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MMI questions

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What are some of the challenges you foresee in your career?

- tiem commitment, sacrifices, takes away time from family, big famiily -disheartening that non-biological factors -however, rwarding- talk about grandfather's physician - no career is supposed to be easy, fulfilling nature will make the challenges doable, time management, prioritization

Tell me about a time you made a mistake approach

-Approach: same question as tell me about a weakness. Except asks you to explain a story that demonstrates your weakness. - Do not offer a story that would dismiss you as a candidate, make excuses for your mistake/behavior. -Make sure you express the consequences of the mistake and talk about what you learned, what you did to fix the problem, how you have changed, and are continuously working to make yourself better

Group questions

-Looking for team players, seeing how you would resolve the activity together -As the instructor: Use clear instructions and speak at a slow and steady pace. Not show condescending attitude, make sure you show understanding of the other person's position. Check in frequently to make sure they understand you. -As the do-oer: keep asking clarifying questions, do not be afraid to ask to clarify as many times as needed. Not asking questions can be a sign of passiveness. "Can I please tell you what I see in front of me right now, so that we know that we're on the right track?" This shows that you are taking a proactive approach to working as a team. -Admissions committees do not care about completion of the task; they're looking for a window into your communication and teamwork skills.

What makes a good physician and where do you fit in that category?

I think that a good position can be described by many different characters mystics but for me a good position is somebody who one has the interpersonal skills to interact with patients from different backgrounds and cultures and provide the highest standard of care to is somebody who is invested in notches the patient's illness is currently present but also all of the other non-biological factors that may be preventing this patient from getting healthy and see if somebody who leads by example. These are three qualities that I've been developing through my activities over the last few years and I would like to tell you more about how I've developed these qualities. The firstly I said that a good physician is somebody who has the interpersonal skills to provide the highest unit of care to patients from different backgrounds this M aspiration was instilled in me after an experience that my mom had after moving to the United States nine years ago where she really struggles with obtaining medical care because of her language barrier this situation was obviously extremely agonizing to watch but I learned that it's very important for physicians to take into account the background of patients and provide care of that fits in with that background so I think that interpersonal skills are extremely important in identifying what matters to patients I am and providing care the best fits their needs I have developed great interpersonal skills by working as a crisis counselor over the last three years I have helped out people and with various adversities and learn empathetic and compassionate skills developing these in our personal skills will definitely help me I am engage with my patients that are in the future secondly I said that a good physician is somebody who is invested in the non-biological factors that affect the well-being of their patients I think that this position should also be innovative in solving their challenges so I have been the cofounder of the healthcare start up called air med that seeks to improve communication between oncologist and cancer patients one of the things that we identified that was hold King cancer patients back from him the kind of recovery that we hoped for was just the overwhelming nature of the call as they were really unable to understand their treatments and participate in decision making and all of them were overwhelmed with the amount of medications they had to take by themselves at home so we created a comprehensive app that would address all of these needs I think that as a future physician I would continue understanding patients in a deeper light than simply the pathology of their illness and work creatively to improve patient care thirdly I said that if physician is somebody who leads by example and what I mean by this is a physician who practices what they are preaching for instants as a position I would have to teach my patients to lead a healthier lifestyle exercise eat healthy etc. I think that I would be able to make a deeper impact if I was able to connect with patients because I was doing most things too I think personal stories are a great way to establish a connection with people and one of the ways that I have been developing this leader ship skills was when I was working as the vice president of finance for my service already in college I eat made it a point to hold the finance presentations on to teach healthy finance practices to the third chapter members and it was important for me to be practicing them myself in college so that I could explain them in In a way that made the most sense for those people so I think yeah those would be the three qualities that I think that a good physician should have

How do you think your role as a physician fits in with your role as a member of the community?

I think that physicians beyond being healers should also be educators of the community and have the creative thinking to understand community needs and provide solutions and to do this they have to be immersed in the community so one of the things that we are aware of if that illness is affected by a lot of non-biological factors and often times are the medical clinic does not provide all of the resources that are necessary for a patient to get better so for instance person's income or the community that they are part of the culture of the community or her I am some aspects of the community they live in or their background prevents them from him from being healthy so what position should always focus on whether the suffering that they're treating is prevented full or whether there is a way to address it that is from a non-medical standpoint and the best way to do this is to be a big part of the community I think that by spending time outside of the clinic and the classroom physicians can't understand patients in a different light they can approach patients in a community setting and understand different aspects of their lives all of this knowledge will help them provide the best treatments for their patients that fit in with there with the patient's background and community secondly I think that physicians should also be educators of the community I think that education is a way that illness can be provided for instants spreading information about healthy eating exercising and lifestyle modifications is extremely Gordon in preventing illness and to be able to do this the physician has to be a part of the community and gain the confidence in the community community events are also where this knowledge can be important to patients. I think participating in healthy community events such as five case or am you know cooking events can be a great way for physicians to be a part of the community and advocate for a healthy lifestyle I think that by being a big part of the community physicians can understand patient meets and community needs and then be able to provide solutions that can creatively I trust the non-biological factors that affect illness.

Tell me about a time when you faced a conflict with another individual.

Roommate lawn moving service

Remember that the interviewers in MMI are testing you on:

communication skills; strength of your argument; consistency vs persuasiveness whichever is relevant in the situation; your fit for the profession based on your answers Communication skills: ability to listen, empathize, understand, body language, tone, pace, confidence in voice Strength of the argument: not defined by the content and the side you take but rather if you actually thought about the situation, considered multiple perspectives, if you accounted for ethical or moral obligations

Follow up questions to group performances

"How do you think you all did" -Key: Always speak positively about your partner's performance and more critically about your own performance. Whatever the reason for the incompletion of the project or errors that occurred, never blame your partner and always reflect on how you could have done a better job in your respective role.

What is your greatest weakness?

- Not having a work-life balance -Not saying no -Not being assertive when you need to do that

What is your opinion on underage drinking at college, have you seen that it affects education?

- There is a reason why 21 is the minimum legal drinking age in the US- alcohol affects cognitive development and frontal cortex development. Impairs judgment = more risk taking behavior, binge drinking, drinking and driving etc. Younger people who are still developing= their brain is more susceptible to the harmful effects and permanent effects of alcohol. In colleges, people drink at unsafe places like frat parties and house parties= unsupervised areas means that there is more chance of risk taking behavior or addictive behaviors. Also expose students to dangerous drugs. However, we have to also understand this issue from the perspective of college students --> away from home, want new friends, want to look cool, want to get along with people. Basic human nature to want to be accepted. --> many times social at college means going to parties --> peer pressure. Need a system in place that is protective against this and that takes into account the mentality of college students --> punishing system doesnt work- need a system that educates students. --> professors should be available for open and honest and nurturing discussions --> promote a culture where partying isnt the cool thing to do. The cool thing is to do what you want. Educate students on the effects of alcohol.

What is you opinion on medical marijuana usage? What about recreational marijuana usage?

