Every ICGP SJT ranking scenario has a published correct order that your response is marked against. That order isn’t random. Read enough scenarios and the same handful of principles keep showing up, applied the same way, case after case. GP Journey calls these principles the Rules of the SJT, fifty in total, each one covering a pattern the exam rewards or penalises consistently. The five below are free to read in full, no account needed, in the exact same format every rule gets inside the platform: a real scenario, five ranked responses, and an explanation for why each one sits where it does, not just which one is “correct.” If you’re sitting the SJT alongside the CPST this November, these are worth learning properly rather than skimming. For how both tests fit into the wider 2027 application process, see our full guide.
Every worked example below follows the real ICGP ranking format: five responses, ranked from most to least appropriate, with partial credit for a near-correct order. That’s deliberate. Candidates who only learn to spot the single best answer leave marks on the table in positions 2 through 5. For the full breakdown of how ranking and multiple-choice items are actually scored, see our ICGP SJT 2027 guide.
Patient Safety Comes Before Everything Else
Not hierarchy, not workload, not the discomfort of speaking up. Nothing outranks an immediate threat to a patient.
The Nuance
Why this trips people upThe SJT is, underneath everything, testing whether you’ll act on a real-time patient safety concern even when it’s socially uncomfortable, whether that means interrupting a senior colleague, pausing a procedure mid-way, or contradicting someone with more experience than you. This isn’t just exam logic: the Medical Council’s guidance on raising patient safety concerns places a direct duty on doctors in Ireland to raise concerns if they believe a patient is at risk of harm, and to practise and promote a culture where those concerns are acted on.
The Strategy
How to apply itIf an option stops an active mistake or removes an immediate threat to a patient, it ranks first, almost regardless of who’s involved or how awkward the moment is. Speed matters here: raising a concern before harm occurs consistently outranks the same concern raised afterward.
Worked example
You’re an SHO on a fast-moving ward round. Your consultant tells the team to start IV gentamicin for Mrs. Doyle, 82, who has stage 4 chronic kidney disease and was admitted overnight with a chest infection. You don’t think her renal function has been checked this admission, and gentamicin can be dangerous at standard doses with this level of impairment. The consultant has already moved on to write up the prescription.
- 1BestCalmly interrupt and state your concern about the gentamicin dose, before the prescription is finalised.
The only option that acts before the drug is written up. Timing separates prevention from correction.
- 22ndAsk to quickly check her renal function results, then raise your concern with the consultant immediately after.
A reasonable check if it genuinely takes seconds and the prescription hasn’t gone through yet.
- 33rdWait until the ward round moves on, then quietly flag the concern to the nurse in charge of the drug round.
Still reaches someone before the dose is given, but adds an unnecessary layer of delay.
- 44thSay nothing during the round, but check the chart afterwards and raise it once the round has finished.
By then the prescription may already be on the chart and awaiting administration.
- 5WorstAssume the consultant has already reviewed her renal function, since they’re more experienced.
Talks yourself out of a genuine safety concern based on hierarchy and assumption alone.
Fear of challenging seniority is a common reason candidates under-rank a patient-safety action. The SJT explicitly penalises deference to hierarchy when it conflicts with patient safety.
Apply the Four Ethical Pillars
Every SJT answer rests on four pillars, whether the scenario names them or not: autonomy, beneficence, non-maleficence, and justice.
The Nuance
Why this trips people upMost scenarios never mention ethics directly. Every one of them still has an ethically correct answer, because these four pillars are the standard framework medical ethics in Ireland and the UK is built on (autonomy, beneficence, non-maleficence, and justice — the Beauchamp and Childress “four principles” approach taught throughout medical training). Learning to check an option against all four, quickly, is one of the most useful habits you can build.
The Strategy
How to apply itAsk of each option: does it respect the patient’s right to choose (autonomy)? Does it do good (beneficence)? Does it avoid harm (non-maleficence)? Is it fair (justice)? An option that clearly violates one pillar, without a strong compensating reason, drops toward the bottom of the ranking almost automatically.
Worked example
Mrs. Nolan, a 54-year-old Jehovah’s Witness with a confirmed peptic ulcer bleed, is losing blood faster than expected. You believe she needs a blood transfusion to stabilise safely. She has capacity, is calm and clear, and tells you firmly that she understands the risk of not having a transfusion but will not accept one under any circumstances, consistent with her long-held religious beliefs. Her husband, waiting outside, doesn’t yet know how serious things have become.
- 1BestAccept her refusal, document clearly that she has capacity and understands the risks, and continue to manage her bleeding with every other clinically appropriate option available.
Respects autonomy while still fulfilling your duty of care through every avenue that doesn’t require her consent.
