Situational judgement tests (SJTs) are intended to help determine how an interview candidate would behave as a foundation year trainee pharmacist while working in practice and faced with realistic scenarios. They do not focus on the clinical decision, rather examine professional judgement.
SJTs are a recognised method of assessing candidates against a range of attributes and are widely used throughout healthcare, particularly in medicine, as a measure of competence.
At present, there is a limited number of pharmacy-specific model questions available for candidates to use as part of their SJT preparation. As a result, you may want to look at online resources for medical and dentistry students. Although these may provide insight into the possible structure of SJT questions, they are not pharmacy specific and should therefore be used as a guide only.
You are required to complete the SJT straight after sitting the numeracy test at a Pearson VUE test centre. There are numerous test centres available nationally (and internationally), allowing you to book a centre that is most suitable for you. Although individual stations in the centres will have been allocated to national recruitment candidates, there may be people sitting other tests, such as driving theory tests, at adjacent stations in the venue.
The Professional Attributes Framework
The Professional Attributes Framework (PAF) (see Figure) has been developed specifically for foundation year trainee pharmacist recruitment and forms the basis for the SJTs.
The PAF consists of nine attributes:
- Person-centred care;
- Multiprofessional working and leadership;
- Professional integrity and ethics;
- Problem solving, clinical analysis and decision making;
- Self-directed learning and motivation;
- Communication and consultation skills;
- Quality management and organisation;
- Resilience and adaptability;
- Pharmacy in practice.
Although you will be expected to exhibit all nine of the attributes during your foundation training year, for the SJT aspect of the Oriel recruitment process it is necessary to familiarise yourself with only the first four (note: these are listed in a slightly different order in the applicant handbook).
|Source: Health Education England|
|1) Person-centred care||1.1 Demonstrates empathy and seeks to view situation from the individuals’ perspective|
1.2 Places the person who is receiving care first, in everything they do
1.3 Accurately assesses, takes into account and is sensitive to the person’s current and longer-term expectations, needs, situation and their wider social circumstances
1.4 Shows genuine interest in, and compassion for, the individual; makes them feel valued
1.5 Works collaboratively with individuals, empowering and guiding every person to make an informed choice in their care
Full details about the PAF and associated behavioural indicators can be found in the latest edition of the Foundation Pharmacist Recruitment Applicant Handbook.
The SJT structure
As the name suggests, SJTs are questions that require you to assess a situation and choose how you should respond as a foundation year trainee pharmacist.
You will be required to answer 52 questions in 104 minutes and the questions will be a split between two types:
Five responses to a scenario will be given, which must be ranked in order of appropriateness, where 1 = the most appropriate action and 5 = the least appropriate
Choose three from eight
You will be given eight responses to a scenario and will be required to select the three most appropriate actions. You do not have to rank these three responses in order of appropriateness, rather you are simply selecting the three best responses.
The following questions and answers are provided as examples only and are included to give you an idea of the types of question that will be asked during the SJT. Please note that these exact questions will not be asked during the assessment.
Example question 1: Rank five question
You are working in a hospital ward, and the supervising pharmacist has asked you to provide advice to a patient about a newly prescribed medication. You have discussed what you need to tell the patient and the pharmacist is happy for you to advise the patient alone. As you begin to counsel the patient, you realise the patient does not speak English or any language you understand. The patient’s ten-year-old daughter, Hannah, is present and is able to speak both English and her mother’s native language.
Rank in order the following actions in response to this situation
(1= most appropriate; 5= least appropriate).
A. Accept you will be unable to counsel the patient as you are unable to speak her native language;
B. Arrange for a translator to counsel the patient whilst Hannah is present;
C. Use Hannah as a translator so you can counsel her on how her mother needs to take the drug;
D. Use Google Translate to change the patient information leaflet into the patient’s native language and use this instead of verbally counselling them;
E. Seek the guidance of the pharmacist, explaining that you are not able to counsel the patient because she does not speak English.
Model answer and rationale:
In order of appropriateness options B, E, A, C then D would constitute the best possible answer.
When thinking of how to answer this question, consider which options would do least harm to the patient, and order your responses accordingly.
Most appropriate action: B
Option B is the most appropriate action, as having a translator able to correctly translate your instructions to the patient will minimise risk to the patient and give them the best chance of taking their medication correctly.
Second most appropriate action: E
This demonstrates you have understood the barrier and are looking to resolve the situation by approaching someone senior for guidance.
Third most appropriate action: A
This demonstrates you have explored the best options before accepting you can’t help. Remember, you are looking at which options potentially cause least cause harm to the patient.
Fourth most appropriate action: C
Although option C may seem appealing, consider the effects of mistranslations or omissions of instructions for a new medication given that you will have no idea what is being said to the patient and so cannot be sure it is correct
Least appropriate action: D
This action is potentially even more high risk and inaccurate than option C, and so comes last.
Example question 2: ‘Choose three from eight’
You are a trainee pharmacist working on a hospital ward. You are approached by a junior doctor, Marcella, who asks you to supply a new medicine that the consultant has just prescribed for a patient. You are aware that the medicine is not kept in the hospital pharmacy and the local formulary has not approved its use in the hospital.
Choose the three most appropriate actions to take in this situation.