-Pros: it is a plant based alternative medicine therapy that is relatively affordable compared to other medications. Research that it offers relief to patients suffering from cancer, chronic pain, seizures, glaucoma, to list a few. For people who dont have insurance and cannot afford medications and those who live in pain everyday and are dibilated by it, this therapy is very useful. Cons: the biggest con is that it is not regulated and FDA approved. Drugs that are commercially prodced undergo extensive clinical trials, numerous hearing, and approval from FDA. This means that we can be confident about the safety and efficacy of these drugs. They are regulated and patients can make informed decision about using these drugs. Marijuana is none of these things. Overall, I think it shows promise but more extensive research and legally approved by the FDA. -Recreational use- pros: compared to other substances, relatively safer and non addicting, does not alter decision making or affect as much as other substances like alcohol, does not affect organs like our lungs as much as cigarettes do. There are multiple ways of administration of marijuana which result in the same psychological effects without some of the risks. For instance, ingestion of marijuana eliminates the risks of smoking it. Cons: The cons are that we are not out of the woods. The thing about comparison is that it almost convinces us that the better alternative is the best and allows us to diminish its cons. When we say marijuana is in ways better to take than alcohol, we diminish the evidence that marijuana by itself is not a safe substance. There is research tha 1 in 4 people show dependence and abuse disorder with marijuana. Smoking it does damage our lungs. not a miracle drug that is good to take. No drug no foreign substance is good to take. Legalizing marijuana introduces people to drug use and encourages drug use for other substances as well.

What would have made patients comply with doctor's orders better?

1. Trusting relationship where patients are able to express the full extent of their medical history and medical problems. For instance, we have seen that many LGBTQ+ patients do not discuss their gender or sexual identity with their physicians due toa fear of stigma that is associated with these topics. This prevents the physician from using the patient visit as an opportunity for education, encouraging for preventative health screenings. If they have a trusting relationshi and the physician makes it known that they want the best for thier patient then aptients are more likle to comply with their orders 2. Education is v. imp- if they understnad their illness and the pros and cons of treatments, then they are able to follow those treatments better.

What is your favorite part of the cell? Tell m e about cellular respiration? How does the body obtain its energy?

I would say the cell membrane because I think its not talked about enough and given enough credit. The cell membrane allows nutrients, water, O2, creates an electric potential, communicates with other cells. All these functions are so vital for the cell. Without the cell membrane, the other organelles would not be able to funciton. Many substrates for other organelles come through the cell membrane so I would argue its a very important part of the cell.

What do you think about Dr. Kavorkian and euthanasia? How do you feel about euthanasia/Terry Schiavo case?

Dr kavorkian= american pathologist, physiican, advocate of physician aid in death.

How will you add to diversity at VCU?

General diversity question

What was the last book you have read? What is the best book you have read etc? Have you read Harry Potter or the DaVinci Code?

I am currently reading the body keeps the score, which is a book on how our brain processes trauma and how to heal from trauma. It is written by a physician and I was inspired to read this book due to volunteering as a crisis counselor. During the pandemic, people have been facing heightened adversities and we have seen record number of people using our crisis counseling services. I have spoken with a huge number of people facing different kinds of trauma, from illness to being in the house in a toxic environment, and this motivated me to pick up this book to better understand trauma and how to help these people. I have read harry potter a long time ago but I am very passionate about the movies. I have watched each movie at least 20 times.

How would you address the social determinants of health or non-biological factors that affect pts health?

I think that to truly eradicate or even diminish the non-biological factors that affect pts health, we need systemic changes in our society but as individual physicians, we can try to address these issues by Increasing access to health, education, and preventative care. I was the co-founder of a healthcare startup called Aermed that is currently in a pilot launch at UCSF and Vanderbilt. One of the things that the Aermed app does is offer a mode of communication between oncologists and cancer patients outside of the medical office. I think that similar initiatives where we creatively harness technology to bridge gaps can be beneficial. The second way is to educate. I think patients feel more empowered to take control of their health and overcome the barriers to healthcare if they understand their illness better. And lastly, preventative care and education on preventative care, such as making simple lifestyle changes, exercising, eating as healthy as possible can help prevent illness in people who are already battling social factors that affect their health.

What is the greatest ethical challenge facing medicine and how do you propose to overcome it?

I think the greatest ethical challenge that is facing medicine is diagreements between patients, family members, physicians, all parties involved on decisions related to treatment. Illness, especially death and end of life issues, affects not just the patients but also their family members and their community. So there are often times when family members and patient have different opinions on treatments. For minors and pediatric patients, their parents have the right to consent to or deny treatment for their children In both of these cases, we see that people other than the patient themselve have an opporutunity to make decisions about their health. When it comes to pts who are not minors and are debating treatments with their family members, As physicians we should make sure that all of the info to make decisions are offered to the pt and thier family members so everybody is informed. We should if pts want, be able to mediate the conversation and try our best to reach a resolution amongst them. We shoudl also encourage pts to create advanced directives so that their wishes can be clearly conveyed. With pediatric patients, our approach should be similar in which we educate parents on the treatment that they are about to agree to or deny. In case of children, it is inevitable for parents to make decisions. but as physicians, we have to effectively advocate for our patients, whether that is mediating conversations between family members and adult patients or trying to reach a resoltion with parents for pediatric patients.

You are notified that the hand sanitizer at the hospital has been running out more frequently than it should be. A week later, you are in the emergency room treating a patient for acute alcohol related poisoning. Two days later, you notice that the same man is consuming hand sanitizer throughout the hospital. What do you do?

Ion be would be to make sure that this person is OK and try to get them help if I do discover that they are suffering from substance use disorder. When I approach this patient I will make sure that I have a open and nurturing conversation where we are just trying to resolve this situation rather than accusing him of taking hand sanitizer from around the hospital. I would ask him why he has been doing so and give him a chance to express himself and explain himself. To make him comfortable in opening up I would let him know that our conversation will definitely be confidential and I am invested in his well being. Let's say that he is suffering from substance abuse. In this case I will definitely make sure that he is educated on how dangerous it is to be consuming this hand sanitizer. And the fact that he has been he being treated for acute alcohol poisoning clearly it is a dangerous situation should be in. I would make sure that he fully understands the risks of this act that he is doing. However I would express empathy to him and educate him on substance use disorder and let him know that seeking the substance that he is addicted to is because of changes in his brain and but it's not his fault so I'm not blaming him. I would definitely offer him a consultation to a psychiatrist or psychologist and I'll do my best to counsel him to go.

Make sure you know every inch of your application, including personal statement.

Need to go over aermed and publication

What is your opinion on illegal aliens using government resources? What is the physician's responsibility to indigents or illegal immigrants who do not have access to health care?

On one hand, illegal immigrants may often use govt resources for a task that improves our economy and allows them to take jobs that Americans wont take. It allows us to circulate more money in our country. However, in all fairness, those govt resources that are paid for by taxpayers money should be reserved for people who have earned the use of those resources- people who haven't broken the law, people who have gone through extensive immigration processes, paid expensive lawyer fees, legally obtained employment authorization, and pay taxes on their hard earned money. So overall, I think we have to address the reasonings behind why illegal immigration exists- lack of education on immigration process, immigration language is extremely cryptic, most people educated or not are unable to understnad it, there is general atmosphere of xenophobia which prevents immigrants from entering the country legally. Require systemic changes in our country. As far as healthcare goes, it is against the integrity of our profession to discrimate. Every person should have a right to healthcare. It should be obtainable by every person. When we as physicians say that we serve people, we are directly going against that if we begin discriminating. Discrimination based on age, sex, gender identity, legal identity etc etc has no place in a service profession. I don't think someone's status in the US is a piece of information that is useful for physicians- they are there to treat illnesses. No medical decision requires one to factor someones legal status. There could be circumstances where it is imp- for instance, lets say I have a pt who I am recommending to join a gym to exercise more. They say that the gym is not affordable for them because they don't have work authorization so they don't a job. In that case, that information is imp for me to know. But I have to see that as any other barrier that my patient is experiencing. My job is to help patients alleviate those barriers.

