MSRACr

ammerCour
se
Pr
ofessi
onalDi
lemma(
SJT)Paper

www.
emedi
ca.
co.
uk
Welcome to this Emedica MSRA Crammer course for the Professional Dilemma
(SJT) paper.

The Multi-Specialty Recruitment Assessment (MSRA / SRA) is being used as part of the
recruitment process for specialty training in GP, Psychiatry, Clinical Radiology, CST,
Anaesthetics, Emergency Medicine, Ophthalmology, Obstetrics, CAMHS, CSRH,
Neurosurgery, and Nuclear Medicine.

Situational judgement test questions assess decision making and judgement in work based
or work-related scenarios.

The secret to scoring well in the Professional Dilemma paper is understanding the key
techniques to tackle situational judgement test questions, alongside knowledge of ethical
guidance and the competences being tested, and how to apply them to different situations.

I hope this course will provide you with the knowledge and skills needed to improve your
understanding and approach to tackling SJT questions, and to go on to score well enough
to get a place in your first choice deanery and specialty. I hope you will find the course
educational, interactive, and even enjoyable. We all wish you every success in securing
a rotation.

Dr Mahibur Rahman MB BCh MSc FRCGP

Medical Director
Emedica

www.emedica.co.uk
 MSRA SJT Mini Mock

Question Ranking Option Mark Notes

1. 1
2
3
4
5
Question Ranking Option Mark
2. 1
2
3
4
Question Ranking Option Mark
3. 1
2
3
4
5
Question Ranking Option Mark
4. 1
2
3
4
Question Ranking Option Mark
5. 1
2
3
4
5
Question Ranking Option Mark
6. 1
2
3
4
Question Ranking Option Mark
7. 1
2
3
4
5
 MSRA SJT Mini Mock
Question Ranking Option Mark Notes
8. 1
2
3
4
5
Question Ranking Option Mark
9. 1
2
3
4
Question Ranking Option Mark
10. 1
2
3
4
Question Ranking Option Mark
11. 1
2
3
4
Question Ranking Option Mark
12. 1
2
3
4
5
Question Ranking Option Mark
13. 1
2
3
4
5
Question Ranking Option Mark
14. 1
2
3
4
5
Question Ranking Option Mark
15. 1
2
3
4
5
 MSRA SJT Mini Mock

Question Answers Marks

16. A B C D E F G H
       
17. A B C D E F G H
       
18. A B C D E F G H
       
19. A B C D E F G H
       
20. A B C D E F G H
       
21. A B C D E F G H
       
22. A B C D E F G H
       
23. A B C D E F G H
       
24. A B C D E F G H
       
25. A B C D E F G H
       
26. A B C D E F G H
       
27. A B C D E F G H
       
28. A B C D E F G H
       
29. A B C D E F G H
       
30. A B C D E F G H
       
 MSRA SJT Preparation
Programme
09.30 Welcome and Introduction
09.35 MSRA - Professional Dilemma Paper - SJT overview
09.45 Key techniques for SJT exams + sample questions
10.45 GMC and ethical guidance for the SJT
11.30 Break
11.45 SJT practice: Section 1 - ranking questions
12.30 SJT practice: Section 2 - selection questions
13.15 Lunch break
14.00 Situational Judgement Test Mini Mock Exam
15.00 SJT Mock: Answers, explanations and feedback Part 1
16.00 Break for Refreshments
16.15 SJT Mock: Answers, explanations and feedback Part 2
17.50 Questions and Answers
18.00 Summary and final tips
18.15 Close

MSRA SJT Preparation

Professional Dilemma Paper

• Situational Judgement Test
• Background
• Competences being tested
• 2 sections – 2 types of questions
• Sample questions
• How to prepare

© Emedica All rights reserved MSRA Crammer: SJT 1

 MSRA SJT Preparation

SJT / PD paper basics

• 95 minutes
• 50 questions (42 marked) – TIMING!
• Average score: ~ 82% = normalised score
of 250
• Band 2 score ~ 70%
• Band 4 score ~ 90%+

Standardised score Score Score meaning Outcome

range band
Below 186 Very poor level of FAIL – not
1 performance ranked
186-210 Below average Ranked by total
2 performance score
211-230
231-250 250=mean Ranked by total
score
251-270 3 251+ = above average
271-290
291-310 Very good level of Ranked by total
4 performance score
Above 310

© Emedica All rights reserved MSRA Crammer: SJT 2

 MSRA SJT Preparation

Background
• Validated, objective, machine markable
• Used by Civil Service, NHS grad, FBI
• FP, AGPT, PH, various specialties
• Decision making and judgement
• Work based scenarios
• Difficult situations / professional dilemma
• Tests against 3 core competences

MSRA SJT Preparation

Core Competences for PD Paper

• Empathy and Sensitivity
• Professional Integrity
• Coping with Pressure

• + Knowledge of core GMC guidance

© Emedica All rights reserved MSRA Crammer: SJT 3

 MSRA SJT Preparation

Empathy and Sensitivity

• Capacity and motivation to take in patient/colleague
perspective
• Caring approach to others
• Treats patient(s) with sensitivity and personal
understanding
• Holistic approach – social, psychological, emotional
• Generates safe/ understanding atmosphere
• Acknowledges / explores patients wants / needs
• Patient centred / empowering approach
• Open, non-judgemental manner

