UCAT Situational Judgement Notes

Advice & Insight From UCAT Specialists

The final element of the UCAT is the Situational Judgement section (SJT) which looks at how you would react in certain clinical and professional settings. It measures your capacity to understand real-world situations and to identify critical factors and appropriate behaviour in dealing with them. The test assesses integrity, honesty, perspective taking, team involvement, and resilience and adaptability.

Having a good understanding of the GMC guidelines or familiarising yourself with the GMC’s publication entitled “Tomorrow’s doctors” will certainly equip you with the right knowledge to answer the SJT questions. However, rather than spend a lot of time reading and learning all them all, a more efficient use of your time would be to focus on the key concepts and most important scenarios, such as those which are explained in this article.

The four pillars of Medical ethics

When answering SJT questions, always hold in mind the four basic principles of medical ethics: beneficence (having compassion and good intentions), non-maleficence (not wanting to do harm), autonomy (respecting patients’ wishes) and justice (equal treatment for all).

Step by step approach

For each question you should follow a similar approach. Firstly, make sure you read the scenario carefully and understand the different roles of the people involved. Who is the main player in the scenario? Are they a doctor or medical student? Is the action putting a patient at potential harm? Next, diagnose the main problem in the scenario and how serious it is. Think about what the central issue is specifically and decide what element needs addressing. For example, is it a question of conflict, confidentiality, patient safety, unprofessional behaviour? Finally, read the statement very carefully.

Step into character

Imagine that you are there in the scenario. You could imagine that you are a caring and conscientious medical student a few years from now in each situation as it unfolds. With your knowledge of medical ethics in mind, what would you do? What do you think would be the right thing to do in this situation? You should have at the forefront of your mind the fact that any decision that affects patient care should be made to benefit the patient and as such, work colleagues’ feelings are only of secondary importance. Patient safety should always be at the centre. If you always bear in mind the key principles of professional conduct, then you will find it easier to choose the right answer.

Multiple responses for the same scenario

Remember that in any given scenario, you shouldn’t judge a response as being the only response that will happen. There can be multiple optimal responses to the same scenario, for example, when a GP wants to do a blood test, there are a number of very important things s/he has to do including gaining consent, checking records, logging results and prescribing appropriate medicines. So, try not to compare responses for the same scenario because it is much better to consider each response on its own merits. After all, you may find that several responses could be “very appropriate” or “very important” for the same scenario.

Example themes that may occur in the scenarios

Dealing with conflict: Always aim to address this with the person involved directly, in private and preferably in non-judgemental approach. Tackle the situation in a polite and sensitive way, as it is always appropriate to be honest and polite.
Addressing concerns: you should take a stepwise approach starting with the involved parties, escalate to immediate supervisors if necessary and then others. It is always a good idea to raise concerns directly with the person involved, rather than going through other people if possible. If patients’ safety is put at risk this is always very important to raise as a concern. Seeking advice is also an appropriate thing to do. For example, if an error has been made, such as a doctor accidentally inputting an incorrect medical record on the computer, this must be addressed as it could impact patient safety.
Confidentiality: hospital policies should always be adhered to and permission should always be obtained, whether that’s for using recording equipment or a patient taking crutches from the hospital that have not been authorised for use. Patients’ confidentiality should almost always be maintained (there are only rare exceptions when it can be broken, for reasons of safety or legality, for example).
Autonomy: patients should be provided with sufficient information so they can make their own informed decision. In cases where the patient does not have capacity, any advanced directives, lasting power of attorney or prior wishes should be considered, with the patient’s best interests at the heart of any decision.
Communicating information to patients: information should always be communicated to patients about the risks to their health in a respectful and caring way.
Reporting unprofessional behaviour: in some cases, it may be appropriate to speak to the person directly but if you feel that this may aggravate matters or put patients at risk, then it is more appropriate to liaise with more senior colleagues. After all, seeking advice is always appropriate in these situations. Furthermore, one’s junior status or the seniority of the offending party should not be a barrier to raising concerns about unprofessional behaviour. For example, a 1^st year medical student should raise concerns regarding an abusive consultant in the same way that a fellow consultant would.