologising to the patient directly attends to the patient’s concerns, and asking for permission ensures that consent is given. The key point in the scenario is that Diego is ‘usually very successful’ at taking blood, and therefore it is acceptable for him to try again. If it was his first time, then it would be best to get another member of the medical team to perform the action. 
 
 Question 6 - B
 
 Remember that patient safety is the main concern. It is appropriate to get a consultant if Diego feels that he is unable to take blood in the stressful scenario, especially as he is just a medical student. If Diego does not feel comfortable and wishes to ask a consultant, it means he is likely to panic and be under pressure if he does take blood again, and so may make the mistake again and put the patient under even more stress. However, the patient is in stress and agony, so leaving the scene is risky 
 Question 7 - D
 
 This is an extremely inappropriate thing to do. The patient is clearly in agony, so trying to take blood again without the patient’s consent is an extreme violation of the guidelines of good medical practice. It would be better to ask first, and only take blood when the patient has agreed. Otherwise, this is a very poor approach, and an inappropriate thing to do. 
 


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Question 8 - B
 
 The patient might want a different person to try because they might not feel comfortable with Diego having another attempt since he was not successful the first time. It would be more appropriate for Diego to take another attempt at taking the blood, because a procedure like blood taking can be complicated and is not always successful due to a number of factors. After obtaining consent this would be a very appropriate thing to do. This is seen as a second best solution to the problem, and so is appropriate but not ideal.

Scenario 3

Question 9 - A
 
 This is exemplary behaviour by Safiya. She is ensuring that the patient has been dealt with, and is then going to the elderly person. The elderly patient is not in an urgent situation, so Safiya should not leave her current patient, but it is important to attend when Safiya is free. Whether the elderly man is a patient or not, it is important for Safiya to reassure and comfort him.


Question 10 - C
 
 This is an inappropriate thing to do because it assumes that the receptionist does not have her own work to attend to. It is not the receptionist’s responsibility to help the elderly man, and by taking time out of her own work she will fall behind on her own tasks. It will, however, mean that Safiya is able to continue on the wards, and so it is seen as an inappropriate but not awful response. 


Question 11 - A
 
 In this scenario, the patient has finished his treatment therefore it is likely that they are not requiring immediate medical care. The elderly man could be in danger, so it would be better to ask the patient to wait politely, find out more about the elderly man and then go from there. This occurs a lot in the medical field, and is often called triaging. This is where doctors decide what patients need to be treated with the greatest priority. It is important to

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note that Safiya is not leaving the patient, but instead asking them to wait a few moments. In this time she can assess the risk of the elderly man, and then re-triage accordingly. 
 
 Question 12 - A
 
 Again this is a very appropriate thing to do. Safiya sees that the elderly man is either confused or lost. By reassuring him it will help comfort them and let them know that they are being cared for. 
 
 Question 13 - B 
 
 This is an appropriate thing to do, it will be useful to check if anyone knows who he is as it will potentially help resolve the situation. However for something to be a very appropriate thing to do, it has to be the optimal approach. If Safiya first comforted and reassured the man and then asked about those nearby it would be a very appropriate thing to do. However, it is an appropriate, but not ideal scenario as there could have been a potentially better solution. 
 


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Scenario 4

Question 14 - C
 
 She should consider this to an extent because it means that several people are being affected by her indecisiveness. However, she should still respond appropriately and calmly regardless of how others are reacting. Passengers becoming more anxious does not necessarily correlate with the severity of the situation, so it should not force Sunita into action.


Question 15 - D No one else has come forward yet, so if Sunita believes she can help she should not wait to see if someone else comes forward. It is best to assume that no one will come forward, and if when Sunita is escorted to the scene there is a qualified doctor she can let him help instead.

Question 16 - A
 
 It becomes increasingly clear that medical attention is required, and by not helping at all Sunita is hindering the situation and potentially endangering the passenger that has fallen ill. It is therefore very important to consider the fact that the situation is an emergency. 


Question 17 - C
 
 She is a 6th year medical student, so it is likely that she is able to help in some shape or form. Her help will be better than a normal person with no medical background, so it can only be a bonus even if she cannot help as much as others would be able to to. This is therefore relatively unimportant for her to think about, and Sunita should not assume that this is the case. 