Have you ever had a strongly held belief that you changed? If so, how?

One of the strongest held belief that was very limiting to me, I was able to change. Prior to me getting rejected from medical schools for the first time, I believed that anything I do in life is affected by some outside forces. For instance, as an international student, my medical school application is dependent on whether the person reading it has biases or not, whether the school has previously accepted international students or not. Overall, my fate is in the hands of all these other factors. This was limiting because it shielded me from coming to terms that my success is in my hands. I used to feel a sting when my other friends did well and I would blame it on the situation, not myself. They did better because life is easier for them. When I was first rejected, these feelings overcame me and then I read about a blogpost where I read the quote that destiny is an excuse for waiting for things to happen rather than making them happen. This really stuck with me and made me realize that the outcome of my work and effort is in my hands. If I set my mind of doing something, i can make it happen. If other people can do it, I can do it too. It was an empowering, not limiting mindset now and I am glad I changed it because I am able to approach every task of mine differently, certainly with more confident.

Tell me about a time you got angry.

One particular time that I felt angry was a few months back when I lived with roommates. We were looking for a new lawn care service and had decided to split the costs between us. One of my roommates one day told us that she booked a contract with ther lawn care service and that they would start coming in and gave us an estimate of how much it would cost per person. Turns out that she had already booked a contract for a whole year without taking our budgets into consideraton. This situation made me very frustrated at first because we had discussed that it was imp for us to discuss our budget first before making any appointments. I was frustrated because it seemed a little inconsiderate to make a decision like that without consulting us first. Although I was angry, I know that anger is not a appropriate emotion to express in this situation. Whenever I get angry, i make an active effort to take a step back, and a deep breath and evaluate the situation from all perspectives. Knowing this roommate and how enthusiastic she is about landscaping, I figured that she got ahead fo herself in her enthusiasm and wanted to lead this project. When I approached her, I calmly discussed with her my viewpoint and she explained hers and it was as I suspected that she was just too enthusiastic about it. She apologized for not discussing with us first and I agreed that I would be willing to rebudget to make sure that this new lawn care service would fit my budgets.

Discuss a time when you were in over your head and how you dealt with it.

Over in yoru head= too deeply involved in something that you cannot get out or have tons of problems to face

Who was the most influential person of the 20th century?

This is a very difficult question because there are so many people who have contributed immensely to bettering our world. I would say that in my opinion mahatma gandhi contributed so much to our world. He was born in a prominent, respected family and studied law. He was very well known for living a very simple lifestyle, clad in only a cloth outfit as a mark of identification for the poor in India, and while he was from a white collar family, he led massive movements for farmers rights, women's rights, peasants, to lower land taxes, very well known for civil rights movements, especially non-violence movements against the british rule in india. He has inspired many civil rights movements after his time and impacted the lives of so many oppressed groups in India.

If I asked some of your friends and family "What is this guy's Achilles' heel?" what would they say?

That is a great question. I think my firends and family would say that my achielles heel is sometimes not maintaining a work life balance. I strive to do my best in all my ventures and often time overcommit myself. I have experienced the consequences of this myself- being exhausted, not being motivated enough, being stressed out- but I have recently realized how much this affects those around me as well. So although I want to pariticpate in eberything that I find interesting or I am passionate about, i have been making a consious effort to take time out for my frineds and family and for myself too. Ever since I have started doing that and living a balanced life, I have realized that I am able to approach my tasks with renewed sense of motivation and a fresh perspective.

How do you relate with other cultures?

To experienced our cultural awareness, I believe that there are three things that we can do- 1. motivation 2. cognition and understadning of culture 3. behavioral changes. So motivation means that we should be motivated to learn about other cultures, interact with people from other cultures and show a genuine interest in them. When I first moved to the US in the midst of high school, I truly expreinced a culture shock upon starting college because of the exposure I had. My friends learned so much about indian food from me while I learned about thanksgiving feasts. 2. A cognition component which means that we invest in learning why people think about a concept in a certain way and the influence of their culture on it. For instance, in medicine, we have to understand why our pts may be interested in alternative medicine. There are some cultures that have a heavy emphasis on it. 3. Behavioral component which involves us changing our behavior when interacting with people from other cultures and making sure that our gestures are not inappropriate with other cultures. Overall, with all this we can have meaningful interaction with people from other cultures and build relationships with them.

Your MCAT scores improved a lot, how did you do that?

To improve my mcat scores, one of the main things I did was change the way I approached the test. Firstly, I learned about the expectations that I should have of myself from a standardized test. I learned that I'm expected to be able ot apply concepts I already know. This allowed me to approach passages differently. 2. secondly, with a standardized test, I realized the I need a study strategy which involved a systematic schedule where I maximized the amt of practice questions I did to begin feeling confidence. Lastly, I told myself every day that mcat is just a test, not a mountain. This really helped me see it as something that I can conquer and improve my self confidence.

How would a friend describe you?

Well, my close friends would definitely talk about my strengths but also would be real with you and talk about some imperfections of mine. They would say that I am a very intuitive person, which allows me to connect with many different people. My strong intuitiion allows me to be empathetic when my friends need my support. My friends would also say that I am a person with a versatile personality and I have many different interests. Besides medicine, I am passionate about fitness, nutrition, especially intermittent fasting and vegetarianism, I am passionate about entrepreneurship, having co-founded a healthcare startup, and I am passionate about rescue animals. But like I said, they would be honest with you to tell you that one of the things I am working on improving is maintaining a work life balance. Sometimes I tend to overcommit myself but I have realized how important it is to take a step back and take one hour each day to just relax, watch tv, destress and pursue hobbies. It really makes you wake up the next day with a refreshed mind.

What area of medicine are you interested in?

Well, so far I have gained exposure in emergency medicine and allergy and immunology. I have shadowed other specialties but these were the ones that I got an extensive look into because I worked in these specialities. I'm not intent on one just yet and I will be going into medical school with all doors open. However, my personal and pre-med experiences have instilled a desire in me to establish long term and trustful relationships with my future patients. One of my goals is to understand and tackle the non-biological factors that affect the wellbeing of patients. My mom's health suffered because of her language barrier wehn we moved to the US. While watching her suffer was aonizing, the experience taught me that i need to understand the background of my future pts so as to provide them the highest standard of care. I would like to choose a specialty that would allow me to build deep enough relationships with pts to understand these things.

You have two patients who desperately need an organ transplant but there is only one organ available. One is a 18-year-old male who has been admitted to the emergency room multiple times due to overdose. The second patient is a 60-year-old female who is an outstanding member of the community, volunteering her time to the poor and needy. Who do you give the transplant to and why?

- Everyone has a right to recieve healthcare and a life saving treatment- any extraneous information about the person such as their gender, religion, contribution to the society should not be taken into consideration because that fundamentally means that we are assigning an organ on a merit based system. As long as both people benefit from the organ, they should be given equal consideration. However, what should be taken into account is the person's ability to strictly adhere to the treament plan that comes after transplant surgery. In order for the body to not reject the donor organ, the recipient must be able to and willing to do the necessary post surgical plan, then we cannot justify giving that person the organ because there is higher chance that that organ will not provide any medical benefit. With organs being such a scarce commodity, it is important for us to make sure there is justice in who the organ is going to and that here weighs over my duty as a physician to benefit each of my patients.