A. Say to Marcella that you are unable to assist;
B. Suggest to Marcella that she makes enquiries on a different ward;
C. Explain to Marcella that the medicine is not kept in the hospital;
D. Ask Marcella why the consultant wants this medicine specifically;
E. Suggest appropriate alternative medicine;
F. Refer the request to the formulary pharmacist;
G. Refer the request to a consultant;
H. Refer the request to a senior pharmacist for their advice.
Model answer and rationale:
Options C, D and H would constitute the best possible answers.
This scenario is assessing your approach to working within a multiprofessional team and taking responsibility for the situation while understanding your limitations as a trainee.
The correct responses demonstrate that you would take responsibility and show leadership by personally explaining to a member of your multiprofessional team that the medicine is not available (option C), further explore why the specific medicine is needed (option D), before taking all the relevant information to the senior pharmacist to explore next steps (option H).
A and B can be discounted quickly as they demonstrate neither leadership nor responsibility. Option E can be discounted because you will be working within your trainee remit in these scenarios and will not have the expertise or authority to suggest an alternative, unless it is under the supervision of a pharmacist (which this scenario does not mention).
Option F would not help resolve the situation as the medicine is not on the formulary so referring to the formulary pharmacist will not help the patient. Option G would not help resolve the situation because the consultant is the one who requested the medicine, therefore the query would just be prolonged.
How the SJT scoring system works
The two types of questions, ‘Rank five’ and ‘Choose three from eight’ have unique scoring systems that ensure that marks are awarded for the best possible answers.
‘Rank five’ questions:
Each ranking questions is worth up to 20 marks, with every individual response permitted 4 marks (see Table 1). There are points for ‘near misses’ i.e. the candidate does not need to get the answer exactly right in order to achieve a good score.
For example, if the correct order to a ‘rank five’ question is D, C, E, A then B, candidates could potentially score 20 marks for this answer (4 marks for each correct ranking). This can be seen in the Table; the applicant rank (i.e. Applicant Rank 1–5) corresponds with the correct letter option so 4 marks for the five ranks provides a final mark of 20.
However, if a candidate thought the answer was D, A, B, E then C, they would score 12 marks as follows:
- 4 marks for option D as the candidate assigned the correct ranking;
- 1 mark for option C as the correct ranking is 2, but the candidate ranked it 5;
- 3 marks for option E as the correct ranking is 3, but the candidate ranked it 4;
- 2 marks for option A as the correct ranking is 4, but the candidate ranked it 2;
- 2 marks for option B as the correct ranking is 5, but the applicant ranked it 3.
|Ideal rank||Applicant rank 1||Applicant rank 2||Applicant rank 3||Applicant rank 4||Applicant rank 5|
|Source: Health Education England, https://www.lasepharmacy.hee.nhs.uk/dyn/_assets/_folder4/_folder4/national-recruitment/PreregistrationPharmacistProfessionalAttributesFramework.pdf|
It is important to understand that if you assign two answers the same ranking, you will score no marks for either option. For example, two ranks of 1 will result on zero marks for those two ranks with other rankings marked accordingly.
Scoring system for ‘Choose three from eight’ questions:
These questions require you to choose three from eight possible responses. These questions are worth 12 marks — each individual correct response is worth 4 marks. Marks are not awarded for incorrect answers and will not be deducted from your overall score.
Tips to remember during the SJTs
It is important to prepare appropriately before sitting the SJT, but there is some advice that can help ensure that candidates have the best chance at success, for example:
- For each question, you should try to determine which attribute(s) is being assessed, then choose the responses that best demonstrate these;
- Remember the SJTs are not assessing your clinical knowledge, even though there may be a medicine involved in the scenario — they assessing your response to a situation based on the PAF.
- Questions should be answered as a trainee pharmacist; not as a student or qualified pharmacist;
- For the ‘rank five’ questions, you should try to identify the clear best option and the clear worst option first — leaving you with only three options left to rank;
- Remember that it is important to be aware of the limitations and capabilities of a trainee pharmacist. You should be careful not to refer a problem on when you can deal with it yourself, but also you should not attempt to resolve a problem that should be referred;
- You should base answers on what you think you should do, not necessarily what you may have witnessed in practice;
- Time management – you have on average two minutes per question, so you should not dwell on a single question for too long. It is possible to skip a question and return to it at a later point, this will ensure you are no spending too much time on single question;
- If you have finished answering all of the questions, you should go back and review any questions you were unsure about; the system allows you to flag questions for review before the exam is finished.
The SJTs are assessing candidates’ attributes as referred to in the PAF and not pharmaceutical knowledge. As such there is nothing to ‘revise’, but you may benefit from writing your own practice questions, related to the PAF, based on your own experiences and the experiences of friends or classmates. You should then share questions and discuss your rationale with others to help map scenarios to the PAF and develop a logical stepwise approach to forming rationale.
During the assessment, it is important to remain calm. The questions are not intended to trick anyone, rather they aim to get an understanding of how you would behave in response to practice-based scenarios.
About the authors
Khalid Khan is head of training and professional standards at community pharmacy chain Imaan Healthcare. He is also a foundation year training programme director at Health Education England.
Aamer Safdar is principal pharmacist lead for education, training and development at Guy’s and St Thomas’ NHS Foundation Trust, where he manages the preregistration programme at his hospital.
Atif Shamim is primary care lead for London and South East at Health Education England, and the national clinical lead for the foundation year recruitment scheme.