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Scenario 5 Question 18 - C
 
 Not reporting the issue or dealing with it directly is likely to mean that it will continue, and it does not help to resolve the situation quickly. The patient is already annoyed, so waiting is not a good course of action here. At the very least Edward should speak to Kar-Yeung if he does not want to report it. The reason it is not awful is because monitoring Kar-Yeung’s behaviour over a longer period of time could help Edward understand if this was a one-off or if it is a continuing problem, and will therefore enable Edward to make a more accurate assessment of the problem. It is therefore an inappropriate, but not awful response.
 In some scenarios monitoring behaviour in the long term is the best option. For example, if you are a junior doctor and saw a fellow colleague use her phone on the ward, you do not have to report it immediately. Instead, it is better to speak to your colleague and see if it is repeated again. It may have just been an emergency or a particularly important call, and even if it wasn’t the colleague might stop after you have a word. Here, the action is not as appropriate because the patient is already annoyed and Edward is not speaking to KarYeung.

Question 19 - A
 
 Instead of reporting to the consultant or other senior professionals directly, Edward is first treating the issue at a local level. Remember it is always best to resolve conflict directly wherever possible, unless it involves a compromise of patient safety or data handling. The manner in which Edward is approaching this scenario is not very confrontational, and by dealing with Kay-Yeung directly, it will help resolve the issue more quickly. If Kar-Yeung repeatedly performed similar behaviour after Edward has spoken to him, it would be completely acceptable for him to report it to a consultant. It is therefore a very appropriate thing to do.


Question 20 - D
 Edward should speak to Kar-Yeung privately at the end. The patient is likely to lose confidence in the two medical students and the medical team in general, so this is an inappropriate action. Kar-Yeung’s actions are not endangering the patient, and to address

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Mock Exam Answers Answers and Explanations the issue immediately Edward can change the topic of conversation instead of confronting Kar-Yeung about the code of conduct she must follow. Even if he does want to speak to her now, instead of reminding her of her code of conduct he can focus the conversation on the patient’s care.

Question 21 - C
 
 Whenever there is an opportunity, you should always try and resolve conflict directly. Here Edward is involving other people who are not necessarily connected to the scenario. If you see this sort of question in the exam, recognise the role of the players and try and appreciate the circumstances at which higher authority or other personnel can be avoided. This is a great example of such a case. Only report to higher authorities or other medical professionals if it involves compromising patient safety, patient confidentiality or data handling. Edward could have approached Kar-Yeung directly and this could have helped resolve the issue much more efficiently as well. It is therefore an inappropriate thing to do. The reason it is inappropriate but not awful is because of the fact that it could help resolve the conflict regardless and it is not the most terrible thing to do. 
 


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Scenario 6 Question 22 - C
 
 Let us consider the consequences of Bhavik staying further than his shift. If he returns home later, there is less time until his next shift and he may not have time to rest much before his next one. Remember patient safety is paramount, and the most important factor to consider in decisions. A common Medic Mind phrase is ‘tired doctors make mistakes’. This means that it is inappropriate to stay too late and compromise on having rest. Another reason this response is inappropriate is that it is unreasonable for Bhavik to be allocated a task out of hours, especially when it means that he will have to stay 2-3 hours beyond his shift. If it was a shorter period than this, then it may be acceptable. Now the question remains whether it is C or D. Arguably Bhavik could just sleep earlier than he normally does to make up for the lack of sleep the night before. Staying beyond his shift will also mean that the task will be completed, which it may not otherwise be. This means the answer is C.
 
 Question 23 - B
 
 Remember patient safety is the main concern. If Bhavik goes to the consultant, it will ensure that the problem is adequately resolved, as the consultant will take action. This will mean patient safety is not compromised, which makes the action appropriate. It is suggested that whenever junior doctor colleagues have disputes, they should attempt to try and solve the problems directly with each other, and only address higher authority if necessary. However, Bhavik did try and ask Lisa who refused, and in this scenario the main priority is to get the CT scan checked. Patient safety is the main concern but the reason the answer is B and not A is because Bhavik has not tried his hardest to convince Lisa to take on the task, and he may in fact be able to persuade her. The answer is therefore B.
 
