Situational Judgement
This is the final section of the UCAT paper. It consists of 66 questions (21-25 scenarios with 2-5 follow up questions each), giving an average of 23 seconds per question. The final four questions are drag and drop, where you have to select the most appropriate and least appropriate response from three possible options. This may seem rushed, but many candidates find this section the most relaxed for time as the scenarios are short and there are often multiple follow up questions. This section tests your ability to understand and respond to real world scenarios. Unlike the other sections, this is graded from Band 1 (the best) to Band 4 (the worst) and is given as a separate score on your exam report. This section consists of two questions:
Appropriateness questions: “How appropriate are each of the following responses in this situation.” (roughly 50% of questions).
Importance questions: “How important are the following considerations when deciding how to respond to the situation.” (roughly 50% of questions).
Before discussing tips for each question, we have outlined some important information you should familiarise yourself with. We have wrote many webpages for our free interview resources, and the links listed below are also important for Situational Judgment:
Good Medical Practice - The full document is written by the GMC. Here, we have selected the most important quotes which outline the traits of a good doctor.
Four Pillars of Medical Ethics - When making important clinical decisions, this page outlines ethical considerations doctors must contemplate.
Key Values of the NHS - These are values that all NHS staff aim to deliver when providing care.
Breeching Confidentiality - This is a very common Situational Judgment scenario, often in the form of “handling files improperly” or “doctors discussing patients in earshot”.
Reporting a Mistake - Many scenarios involve mistakes. In most cases, they should be resolved locally and then reported correctly as outlined on this page.
In all scenarios, if a patients welfare is at risk, any response or fact that helps to prevent this risk is the ideal response and is always ‘very important’ or ‘very appropriate.’ On top of those above, common themes that come up are:
Teamwork: Often there is a breakdown of communication or tension between members of a team. You should always resolve the situation professionally. Never spread rumours and always encourage level-headed discussion between members of the team. Offer support to the people involved, and always aim to resolve the tension.
Communication: This can be between doctors or between the doctor and patient. In these scenarios, all mistakes should be fixed immediately, and hierarchies in medicine should be ignored (a newly qualified nurse can fix a senior doctors mistake). Any mistakes should be pointed out discretely and then resolved accordingly. When dealing with communication between doctors and patients, patients have autonomy and, provided they have capacity, can choose their treatment (or choose to refuse treatment). The doctor should always ensure the patients have been given all relevant information including likely outcome and possible side effects. A doctor should never be deceptive to get their own way.
Professionalism: A doctor should always maintain a professional relationship with colleagues and patients. This means to avoid: relationships, becoming emotionally dependant on patients, discussing personal life (if it isn’t beneficial to the situation), being rude towards patients, or allowing any of this to happen without acting upon it. A doctor must be honest, organised and competent (keep their knowledge up to date).
Distressed patients: Doctors should always act professionally and sympathetically towards distressed patients. Doctors should never get attached to patients (and certainly never have sexual relationships), and should enable distressed patients to express their concerns and wishes. If this discussion affecting surrounding patients, an ideal response would be to move somewhere quieter.
Dealing with pressure: Scenarios can include personal life stress or stresses in the hospital. It is important for a doctor (or medical student) to maintain a work-life balance. They should only miss important family functions if absolutely necessary (but can come in on their day off for an interesting or beneficial activity). Doctors should, however, respond to emergencies outside the clinical setting by: asking for help, working as a team, and using medical knowledge. Always consider the physical and mental health of all people involved.
Know your limits: As a medical student you cannot treat, diagnose, or advise patients ever (in a hospital setting or outside). Also, doctors should never treat a family member. A doctor should know their limits and only give information/advice they are certain of (otherwise the correct response would be to consult another doctor or do some research). Make an effort to acknowledge who you are in the situation, and your role in the hospital (see example below).
Conflicts and solving problems: For all conflicts and problems, they should be settled locally (between the people involved) first. If this doesn’t resolve the issue, only then should it be escalated to more senior staff or the medical school. For example, if a student’s mental health is suffering due to overworking, you should speak to them first about it, and encourage them to report it. If they won’t, then you should report it to the medical school.
Accepting gifts: Doctors are allowed to accept small tokens (e.g a card or some biscuits) however, they are not allowed to accept expensive gifts, as this could persuade the doctor to spend a disproportionate time on that patient. The doctor should politely decline when given an expensive gift.
Alcohol: This is a rather common scenario involving a consultant who comes to work drunk and confides in you that they have been drinking. We must consider this situation from the viewpoint of everyone involved, but primarily the patient. Patient safety is of most importance, and thus the first step of the ideal response involves preventing the consultant from treating any patients and ordering them a taxi home (don’t drive) while ensuring there is another consultant to take the drunk consultant’s place. Afterwards, the incident should be reported accordingly. You should then consider the scenario from your viewpoint (often as a junior doctor) as the consultant would be giving you a reference at the end of your rotation for future jobs. You should not let this fact affect your decision, however, you should handle the situation diplomatically and professionally (as always). Finally, you should consider the situation from the consultant’s viewpoint, if they have been drinking, it is likely they are dealing with a difficult scenario at home, therefore, you should approach the whole situation with empathy.