Describe a time you have failed at something in a non-academic setting.

- Talk about not covering for MA job- failure b/c it was unprofessional but also b/c I had failed myself when I had resolved to lead a balanced life. -Ever since I have made more of a conscious effort to make sure that I know my limitations, i have fund that not only do I perform better at the tasks I have commited too, but I also act professionally and dont disappoint.

Tell me about a time you made a mistake.

- Talk about not covering for MA job- failure b/c it was unprofessional but also b/c I had failed myself when I had resolved to lead a balanced life.-Ever since I have made more of a conscious effort to make sure that I know my limitations, i have fund that not only do I perform better at the tasks I have commited too, but I also act professionally and dont disappoint.

Give an example of a time you changed your position on a topic. Why?

A time that I changed my position on a topic was when I was working as the cofounder of my healthcare start up. My helper start it is cold air mad and it is an app that connects cancer patients with her oncologist outside of the medical office originally our app was inspired by emergency medicine where I was working as a medical scribe there were certain things that I had noticed that I want to tackled through the air med app so I was very passionate about reaching out emergency medicine physician's and business people and make our airman app an emergency medicine focused up. During the time that me and the remainder of my team that consisted of that engineer visit people when we were networking for different physicians we actually came across these oncologists at UC San Francisco they were looking for a team to build in our web for their patients although I was adamant on our app being focused on emergency medicine I am that's why I was hesitant to change my opinion on this topic however the way I was able to change my opinion was by having an open conversation with the remainder of my team and the oncologist themselves the business people on my team explain to me the value of utilizing a market Nied that the oncologist had identified and utilizing this opportunity where as speaking with the oncologist I was really able to see the passion they had for their patients and I wasI realized that no matter the specialty I would still be able to impact the lives of patients who are suffering and that's how I was able to change my opinion on this topic. From this experience I really learned the importance of keeping an open mind when you are working in a team obviously people coming with different backgrounds and have different perspective and ideas and so it's important to be flexible and respectful enough to listen to other peoples ideas I think that debate of this sword in a team can be extremely useful because it cannot only illuminate some of the flies in the existing ideas but also is a great way of understanding everybody else's strengths and complementing their strengths with your own I think that would be of this kind you can truly a.m. or achieve better ideas because of the deal the amount of time that I spent into thinking about the problem.

Describe a time you have failed at something in an academic setting.

A time when I failed at something in an academic setting was definitely when I was in my freshman and sophomore year of college I did not do so well in my courses and that is because as an international student I had moved to the United States from a country where the education system was vastly different I had moved two years prior to college and was experiences massive culture shock in which I was really struggling with switching from a memorization based education system to a analysis in critical thinking based education system. At this time I knew what I had to do to do well in my classes however I was more focused on my family because my brother was going through the mental health issues and I was focused on taking care of him and going back home every weekend to spend time with him. My grades definitely suffered because of this but one of the things that I did do to fix this mistake and get back on track was to ask my peers for help. It was a definitely a challenge is meant about the situation that I was in and asking them to help me adjust to this new education system. It was asking a lot of them. However my friends were very generous they helped me out by introducing me to teaching assistance to professors and showing me what you do in office hours and how to really do critical thinking problems in my classes the showed me some resources online such as Khan Academy where they they discuss the approach that they were taking two questions that I was struggling with an overhaul this really helped me a lot. Think fine I realize from this whole experience died you know obviously none of us were good at everything and when we fail it is important to recognize the reasons why we failed but also be able to ask for help.

Describe a time you needed to ask for help.

Tell me about a time when you had to build rapport quickly with someone under difficult conditions.

A time when I had to build rapport with somebody very quickly under difficult conditions was actually pretty regularly because I work as a crisis counselor. I've been working in this role for about three years now and I assist people who are facing different kinds of personal adversities. One of the things that I have assisted people with are suicidal thoughts. In these cases we have people text in pretty severe situations when they are contemplating suicide or often times people might even be have initiated the act and they are texting in to reach out for support. During this time you have to build rapport pretty quickly. My job during this time is to assess the severity of the situation and gain as much information about the situation. Engaging the person in an empathetic conversation while validating their feelings and being straight to the point definitely helps. So if I am asking if somebody has something sharp that they might cut themselves with I want to ask that directly because it doesn't allow room for misinterpretation. In these situations you have to make sure that you are communicating efficiently and effectively while also empathizing with the other person's feelings and engaging them in a conversation. I'm sure that as a physician there will be many opportunities when I would have to build rapport with people on the spot and I think my crisis counseling experience will be very helpful.

Tell me about a time when you had to go above and beyond the call of duty in order to get the job done.

A time when I had to go above and beyond to get something done what is when I was the vice president of finance of my service already one particular semester a member of our sorority reached out to me and letting me know that she would be unable to pay her durdis because she was suffering from a mental illness and was going to be seeking help she had to quit her job and therefore she was really trying to make her ends meet so in order for me to approve her dues to be extendedI would have to ask the president of the chapter and the district advisor that we had. When I asked the chapter president I was adamant on not telling her The private details of the situation especially the fact that this person was and suffering from mental illness. She had asked me to try to get her to dues extended without mentioning this private medical information about herself. So I really tried my best and I presented the chapter president with an alternative budget this was because because of not receiving this persons dues our budget for our philanthropy activities would have to be changed. I really worked overnight for a couple of days and altering the budget and making sure that we would still be able to host our philanthropic events without the extra money that we would have received from the person. I really just wanted to make sure that herHer case would be approved. Unfortunately the president of the chapter denied the request but I continued working hard on the budget and once I told you to the district advisor that we had for a chapter I was able to get it approved. I am ultimately glad that I spent those nights working really hard on adjusting the budget so that I could have I am in the supportive information to get her case approved had I not gone in with the altered budget I don't think that I would've gotten her request approved. Overall I'm just really glad that I spent the time and I was able to advocate for a person that needed my help I think moving forward as well I would be happy to go above and beyond when I am doing some thing though if Ally aligns with my morals in the situation I've been really thought that it would be unfair for this patient person to be paying her do you listen so in the future as well I will continue to advocate like this for my friends and also my patients

Discuss a time when you went against the orders of your superiors.

