Appropriateness Questions: Strategy

Appropriateness questions make up a significant portion of the SJT. They present a scenario and ask you to rate each action as "very appropriate," "appropriate but not ideal," "inappropriate but not awful," or "very inappropriate." This lesson provides a systematic strategy for approaching these questions with confidence.

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The Golden Rule: Rate Each Action Independently

This is the most important principle and the one most commonly violated.

You are NOT ranking the actions against each other. You are rating each action on its own merits. This means:

• Two actions can both be "very appropriate"
• Two actions can both be "very inappropriate"
• The actions do not need to span the full range of ratings
• You should evaluate each action as if the others did not exist

Why This Matters

Many candidates fall into the trap of thinking: "Well, Action A is the best, so I will rate it 'very appropriate,' and since Action B is not as good, I will rate it 'appropriate but not ideal.'" But Action B might also be "very appropriate" — it is just one of several good options.

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The Assessment Framework

For each action, evaluate it against these criteria in this order:

1. Patient Safety

Question	If yes...
Does this action put patients at risk?	Rate it "inappropriate" or "very inappropriate"
Does this action protect patients?	Rate it more favourably
Does this action address a patient safety concern?	Rate it more favourably

2. Professional Guidelines

Question	If yes...
Does this action violate professional guidelines (GMC, NHS values)?	Rate it "inappropriate" or "very inappropriate"
Does this action align with professional guidelines?	Rate it more favourably

3. Ethical Principles

Question	If yes...
Does this action respect patient autonomy?	Rate it more favourably
Does this action cause unnecessary harm (non-maleficence)?	Rate it less favourably
Does this action promote patient welfare (beneficence)?	Rate it more favourably
Is this action fair and equitable (justice)?	Rate it more favourably

4. Practical Considerations

Question	If yes...
Is this action practical and achievable?	Rate it more favourably
Does this action address the root cause of the problem?	Rate it more favourably
Is this a proportionate response?	Rate it more favourably
Could this action be misinterpreted or have unintended consequences?	Rate it less favourably

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The Four-Point Rating Scale: What Each Level Really Means

"A Very Appropriate Thing to Do"

This action:

• Directly addresses the core issue in the scenario
• Is ethically sound — respects patient autonomy, promotes welfare, causes no harm
• Aligns with professional guidelines and NHS values
• Is proportionate to the situation
• Is what a reasonable, competent professional would be expected to do

Examples of "very appropriate" actions:

• Raising a patient safety concern with the appropriate person
• Speaking to a colleague privately about unprofessional behaviour
• Seeking senior advice when uncertain
• Ensuring a patient has given informed consent before a procedure
• Apologising and being honest when a mistake has been made

"Appropriate, But Not Ideal"

This action:

• Has some merit — it is not wrong, but it is not the best approach
• May address the issue partially but not fully
• May be slightly delayed or indirect (e.g., emailing when a face-to-face conversation would be better)
• May lack specificity (e.g., "keeping an eye on the situation" rather than taking concrete action)
• Is not harmful but could be improved

Examples of "appropriate, but not ideal" actions:

• Asking a nurse to pass on your concern to a doctor (rather than speaking to the doctor directly)
• Monitoring a situation before acting (when immediate action would be better)
• Offering general support to a colleague (rather than addressing the specific issue)
• Documenting a concern (appropriate) but not also communicating it verbally (not ideal)

"Inappropriate, But Not Awful"

This action:

• Is not recommended and has some negative consequences
• May be unprofessional but not dangerous
• May fail to address the issue and allow it to continue
• May be disproportionate (too aggressive or too passive)
• Does not directly harm anyone but does not help either