Situational judgement testing at different stages of undergraduate medical training and the risk of professionalism lapses: A cohort study.

Introduction: Identifying medical students at risk of professionalism lapses is critical for future patient safety. Situational Judgement Tests (SJTs) are commonly used to assess procedural knowledge of professionalism. Evidence suggests SJT scores can predict professionalism lapses, though longitudinal data across different stages of medical training are lacking. This study investigates the relationship between SJT performance at three points in pre-qualification medical education and professionalism lapses.

Methods: A longitudinal study was conducted using linked data from the UK Medical Education Database (UKMED) and the University of Nottingham. Data were available for 705 students who sat a professionalism-focused SJT in their second year (2016 to 2018). Professionalism lapses were identified using concern forms. The study used scores from three SJTs administered at different stages: the University Clinical Aptitude Test (UCAT) at application; a Nottingham Medical School (NMS) test mid-training, and the UK Foundation Programme (UKFP) SJT, at the end of medical school. The relationship between SJT scores and the odds of a professionalism lapse was modelled using logistic regression.

Results: Performance on the NMS SJT was statistically significantly associated with the odds of professionalism lapses (Odds Ratio [OR] 0.64, p = 0.001) even after adjusting for educational and cognitive performance (OR 0.68, p = 0.005). The UKFP SJT scores showed a univariable (0.66, p = 0.006) but not an independent relationship with the outcome (OR 0.77, p = 0.14). The UCAT SJT scores were not statistically significantly predictive of professional lapses, on univariable (OR 0.85, p = 0.34) or multivariable analysis (OR 0.92, p = 0.66).

Conclusions: SJTs can support medical professionalism in students. They are likely to be most effective in this context when they are administered during training, rather than as a selection measure for entry to medical school. Moreover, SJTs designed to have specific, professionalism-focused content and a limited cognitive load are most likely to add unique value in this respect.