A time when I win against the orders of my superior was when I was the vice president of finance in my service sorority the superior that I am talking about in this case is the president of the sorority so one particular semester a number of our sorority approached me letting me know that she would be unable to pay her dues because she had recently left her job because she was seeking help for a mental health condition now the issue here by side without her do you think we would be running short on the funds that we needed to plan our philanthropy events in my job was to make sure that we have enough funds to plan all of her philanthropic events properly so in order to get her request approved I would have to get the approval from the president herself are the things that I was adamant on was not discussing the confidential things that this person told me especially the fact that she was seeking care for her medical condition instead I told her that this person had quit her job and was trying to make ends meet which is why she would be unable to pay her do you know naturally the president denied this request by and even then I did not believe that it would've been fair for us to ask this person to pay her Deas I didn't think that she will need it to be burdened with finding the money to pay her to use while she was seeking medical care but also the fact that she wouldn't be attending any of the chapter events anyway so it would be really unfair to ask her to pay her dues. I think it were my morals hear that really propelled me to disobey the chapter president and contact the district advisor of out chapter. I worked and 90 create an alternative budget time took into account the less amount of funds that we would have had without this person stews and when I presented by to the district advisor I was able to get her case approved overall I am you know when I did approach the president I explain to her the reasoning behind me disobeying her and I think that she understood that I was just trying to do something that align with my morals. I think that the biggest take away from this whole experience with that although there are rules for behavior such as Obeying your superior so far and since you know in the future when I am a medical and student and in my clerkship I would have to pay the residence and physicians and it's important to understand that those over there for a reason but I think that it's also important to stay true to yourself and your morals and advocate for yourself and for your believes when you have to. If I hadn't gone against the orders of my superior the chapter president then I would not have been able to get this numbers do use them approved so I think in the future as well the key in the situations is to have a respectful conversation with your superior to let them know why he you chose to do so be them if the situation calls for talking to the superior first and understanding why they are not allowing some thing they think that then it is my responsibility to talk to them first ultimately my superior help would have more knowledge and experience than me and it's important to be able to be done but in case there is some thing I disagree with it's important to be able to voice my concerns.

Tell me about a time when you had a difficult communication problem.

An instance of a communication problem my face was when I was working as the vice president of finance of my therapist already as vice president finance one of my responsibilities was to allocate different funds to all of the different executive board members besides myself for them to utilize in the activities that they were planning. And one semester we were in the process of making budgets for each of the chapter officers but there were some last-minute changes to the budget that I wanted to make I announced this in one of my meetings and I asked the remainder of the exec board and not utilize any other funds until the changes to the budget have been made. One of the things that I didn't realize was the fact that one of our chapter officers was not present at the meeting. She had actually been working on a big project done she was going to withdraw money fryer for I'm in the upcoming weeks. I didn't realize she wasn't there and sell this minute miscommunication let her to utilize some of the money that I had been planning on not putting in her budget. Ultimately I am we were able to resolve this issue by making adjustments in the remainder of the budgets but I made sure line that we start taking notes during all of our meetings and forward all the notes to all of the executive board members after our board meetings in this way if there was something that was missed by anybody then they could look in the meeting notes.

In an operating room, you'll find many people: the surgeon, anesthesiologist, nurses, techs, etc. Who is the most important person in this room?

In the operating room if the patient present there I would argue with the patient is the most important person in the room everything that we should be doing should be him every decision that we're making should be in better benefiting the patient however if the patient is not there that would make an interesting question because I think that we're really moving away from a hierarchy in the medical field where the physician is on top of the ladder to a multidisciplinary team we're different people bringing their expertise and knowledge and skills and contribution equally to the team however if I had to pick one person as the most important person in the room I would pick the anesthesiologist and the reason why is because without the anesthesiologist expertise the surgery could not proceed. Everybody in the medical team realize on the anesthesiologist efforts to keep the patient sedated and pain-free as possible so that the surgery can continue obviously the people performing the surgery would definitely also be very important but without the anesthesiologist the surgery could not begin or with you at all.

Your patient is getting ready for surgery but is extremely anxious and nervous. Enter the room and talk to Maddie.

I have a patient called Maddie who is extremely nervous and scared about her surgery. Ask her physician it is my job to make sure that my patient is comfortable with the procedure that she is going to go under period to help Maddie feel less nervous and anxious , I would first of all go in and ask her what in particular is making her nervous . Let us say for example that she says she is very nervous about the fact that she is going to be nested size and it is that process that's making her very nervous. My approach here would be to validate and empathize with her feelings. I would express to her it is completely normal the way she is feeling, and it is completely reasonable to be feeling this way. I will tell her that anyone in her situation would feel this way. Then I would go ahead and explain to her the process so that she understands what it entails. I believe that educating patients is the best way to calm their nerves. After a educate her on what the process entails I would hope that knowing a little bit more about what's happening would help her nerves a little bit. I would ask her again how she is feeling and let's hope that she is feeling much better or much less anxious. Lastly I would reassure her that she's in the best hands and I would offer to provide her any comfort that I can within limits that I can being in the in the operating room period for instance I would offer to be right next to her and hold her hand before she is going under. Or I would offer to explain to her everything that happened once she wakes up.

Your best friend confesses to you that she hit a person a month ago while driving under the influence. She tells you that she kept driving because she was scared and feels really guilty about this incident. How would your respond?

In confronting my friend about this incident there are several things that I would like to keep in mind first of all it sounds like she is already pretty shaken up and she feels very guilty about the situation it really sounds like she was very scared and did not know what to do so she gave in to her instincts in fleeing the scene where she hit this person with her car it sounds like she didn't want to do this but her nervousness in her being scared really took over her and Obviously she knows that it was wrong of her to do hence she feels guilty right now. As her best friend, I would want to make sure that she is able to confide in me in the future as well so I would say to her that first of all I can't imagine how scary it must be to talk about this and to admit to this to somebody else I'm sure that she is also traumatized by this scenario and it must have taken a lot out of her to be able to admit to doing something like this so I would commend her on her courage here I would also empathize with her and let her know that her feeling scared in the moment was completely valid she gave in to her instincts and that is natural it is normal and that is that is what she did. after empathizing with her and validating her feelings I would recommend her to turn herself into the police and tell them about the fact that she had hit this person. Ultimately if she hit this person and this person was seriously injured or even may have lost their lives it is her duty to turn herself in and make sure that that person's family deserves some justice it can be extremely hard to do so it's easier said than done obviously but in fairness to the persons family I would recommend her to turn herself in again I completely acknowledge that this is easier said than done it would be one of the biggest most courageous things that she would do to her turn herself in and it's very hard but I as her best friend would be so proud of her if she turns herself in because she is doing the right thing and she's being a good citizen she is owning up to her mistakes and she is paying for it in the way that is appropriate.

Describe a time when you worked with someone who did not pull his or her weight.

In my grad program we had a group paper to write in which we were supposed to do a significant amount of research and write a very extensive paper which meant that we had to work outside of the classroom for very long time . We had one individual in our group who we just were are Fortunately not able to schedule our meetings with period he was often I'm unsure if when he would be free and sometimes missed or meetings. Because this was a group project in each person had a specific amount of jobs to do we were really relying on him to complete his portion of the paper through the hot bar paper could be synthesized well and completed them this was obviously a very frustrating situation because we were being very flexible with our time also had a lot of other activities that we were involved in and we had switched around our meeting time at the last minute for long time many times and even then this individual would miss them miss the meetings. So as frustrating as it was we reached out to this person and approached him and respectfully talk to him about it without accusing him about what was going on in his life. Turns out that he was a dad and he had five children but he was taken care of at home him and his wife had very young children and so things just came up last talking where he wasn't able to make it. So I'm just glad that we were able to approach him and understand his situation better. Unfortunately, he was just not able to be a part of the group. He eventually reached out to the professor and discussed an alternative assignment for him.

Give me an example of a time when you were on a team and it didn't work out. What would you do differently?

You are a physician taking care of a male patient. After a complete physical exam and workup, you discover he has HIV. He tells you that he doesn't want his girlfriend to know about this diagnosis in fear that she will leave him. Enter the room and have a discussion with the patient.

