1. The patient is the first concern.
The core principle of Good Medical Practice, this principle should be applied to every scenario you face. If a solution does not address the core patient issue, it cannot be the optimum answer.
2. Act as quickly as possible.
Solutions to the issues you face should be solved as fast as you can. If a solution to a problem sounds perfect, however it includes an unreasonable delay, it is not a perfect answer.
3. Be honest and trustworthy.
If a solution ever involves lying, cheating or hiding the truth, it is always a very wrong answer!
4. Treat each patient in each scenario the same way.
Some scenarios will make their characters sound difficult, for example with social issues or violent behaviour. A core medical ethical principle is justice - your approach to solutions should not be affected by these distractions, the patient is always the first concern, no matter who the patient is.
5. Identify who you are in the scenario, and be aware of your competency.
In each scenario, you will be told you are a different person, from Medical student to junior dentist - be clear when answering the solutions who you are acting as. Bearing this in mind, be aware of what you can and cannot do - for example a doctor can prescribe pain killers, and a medical student cannot.
6. Solving disputes locally and escalating appropriately.
You will be faced with scenarios where colleagues are poorly behaved and you will be asked how to handle this. As a rule, try to initially solve these disputes locally by discussing with the person concerned directly. If the persons behaviour is impacting patient safety, escalate the issue to a senior colleague in a time appropriate manor. Anonymous complaints to the hospital director are rarely a good solution! If patient safety is ever acutely at risk, for example in an intoxicated colleague scenario, protecting your patients is your immediate priority (not writing a formal complaint!).
7. Respect patient wishes.
Autonomy, as another core medical ethical principle, is something you should be aware of in the SJT. If patients wishes are explicitly stated in the question stem, these wishes should be respected in your solutions. Similarly, you should be aware of general principles surrounding capacity and when patients wishes can maybe sometimes be overridden. Patients always have the right to a second opinion and if they don’t want you to perform a procedure they are entitled to request this.
8. Protect yourself.
Although we already discussed that ‘The Patient is the First Concern’ is the SJT mantra, your safety is of equal priority. If a solution ever places you in a dangerous or uncomfortable scenario, this often is not the best answer. Equally, if a solution is expects you to keep a secret or lie about anything, it is also often incorrect.
9. When to break confidentiality?
Generally for every SJT scenario, patient confidentiality should be respected and only shared within the medical team caring for that patient. There are some situations where confidentiality can be broken (such as if the patient is a risk to themselves or others) and you should be aware of these situations. Equally, if confidentiality must be broken, the patient should be told this will happen.
10. Trust your instincts!
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The scenarios you face will be challenging and sometimes it feels like there isn’t a right answer. Overthinking the solutions an complicate an otherwise straightforward answer, if you are in doubt go with your instinct and trust yourself!