At this stage, you are not meant to know who the “appropriate member of staff” is, however, they are often someone more senior but not the most senior (e.g you may report an issue about one of your friend’s at medical school to their tutor/mentor instead of going straight to the Dean of the Medical school). When speaking to colleagues be careful, as unless you are asking for advice, this can be seen as gossiping.
Appropriateness Questions
: “How appropriate are each of the following responses in this situation.”
These questions assess your ability to craft an ideal response to a situation. While reading the passage, you should determine the ideal response to the scenario. This will often consist of immediate actions (e.g. stopping the patient from coming to harm) and long term actions (e.g. reporting the incident). This response should be based on the information we have provided above. Once you have decided your ideal response, read the response they have given, and rank it as follows. Let’s use the example of “a young boy crying and screaming at the dentist while the dentist is examining his teeth.”
A. Very appropriate thing to do: This is part of, or the entire ideal response to the situation (e.g. stop examining the boys teeth, ensure the boy calms down, talk to the boy about his worries and, if suitable, continue the examination).
B. Appropriate, but not ideal: This will benefit the situation, but there are better responses. Alternatively, this will be beneficial long term but doesn’t fix the immediate issue. (e.g. ask the mother of the child to book an appointment again at a later date).
C. Inappropriate, but not awful: This does not better the situation, but it doesn’t make it worse. (e.g. asking the mother to calm the child while continuing).
D. A very inappropriate thing to do: This endangers patients or actively makes the situation worse. (e.g. continuing to examine the boy’s teeth without acknowledging his reaction).
Important points to note:
Each of the responses they give are independent. They assume that none of the prior responses have occurred.
The responses given in the question should be treated as a step. You should rank the step on its appropriateness as a step; it is not the entire response. E.g stopping doctors from breeching confidentiality is “very appropriate”. However, you still need to report it after (the second step).
You get partial marks for working out if the response is positive (A/B) or negative (C/D).
When answering these questions, as you read the response, you should immediately decide if its positive (A/B) or (C/D). Then, re-read the response and determine its exact letter. Guess, flag, skip, and come back if you are unsure but your first response is more likely correct than if you were to change it.
Importance Questions
“How important are the following considerations when deciding how to respond to the situation.”
These questions test your ability to understand real word scenarios and to pick out relevant information when deciding how to respond. These are very similar to those above, with a greater focus on the situation rather than the response. The scenarios of the two question types will be written almost identically and you will be asked 2-5 questions about whether a detail mentioned in the passage (or a new detail that hasn’t been mentioned) is important when deciding how to respond. Lets use the example of “a patient refusing treatment as he found a homeopathic remedy (a non-clinically advised method of treatment using very diluted solutions) online”:
A. Very important: This is a fact which is crucial in deciding how to respond. (e.g. the patient has autonomy when making a decision about their healthcare).
B. Important. This is information which will affect the ideal response. Therefore, it may mean you will have to make an alternate response. (e.g. the doctors don’t believe the patient’s best wishes are met due to misinformation).
C. Of minor importance: This is a fact which may affect the long term responses or the outcome of the problem, but it holds little to no bearing on the immediate response. (e.g. the patients mother is a homeopath - this may be why the patient is confused and thus may affect the approach of the doctors in the long term, but it isn’t greatly important in this consultation).
D. Not important at all: This fact has no affect on the short or long term response to the situation. (e.g. most other patients take this treatments without questioning it - this is irrelevant to the situation at hand).
Remember the tips mentioned above and be careful of distractions, the text may mention facts to try and convince you they are important when they are not.
Exam Style Question I
Charlie, a medical student, is shadowing a senior doctor, Dr Hall, on an admissions ward. A patient is admitted with a weakness in one arm and Dr Hall believes the patient’s most likely diagnosis is a stroke. However later, a physiotherapist informs Charlie that she believes Dr Hall is wrong and there is another, more probable, diagnosis. This physiotherapist is intimidated by Dr Hall and is very busy; she has asked Charlie to inform Dr Hall himself.
How appropriate are each of the following responses by Charlie in this situation?
1. Ignore the physiotherapist as Dr Hall is more senior.
A. A very appropriate thing to do
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to do
2. Ask the physiotherapist for more details about the alternative diagnosis so that he can describe them to Dr Hall.
A. A very appropriate thing to do
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to do
3. Ask the physiotherapist why she does not want to speak to Dr Hall.
A. A very appropriate thing to do
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to do
4. Tell the patient that he believes Dr Hall misdiagnosed him and that he needn’t worry about a stroke.
A. A very appropriate thing to do
B. Appropriate, but not ideal
C. Inappropriate, but not awful
D. A very inappropriate thing to do
Exam Style Question II
Jane is a nurse working in a crowded A&E department. The staff rooms are crowded. She hears two junior doctors speaking loudly about a patient while they are on the ward. They are discussing potential diagnoses of the patient including private information which makes the patient easy to identify. Patients on the ward are visibly distressed about hearing the doctors talk.
How important to take into account are the following considerations for Jane when deciding how to respond to the situation?
