Integrity & Honesty
Joe Wolfensohn
Teacher
Contents
Integrity & Honesty
Why is integrity and honesty important?
- In clinical settings, this means being honest about mistakes, transparent in communication, and accountable for actions - regardless of personal consequences.
- This helps to uphold trust with patients and colleagues.
- Integrity strengthens patient safety, maintains public trust, and fosters a culture of openness.
What is integrity and honesty?
- The quality of being transparent and being trustworthy and reliable when no one is watching.
- Integrity means being truthful in their words and actions and not aiming to deceive or mislead others.
Example:
Being dishonest when a procedure has gone wrong due to human error and choosing not to inform a patient would be a serious violation of patient trust.
Why is this important in an SJT context?
- Assesses your ability to take responsibility and accountability when things go wrong.
- Your duty to uphold responsibility for your actions and acknowledging the impact that you and your colleagues’ behaviour can have on patients.
- Protecting patient safety and maintaining the doctor-patient relationship is an integral part of working as a doctor.
Key GMC quotes to remember:
"You must be honest about your experience, qualifications, and limitations"
"Never discriminate unfairly or abuse your professional position"
Tips and Tricks
Appropriate actions for integrity:
- Disclosing errors promptly, even minor ones.
- Admitting knowledge gaps rather than guessing.
- Challenging unethical behavior professionally.
- Respecting confidentiality without exceptions.
Inappropriate actions:
- Omitting or falsifying records to cover mistakes.
- Sharing confidential information casually.
- Prioritizing personal reputation over patient safety.
- Ignoring misconduct to avoid "rocking the boat."
- Patient safety first – Justifies difficult truths.
- Transparency builds trust – Colleagues and patients rely on honesty.
- Accountability is professional – Owning errors demonstrates maturity.
- Escalate doubts – If unsure, consult seniors or guidelines.
The GMC’s Good Medical Practice states doctors must "be honest and trustworthy" and "take prompt action if patient safety is compromised". This means disclosing errors, avoiding misleading statements, and challenging unethical behavior. The SJT assesses these principles through scenarios on errors, confidentiality, and professional boundaries.
While the SJT is less time-pressured than other UCAT sections (26 minutes for 69 questions), your responses should reflect the GMC’s emphasis on uncompromising ethical standards.
Question Types in the SJT
1. Appropriateness Questions
"How appropriate is it for [Name] to do this?"
Scale:
- A very appropriate thing to do.
- Appropriate but not ideal.
- Inappropriate but not awful.
- A very inappropriate thing to do.
2. Importance Questions
"How important is the following factor when deciding what to do?"
Scale:
- Very Important.
- Important.
- Of Minor Importance.
- Not Important At All.
3. Most / Least Appropriate Questions
Three actions:
- Choose the most and least appropriate.
- The third is a null option (neither best nor worst).
Worked Examples
Scenario 1: Most/Least Appropriate Question
A student accidentally breaks hospital equipment and worries about repercussions.
Difficulty: Easy
Report the damage promptly and offer to help rectify it.
Answer:
Most Appropriate.
Worked Solution:
Demonstrates accountability and ensures that the damaged equipment will be replaced.
Inform a trusted colleague to decide whether to report it.
Answer:
Null Option.
Worked Solution:
- Partial honesty but delays resolution and puts accountability in the hands of others.
- This does not ensure that the damaged equipment will be replaced.
Hide the equipment and pretend it was misplaced.
Answer:
Least Appropriate.
Worked Solution:
- Actively dishonest and unprofessional.
- Not replacing the damaged equipment could impact a patient’s treatment and safety.
Scenario 2: Appropriateness Question
A foundation doctor realises they forgot to document a patient’s allergy, but the patient suffered no harm. The consultant is unaware.
How appropriate are these responses?
Difficulty: Medium
Document the oversight immediately and inform the consultant.
Answer:
Very appropriate.
Worked Solution:
- Proactively ensures transparency.
- This allows the error to be identified and to prevent future similar errors from occurring.
Add the allergy to the notes without mentioning the delay.
Answer:
Appropriate but not ideal
Worked Solution:
- Corrects the record but is risky as decisions that may have adverse consequences may have already been put into motion. Furthermore this lacks full accountability.
- Not mentioning the delay could impact the patient’s future treatment.
Omit the allergy entirely since no harm occurred.
Answer:
Very inappropriate.
Worked Solution:
- Dishonest and risks future safety.
- Not documenting this could risk this error from occurring again.
Ask the nurse to document it instead.
Answer:
Inappropriate but not awful
Worked Solution:
- Shifts responsibility unprofessionally.
- This is not taking accountability for their own actions and is a violation of the FY1’s personal integrity.
Scenario 3: Importance Question
A medical student is pressured by peers to share confidential patient details for a research project.
How important are these factors?
Difficulty: Hard
Patient confidentiality is legally protected.
Answer:
Very Important.
Worked Solution:
- This is a serious violation of a patient's confidentiality.
- If the patient finds out about this they could be reluctant to participate in future research projects.
The potential academic benefits of the research.
Answers:
Not Important At All.
Worked Solution:
- Never justifies breaching confidentiality.
- Sharing patient details without the patient's knowledge is a violation of the patient’s trust.
Whether the patient could be identified from the data.
Answers:
Important.
Worked Solution:
- Influences severity but doesn’t change the principle.
- Regardless this is still a violation of a patient’s confidentiality.
The peers’ insistence that "everyone does it".
Answers:
Of Minor Importance.
Worked Solution:
Peer pressure doesn’t override ethics.
Worked Examples Video