To prepare effectively for the MSRA, you need a clear understanding of the Situational Judgement Test, often referred to as the SJT or Professional Dilemmas paper.
This paper assesses how you behave when faced with professional challenges at work. It looks at judgement, prioritisation and how you respond to pressure, rather than clinical knowledge. Many candidates underestimate this paper because it feels familiar, but performance often comes down to structure and consistency.
Key Points About the SJT
– The paper contains 50 questions
– Total duration is 95 minutes
– It assesses professional behaviour, not clinical knowledge
– There is no negative marking
– Questions are presented in two different formats
What the SJT Assesses
All questions are mapped to three core competencies:
– Professional Integrity – This includes honesty, accountability, patient safety and acting within your role.
– Coping With Pressure – This looks at how you prioritise tasks, manage workload, seek help appropriately and respond to stressful situations.
– Empathy and Sensitivity – This assesses communication, awareness of others’ perspectives and respectful behaviour towards patients and colleagues.
Understanding these competencies helps you answer questions with intent rather than instinct. Strong candidates consistently link their choices back to these principles, which makes their decision making clearer and more reliable under exam pressure. All of these competencies and more are covered in our MSRA SJT Resources.
SJT: The two types of question
The SJT uses two distinct question formats. Understanding how each one works helps you approach them more calmly and consistently.
1) Ranking Questions
In ranking questions, you are given four or five possible actions related to a professional scenario. You are asked to rank these actions in order of appropriateness.
– 1 represents the most appropriate action
– 4 or 5 represents the least appropriate action
These questions test prioritisation and judgement. Often more than one action seems reasonable, but you are being assessed on what should come first in that specific situation.
2) Multiple Choice Questions
In this format, you are given eight possible actions. You must select the three most appropriate responses. The correct combination usually addresses:
– Immediate safety or professionalism
– Appropriate escalation or support
– A constructive next step
Each selected action should contribute to resolving the situation. Choosing actions that overlap or avoid the core issue often leads to lost marks.
Sample SJT question
You are a FY2 Doctor on an orthopaedic ward. Your team has just seen an elderly Spanish man on the busy ward round who understands limited English. Your registrar has gained written consent from him for a hip operation scheduled for 2 days’ time. One of the nurses quietly says to you that she suspects the patient was just nodding politely and understood very little. She says she doesn’t want to undermine the registrar. You know his daughter visits daily and always translates if she is present. Do you:
Rank the following actions in order from the most appropriate (1) to the least appropriate (5) in this situation.
A) Call the patient’s daughter directly to alert her what has happened
B) Address your registrar in front of the patient about these concerns, presuming the patient does not understand
C) Speak to the registrar privately at the end of the ward round about the concerns
D) Ignore the nurse’s comment as the patient’s daughter could always relay any concerns when she visits later
E) Encourage the nurse to speak up and then carry on with your ward round tasks
Suggested Answer: CBAED
C is the best option as you are speaking directly with the registrar, and not undermining them in front of the patient or team. The question states that the ward round was busy so waiting until the end may be more appropriate, especially as the operation is still in 2 days’ time. GMC Good Medical Practice states that you should make sure ‘arrangements are made, wherever possible, to meet patient’s language and communication needs’ and be satisfied that consent is taken before providing treatment. As the nurse is reluctant to speak it is important to ensure the concerns do not go unnoticed, especially since you are aware his daughter usually translates.
B is not as good an option because although it does directly act on your concerns, it undermines the registrar in front of others and may impact your working relationship. Furthermore, it may distress the patient who has limited understanding of English. It ranks higher than A, E or D because at least the concerns are actively voiced directly to him.
A is a poor option as it potentially breaches patient confidentiality and may cause distress to the patient and relative. You are taking action to try and ensure patient understanding but going about it in a way that i) undermines the registrar, ii) may negatively impact your working relationship and iii) may negatively impact the patient and family’s trust in the medical care being provided.
E is the next worst option here as although you are encouraging her to speak up, you are not taking any responsibility in following this up – and thus checking to ensure that the consent taken is valid.
D is the worst option as it disregards a suspicion that the consent taken was invalid and fails to act on this at all. Relying on the patient’s daughter to relay any concerns that the patient may confide to her is inappropriate. This does nothing to actively voice concerns to the registrar, who is in a position to discuss the operation again and ensure consent taken is valid (in the presence of an appropriate interpreter if necessary).
Practice more SJT questions: Check out our MSRA free trial.