- 22ndAsk a senior colleague to independently review her capacity assessment, while continuing all other appropriate treatment in the meantime.
A reasonable safety check if there’s genuine doubt, though on the facts given her capacity is already clear.
- 33rdExplain the situation to her once more in case she wants to reconsider, then proceed to respect whatever she decides after that.
A single calm re-confirmation that she has all the information is standard practice, not pressure, provided you respect whatever she decides next.
- 44thAsk her husband to come in and try to persuade her to accept the transfusion, given how serious her condition is.
Worse than re-confirming with her directly: it brings in a third party to override a decision she’s already made clearly and competently, and risks breaching her confidentiality if she hasn’t consented to her husband being told how serious things are.
- 5WorstAdminister the transfusion regardless, given how serious the clinical situation is.
A direct violation of autonomy, and in Ireland, treating a patient with capacity against their clearly stated refusal breaches the Assisted Decision-Making (Capacity) Act 2015, which entitles a person with capacity to refuse treatment for any reason, including a religious one, even where the refusal may result in death.
Autonomy is one of the most frequently tested pillars in the SJT. A patient with capacity can refuse treatment you believe is necessary, and overriding that refusal ranks very low almost without exception.
Never Take Blame That Isn’t Yours
You can apologise for a situation without ever claiming responsibility for a mistake you didn’t make.
The Nuance
Why this trips people upWhen a colleague makes an error, the instinct to smooth things over with the patient by saying “I’m sorry I did that” feels empathetic in the moment. It reads as dishonest to the SJT, because it is: you’re claiming an act you didn’t commit, and it muddies exactly who’s accountable for what happened. The Medical Council’s guidance on truthfulness with patients is explicit that trust depends on truthfulness in every aspect of practice, including how doctors communicate with patients when something has gone wrong.
The Strategy
How to apply itYou can and should express genuine regret for what a patient has experienced, phrased around the situation rather than a false personal admission. Naming who actually did what, calmly and without deflecting, ranks above both dishonest ownership and evasive distancing.
Worked example
Mr. Egan, recovering from a hip replacement, angrily confronts you at the nurses’ station. He says he was given the wrong dose of his blood pressure medication overnight, leaving him dizzy and unwell, and demands to know why “you people keep making mistakes.” You weren’t on shift last night, but the chart shows the error was flagged and corrected by the night team.
- 1BestAcknowledge his distress directly, express genuine regret that this happened to him overnight, and tell him you’ll find out exactly what occurred and make sure he has a clear explanation.
Honest and accountable, without misrepresenting who did what.
- 22ndExplain that you weren’t on shift last night, but that you can see an error occurred and was corrected, and that you’ll look into exactly what happened.
Factually accurate and still responsive, though it leans more on your own position first.
- 33rdTell him clearly you weren’t involved and weren’t on shift, and suggest he raise a formal complaint if he wants it investigated.
Accurate, but cold. It protects you while doing little to acknowledge what he’s upset about.
- 44thApologise on his behalf as if you personally were responsible, to calm the situation down quickly.
Feels kind in the moment, but it’s a false statement that blurs who was actually accountable.
- 5WorstTell him you understand he’s upset but that these things happen occasionally on busy wards.
Minimises a genuine medication error and offers no real path to an explanation.
“I’m sorry this happened to you” is honest and scores well. “I’m sorry I did this,” when you didn’t, is a false statement, and the SJT scores it as one.
Put this into practice before November
These patterns click fastest when you see them across real scenarios, not just read about them once.
An Impaired Doctor Is a Patient Safety Risk
The SJT treats pushing through illness to help a short-staffed team as a risk, not a virtue.
The Nuance
Why this trips people upIf a scenario describes you as febrile, significantly sleep-deprived, or emotionally affected by something recent, staying on to “help the team” isn’t a virtue. It’s a clinical risk, in exactly the same category as any other safety hazard the SJT tests for. The Medical Council’s guidance on a doctor’s own health and patient safety recognises doctors are entitled to support when unwell, but is clear that a doctor’s own health must not be allowed to put patients at risk.
The Strategy
How to apply itThe top answer when you’re meaningfully unwell or impaired is almost always to tell your senior and step back, with cover arranged, rather than working through it. Stepping back is a professional obligation that understaffing doesn’t override.
Worked example
You wake up for a Monday morning shift with a temperature of 38.6°C, muscle aches, and a pounding headache. You know the medical ward is already down two doctors this week due to sick leave, and you’re aware your absence would mean the remaining team covering an already-stretched rota. You feel well enough to function, if a little rough, and briefly consider just taking some paracetamol before heading in.
- 1BestCall your registrar straight away, explain honestly how you’re feeling, and work with them to arrange cover before staying home.