MSRA SJT Preparation

Professional Integrity
• Honest and open – willing to admit mistakes
• Treats others with respect and dignity
• Balances ethical tensions
• Strives for quality and manages risk
• Proactive approach
• Takes responsibility for self and others
• Commitment to equality of care

© Emedica All rights reserved MSRA Crammer: SJT 4

 MSRA SJT Preparation

Coping with Pressure

• Recognises own limitations
• Recognises and manages stress / emotions
• Able to develop appropriate coping mechanisms
and is prepared to ask for help
• Calm under pressure and able to ‘switch-off’
• Able to manage multiple roles / responsibilities
• Able to manage uncertainty
• Manages criticism well
• Able to adapt behaviour depending on role

MSRA SJT Preparation

PD Paper – sections
• 2 sections – two approaches (~50/50)
• Section 1 – ranking
• Section 2 – selecting combined responses

© Emedica All rights reserved MSRA Crammer: SJT 5

 MSRA SJT Preparation

Sample questions – Section 1

• For each scenario, rank the options from
1-5 (or 1-4 in some questions)
• 1 is the best or most effective option
• 5 is the worst or least effective option
• Drag and drop into correct order
• Not possible to allocate tied ranks
• Do not leave any blank ranks!
• ~1 min 54 seconds per scenario

MSRA SJT Preparation

Mark Scheme: Section 1

• Mark scheme: keyed responses
• 20 marks per question if 5 options
• E.g. all 5 correct = 20 marks
• Incorrect answer – 8-18 marks
• There IS a best answer (controversial)

© Emedica All rights reserved MSRA Crammer: SJT 6

 MSRA SJT Preparation

SJT / PD Section 2
• Scenario – as Section 1
• Given 8 options
• Asked for 3 responses from 8
• Most appropriate COMBINED response

MSRA SJT Preparation

Mark Scheme: Section 2

• Mark scheme: binary
• 12 marks per questions
• 3 correct = 12 marks
• 2 correct = 8 marks
• 1 correct = 4 marks

© Emedica All rights reserved MSRA Crammer: SJT 7

 MSRA SJT Preparation

SJT – how to prepare

• Know the SJT domains / attributes
• Read Good Medical Practice
• Read GMC ethical guidance
• Understand differences
between question types
• Practise questions
• Consider scenarios at work!

MSRA SJT Preparation

Tips – General
• Read each scenario carefully before you
start reading the answers
• Highlight key words or phrases, look for
useful clues
• TIME is of the essence

© Emedica All rights reserved MSRA Crammer: SJT 8

 MSRA SJT Preparation

Tips – Section 1 Ranking

• Read all options before ranking
• Remember they are not asking which is
the RIGHT or WRONG answer
• Rank from MOST effective (BEST) to
LEAST effective (WORST)
• Compare to option ABOVE and BELOW
• Potential for harm / potential for benefit
• Each option is discrete / separate (“OR”)

MSRA SJT Preparation

Tips Section 2
• Choices COMBINED (“AND”)
• Read back your choices together – does it
make any sense?
• Look for pairs / triplets – ONLY 1 from a set

© Emedica All rights reserved MSRA Crammer: SJT 9

 MSRA SJT Preparation

Tips – Consider the following:

• Time available / impact of time
• Who to involve
• Formal or informal approach
• Issues for you, patients, team, colleague
• Lines of authority
• Ethics / GMC guidance

MSRA SJT Preparation

Ethical Guidance
• Ethical principles
• Confidentiality
• Capacity
• Informed consent
• Personal beliefs
• Financial issues
• Raising concerns
• End of life care

© Emedica All rights reserved MSRA Crammer: SJT 10

 MSRA SJT Preparation

Ethical Principles
• Autonomy – right to self determination
• Beneficence – act to do good
• Non Maleficence – avoid doing harm
• Justice – fair treatment, use of resources

MSRA SJT Preparation

Confidentiality
• Right to confidentiality protected
• Disclosure of confidential information
– If required by law
• Notifiable disease
• Court order
– Risk of death or serious harm
• Patient
• Third party

© Emedica All rights reserved MSRA Crammer: SJT 11

 MSRA SJT Preparation

Capacity
• Capacity: ability to make own decisions
• Adults deemed to have capacity
– Unless evidence otherwise
• Children <16 – no capacity
– Unless assess them as Gillick competent
• Capacity assessed at point of care

MSRA SJT Preparation

Bolam / Bolitho Test

• Bolam vs. Friern Hospital (1957)
• “If a doctor reaches the standard of a
responsible body of medical opinion, he is
not negligent”
• Bolitho amendment: “provided that the
Court finds such an opinion to be logical”
• Applies to diagnosis, investigation,
management
• Does NOT apply to consent any more

