The Professional Dilemmas (PD) paper is a Situational Judgement Test (SJT).

Aims of the Professional Dilemmas paper

The Professional Dilemmas (PD) paper is a Situational Judgement Test (SJT). A SJT is an assessment method which measures how a candidate believes they should behave when posed with a challenging professional dilemma.

The PD paper is not a test of knowledge of problem-solving ability, but rather aims to assess professional attributes (domains or competencies) which are considered to be important for successful progression through training and performance in one’s job role. There is no negative marking used.

Number of questions

As of 2020, the PD paper has been shortened slightly from 58 to 50 questions. This has been done to improve the candidate experience by reducing the number of questions to read and length of the paper and MSRA overall. The time allowed to complete the PD paper has been shortened accordingly.

This decision was made based on modelling work which showed the current high levels of reliability could be maintained with a shorter test that used the best quality items.

Context and setting

As the PD test is a measure of aptitude for entry to specialty training, it is set within the context of the Foundation Programme with the candidate assuming the role of an F2 doctor.

Although you are asked to assume the role of a F2 doctor, each scenario is reviewed by subject matter experts (SMEs) to ensure that the scenario does not contain any knowledge of procedures or policies that would only be applicable in certain localities or that are very UK-specific, as this would disadvantage certain candidates (such as International Medical Graduates).

To ensure the PD paper is relevant to those applying to any specialty, and to increase the overall face validity of the test, the blueprint also requires that items are based within a range of contexts and rotations that a Foundation Doctor would realistically find themselves in. Therefore, there is a mixture of items based in hospital settings (across a variety of wards or placements), general practice, out-of-hours clinics, as well as a few based outside of a medical context (where relevant).

Even where a setting is specified in the question, this has only been chosen to provide a context. The judgement required to answer the question is not specific to that setting.

Target domains

The PD test covers 3 core competencies.

Professional integrity

Behavioural indicators linked to this competency.

  • Open and honest with others; willing to admit own mistakes.
  • Treats others with respect and dignity and knows where personal/professional boundaries lie.
  • Able to balance ethical tensions in relation to demand, resources and expectations.
  • Strives for quality and manages risk.
  • Works proactively and is inquisitive in approach.
  • Takes responsibility for self, others and the health of the wider population.
  • Demonstrates a commitment to equality of care for all and strives to act in the patients’ best interests.
Coping with pressure

Behavioural indicators linked to this competency.

  • Understands and manages own emotions; understands the impact of these on decision making.
  • Willing to admit when experiencing difficulties and seek assistance where needed.
  • Readily employs tactics for managing own stress and pursues a healthy work/life balance.
  • Maintains a professional demeanour; remains calm under pressure.
  • Demonstrates self-awareness, understanding own limitations and how behaviour may affect others.
  • Accepts and manages uncertainty and change; responding flexibly when required.
  • Is resilient, managing criticism well.
  • Able to take on multiple complex roles and effectively balance differing responsibilities and commitments.
  • Capable of modifying behaviour to adapt to differing roles or skills required in the future.
Empathy and sensitivity

Behavioural indicators linked to this competency.

  • Employs a caring approach towards patients and colleagues.
  • Capacity and motivation to view situations from the patient/colleague perspective.
  • Demonstrates an understanding of others' situations and circumstances.
  • Takes a holistic approach to patient care and considers social, psychological and emotional factors as well as the wider healthcare system.
  • Empowers patients through involvement in their own care.
  • Acknowledges and explores the patient’s wants and needs.
  • Takes a patient-centred approach, treating patients as individuals.
  • Acts in an open and non-judgemental manner.

Item types and formats

There are 50 scenarios in the PD paper. Around half of the questions ask candidates to rank options in order and the other half are multiple choice. There is no negative marking, so you should attempt to answer all questions.

Responses to scenarios are usually actions taken to address the situation. Response options will be realistic and the "best response" will always be included. For scenarios where you are asked to consider the appropriateness of actions (whether ranking or multiple choice), there will be a mixture of good, acceptable and poor responses to the situation, as judged by SMEs. Completely implausible responses are not included as options.