 Question 24 - D
 
 If CT scans are not checked, the patient’s safety could be compromised.This can lead to potential consequences that could otherwise have been prevented. By assuming that Lisa will carry out the command despite the fact that she has refused, or assuming that he can just do the checks tomorrow is naive, and a direct compromise of patient safety. The answer is therefore D ••••••••••••••••••••••••••••••••••••••••••••••••• UKCAT

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 Question 25 - A
 
 Here Bhavik is approaching the situation very delicately. He is first accepting of the fact that Lisa did not accept the first time, and by looking at her point of view he is maintaining peace with his fellow colleague. By asking her to reconsider, it gives a sense of discussion rather than order. Bhavik is also approaching her directly and dealing with the issue locally, instead of asking one of the consultants or someone with authority. It is therefore a very appropriate thing to do. 


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Scenario 7

Question 26 - B
 
 This is a very general update, and is based on what Dhruv directly observed when he visited the child, and so he is not breaching confidentiality. Bethany is not the parent so Dhruv needs to be generic and unspecific with the information he gives out. However, it is not ideal for Dhruv to text patients or relatives of patients as a form of medical communication, so it is not the optimal approach.
 
 Question 27 - B
 
 Dhruv is a medical student and so does require authorisation to view a patient’s notes. He is therefore right in saying that he is not allowed. This is where it is important to know what role each character is playing - if Dhruv was a junior doctor, this probably would have not been the case. However, for a worried aunt of a child this is unlikely to reassure them, and therefore a more sensitive and polite manner in answering Bethany’s questions would have been better. This makes it B and not A. Again, it is not the optimal approach. Perhaps Dhruv could have said that he does not have access to the records currently but will ask one of his colleagues.


Question 28 - B
 
 Dhruv is correct in saying that the parent’s consent is required, as she is not a direct guardian of the child. It is therefore correct to inform Bethany that she cannot have access to information without the parent’s access. However, just like in the previous scenario, for a worried aunt of a child this is unlikely to reassure them, and therefore a more sensitive and polite manner in answering Bethany’s questions would have been better. This makes it B and not A. Again, it is not the optimal approach.
 
 Question 29 - A
 
 The paediatrics team will be better placed to provide information on the patient, in particular junior doctors and consultants. They will also be able to better manage the concerns Dhruv heard confidentiality, and so will make sure that Dhruv is complying with

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all the guidelines of being a good medical student as well as ensuring that Bethany is given the right assistance. 
 Question 30 - D 
 
 This is an absolute breach of confidentiality and should not occur in medical practice. Firstly, Dhruv is not working on the ward and so it would be extremely inappropriate for Dhruv or anyone in the medical profession to read the medical notes of a patient they are not directly involved in. If Dhruv had asked one of the consultants or junior doctors in the paediatric wards and they agreed to it, it still would be very inappropriate to share any details without any consent from the parents. Dhruv has no experience in paediatrics either which means he could misinform Bethany about the pyeloplasty. It is therefore overall a very inappropriate thing to do.

Scenario 8 Question 31 - A 
 Jeffrey is extremely anxious, and so informing him the reasons why the surgery can’t take place is an extremely appropriate thing to do because it will put him at ease and reduce any anger towards the medical team.
 
 Question 32 - D
 
 Alex already knows Jeffrey and it is likely that Jeffrey has a significant amount of trust in Alex as a doctor, and so will rely on him for information. Delegating the task onto a medical student is a very inappropriate thing to do because it will not reassure Jeffrey, as he is already anxious. Delegation can sometimes be useful, however when a patient is anxious and has a great deal of trust in a certain doctor, it can have implications in the future as the patient can lose trust in the medical team. Additionally, it is unfair to let a medical student break unwanted news to an already anxious patient. 
 
 Question 33 - D
 
 This is an extremely inappropriate thing to do. The surgeons have already informed Alex that the operation cannot take place today, so giving false hope will not bring any benefits in the long term. The operation most probably won’t happen today, and Jeffrey will lose trust in the team.
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 Question 34 - D
 
 This is an extremely inappropriate thing to do. Making Jeffrey wait until tomorrow will make him even more anxious and will mean that he has to wait even longer to find out the latest update. Alex should take the earliest opportunity to try and clarify everything. 
 As a doctor, you will be very time pressured, but you cannot let patients see that their time with you is short-cut or rushed. For example, GPs often have to run appointments in 10 minute slots, seeing patient after patient. There is a balance between time efficiency, and cutting the patient off to give a rushed service. Here Jeffrey is exposing structural and management issues in the hospital’s staffing as an excuse for poor care, which should not happen. 
 Question 35 - A
 
 We know that Jeffrey is extremely worried and anxious already, and so telling him that the delay will not affect his safety will help to settle and reassure him. It is therefore a very appropriate thing to do.