Deals honestly with the risk you pose while unwell, early enough for cover to be organised.
- 22ndGo in, tell the registrar in person how you’re feeling, and ask to be reassessed for suitability to work once there.
Gets the concern raised, but going in first means potentially exposing patients before the decision is made.
- 33rdText the registrar to say you’re unwell but will try to come in for the busier parts of the day if you feel better.
A half-measure that leaves your fitness to work genuinely uncertain.
- 44thTake paracetamol, go in as normal, and push through the shift given how short-staffed the ward already is.
Treats short staffing as a reason to override a genuine fitness-to-work concern. It isn’t.
- 5WorstGo in and ask to be allocated only administrative tasks for the day instead of clinical duties.
A febrile doctor is still on the ward, still potentially infectious, and the decision to attend bypassed the registrar entirely.
Being short-staffed does not change the answer. A febrile doctor still on the ward creates more risk than being one person down for a shift.
Disclose Errors Fully, Even When No Harm Was Done
The patient’s right to know doesn’t depend on whether they’d have noticed otherwise.
The Nuance
Why this trips people upIn Ireland, the duty of candour is a professional and ethical obligation under the Medical Council’s guidance on disclosure after a clinical error (there is no separate Irish statute creating the duty, unlike the UK, which also has a statutory duty of candour for certain incidents). If an error occurs, even one that caused no harm, and even one the patient would never have known about, you’re still required to tell them.
The Strategy
How to apply itAny option built around waiting to see if the patient notices, or documenting an error without telling the patient, ranks at the bottom without exception. Full, honest disclosure, with a genuine apology for what happened, is the standard regardless of the outcome.
Worked example
You’re an SHO on a busy medical ward. While reviewing the drug chart at the end of your shift, you realise that Mrs. Kinsella was given her regular 8am dose of levothyroxine at 9pm instead, a full thirteen hours late, because the morning nurse missed it and no one caught the gap until now. Her observations are entirely normal, she says she feels fine, and she hasn’t mentioned noticing anything unusual all day.
- 1BestTell Mrs. Kinsella what happened, apologise clearly for the delay, explain that no harm appears to have occurred, and complete an incident report.
Meets the duty of candour in full, regardless of the good outcome.
- 22ndInform your registrar of the error and ask them to decide together with you how and when to tell Mrs. Kinsella.
Sensible, though ideally you’d already be planning to tell her yourself.
- 33rdDocument the late administration clearly in the notes and monitor Mrs. Kinsella for any delayed effects over the next day.
Good clinical follow-up, but silent on the one thing that actually matters: she still hasn’t been told.
- 44thMention it briefly to the night nurse so observations continue, without telling Mrs. Kinsella directly since she seems well.
Passes along monitoring but still avoids the actual disclosure the duty of candour requires.
- 5WorstWait to see whether Mrs. Kinsella develops any symptoms overnight before deciding whether disclosure is necessary.
Makes disclosure conditional on harm, which is precisely what the duty of candour rules out.
The duty of candour applies even when an error caused no harm at all. “No harm done” is not a reason to skip disclosure — a frequently misunderstood point on the exam.
These Rules Only Work If You Practise Them
Reading a rule and recognising it under exam pressure are two different skills. The gap between them is repetition: seeing the same reasoning pattern across enough different scenarios that it stops feeling like a rule you memorised and starts feeling like your own judgement.
That’s what the rest of GP Journey is built around: the full SJT question bank in the real exam formats, ranking items with partial credit and multiple-choice items with independent marking, plus domain-by-domain analytics so you can see exactly where your remaining prep time is best spent before November.
For the full breakdown of SJT format and scoring, including how the 40% weighting is calculated, start with our ICGP SJT 2027 guide. If you want a week-by-week plan for the run-up to test day, our SJT study-plan guide covers that in detail.
Frequently asked questions
Fifty. Each one covers a recurring pattern behind ICGP SJT ranking decisions, with a full worked scenario and an explanation for every ranked option. The five in this article are free to read in full; the rest are inside the GP Journey platform alongside the SJT and CPST question banks.
The rules are built from the recurring reasoning patterns found across ICGP SJT ranking scenarios, and each worked example is written in the same ranking format used on the real exam: five responses, ranked from most to least appropriate, with partial credit for near-correct rankings.
They work together. The Rules of the SJT teach the underlying logic; the question bank is where you apply it across hundreds of scenarios with full expert explanations and domain-by-domain analytics.
You’ve read 5 of the 50 Rules of the SJT.
Full worked examples for the rest, plus the complete SJT and CPST question banks with expert explanations and domain analytics, live inside your GP Journey account. It’s free to start, and HSE TSS eligible for most candidates.