The Professional Dilemmas (PD) section of the MSRA is a Situational Judgement Test (SJT) that evaluates your decision-making skills in real-world medical scenarios. It’s designed to assess key professional attributes like teamwork, empathy, coping under pressure, and maintaining professional integrity. Scoring highly in the SJT is crucial, as it significantly influences your overall MSRA performance and subsequent specialty ranking.

This article will guide you through the structure, domains, and best preparation strategies for excelling in the PD section of the MSRA.

What is the MSRA SJT Section?

The SJT is a 95-minute paper with 50 questions, split evenly between ranking questions and multiple-choice questions (MCQs). You’ll play the role of an FY2 doctor facing complex dilemmas across various clinical settings, from hospital wards to GP clinics.

Ranking Questions

These require you to rank 4–5 possible actions from most to least appropriate, based on how well they address the scenario. Marks are awarded based on how closely your rankings align with a pre-determined key.

Example of a Ranking Question

Multiple-Choice Questions (MCQs)

Here, you’ll select the three most appropriate actions from a list, earning up to 12 points per question.

Example of a Multiple Choice Question

Key Tip: Make sure you attempt every question. There’s no negative marking, so every question is worth an educated guess! 

Domains Assessed in the Professional Dilemmas Paper (SJT)

Your answers will be evaluated against three core domains:

  1. Professional Integrity
    • Acting in the patient’s best interest.
    • Taking responsibility for your mistakes.
    • Respecting colleagues and maintaining boundaries.
  2. Coping with Pressure
    • Staying composed under stress.
    • Adapting flexibly to unexpected situations.
    • Seeking help when needed.
  3. Empathy and Sensitivity
    • Understanding patients’ perspectives.
    • Tailoring care to individual needs.
    • Being non-judgmental and supportive.

Focus on these domains when ranking and selecting actions, as they guide the marking scheme.

Strategies for Excelling in the Professional Dilemmas - Our Top Tips!

  1. Know the GMC Good Medical Practice Guidelines
    Use this as your ethical compass. Principles like patient safety, honesty, and teamwork should guide your responses.
  2. Master Ranking Questions
    • Identify the best and worst options first. These are usually the most obvious. Then consider the middle 3. 
    • Avoid chronological reasoning—evaluate each action independently.
    • Think about what resolves the issue effectively, ethically and in the least steps/most directly. 
  3. Approach MCQs Systematically
    • Spot mutually exclusive options (e.g., “contact GP” vs. “send to A&E”) to eliminate incorrect answers. You shouldn't choose contradicting answers together! 
    • Combine actions that comprehensively address the problem.
  4. Prioritise Patient Safety
    • Always choose actions that prevent harm.
    • Rank unsafe or unethical actions lowest.
  5. Practice Timed Mock Tests
    • Aim for 25 questions in the first 45 minutes to stay on track.
    • Use realistic question banks like Revise MSRA to refine your approach.

Common Mistakes to Avoid in the MSRA SJT

  1. Overthinking the Scenario
    • Stick to the information provided in the vignette—don’t make any assumptions. 
  2. Ignoring Team Dynamics
    • Involve colleagues appropriately while respecting the chain of command. Escalate accordingly. 
  3. Delaying Critical Actions
    • Avoid solutions that unnecessarily delay addressing patient safety concerns.

Top Resources for MSRA SJT Preparation

  1. Revise MSRA’s Professional Dilemmas Question Bank
    • Over 250 questions tailored to the SJT format.
  2. GMC Ethical Guidance
    • Regularly review sections on confidentiality, safeguarding, and professionalism.
  3. Mock Exams and Feedback
    • Simulate exam conditions and reflect on your performance to identify areas for improvement.

Conclusion

Scoring well in the MSRA Professional Dilemmas paper requires a structured approach, consistent practice, and a thorough understanding of GMC principles. By focusing on key domains, avoiding common mistakes, and using tailored resources like Revise MSRA, you’ll be well-prepared to tackle the Professional Dilemmas paper confidently.

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