Common SJT Scenarios

Certain scenario types appear repeatedly in SJT papers and practice materials. By studying the model approaches for each type, you can respond quickly and accurately in the exam. This lesson covers the most frequent scenarios and the principles that guide the correct responses.

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Scenario Type 1: The Struggling Colleague

Typical scenario: A fellow medical student or junior colleague is underperforming, arriving late, making errors, or seeming distressed.

Model Approach

Priority	Action	Rating
1	Speak to them privately and sensitively — ask if they are OK, express concern	Very appropriate
2	Offer practical support (help with revision, share notes, suggest study groups)	Appropriate, but not ideal (helpful but does not address root cause)
3	Encourage them to seek formal support (personal tutor, occupational health, counselling)	Very appropriate
4	Report them immediately to the medical school/employer without speaking to them	Inappropriate, but not awful (bypasses the direct approach)
5	Cover for their mistakes or do their work	Very inappropriate (enables the problem, risks patient safety)
6	Ignore the situation	Inappropriate, but not awful (fails your duty but does not cause direct harm)

Key Principle

Speak to the person first. Direct, private, compassionate conversation is almost always the correct first step.

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Scenario Type 2: The Patient Who Refuses Treatment

Typical scenario: A patient with capacity refuses a treatment that you believe would benefit them.

Model Approach

Action	Rating
Ensure the patient has all the information needed to make an informed decision — explain the risks of refusing, the benefits of treatment, and the alternatives	Very appropriate
Respect the patient's decision once you are satisfied they have capacity and are fully informed	Very appropriate
Ask the patient about their reasons for refusing — understanding their perspective may reveal concerns that can be addressed	Very appropriate
Arrange for the patient to speak with another doctor for a second opinion if they wish	Appropriate, but not ideal
Continue to try to persuade the patient to change their mind	Inappropriate, but not awful (borderline coercion; you should inform, not pressure)
Administer the treatment despite the patient's refusal	Very inappropriate (violates autonomy; potentially assault)
Discharge the patient for being "difficult"	Very inappropriate (abandonment of care)

Key Principle

Autonomy is paramount when the patient has capacity. Your job is to inform, not to decide for them.

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Scenario Type 3: Conflict Between Team Members

Typical scenario: Two colleagues disagree about a clinical decision, or interpersonal tension is affecting the team.

Model Approach

Action	Rating
Facilitate a calm, private discussion between the parties to understand both perspectives	Very appropriate
Focus the conversation on the shared goal (patient care) rather than personal differences	Very appropriate
Suggest involving a senior colleague or mediator if the conflict cannot be resolved directly	Appropriate, but not ideal
Take sides publicly	Inappropriate, but not awful (unprofessional and escalatory)
Ignore the conflict and hope it resolves itself	Inappropriate, but not awful (it will likely worsen)
Discuss the conflict with uninvolved colleagues (gossip)	Very inappropriate (unprofessional, breaches trust)

Key Principle

Focus on the shared goal of patient care. Professional disagreements are normal; what matters is how they are resolved.

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Scenario Type 4: The Mistake You Witnessed

Typical scenario: You see a colleague make an error — a medication mix-up, a protocol breach, or a documentation mistake.

Model Approach

Action	Rating
If patient safety is at immediate risk, take action to prevent harm (e.g., stop the wrong medication from being given)	Very appropriate
Speak to the colleague privately about what you observed	Very appropriate
Report the incident through the proper channels (incident reporting system)	Very appropriate
Encourage the colleague to self-report the error (supporting them through the process)	Very appropriate
Say nothing because the colleague is your friend	Very inappropriate (patient safety overrides personal relationships)
Announce the mistake publicly in front of the team	Inappropriate, but not awful (the issue should be raised, but not this way)
Report only to the colleague's supervisor without telling the colleague first	Appropriate, but not ideal (correct to escalate, but better to speak to them first unless safety is at immediate risk)

Key Principle

Prevent harm first, then address the error through appropriate channels. Honesty and transparency are essential.

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Scenario Type 5: The Overheard Inappropriate Comment

Typical scenario: You overhear a colleague making a discriminatory, offensive, or unprofessional comment about a patient or another colleague.

Model Approach