SJT ranking questions are not about guessing what the examiner ‘wants’. They are about applying repeatable priorities when multiple actions are plausible. Your aim is consistency: the same principles applied the same way every time.
Core ranking intuition
When in doubt: immediate safety → escalate appropriately → act within competence → communicate clearly → document and follow up. Ranking questions usually test sequencing, not exotic ethics.
1
Rule 1 — Identify the risk (30 seconds)
Ask: Is there an immediate patient safety risk? If yes, the top-ranked actions reduce harm now (not later).
2
Rule 2 — Escalate early, but appropriately
Escalation is not dumping. It’s briefing the right person with the right framing, then staying engaged.
3
Rule 3 — Stay within scope while still acting
Do what you can safely do now, and escalate what you cannot. ‘Do nothing’ is rarely correct when a safe action exists.
4
Rule 4 — Communicate and align the team
Many SJTs reward structured communication: clarify, confirm, and hand over with a plan. Team functioning is often the hidden theme.
5
Rule 5 — Document and close the loop
If it matters, it gets documented. If it’s serious, ensure follow-up is explicit. The last-ranked options are often vague, passive, or defer responsibility.
Common failure mode
Over-indexing on ‘being nice’ instead of being safe. Professionalism includes empathy, but safety and appropriate escalation usually outrank reassurance.
SourceNHS England Medical Hub — PD paper (SJT) overview
Open Link