Deciding between ‘Appropriate, but not ideal’ and ‘Inappropriate, but not awful’

I think when deciding between ‘Appropriate, but not ideal’ and ‘Inappropriate, but not awful’ it is important to think about the positives and negatives of each response before then deciding which is greater. I will show you an example of this below. You don’t have to physically write it out each time; however, if you find you are consistently getting these scores wrong it may be worth jotting down a quick list. I largely recommend this because timing is commonly not an issue during the SJT. I commonly advise students to slow down and to dwell on the questions slightly more.

For example for this question:

During a surgical rotation, John, a medical student, observes a doctor performing a catheterisation (small medical procedure) on a patient. John did not see the doctor obtaining proper informed consent. John becomes concerned that the doctor may not have adequately explained the risks, benefits, and alternatives of the procedure to the patient.

How appropriate are each of the following responses by John in this situation?

a) Contact the consultant as you are concerned that this is a breach of patient safety.

As discussed above this will be neither very appropriate nor very inappropriate. Here are some Pros and Cons which will guide us between the other two options:

Overall I would conclude this is appropriate but not ideal. There is more positive impact by discussing with the consultant as it limits the potential for compromising patient safety (always really important). Also, the arguments against this are relatively weak, as, if patient safety and autonomy are being broken, the consultant should be made aware. Therefore, by clearly writing out the pros and cons of this action it becomes clear to see that overall this will have a positive effect, making it appropriate but not ideal.

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