Scenario 9 Question 36 - A
 
 Konstantinos should not have been drinking in his hospital office regardless if it was not on duty. The main issue to address is that patient confidence in the medical profession should not be compromised. Texting Tim addresses the problem of the photos being publicly available and will help resolve the situation. Question 37 - C
 
 Tim should not have put that on his Snapchat story, and so it is completely understandable why Konstantinos would want to block him. However, it is not ideal as it does not address the emerging problem which remains that the photos are public and could damage the hospital’s reputation. Moreover, Tim may put more incriminating evidence on social media, which Konstantinos will not be able to see or respond to if he blocks Tim. 
 Question 38 - C


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 The hospital’s reputation has been potentially compromised because of Konstantinos’ and Tim’s behaviour. Therefore informing them is not the worst thing to do. However, it is highly unlikely that emailing the hospital will directly and immediately help solve the problem. Konstantinos is bypassing those that are involved, and therefore it will delay the response. You may argue that this will lead to a much more prompt and response, since it involves higher authority. However, the group of junior doctors themselves need to recognise the obvious bad behaviour they have committed and therefore come to response solution. Instead of e-mailing the hospital management, it would be better to e-mail Tim and inform him to take it down. It is therefore not an ideal thing to do. 
 Question 39 - C
 
 This is not addressing the issue directly because Tim is not in this scenario. Konstantinos is bringing it up with fellow staff members that may or may not have been at the party. Nonetheless, informing them of what happened will not change the probability that Tim will take the snapchat story down. A better method would have been to respond directly to Tim instead of doing it this way. The reason it is inappropriate but not awful is because this discussion will not have a negative impact, however it is not useful. 


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Scenario 10 
 Question 40 - C
 
 Sujinth is being extremely confrontational here. Saying this to the consultant will create friction in the team, and could lead to further problems in the future. This means it is inappropriate. It could be seen as an attack on the consultant’s ability to assess his team’s abilities. The reason this response is not awful is because it means that Sujinth is less likely to carry out the lumbar puncture and potentially endanger the patient.
 
 Question 41 - A
 
 This is a very appropriate thing to do. As we considered earlier, the most important person in this scenario is the patient. It is vital that their safety is not compromised and if Sujinth does carry out the procedure, he could panic and potentially permanently damage the patient. A lumbar puncture needs to be done very precisely, as it can lead to nerve damage to the spine and paralysis if performed wrong. 
 
 It can also be argued that it is reasonable for him to say no to the procedure, and ask someone else to do it. It becomes even more appropriate when you consider the fact that Sujinth’s future speciality will not involve needles. If it was a speciality such as surgery, Sujinth would have to somehow find a way to overcome his fears and learn. 
 
 He also apologises to the consultant, compared to the previous response where it came across as more hostile. Sujinth is being sensitive to the situation and this will ensure patient safety is not compromised, so the answer is therefore A, a very appropriate thing to do.
 
 Question 42 - D
 
 Remember patient safety is the most important thing. The fact that Sujinth is not carrying out the procedure is a good thing. However, Sujinth is lying to his consultant by telling them that he will indeed carry out the procedure. It would have been better for Sujinth to tell the consultant the truth. Indeed, if another doctor performs the puncture well, the consultant will ask Sujinth again next time if he believes Sujinth did it. This response involves lying to the consultant, and as a junior doctor this is not appropriate. 


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 Question 43 - C
 
 The patient may see Sujinth panicking if he carries out the lumbar puncture, and even if someone takes over this won’t change. It might be a better solution if the person supporting and accompanying them carries out the procedure from the beginning.
 
 However, the reason it is C and not D is because Sujinth is accepting the fact that he may be a risk to the patient and by having someone accompany him the environment becomes much safer and secure. 
 If the other person did the procedure, it would’ve been faster, safer and would not compromise the patient’s safety. The answer is therefore C.


