The four ratings
| Rating | It means |
|---|---|
| A very appropriate thing to do | It deals with the problem, or a real part of it, with no drawback worth naming. |
| Appropriate, but not ideal | It helps and does no harm, but it is incomplete, slow or roundabout, or there is plainly a better way. |
| Inappropriate, but not awful | It should not be done, but it harms no one much: it avoids the issue, delays, or involves the wrong person. |
| A very inappropriate thing to do | It puts someone at risk, is dishonest, breaches confidentiality, or goes beyond what the person is entitled to do. |
Importance questions use the same shape: very important, important, of minor importance and not important at all.
Two decisions, not one
- Which side of the line? Should this be done at all? That puts you in the top two ratings or the bottom two.
- How strongly? Then choose between the two on that side.
Make the first decision before you think about the second. A rating next to the correct one earns part marks, so getting the side right and the strength slightly wrong still scores; a rating two or three steps away earns nothing.
Very appropriate, or appropriate but not ideal?
- Does it act on the actual problem, or only near it? Acting on it directly is very appropriate.
- Does it go to the right person first? Speaking to the person concerned, or the person responsible, usually beats going around them.
- Is it soon enough for how urgent the situation is?
- Is there an obvious cost, such as embarrassing someone in front of others? A good action with a clear cost is not ideal.
It does not have to be the whole answer
Each response is judged on its own, not as the only thing the person will do. A sensible first step can be very appropriate even though more would need to follow.
Inappropriate but not awful, or very inappropriate?
Ask what the worst realistic result is. It is very inappropriate if the response:
- leaves a patient, or anyone else, at risk;
- involves lying, hiding a mistake or falsifying a record;
- shares confidential information with someone who should not have it;
- has a student or junior doing something they are not trained or permitted to do;
- ignores a serious problem altogether.
If it is merely unhelpful, a little unkind, or a way of avoiding an awkward conversation, it is inappropriate but not awful.
The principles behind the answers
- Patient safety comes first, ahead of loyalty, embarrassment and convenience.
- Be honest, including about your own mistakes.
- Keep confidences.
- Stay within your role and ask for help when something is beyond it.
- Raise a concern with the person first, privately, unless someone is at risk or it has already been tried.
- Treat people with respect, including colleagues who are in the wrong.
When two principles pull in different directions, the earlier one in this list usually wins.
A worked example
Original example: four responses to one scenario
Mele is a medical student on a ward placement. Looking at a patient's medication chart, she notices that a junior doctor, Dr Hassan, has written a dose that looks ten times higher than the one agreed on the ward round that morning. The nurse looking after the patient is due to give the medicine in half an hour. Dr Hassan has left for a clinic in another building.
How appropriate is each of the following responses by Mele?
- Tell the nurse looking after the patient about her concern straight away.
- Wait until Dr Hassan returns to the ward and raise it with him then.
- Cross out the dose on the chart and write in the one agreed on the ward round.
- Ask another medical student whether the dose looks wrong to them.
Answer: 1 very appropriate; 2 very inappropriate; 3 very inappropriate; 4 inappropriate, but not awful
1. A very appropriate thing to do. It protects the patient at once, and the nurse is the person who can hold the dose and have it checked.
2. A very inappropriate thing to do. Raising it with Dr Hassan is right in itself, but he is away and the medicine is due in half an hour. Waiting leaves the patient at risk.
3. A very inappropriate thing to do. A student may not alter a prescription, and Mele may be mistaken about the dose. This is acting beyond her role, however good the intention.
4. Inappropriate, but not awful. It does no direct harm, but another student cannot fix the problem, and it uses up time. It is not very inappropriate, because it does not itself put the patient at risk or break a rule.
Rating importance
The same two decisions apply. First ask whether the consideration should affect what the person does at all. Then ask how much.
- Very important: safety, honesty, confidentiality, consent, and whose responsibility something is.
- Important: things that properly shape how to act, such as a colleague's feelings or the effect on the team.
- Of minor importance: real but small, such as mild inconvenience.
- Not important at all: things that should not influence the decision, such as avoiding embarrassment for oneself, or what is easiest.
Judge the consideration as the scenario states it. Do not widen it into something the scenario does not say.
Pace
There are 69 questions in 26 minutes, about 23 seconds each. Read the scenario once, carefully, since several questions hang on it. Then give each response a few seconds: side of the line, then strength. Timing and time per question has the checkpoints.
Practise them
When you review, look hardest at the ones where you were one rating out, and read why the answer is not the neighbouring rating. That boundary is where the marks are. Try free Situational Judgement questions, or read the full Situational Judgement guide.
Official sources
Dates, fees and entry rules change every year. Always confirm them on the official page before you act on them.