Understanding "Importance" Questions

Importance questions are the second format in SJT. Instead of rating actions, you rate considerations — factors that should (or should not) influence a decision. These questions test a different skill: the ability to evaluate how much weight a factor deserves when making a professional judgement.

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The Four-Point Scale for Importance

Rating	Shorthand	What it means
Very important	VI	This consideration is essential. Ignoring it would be negligent, dangerous, or unprofessional
Important	I	This consideration is significant and should be factored in, but it is not the most critical element
Of minor importance	MI	This consideration has some relevance but should not heavily influence the decision
Not important at all	NI	This consideration is irrelevant to the decision and should not factor in

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How Importance Questions Differ from Appropriateness Questions

Feature	Appropriateness	Importance
You are rating	Actions (things to do)	Considerations (factors to think about)
The question	"Should you do this?"	"Should this affect your decision?"
The skill tested	Can you identify the correct course of action?	Can you evaluate what matters and what does not?
Common errors	Confusing "ideal" with "not ideal"	Overweighting irrelevant factors; underweighting safety factors

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The Hierarchy of Considerations

When deciding how to rate a consideration, use this hierarchy (most important first):

Tier 1: Almost Always "Very Important"

Consideration type	Examples
Patient safety	Risk of harm, medication errors, deteriorating condition
Legal obligations	Consent, confidentiality duties, mandatory reporting
Core ethical principles	Patient autonomy, non-maleficence, informed consent
Professional duties	Duty of candour, duty to raise concerns, honest communication

Tier 2: Usually "Important"

Consideration type	Examples
Quality of care	Whether the action improves or maintains care standards
Communication	Whether relevant people are informed
Team function	Impact on team effectiveness and morale
Patient dignity	Whether the patient's dignity and comfort are maintained
Professional guidelines	Whether the action aligns with GMC or NHS guidance

Tier 3: Usually "Of Minor Importance"

Consideration type	Examples
Personal convenience	Whether the action is convenient for you
Time pressure	Whether it is near the end of your shift (when patient safety is not at stake)
Social dynamics	Whether the action will make you popular or unpopular
Administrative burden	Whether the action creates extra paperwork

Tier 4: Usually "Not Important at All"

Consideration type	Examples
Patient's social status	Their wealth, education, or social standing
Personal preferences about colleagues	Whether you like or dislike the person involved
Career advancement	Whether the action benefits your career (when patient welfare is at stake)
Irrelevant personal characteristics	The patient's appearance, lifestyle choices (unless clinically relevant), or personality

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Recognising "Very Important" Considerations

The Test

Ask: "If this consideration were ignored, could someone be harmed, a law broken, or a core professional duty violated?"

If the answer is yes, the consideration is very important.

Examples

Scenario	Consideration	Why it is "Very Important"
A patient needs a blood transfusion	Whether the patient has consented	Consent is a legal and ethical requirement
A colleague is prescribing medication	Whether the patient has any known allergies	Ignoring this could cause anaphylaxis or death
You are considering sharing information with a patient's family	Whether the patient has given consent for information to be shared	Confidentiality is a legal and professional duty
A patient is refusing treatment	Whether the patient has capacity to make this decision	Capacity determines whether the refusal must be respected

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Recognising "Not Important at All" Considerations

The Test

Ask: "Does this consideration have any bearing on patient safety, ethics, or professional standards?"

If the answer is no, the consideration is not important at all.

The Distractor Recognition Technique

Importance questions often include distractors — considerations that sound relevant but are actually irrelevant. Recognising these is a key skill.