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How appropriate is the situational judgment test in assessing future foundation doctors?

BMJ 2023; 380 doi: (Published 13 January 2023) Cite this as: BMJ 2023;380:p101

Rapid Response:

Re: How appropriate is the situational judgment test in assessing future foundation doctors?

Dear Editor,

The situational judgement test (SJT) is no less suitable for selecting foundation doctors than post-foundation doctors in training. Since the first time the SJT was used in selecting foundation doctors, there have been questions regarding its suitability for purpose and its contribution as part of the selection process to trainee attrition [1-3].

The statistically significant (p < 0.001) differential attainment between doctors of different ethnicities highlighted suggests that the SJT may perpetuate inequality, especially for an examination that has not been validated to measure professionalism appropriately – the competence the test intends to measure [3-5]. In addition, differential attainment in SJT scores means that ethnic minority doctors are less likely to be posted to their preferred locations and are, thus, more likely to leave their social support circle, resulting in decreased resilience, which is known to contribute to burnout and moral injury; possibly even attrition from training [1 6 7].

The utilisation of the SJT thus poses so many questions. Why is there a difference in the cut-off marks required for speciality training between different specialties? Is the expected 'level of attainment' different for the competencies measured by the SJT different for different specialties? Furthermore, if yes, why is that the case? Why does the radiologist require a significantly higher SJT score than the general practitioner to obtain a training post? Do the competencies measured by the SJT differ between specialties? If yes, is a score difference the most appropriate measure of this difference in expected competencies? Is there evidence that these SJT scores translate to better performance in the competencies measured in practice? The evidence so far shows that scores in the SJT do not translate to performance at fellow of the royal college (FRC) level examinations. Does the 50% weighting given to the SJT affect medical students' educational performance? From an accountability perspective regarding medical education, how specific and measurable are the 'learning outcomes' that the SJT measures in terms of Bloom's taxonomic levels, and what is the evidence that the SJT is meeting these outcomes? Should we be using more specialty-specific examinations?

1. Ogbu, II, Kaliaperumal C. The Future of Neurosurgical Training in the United Kingdom. World Neurosurg 2022;168:89-93. doi: 10.1016/j.wneu.2022.09.038 [published Online First: 20220914]
2. Walsh J, Harris B. Situational Judgement Tests: more important than educational performance? BMJ 2013;346
3. Najim M, Rabee R, Sherwani Y, et al. The situational judgement test: a student's worst nightmare. Advances in Medical Education and Practice 2015;6:577-78. doi: 10.2147/AMEP.S95023
4. Schubert S, Ortwein H, Dumitsch A, et al. A situational judgement test of professional behaviour: development and validation. Medical Teacher 2008;30(5):528-33. doi: 10.1080/01421590801952994
5. Patterson F, Sheridan S, Laidler S, et al. Analysis of the situational judgement test for selection to the foundation programme 2020: Techincal Report. Derby: Work Psychology Group 2020:29-34.
6. McKinley N, McCain RS, Convie L, et al. Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study. BMJ Open 2020;10(1):e031765. doi: 10.1136/bmjopen-2019-031765 [published Online First: 20200127]
7. Hunt J, Bristow P, Cooper R, et al. Workforce Burnout and Resilience in the NHS and Social Care: Second Report of Session 2021–22. In: Committee HaSC, ed. London: The Stationery Office., 2021.

Competing interests: No competing interests

07 February 2023
Ikenna I Ogbu
General Practice Specialty Registrar
Gloucestershire Hospitals NHS Foundation Trust
Department of General Medicine, Yeovil District Hospital, Yeovil BA21 4AT