In this case it sounds like my patient is infected with HIV an is scared about telling their partner about this state. In having a discussion with him there are few things that I would like to consider. First of all HIV/AIDs is a condition that has a lot of social stigma attached with it. I understand why this patient might be reluctant to tell his partner. Because he must have infected her but also he is confused and lost and probably really struggling with this diagnosis himself. Secondly I would consider my duty here to maintain his confidentiality but also the fact that there is another patient out there his partner which could be who could be infected. I would have to debate whether my confidentiality with this patient weighs more than being able to potentially be informing another HIV patient. So in having this discussion first of all I would make sure that this patient understands what the diagnosis entails and I would educate him on treatments and make sure that he understands everything there is to know about his illness. I personally believe that educating patients is the best way to help them navigate their diagnosis and also remove some of the anxiety and helplessness that comes with having a major diagnosis like this. Fortunately we are at a point where medicine is advanced enough that with medications, this patient is going to be healthy . I would make sure that we have an open and honest and nurturing discussion about this patient's mental health with regards to this diagnosis I would make sure that he is OK and make sure that he is comfortable enough to come to me with any questions. I would empathize with him if he is feeling very nervous but I would definitely encourage him to tell his girlfriend himself. I would tell him about importance of telling his girlfriend especially because there is the possibility that she is infected and it is something that we can treat in her. I would tell him die but I am a mandatory reporter to the public health Department and the specific info I would be providing them. I would encourage him to utilize an anonymous service of informing her so that she can be tested as well. Overall my approach with this patient would be to make sure that he is healthy; I am committed to my patient at the end you know I want to make sure that he is getting all his physical mental emotional needs satisfied; I will make sure that he is educated on this diagnosis and I would make sure that he understands that I am there for him to navigate this diagnosis.

A man has been taking care of his wife, who is in a vegetative state, for three years after she suffered severe brain damage due to cardiac arrest. She can breathe on her own but that is the extent of her abilities. He requests that her feeding tube be removed. What should you do as her physician?

In this scenario I have a patient's family member who is requesting to remove the patient's feeding tube after she's been in a vegetative state for about 3 years now. In this scenario there are multiple things that I will consider first of all this involves end of life care and ethical issues with regards to end of life care. The patients advanced directive will guide me as to the patient's desires and power of attorney. So I will definitely make sure that I am knowledgeable about this patient's advanced directive let's assume that she has listed her husband as her power of attorney. In having a conversation with the husband I will first of all empathetically and honestly explained to him how sorry I am that he is in the position he is in I can't imagine how difficult this decision must have been to remove his wife from measures that are keeping her alive . I will make sure that the husband has all of the information necessary on what will happen after removing the feeding tube and what this patient's next few days or trajectory of her illness will look like. I will educate the husband and make sure he has the emotional support that he deserves. I will offer to call any family members for him and involve any spiritual leaders that might be of importance to her husband. All of this is so that I am taking care of not just my patient but also her family members. I would personally support the decision of removing this patient from life supported because if we're just talking about the justice in which resources or allocated to all of the patients it sounds like this patient is on a trajectory of to death and she has been on life support for about 3 years. In fairness to other patients, our resources can be used to treat other patients. Overall, I will make sure he has all the information and support necessary to make this decision.

An 18-year-old female arrives in the emergency room with severe blood loss due to injuries she sustained in a car accident. As the physician, you decide that a blood transfusion is required immediately if she is to survive. You then realize that there is a card from Jehovah's Witnesses Church in her purse that refuses blood transfusions You cannot ask her any questions because she is in a coma. What do you do?

In this scenario it sounds like I had a patient who is a Jehovah's witness who is in need of her blood transfusion this issue is complicated by the fact that she is in a coma in this situation there are many things that I want to keep in consideration first of all if I were to give this patient in blood transfusion it would be against her cultural and moral values I would be blatantly ignoring and disrespecting them and also this patient being in a coma is not able to consent to this process to this procedure here in have the right to refuse or to her body if her interviews are severe enough she could die from these injuries. In this case I my duty to not do any harm and only benefit the patient would weigh against the need for consent from this patient because this is an emergency situation and a life threatening situation. If it weren't an emergency or life threatening situation my thought process would have been different . However I will go ahead and contact the ethical and legal teams at my hospital I would definitely discuss the scenario with them and make sure that I understand the laws of behind this situation. I would go ahead and give her the blood transfusion. Let's say she wakes up from a coma the next day and we talk about the care that she received. I would make sure that I am prepared for this conversation and explain my thought process and reasoning to her while being respectful of her culture and validating her feelings if she is upset.

You are a student working in a free clinic. After going through the scheduling, you notice that some appointment times are double-booked. Enter the room to talk to the receptionist about this.

In this scenario it sounds like I'm working at a free clinic and I've noticed that some of the appointment times are double booked the receptionist is in charge of booking patients so it sounds like this could be a mistake that she had while she was looking patient. In the scenario before approaching her I would want to make sure that I I remind myself of the few things firstly I want to make sure that the receptionist let's call her Ashley Ashley doesn't feel like I am accusing her of not doing her job correctly. I would make sure that I Ashley realises that I just caught a mistake and I just want to talk about it without sounding accusatory or condescending in any way. I just wanted to bring it to her attention. Secondly I want to make sure that Ashley and I talk about how you know double booking patients can be fully stressful for the team the medical team but also for patients themselves. So in approaching Ashley my conversation would go something like this. I would say hey Ashley so I notice that there why are some time slots in our home and our calendar that have been double booked I just wanted to check with you if that was a mistake. Let's see Ashley says that oh I'm really sorry I didn't realize that I had doubles booked patience. I would say to her I I just want to make sure that we are on the same page about booking only one appointment per timeslot because it can be really stressful for patients to have to wait longer and their double booked and the team the medical team is working with another patient it can be frustrating for them to be given an appointment but have to wait around but also it really stretches the medical team. Ultimately Ashley and I would both want to do the best for patients and make sure five patients and medical team overhaul have a good experience if we are double booked and working under a lot of stress. It is possible that you know working under stress and trying to get done as much as possible and being stretched can lead to some unintentional mistakes we want to avoid that with our patients. Lastly I would say to Ashley that hey Ashley I hope that you didn't feel that I was accusing you of anything I just wanted to point something out. It is totally possible that you know sometimes we just double book or do something without thinking how did it so I didn't mean to make you feel that you are being accused of anything I just simply wanted to bring it to your attention. So overall my approach would be to bring it to your attention but do it in respectful manner.

You have promised your best friend that you would attend their wedding; however, the day before the wedding, your dad has a stroke and is hospitalized. Enter the room and talk to your friend.

In this scenario it sounds like my best friend was counting on me to show up for her wedding but because my father is really sick he just had a stroke and he was hospitalised I am torn between going to my best friends wedding but also taking care of my father who'd likely needs me right now to be by his side and take care of his medical treatment. In this case personally I would on my way the two options against each other and would want to be there for my father and take care of him and support him when he sick especially because it's a serious illness such as a stroke. So my objective when I go ahead and talk with my friend would be to break the news to her in the most empathetic manner and no really expressed that I'm so sorry that I would not be able to attend her wedding. I would help her thought being her best friend it is obviously very important for me to be able to be there for her and because it's her wedding it's not something that happens over and over again for once in a lifetime lifetime thing it's not like there will be another chance to make it up to her. I would start by sitting her down and saying thought there is something important that I have to tell her period I would begin by telling her that my father thought his stroke and he is in the hospital and unfortunately because I have to be there and take care of him I would not be able to attend her wedding. I would listen to her and let her get upset if she gets upset about this and I would empathize her feelings and validate them. I would tell her that it is normal and totally acceptable of her to be upset in this scenario because if I were in her shoes I would be really upset about my best friend missing my wedding too. I would explain to her that my thought process behind picking My father in being there for him instead. I would make sure that she understands that I am very sorry about the situation and if there was anything else if the situation was any different I would definitely prioritize her period Lastly I would offer her to help her out in any way that I can with the wedding or be any other part of the wedding I could you offer her my support and be there for her on her important day.

