Rank 5 from Best to Worst Action

SJT Textbook: Rank 5 from Best → Worst (Order All Five)

Rank 5 Scenarios MSRA

This guide dissects the Rank 5 Scenarios MSRA format. Ranking questions are the most cognitively demanding part of the Professional Dilemmas paper because they require nuanced differentiation between “Good,” “Better,” and “Best.”

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Rank-5 questions test your ability to order five actions from best (1) to worst (5). Unlike Best-of-3, you must judge *relative* safety and professionalism. The safest action that prevents harm or risk escalation is usually first, followed by proportional escalation, communication, and documentation.

These scenarios often involve safeguarding, time-critical deterioration, candour, information governance, unprofessional behaviour, or missed care. GMC standards expect immediate action to protect patients, lawful information sharing, honesty, and respect. Delays, passive monitoring, secrecy, and discourtesy fall consistently to the bottom.

You score highest when you prioritise:

1. Immediate safety or safeguarding,
2. Appropriate escalation,
3. Clear communication,
4. Accurate documentation, and
5. Constructive follow-up/learning.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Act immediately to protect life, limb, or safeguarding risk.
2. Escalate early to the appropriate senior or safeguarding authority.
3. Share information lawfully and proportionately where risk exists.
4. Use calm, respectful, private communication in sensitive situations.
5. Document accurately, objectively, and in a timely fashion.
6. Prioritise tasks that reduce risk before those that merely improve workflow.
7. Engage organisational pathways (MASH, senior, governance) rather than ad-hoc actions.
8. Create capacity where needed to prevent further deterioration.
9. Use clear, factual language without blame.
10. Avoid unverified assumptions or unilateral decisions when multi-agency input is required.

Avoid options that delay action, minimise risk, shame colleagues publicly, or involve poor documentation or unsafe delegation.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I’ll escalate to the appropriate senior and document clearly.”
* “Information can be shared lawfully when there is a safeguarding risk.”
* “Let’s discuss this privately to understand what is happening.”
* “I’ll record the concern objectively and outline the agreed plan.”
* “Thank you for telling me; you’re right to raise this.”

Safety first → Act early → Follow pathways → Escalate → Document.

📋 QUICK FAQ

Do I always rank the most urgent clinical task first?
Yes. Safety and safeguarding outrank everything else, including admin or courtesy tasks.

Should escalation come before documentation?
Yes. Act → escalate → then document. Documentation is never before safety.

Do respectful behaviours score higher?
Yes. Courtesy, privacy, and professionalism are always rewarded.

Can information be shared without consent for safeguarding?
Yes. When a child or adult is at risk, lawful sharing is permitted and expected.

Is passive monitoring ever correct?
Almost never in Rank-5. It delays action and is usually unsafe.

📚 GMC ANCHOR POINTS

• Protect children and young people – GMC, safeguarding duties.
• Share information appropriately when risk exists – GMC Confidentiality.
• Act promptly when patient safety may be compromised – GMP (2024).
• Raise and escalate concerns – GMP (Raising concerns).
• Treat people with kindness, courtesy and respect – GMP (Professionalism).
• Keep clear, accurate, contemporaneous records – GMP (Record keeping).

💡 MINI PRACTICE SCENARIO

A teenager discloses that their stepfather has threatened them and they are frightened to go home.
Best action: Make an immediate safeguarding referral, inform a senior, and document verbatim.
Why: The child is at imminent risk; GMC and local safeguarding pathways require immediate protective action.

🎯 KEY TAKEAWAYS

✓ Safety and safeguarding always rank first.
✓ Escalation is usually second unless integrated into the safest action.
✓ Documentation follows action, not before.
✓ Public shaming or WhatsApp use ranks last every time.
✓ Passive monitoring is rarely acceptable.
✓ Consent is not required to refer when a child is at risk.

🔗 RELATED TOPICS

* → Safeguarding Children
* → Raising Concerns
* → Managing Conflict in a Team
* → De-escalation Techniques
* → Self-awareness & Insight

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

Scenario:
An inpatient’s daughter says staff were rude and asks how to complain and access the notes.

Options:
A. Apologise and explain the complaints pathway with timescales
B. Provide PALS details and a named contact
C. Refuse and tell her to write to the Trust
D. Promise a response soon but do not log anything
E. Explore any immediate fix (communication, visiting times)
F. Explain the IG/SAR route for accessing records
G. Tell staff off publicly
H. Log the concern and share learning later

Example SJT — Rank 5 (best → worst)

Scenario:
A 7-year-old says: “Mum’s boyfriend hits me.”

Options:
A. Thank the child; avoid leading questions; same-day MASH referral; inform senior; record verbatim
B. Promise secrecy and send them home
C. Ask the alleged perpetrator for their version first
D. Share information lawfully without consent if risk; document the basis
E. Wait for parental consent before referring