Situational Judgement Test (SJT)

The Situational Judgement Test (SJT) is an exam sat by final-year medical students who are applying to the UK Foundation Programme. It currently makes up 50% of your score for your application to the Foundation Programme, the other half comes from the educational performance measure (EPM) which is based on your academic performance at medical school (each school will calculate its EPM differently depending on the exam structure). It is scored on a scale from 0 to 50 points, which is then combined with the EPM score to make up a total score out of 100.

It’s a really important exam that doesn’t test typical academic content, however, it is possible to prepare for it!

What is the SJT?

The SJT is a computer-based assessment currently taken at Pearson VUE test centres or in your own home via online proctoring facilitated by Pearson VUE. It aims to assess attributes listed in the person specification for the Foundation Programme such as patient focus, professionalism, communication, team working, and dealing with pressure.

The exam will present you with various work-related scenarios and ask you how you would respond in these situations, there are multiple question formats and types.

Anyone applying to the Foundation Programme needs to sit the SJT and there are no exceptions to this rule. It’s also important to be aware that your SJT score will only be valid for the year you sit it, so if you had to re-apply to the Foundation Programme in later years you would also need to retake the SJT.

There is a separate SJT for people applying to the standalone F2 programme.

SJT timeline

While the specific dates will vary each year, the rough timeline will stay the same within each application year.

You need to make your initial booking within the specified window, however, after that, you are able to reschedule (depending on availability) your test up to 48 hours beforehand. If you have any reasonable adjustments (apart from extra time) then you will need to speak to Pearson VUE directly to reschedule your test.

Format of the SJT

The SJT is a long exam, with 2 sections lasting 70 minutes each, and a lot of reading involved. As of 2022, the Foundation Programme gives the structure as follows:

• NDA (untimed) – a non-disclosure agreement you must accept to progress to the test
• Tutorial (5 minutes) – an optional tutorial is available to show you how to navigate around the computer-based test
• SJT exam (140 minutes) – the overall exam is split into three parts, with different question styles for each part
• Survey (10 minutes) – at the end of the exam you will have the option to complete a survey giving feedback.

There are 75 questions in total and will consist of “evolving dilemmas” (multiple scenarios linked by a common context) and “speech dilemmas” (selecting how you would respond in conversation to difficult situations). Some of the questions may also feature additional content such as videos.

Question types in the SJT

There are 3 question types in the SJT.

Rating questions

You will be asked to individually rate between 4 and 8 responses to each scenario. There are three possible formats:

• Rate the appropriateness of a response (very appropriate; somewhat appropriate; somewhat inappropriate; inappropriate)
• Rate the importance of factors you may need to consider when managing a situation (very important; important; of minor importance; not at all important)
• Rate the appropriateness of verbal responses to a situation, assuming they are said in a polite way (very appropriate; somewhat appropriate; somewhat inappropriate; inappropriate)

Multiple choice questions

You will be asked to select 3 answers from a choice of 8 for each scenario. The three answers given should also make sense and work together as a solution. There are three possible formats:

• Choose the three most appropriate actions to take
• Choose the three most important considerations when managing a situation
• Choose the three most appropriate responses to say, assuming they are all said politely

Ranking questions

You will be asked to rank 5 answer options from most to least appropriate for each scenario. There are three possible formats:

• Rank the appropriateness of actions in response to a scenario (1= Most appropriate; 5= Least appropriate)
• Rank the importance of different considerations when managing a situation (1= Most important; 5= Least important)
• Rank the appropriateness of various verbal responses to a situation, assuming they are said politely (1= Most appropriate; 5= Least appropriate)

Marks available for different types of questions in the SJT

It is important to remember that each question should be answered individually and answers to previous questions about the same scenario should not be taken into account. Additionally, for questions that have multiple linked scenarios, each part should be answered independently.

The table below shows the marks available for the different types of questions. There is no negative marking and a “near-miss” scoring system is used, so marks will be given based on how close you were to the correct answer. For example, if in a rating question you rated a response as “inappropriate” but the correct answer was “somewhat inappropriate” you would still get some of the marks available.

Tips for the SJT

Prepare

While this isn’t a typical academic exam you can still prepare. Give yourself plenty of time to revise so that you don’t feel rushed towards the end of your preparation period.