A Native American man has broken his arm while working. Even in pain, the man asks for a medicine man and refuses treatment until then. What do you do?

In this scenario it sounds like my patient has broken his arm and he is in severe pain however he wants to have a medicine man present before we go forward with any medications. Here there would be several things that I want to consider first of all it is my duty to respect the autonomy and desires and cultural values of this patient . If he is making autonomous decision to not receive any pain medications it is my duty to to respect that. However I would be weighing this against my oath as a physician to not do any harm to my patients. In withholding medication from him I could be doing damage to this patient. For instance his fracture may be so severe and his pain may be so severe that he could be at risk for depressed breathing or a heart attack or stroke because of the severity of this pain. So therefore I would be weighing value to respect his autonomy and his culture versus my oath to not do any harm to him. My conversation with him I believe would go something like this I would first of all ask him respectfully why he believes that he wants to have medicine man present; understand his side and his values and culture and respect that. I will make sure that he understands the reason why I am counseling him to get pain medication I would make sure that he has all of the information that is necessary for him to make the autonomous decision to wait for the medicine man. I would try to reason with him to come to a compromise. Maybe we would be able to reach a compromise to give him an initial dose of pain medication and then wait for his medicine man to come. Let's say that in our conversation realize that this patient is a competent man who is making a competent decision with understanding all of the risks of withholding treatment and wants to go with his beliefs and cultural values of having a medicine man present. My respect for his cultural values and his autonomy would weigh against my duty to not do any harm to the patient.

You are working in a clinic for street youth when a 17-year-old girl comes in seeking pain medication. After a physical exam and thorough past medical history, you determine that she doesn't need them. She says she will see another doctor if you do not prescribe them. What would you do?

In this scenario it sounds like there is a 17 year old girl who is coming in and asking for pain medication in my analysis of the situation I have found that there is no pathalogical condition that is causing her pain. There are a few things that I would be concerned with here: first of all she's 17 years old so she is a minor and in this case would have to involve her parents in her care. Secondly if I have not found a pathological reason for her pain I would consider the fact that she is suffering from substance use disorder. I would definitely like to explore this with her but I would make sure that she understands that I'm not making any assumptions about her and I'm not accusing her or condescending her. Rather I am simply trying to understand the situation better and help her out in the best way that I possibly can . Thirdly I would be concerned with my duty to do the best for my patient and benefit them, which would be to give her pain medication versus not doing her any harm if she is addicted to pain medications. So when I approach her I believe that our conversation would go something like this: I would ask her firstly why she's asking for pain medication and I would explain to her that I haven't found any pathological reason for her pain. I would have a nurturing conversation with her where I try to understand if there is any chance that she is suffering from substance abuse. now she may get agitated if I come off as accusing and presumptuous. However I would explain to her that I simply want to make sure that I have considered every possibility an I am there to help her in a confidential and nurturing and in an empathetic manner. I would also ask her and explain to her that since she is a minor her care I would have to involve her her parents. I would tell her about my need to consult her parents before prescribing medication to her. In this case I'm going to assume that she is an emancipated minor therefore she does not need her parents permission for in making any medical decisions and I would assume thy she is not suffering from substance use. In this case then my duty is to offer her pain medication. I believe that if I don't give her pain medication it would be just disrespecting her basic dignity as a human being. If I were to not prescribe pain medication I would cause her undue suffering and that is against my morals and my oath as a physician to not do any harm to my patients. I would definitely offer her a combination of NSAIDS and alternative therapies and also offer her a referral to a pain specialist.

You are on call as the attending physician in the emergency room. At 1:00am, a 3-year-old girl is brought in. You realize that she has lost a lot of blood and a blood transfusion is her only chance of survival; however, Jehovah's Witness parents are adamantly against it. How would you react?

In this scenario it sounds like there is a child who is in the emergency Department with life threatening injuries and needs a blood transfusion however her parents are Jehovah's Witnesses which means that it is against their culture to receive these blood transfusions. In this situation there were there are a few things that I would like to consider first of all the child is a minor so her parents have the right to refuse or deny any treatment for her. however this patient's life is in danger and if she receives a blood transfusion her life could be saved. Therefore my duty to not do any harm to this patient by withholding the transfusion is in conflict with this patient's parents cultural values their autonomy and their right to make decisions for their child. The way I would approach this scenario is by having an open and honest conversation with the parents where I give them opportunity to express their viewpoints. I would want to understand their thought process. I would even offer to call a spiritual leader a cultural leader to mediate the conversation and so that they don't feel that and you know the world is against them. I will make sure they have a good understandingof the sitatuon from a medical standpoint, which means that I would ensure they understand the seriousness of the situation. Hopefully with explaining to them the seriousness of the situation, they will change their. However if they still do not agree I do think that my duty to do the best for this patient would weigh over her parents interest in this case I do know that there are laws regarding care of minors in emergency situations where I can speak with the legal team at my hospital or even get a court order if if that's how far things go where custody is transferred over to the court and would allow us to save this child's life. In other circumstances if this child's life was not in danger my actions would not be as extreme. If things get this far, I would make sure that her parents are involved as much as possible. I absolutely do not want them to feel helpless or no autonomy anymore or that their child has been taken away from them.

During a physical examination, you notice that your 12-year-old patient has been physically abused, showing signs of scar tissue and long-term bruising. When you ask the child, you see that he tenses up. Both of his parents are in the waiting room. What would you do in this situation?

In this scenario, I am suspecting child abuse, espeically phycial abuse, on a young chil who has bruises. When I asked him about his injuries, he seemed to get tense. In approaching this situation, the biggest thing I have to keep in mind is the child's confidentiality, what I mean by that I would want to make sure that the caregivers who I suspect of child abuse do not find out that the child explicitly told me about the abuse because there is a high chnace that the hcild will be punished for this with further abuse, beatings. There are so many cases where child beatings in rage have cost the life of the child. The last thing I would want is my efforts to be counterproductive by causing harm to the child. With that being said, I would approach this problem in 4 ways- first, I would immediately order a blood test to rule out clotting disorders that may explain excessive bruising on this child's body. This is so that when I confront the parents or launch a legal investigation that I have a good reason to do so. If the blood test were to reveal a clotting disorder and I had already begin investigating the bruises with the parents, I could have unknowingly broken trust and my relationship with the parents. Secondly, I would have an open and nurturing convo with the child in which I reassure him that I am there to help him and that he does not deserve the treatment that he recieved. It is possible that the child has been intimidated by the caregivers into telling a false version of the story. So I would be very careful of the details that the child tells me because that would give me clues into the situation. Ultimately, my goal of the conversation is to establish a trusting relationship with the child where they feel comfortable enough in being honest with me. I would do this with not just my words but also body language that is comforting. If the child reveals that there is indeed physical abuse, I would then contact the legal team at my hospital to further investigate the scenario. Next, I would speak with the parents in person and in private in order to guage a better understanding of their view point. I would ask questions in a unobstrusive way becasue again Ihave to be careful to not give them an inklination that could cause further damage to the child. I would ask questions about their home environemnt, the parents relationship, their income levels, any violence in the community, and I would ask them about their opinions of their child, I would ask what theri expectations are of the child, whether they think he has good behavior, and I would ask about any nannies or babysitters. Overall, all of these steps would give me a better idea of the situation and would allow me to best help the child.