Scenario 11 
 Question 44 - C
 
 Hector is meeting his wife for dinner. This is not an urgent or unavoidable reason for missing work, whereas Abdul’s is because he cannot leave his son unattended. This means that there is no reason not to wait for 30 minutes, especially because it is a small duration and avoids the workload being burdened on others, including junior doctors who are likely to already be quite occupied. This makes it an inappropriate cause of action. Now we need to decide whether it is C or D. Although his reasons are not very reasonable, Hector is still leaving a record of notes and this may be sufficient even if it is not ideal. This makes it an inappropriate but not awful course of action. The answer is therefore C.
 
 Question 45 - A
 
 This is a very appropriate thing to do. In terms of time, texting his wife is the most efficient method of letting her know that he is going to be late as it will not take a long period of time. He is informing her and keeping her in the loop about what is happening. This also means that Hector is prioritising patient safety over personal dealings, as it is likely that this dinner is not an event that is completely unavoidable. 


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 Question 46 - C
 
 Hector would potentially leave early simply based on the reason that he can make his dinner. This is not an emergency, and is something that can be missed or delayed. It is therefore inappropriate of him to burden a junior doctor, who is likely to be busy with other things. However, telling a junior doctor will mean that the patient information is still passed on, rather than Hector leaving and not doing anything. The answer is therefore C, inappropriate but not awful. 


Question 47 - A 
 Giving a verbal handover with accompanying notes means that Abdul is very informed, and it is the best way to deal with the scenario. 
 
 Question 48 - D
 
 This is worse than the response in Question 44, because the notes lack detail and are written quickly. Consider Abdul in this scenario. He will arrive at the hospital, and will be given a set of notes which have been written in a certain manner, perhaps ineligible and could consist of a lot of shorthand which each doctor uses differently. Written communication is not always effective. It would have been better if there was verbal communication between the two, like in the previous scenario where notes were accompanied by verbal handover as well. It could occur that the information is misinterpreted, and so this is a very inappropriate thing to do, especially as Hector is assuming that everything will be sorted out, when actually this may not be the case. The answer is therefore D, a very inappropriate thing to do. 
 


Scenario 12 
 Question 49 - A
 
 Usually, we advise you to always try to resolve conflict directly and at a local level. However this is a scenario is an exception. The teacher has made very serious comments to the pupil, which require immediate action that can only be authorised by senior employees including a headteacher. It is therefore a very appropriate thing to do.


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 Question 50 - A
 
 The two issues at hand are that Harveen is very upset, and that the teacher is acting unprofessionally to students. This deals with the first issue. It is very appropriate for Roshni to comfort her friend. She is obviously hurt by the comments that have been made, and so it is vital that she responds as immediately as possible, and comforting Harveen will help her feel reassured that there are people at hand to help her if she feels hurt by the comments made.
 
 Question 51 - C
 
 Provocation is not an excuse for the behaviour of a teacher. The rude language by Harveen did contribute to the teacher’s actions, so it is an important factor to consider. Nonetheless, this is not a sufficient excuse for the behaviour that was exhibited and therefore Roshni should not let the situation pass based on the fact that the teacher was provoked. 
 
 Question 52 - C
 
 It is likely that Harveen is traumatised by the event that has occurred, so it may be rash to persuade her to speak to the headteacher right away. It is important for Harveen to account her story, because the story may become twisted or change if it is not given from the perspective of the person it was directly involving. However the response is not appropriate because of the term ‘immediately’ - it is not an immediate concern for her and she may not be in a position where she can tell others about her story. It would be better to wait instead of doing this directly.


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Scenario 13

Question 53 - A
 
 The main issue is that Mark is not pulling his weight. This is a very non-confrontational solution, as Raheem is not directly referring to Mark, and does not mention his name. By telling everyone to take turns, it will hopefully remind Mark that he is a medical student and that at University he should be contributing to the problem based learning session. It is also a very appropriate approach because at this moment in time certain people are contributing more than others. 
 
 Question 54 - C
 
 Raheem is addressing the issue by speaking to Mark and hopefully it will mean that Mark contributes more to the conversation. The reason this approach is inappropriate is because it could be seen as confrontational, and it could mean that Mark becomes more angry at Raheem, so contributes even less. The scenario is also suggestive of a significant character shift, which could represent a traumatic life event or depression for Mark. Being delicate would have been better. 
 Question 55 - D
 
 Read the scenario carefully. It is their first group discussion. It is an extreme overreaction for Raheem to involve a professor, because it may just be a one-off. It is also means that Raheem is involving people that may not necessarily be involved. It would be better for Raheem to deal with it in the group or bring it up to Mark delicately. It is therefore a very inappropriate action. 
 
