Situational Judgment Tests (SJTs) to Measure Beyond Recall

by Karmen McMinn, PGY1 Pharmacy Community Practice Resident, Mississippi State Department of Health

In order to become a pharmacist, a student must receive a Doctor of Pharmacy degree. This means that they receive several years of education, but does all of that knowledge mean they will be successful? In addition to having a wide range of factual knowledge, pharmacists must also be able to display empathy towards patients and caregivers, work well in teams, and many other qualities that do not rely on the recall of facts.^1,2 These qualities (empathy, team player, etc) are sometimes be referred to as “soft” skills while being able to recall factual knowledge is often referred to as academic or cognitive skills.³ Some have argued that strong academic skills are inversely related to soft skills.^1,2 Thus, someone who earned straight A’s in those early science classes may struggle during advanced practice experiences.

One common requirement for pharmacy school admission is the Pharmacy College Admission Test (PCAT). The PCAT was designed to measure general academic ability and scientific knowledge. This background knowledge is something all students must have in order to be successful in pharmacy school. The problem with a test like this is that it only looks at a student's general academic knowledge while neglecting to assess other important skills a successful pharmacist must possess. For example, the PCAT does not assess a person’s ethical decision-making ability. This is where situational judgment tests (SJTs) might be useful. They can be an effective tool for assessing soft skills.^2,4

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SJTs are a type of psychometric test in which learners are presented with a realistic scenario or situation. Examinees are then presented with 4 or more actions they could take and instructed to pick the option they believe is the most appropriate – an action they would take in real life. The test taker is often asked to pick not only the most appropriate response but also the least appropriate response. In some SJTs, they are asked to rank the relative appropriateness of the responses from most appropriate to least appropriate.⁵ SJTs can measure traits not related to a person’s ability to recall factual knowledge.⁶ This can be done by making sure questions ask what the person “would do” instead of what someone “should do.”⁷ Skills that can be measured on an SJT include personality traits like conflict management, interpersonal skills, teamwork, and cultural awareness.^3,5 All of these skills can help identify people who would make amazing pharmacists that have the ability to interact with a wide range of people and work effectively as a part of a healthcare team.¹

In one study, investigators at Monash University in Australia developed an SJT. They used experts to evaluate the tool’s validity, reliability, fairness, and to determine the appropriateness of using an SJT as a formative assessment. This study appears to be the first to report on the development, implementation, and evaluation of SJT as a formative assessment for pharmacy students. They developed the test to help identify students that might need more training to develop the soft skills integral to becoming a successful pharmacist.³

Here is an example SJT scenario and directions³

Scenario
Nikhil, a pharmacy student, is working in a community pharmacy. A customer explains to Nikhil that she came to the pharmacy yesterday to collect some blood pressure tablets. However, when she arrived home, she realized that she had been given double the strength of the tablet that she required and has not taken any of the new medications. Nikhil arranges for the pharmacist to correct the medication and apologizes to the customer for the error. However, the customer looks angry and says, “sorry is not good enough.”

Response Instructions
How appropriate are each of the following responses by Nikhil in this situation?

Options: 
1 = a very appropriate thing to do; 2 = appropriate, but not ideal; 3 = inappropriate, but not awful; 4 = a very inappropriate thing to do

Responses

Inform the customer that he has already apologized to her and that there is nothing more that he can do

1. Tell the customer that he was not working yesterday
2. Tell the customer that she needs to calm down
3. Ask the customer whether she would like compensation
4. Ask the pharmacist to come and speak to the customer
5. Provide the customer with information on the pharmacy’s formal complaints procedure

The potential advantages of using SJTs in health professional curricula include building a student’s understanding of the concept “best” and “better” ways of performance and increases self-assessment skills. Self-assessment skills are an important part of continuing professional development. Providing students with feedback and the opportunity for reflection can help motivate further development of these soft skills. It can also be helpful to students by administering multiple SJTs so that they can see their improvement over time.^3,6

There are a few issues that educators should consider before implementing SJTs. First, it is important to make sure the scenario or situation is well described. There must be enough information for a student to be able to fully visualize the scenario. If a student cannot envision the scenario, it will be difficult for them to pick the “best” answer. Secondly, it is best to develop a scenario that does not force a student to choose an action that would go violate their personal beliefs and values.^3,7

Educators can use SJTs to help develop skills and traits, such as interprofessional skills and cultural sensitivity, that help students become better pharmacists. These tests can be used as a tool to assist with admission decisions but also deployed repeatedly throughout the curriculum in order to document change over time. By using SJTs for formative purposes, an institution can personalize the development of soft skills, focusing the student’s attention on weaknesses as well as uncovering strengths. In the end, every school wants to graduate well-rounded and well-educated pharmacists.^1,3


References:

1. Gilchrist A. Top 5 Pharmacist Personality Traits. Pharmacy Times. 2015 July 23.
2. Jones J, Krass I, Holder GM, Robinson RA. Selecting pharmacy students with appropriate communication skills. [Internet]. Am J Pharm Educ 2000; 64(1): 68-73.
3. Patterson F, Galbraith K, Flaxman C, Kirkpatrick CMJ. Evaluation of A Situational Judgement Test to Develop Non-Academic Skills in Pharmacy Students. Am J Pharm Educ 2019 [Ahead of Print]
4. About the PCAT. [Internet]. Pearson. 2019. Cited 2019 Nov 12.
5. Situational Judgement Test [Internet]. Psychometric Tests. 2019 Jan 9. [cited 2019 Nov 11].
6. Austin Z, Gregory PAM. Evaluating the accuracy of pharmacy students’ self-assessment skills. Am J Pharm Educ. 2007;71(5): Article 89.
7. Assessment & Selection. Other Assessment Methods. Situational Judgment Tests. United States Office of Personnel Management. 2019. Cited 2019 Nov 21.