Make sure you’re familiar with the structure and format of the exam and make use of the resources available online.

There are sample questions and a practice paper available on the Foundation Programme website. While there are courses and books available online the official resources are the best ones to use as they have the rationale for the answers included within them. It’s worth going through each paper more than once and trying to get a good understanding of the reasoning behind the answers given. There will be some common themes throughout, for example:

• Patient safety is always the priority
• When dealing with difficult colleagues, escalation to a senior tends to come after talking to the person directly (unless patient safety is being compromised)
• Acting to put a situation right is a priority if safe to do so, so doing nothing is often ranked as somewhat inappropriate/inappropriate

Realistically books or courses are only giving their best guess at possible answers to scenarios and they can be fairly expensive! If you’re worried about having enough questions to practice with there are sample questions from previous years also archived on the website.

There is also a full practice paper available on the Pearson VUE website, which can help you get used to the format of the exam.

Familiarise yourself with Good Medical Practice

The SJT is focused on assessing whether you can make decisions in accordance with the guidance set out in the GMC’s “Good Medical Practice” guidelines.

These guidelines are published by the GMC and set out the standards of behaviour expected from medical professionals within the UK. The guidance covers a variety of areas including confidentiality; raising concerns about colleagues; maintaining professional boundaries with patients and several others. Make sure you understand important principles like capacity, consent, and the ethical pillars of medicine.

The document is available online on the GMC website.

You should keep in mind the domains the SJT is assessing while reading through Good Medical Practice and the types of scenarios that could be included in each:

• Patient focus – patient-centred care, demonstrating empathy, respecting the patient, maintaining safety
• Coping with pressure – knowing when to seek help, acting within your competence, remaining calm in difficult situations
• Communication – use of clear and understandable language, adapting communication depending on the situation, appropriate written communication
• Professionalism – honesty, ethical practice, raising concerns, respecting confidentiality
• Team working – respecting colleagues, sharing knowledge, ability to delegate and take direction

Spend time on the wards

The SJT is designed to test your decision-making in clinical scenarios, so make sure you spend plenty of time on the wards! Obviously, placements on the wards are essential for the academic part of medicine, but they will also allow you to come across some of the situations assessed within the SJT.

Observe how people deal with different situations and how they communicate with patients, relatives, and their own colleagues.

That being said, when answering questions in the SJT, you need to answer with how you should respond according to Good Medical Practice, which may not always match up with what you see in reality!

Read the question!

It might seem like an obvious tip, but always make sure you read the question more than once and make sure you know exactly what it is asking you to do.

There are different question formats available for each question type and it can be easy to misread them and end up answering the question incorrectly.

In the same vein, make sure you read through all of the answer options before making a decision.

Don’t make assumptions when answering questions

This is one that is very easy to forget when taking the SJT. The scenarios will often purposely give limited information and it’s always tempting to make assumptions about the situation when answering them – don’t do this, the question should always be answered only using the information given in the scenario.

Additionally, when there are multiple questions about the same scenario it is important to consider each question individually. Don’t give an answer based on your responses to previous questions about the same scenario.

Practice timings and take breaks

The SJT is a long exam, with lots of reading and a lot of questions to get through. It’s easy to accidentally run out of time so make sure you time yourself doing a practice paper.

Always make sure to put your answers down as you go and you can flag any that you are unsure of for review and come back to them later.

It’s also easy to get fatigued and lose focus in the SJT, so it may be worth making sure you take a short break every so often to regroup. One example might be taking a 20-30 second break after every 20 questions or so, it will vary from person to person – another reason why practising your timing is important!

References

1. UK Foundation Programme. The Situational Judgement Test. 2022. Available from: [LINK]
2. BMJ Careers. Top Tips for the SJT. 2022. Available from: [LINK]
3. Mind the Bleep. Preparing for the Situational Judgement Test. 2022. Available from: [LINK]
4. GMC. Good Medical Practice. 2019. Available from [LINK]
5. UK Foundation Programme. Practice SJT papers. 2022. Available from [LINK]
6. Pearson VUE. UK Foundation Programme. 2022. Available from [LINK]