Part 1: Ranking

You will be asked to judge the appropriateness of 4 or 5 independent actions and, for example, might be told: "Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)". These scenarios require you to think about the appropriateness of each of the different options presented. For these scenarios the actions are discrete actions and should not be thought of as chronological.


You are a Foundation (F2) doctor working on a busy orthopaedic ward. During an evening shift, one of the nurses asks to speak to you in confidence. She is concerned about one of your F2 colleagues, James. The nurse tells you that she has observed James making several mistakes today and when she told him this he burst into tears and said he couldn’t cope with this workload.

Rank in order the following actions in response to this situation.

1 = Most appropriate

5 = Least appropriate

  • a. Discuss distribution of workload with the junior medical team.
  • b. Speak to James about the nurse’s concerns.
  • c. Suggest the nurse advises James to make an appointment with occupational health as soon as possible.
  • d. Suggest that the nurse contacts your consultant to discuss her concerns about James.
  • e. Seek advice from your seniors as to how to support James.
Part 2: Multiple choice

You will be asked to select 3 most appropriate actions to take in combination, out of a total of 8 plausible actions. For example, "Select the 3 most appropriate actions to take in this situation".

These scenarios require you to think about the appropriateness of each of the options presented. The 3 most appropriate actions taken together should fully resolve the situation.


You are a Foundation (F2) doctor working in urology. You have just led a teaching session with the medical students. You had prepared a presentation especially for the session. Your consultant tells you that the feedback from the medical students was poor.

Choose the 3 most appropriate actions to take in this situation.

  • a. Ask for feedback from your F2 colleagues on your teaching skills.
  • b. Ask the consultant for more detailed feedback.
  • c. Arrange training on presentation skills from the hospital IT department.
  • d. Ask an F2 colleague to help you practice your next teaching session.
  • e. Do more reading on the subject in preparation next time.
  • f. Ask your consultant to observe you in your next teaching session.
  • g. Include this experience as a reflective entry in your Foundation portfolio.
  • h. Discuss this experience with your educational supervisor.

Item development

A well-established team of trained item writers, including representation from each of the specialties that use the MSRA in their selection processes, develop new content year on year. Some of this content is then piloted alongside the tests used live. As new specialties join the MSRA, they are invited to participate and engage with the process in order to enhance the overall validity of the test and to ensure that content it relevant for all applicants.

The development process is summarised below:

Item writing
  • Development of content by SME item writers.
Item review
  • Review of content by WPG item writing experts.
  • Review of content by SME item writers.
  • Finalisation of content, including language review to ensure fairness for all candidates.
  • Piloting of content alongside operational test.
  • Psychometric review of item performance.
  • Identification of levels of agreement between experts on the scoring key for each item, where SMEs complete the items from a F2 perspective.
Operational use
  • Scenarios which have performed well will be transferred to the operational bank.

Scoring process

PD scenarios are scored against pre-determined keys that have been determined throughout the development process. This means the scoring of the test is standardised and fair to all candidates.

Scoring ranking scenarios

The items in the ranking section (Part 1) require you to rank a series of options in response to a given situation. Answers are marked by comparing your response to the pre-determined key. The closer your response is to the pre-determined key, the more marks are awarded. You do not need to get every option in exactly the same order as the pre-determined key to obtain a good score on an SJT item. Given that there is no negative marking, and the way the scoring convention works, it is strongly recommended that all questions are attempted.

Scoring multiple choice scenarios

The items in the multiple choice section (Part 2) require you to select 3 response options from a minimum of 8 possible responses, which together are the most appropriate response to the given situation. As with ranking items, answers are marked by comparing a candidate’s response to the pre-determined key. There is no negative marking therefore it is recommended that all questions are attempted.

Related information

Page last reviewed: 27 July 2023
Next review due: 27 July 2024