1. The doctors are using private information which makes the patient easy to identify.
A. Very important
B. Important
C. Of minor importance
D. Not important at all
2. The A&E department is crowded.
A. Very important
B. Important
C. Of minor importance
D. Not important at all
3. The patient, in which the doctors are discussing, is on a different ward.
A. Very important
B. Important
C. Of minor importance
D. Not important at all
4. The patients on the ward are visibly distressed about hearing the doctors.
A. Very important
B. Important
C. Of minor importance
D. Not important at all
Answers
Exam Style Question I
Charlie, a medical student, is shadowing a senior doctor, Dr Hall, on an admissions ward. A patient is admitted with a weakness in one arm and Dr Hall believes the patient’s most likely diagnosis is a stroke. However, later, a physiotherapist informs Charlie that she believes Dr Hall is wrong and there is another, more probable, diagnosis. This physiotherapist is intimidated by Dr Hall and is very busy; she has asked Charlie to inform Dr Hall himself.
How appropriate are each of the following responses by Charlie in this situation?
Key details you may have picked out from the passage: Charlie is a medical student, the doctor he is shadowing is a senior doctor, and he has to communicate information from a physiotherapist to the senior doctor. You should now be considering the ideal situation: the physiotherapist speaks to the senior doctor herself to ensure all information is communicated correctly. By being in the middle, Charlie may just delay, confuse, or misinform Dr Hall. Therefore, any response that strives to do this, is very appropriate, and the others should be rated accordingly.
1. Ignore the physiotherapist as Dr Hall is more senior. D. A very inappropriate thing to do. This is because the priority of a doctor (or medical student) is patient welfare. By ignoring the physiotherapist, Charlie may be risking the health of a patient, and thus it is a very inappropriate response. In most UCAT questions, the hierarchy in medicine should be ignored; anyone at any stage of their medical career can make mistakes and patient safety and care is the number one priority.
2. Ask the physiotherapist for more details about the alternative diagnosis so that he can describe them to Dr Hall. B. Appropriate, but not ideal. Like discussed earlier, the ideal response would be to encourage the physiotherapist to do it herself to ensure there is no miscommunication. But, if Charlie is the person delivering the information, it is appropriate that he knows as much information as possible to explain it to the senior doctor. Options that aim to find more information are almost always appropriate or very appropriate.
3. Ask the physiotherapist why she does not want to speak to Dr Hall. B. Appropriate, but not ideal. As this leads us closer to the ideal response, this is an appropriate response. However, it is not ideal, as this step does not actually improve the situation. As aforementioned, finding out more information is often an appropriate response.
4. Tell the patient that he believes Dr Hall misdiagnosed him and that he needn’t worry about a stroke. D. A very inappropriate thing to do. As a medical student, Charlie does not have the authority and knowledge to diagnose and inform a patient without supervision. By going directly to the patient: he could be spreading misinformation, he is undermining the doctor’s trust and the trust the patient has for the NHS, he will likely confuse the patient, and he hasn’t even discussed it with Dr Hall. This is a very inappropriate response on multiple accounts.
Exam Style Question II
Jane is a nurse working in a crowded A&E department. The staff rooms are crowded. She hears two junior doctors speaking loudly about a patient while on the ward. They are discussing potential diagnoses of a patient on a different ward including private information which makes the patient easy to identify. Patients on the ward are visibly distressed about hearing them talk.
How important to take into account are the following considerations for Jane when deciding how to respond to the situation?
This passage is focused on breeching confidentiality, so immediately you should be thinking about stopping the breech before more private information is shared. The ideal response in this situation would be walking up to the doctors and quietly informing them to stop talking. The nurse should then report the incident to the necessary staff to ensure it doesn’t happen again. The doctors may deem it’s necessary to apologise to the patients.
1. The doctors are using private information which makes the patient easy to identify. A. Very important. This is very important because by using this information, the doctors are breeching the patient’s confidentiality. If, instead, the doctors were discussing the symptoms of a disease, without mentioning patient specific details, this is simply them ensuring the best clinical care and correct diagnosis. While this should be performed outside patients’ earshot, it is much less of a series issue.
2. The A&E department is crowded. C. Of minor importance. This may hold a very small significance in the long term response when the incident is reported, but breeches of confidentiality are non-excusable and should be stopped immediately. The doctors should use the minimum private information possible when discussing a patient and should always do it in confidence, regardless of the nature of the ward.
3. The patient in which the doctors are discussing is on a different ward. C. Of minor importance. Once again this may hold a small significance as it changes who the doctors should apologise to, however, as it is distressing the patients on the ward, the patient in question is largely irrelevant. The doctors are undermining the patients’ trust in the NHS and harming the doctor-patient relationship. This is irrespective of the patient they are talking about since confidentiality should be maintained for everyone.
4. The patients on the ward are visibly distressed on hearing the doctors. B. Important. This is important as this will encourage the doctors to apologise to these patients, however, it is not “very important” as a breech of confidentiality is wrong regardless of the patients’ response. Therefore, it holds a level of significance as it effects how the doctors may respond, but it doesn’t effect the immediate response (the doctors should stop talking), hence option B.