 Question 56 - C
 
 It is likely that soon the group will be unhappy with Mark not contributing, and it is an issue because as a medical student he will have to constantly contribute in these sorts of problem based learning scenarios. Avoiding the issue completely would be inappropriate. However, there are many potential explanations for Mark’s silence, including the fact that it

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is the first meeting, plus the potential that he is just getting to grips with the topic. It is therefore an inappropriate, but not awful approach. 
 


Scenario 14

Question 57 - C
 
 This is not very important. It does not matter whether Nimby is a nurse, medical student or a consultant. Reporting information about behaviour that is unacceptable does not depend on how much authority they have. Remember patient safety and professionalism are two of the most important considerations to make. If Nimby does not report this to the authorities, patient safety and professionalism are potentially compromised. However, the reason the answer is C, is because the fact that he is a medical student means that he has to be more delicate in his approach. If he was a consultant, he could confront Dr Nawan firmly, but being a fourth year student means he needs to be more delicate. 
 Question 58 - D
 
 Again this is not important. The patient may defend Dr Nawan, and the matter could be easily brushed under the carpet. However, this should not occur. Nimby should not be afraid of the relationship that the two have already, because Nimby did hear the patient complain about the doctor, and so is not reporting any misinformation. The answer is therefore D, not important at all.


Question 59 - B
 
 Patient trust is paramount, and if the patient does not feel like they can trust the medical team, it will severely compromise how well the patient receives future treatments and if she returns again, she may not trust the team again. However, this still doesn’t mean that Nimby shouldn’t report it. The answer is therefore important.


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Question 60 - C
 
 Even if Nimby is leaving the ward soon, he has to address the problems he has spotted and act appropriately. Therefore this factor is not important, but it may affect how quickly he decided to act because he needs to address the issue before he moves wards. So the answer is C. 
 
 Question 61 - D 
 This should not be an important factor. While it may affect the team dynamic, patient safety is important. The team should not look down on Nimby for reporting unprofessional behaviour, and should be able to understand that the issue Nimby is reporting could be significant.

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Scenario 15

Question 62 - A
 
 It is clear that Aké is extremely nervous, so calming him down will hopefully reassure him and relieve some of the pressure he is facing. It is therefore a very appropriate thing to do.
 
 Question 63 - C
 
 Remember, always look at situational judgement scenarios from a medical point of view Imagine Aké was a patient. If Aké is abandoned then he would likely become even more anxious, because he will be alone without any support. Instead, it would be better to reassure him and make sure he is relaxed. Additionally, bear in mind that they need to enter the exam hall now, so Songo needs to act fast. The reason the answer is not D is because Songo needs to enter the hall herself, and sometime time alone can be helpful. 
 
 Question 64 - A
 
 If Aké speaks to one of the invigilators it will hopefully help reassure him and calm him down, and will help to deal with the situation at hand. It is likely that the invigilator will help him overcome his anxiety. It is therefore a very appropriate thing to do.
 
 Question 65 - C 
 This is an inappropriate thing to do because it could potentially raise his anxiety and put him under even more pressure than he already is under. It could however, stress to him the importance of sitting the exam rather than skipping it. 





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Scenario 16

Question 66 - D
 
 This is not important at all. The game the dentists are playing is a huge breach of confidentiality. It is irrelevant whether Vish is a nurse, an experienced dentist or a new dentist - he has to do something. 
 
 Question 67 - A
 
 If Vish finds the game a breach of confidentiality, it is more than likely that patients would as well. This is a violation of the trust they are putting in the dentist. 
 
 Question 68 - D
 
 This is a breach of confidentiality. It is irrelevant whether the colleagues think it is right. They are in the wrong and are breaking the code of the dental profession. It is therefore not important at all if they believe it is normal because it is not. 
 
 Question 69 - C
 
 If this is reported to higher authorities, they may end up resenting Vish and this is of slight importance because it will have obvious consequences to the team dynamics. However, it is less important than the fact that they are breaching confidentiality. 


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