© Emedica All rights reserved MSRA Crammer: SJT 12

 MSRA SJT Preparation
Informed Consent
• Consent has to be informed to be valid
• Patient must have capacity
• Decision made voluntarily
• No duress or undue pressure
• Information on risks and benefits
• Montgomery vs Lanarkshire HB 2015
– Bolam test no longer applies to consent
– “reasonable care to ensure patient is aware of
any material risks + reasonable alternatives”

MSRA SJT Preparation

GMC Decision Making & Consent
1. Patients have a right to be involved in decisions about
treatment and care
2. Decision making requires ongoing meaningful dialogue
3. Patients have the right to be listened to
4. Doctors must try to find out what matters to patients and
share relevant options
5. Start with presumption adults have capacity
6. Treatment / care for patients without capacity must be of
overall benefit, and decision shoulds involve those close to
them
7. Patients whose right to consent is affected by law should be
supported to be involved in decision making / exercise
choice if possible

© Emedica All rights reserved MSRA Crammer: SJT 13

 MSRA SJT Preparation

Personal beliefs and medical practice

• Advise patients of their right to see
another doctor where beliefs may cause
conflict e.g. termination of pregnancy
• Provide high quality care despite conflicts
• Respect patient’s right to practise their
beliefs e.g. Jehovah’s witness / blood

MSRA SJT Preparation

Financial issues
• Do not encourage personal gifts or loans
• Do not pressure patients to donate money
• Unsolicited gifts may be accepted
– If it does not alter care / result in advantage
• Gifts should not be accepted if they may
be perceived as an abuse of trust

© Emedica All rights reserved MSRA Crammer: SJT 14

 MSRA SJT Preparation

Raising concerns
• Duty to raise concerns re: patient safety
– Practice of colleague
– Systems, policies, procedures
• Duty to report suspected child abuse /
neglect
• As an FY2, raise concerns with senior staff
• Where an incident leads to patient harm /
potential serious “near miss” – consider
incident form

MSRA SJT Preparation

End of life care

• Provide same quality of care as any other
patient
• Presumption in favour of prolonging life
• DNR orders should involve the patient –
legal duty (Tracey case 2014)
– Exception if “convincing reasons not to
involve”
– Avoiding potential distress not a valid reason
• Valid advanced refusals binding

© Emedica All rights reserved MSRA Crammer: SJT 15

 MSRA SJT Preparation

Core Knowledge – MSRA SJT

• SJT asks what a good doctor SHOULD do
• Some SJTs test knowledge of key guidance
• Most relates to GMC / ethical guidance
• Revise core knowledge before exam
• We will cover more key guidance later

MSRA SJT Preparation

Possible New Formats

• Most appropriate immediate actions
– This IS about the best order in terms of time /
urgency to do things
• Suggestions to a colleague / responses to
say
– Consider role / empathy / sensitivity / knowing
your limits / outcomes / specific wording
• Video SJT scenarios
• Example questions in the post course
learning

© Emedica All rights reserved MSRA Crammer: SJT 16

 MSRA SJT Preparation

Recap Key Tips

Section 1 – “OR” NOT “then”
• Compare to one above / below
• Not good or bad, better or worse!
Section 2 – “AND”
• Must make sense together
• Should resolve situation as much as possible
• Map back to domains + ethics / GMC guidance
• Empathy + sensitivity
• Professional integrity
• Coping with pressure

MSRA SJT Preparation

SJT Mini Mock

• Questions on screen
• Write your answers on the answer sheets
• Slides will advance automatically
• Timed ~ REAL exam
• 1 SJT = 1 min 54 seconds
• Total 30 questions (57 minutes)
• 15 Section 1, 15 Section 2

© Emedica All rights reserved MSRA Crammer: SJT 17

 MSRA SJT Preparation

Summary
• Different approach and marking for each
section
– Section 1: “OR”, Section 2: “AND”
• Read the scenario + options carefully
• Map back to the 3 domains
• Consider GMC / ethical guidance
• Consider possible outcomes
• Be disciplined with time

MSRA SJT Preparation

Useful resources
• Emedica SJT questions – 200+ scenarios
• MSRA official sample questions
• Foundation Programme SJT practice
papers – 140 scenarios
• GMC Good medical practice in action
• We will email you further reading and links

© Emedica All rights reserved MSRA Crammer: SJT 18

 MSRA SJT Preparation

Final Tips
• Competitive rank – every mark counts
• Focus your revision – complete all the
SJTs on Emedica online
• Practise under timed conditions
• Remember the clinical paper is equally
weighted!

© Emedica All rights reserved MSRA Crammer: SJT 19

"
Verydetail
edforanewcomer.Il
ikedt
hefactt
hatthecour
sealsocoveredthenoncli
nical
bit
sli
keexpenses,pre-empl
oymentpaperwor
k.Iwouldsuggesteveryoneshouldatt
end
t
hiscoursebef
orestar
ti
ngtr
aini
ng.Eveni
fonethinkst
heyknoweverything,t
her
eissti
lla
l
otofinf
ormati
ontogain.
"

www.
emedi
ca.
co.
uk/
gpst
max