A 9-year-old boy has presented to your emergency department for the sixth time this month for seizures. Upon questioning you find out his mother has been neglecting to give him his anti-epileptic medications. What do you do?

In this scenario, I have a child who has had recurrent seizures and his mom has not given him his seizure medication. Initially, this situation indicates that there could be some signs of neglect from his mom. If his mom has been neglecting to give him meds for a serious condition and has had to take him to the hospital multiple times, there could be further neglect that this boy is suffering beyond just his medications. However, before I hold a conversation with the mom about this explanation, I would investigate other potential reasons. As we know, many nonbiologic factros affect the wellbeing of patients. this inckudes income, access to meds, insurance etc. It is possible that this pt has not recieved his meds because his mom cannot afford them or her insurance does not cover them or maybe she has to travel very far to the pharmacy that sells this medication. There could be a variety of reasons that would explain this that have nothing to do with intentional neglect. So I would hold an open and honest and nurturing conversation with the mom and ask her if she has had trouble obtaining this medication. If our conversation appears suspicious to me and points me towards neglect as an explanation, then I would try to speak to the boy alone. Although he is only 9 years old, I would ask him questions to gauge an understanding in general if he is suffering from abuse or neglect. I would aslo try to investigate this situaiton by speakin with the child's neurologist or pcp, if he has one or any other member of the family. If all of these signs point to neglect then I would discuss it openly with the mom, but in a non-accusatory way. I would like for her to have a fair chance of expressing her opinions. I would involve the legal and ethics team at my hospital to further understnad the laws regarding neglect and child abuse. If needed, I would obtain a court order to transfer custody of the child to the state so his health can be properly taken care of.

You are a primary care physician (PCP) who has cared for Mrs. Carter for over 40 years. She has been diagnosed with a terminal disease and comes into your office asking for pills she can take when she is ready to die. What do you do?

In this scenario, I have a paitent who has a terminal illness and is asking me for pills to end her life. In approaching this situation, there are a few things that I would consider- first of all, my duty as a physician is to benefit my patient. In aggreing to this request, I would be doing harm to the patient by assisting her in obtaining medication that will kill her. However, physician aid in death is a practice that I eblieve is a compassionate oractice that allow spatients to chose the methods with which they die if they are already on the path to death and allows them autonomy and dignity in ending their life. During my conversation, I would ensure that the patient is competent and I would also discuss the repurcussions of this decision on her family and also discuss hospice and palliative care as an option.

You are a physician taking care of a patient with gastric cancer. You realize that your patient has occasionally been missing their chemotherapy and radiation appointments. You talk to the patient during your next appointment and realize that they've been seeing a homeopathic practitioner who has recommend they stop their treatment. How would you respond?

In this scenario, I have a patient who is undergoing chemo but have missed a few appts. When I investigate more into why they are mising appointments, I found out that they were taking homeopathic medicine and the physician had recommended him to stop chemotherapy. In this scenario, my biggest concern would be that the homeopathic medication that this pt is taking could interfere with the chemotherapy effectiveness and that he has been missing his appointments which can make his prognosis worse. However, I have to weigh my duty to have the best interest of the pt in mind by encouraging him continue chemo against his cultural beliefs and right to autonomy in choosing medical treatments. There are many cultures, including my own, that have a firm trust in homeopathic medicine and alternative medicine. and as a physician I would respect that. So in having a conversation with this pt, I would first ask them more about their beliefs. I would have a nurturing conversation about the medications he is taking and in my own time conduct research on the effectiveness of those medications. I will speak with the homeopathic physician myself to discuss this pts care. Ultimately, if this pt trusts the homeopathic physician and hopes to continue seeking treatment there, I would like to team up with the homeopathic physician and work together to treat our patient. I would discuss with the homeopathic physician why he/she believes that our pt should stop chemo and I would advocate in our conversation for the pt to continue chemo. Hopefully, our conversation will change the homeopathic physicians' opinion and we can both encourage the pt to continue chemo. In this conversation, i would also like to keep an open mind and learn more about homeopathy and its effectiveness. Ultimately, if my patient chooses to discontinue his treatment, I will have a conversation with them where they understand the risks of discontinuing his treatment and the factual evidence that I have found on homeopathy. When the pt is fully edicated on their treatment option,s if they still choose to discontinue chemo then i will respect their right to deny treatment.

As a physician, you are caring for a high-risk pregnant woman. The child's life is in jeopardy and delivery is urgently needed, but the husband won't agree to the procedure because there is a 10% mortality rate. What do you do?

In this scenario, I have a pregnant patient whose child needs to be urgently delivered, however her husband is not consenting to the procedure. In this situation, there are many things that I would have to consider- firstly, my duty to do no harm to my patient, which includes the child, which means that I would advocate as much as I can in favor of perfomirn the procedure. This I would have to weigh against the mother's and the father's right to autonomy and right to make decisions about this procedure. Based on the wording of the prmpt, I am assuming that the mother of the child is unable to consent because she is either incompetent or she has named her husband her power of attorney in making medical decisions, whihc is why we are requesting the consent of the father. I am going to be assuming this. So now, I would have to have a conversation with the father to understand his thought process and explain mine. In approaching him, I would aim to be as nonjudgemental and nurturing as possible and I would ask him to express to him his reasons for not consenting to the procedure. I would listen to him and empathize with his feelings. lets say that he says that the statistics of the 10%mortality rate is really makig him nervous. In that case, i would make sure that he understands the risks in leaving the hcild in the womb vs the 10% mortality rate. Hopefully with our conversation, he will agree to the procedure and as a parent he would be willing to take the risk of the statistics vs the risks of continuing the high risk pregnancy. If not, I would have to weigh his autonomy against my medical judgment. I would involve the ethics board and legal board at my hospital. Right now, I am not sure if any other measures can be taken. I do knwo that with minors, if they have a life threatening illness, physicians can involve courts to take temporary custody of children and allow for the life saving treatment. When I am a physician, I would have more information about how this applies to unborn children. With the help of the legal and ehtics board, I would weigh my duty to benefit the patient against my duty to respec the autonomy of the father.

A 14-year-old girl is diagnosed with terminal cancer. Her parents insist that you do not inform her of the prognosis. What is the appropriate response in this situation?

In this scenario, I have a pt with terminal cancer but her parents are insisting on me not telling her. In this case, I have a dilemma. On one hand, my pt is 14 years old and will be able to understand what is going on with her and what is likely to happen. As a 14 year old, I would have wanted to know and there is a good possibility that she would want to know her prognosis. As my duty is to my patient, I would want to make sure she has information about what is going on with her body. On the other hand, there is a good chance that her parents are asking me not to tell her either becasue they want to break the news to her themselves or they want to spare her the pain and suffering, anxiety, depression, hopelessness, helplessness that comes with a terminal diagnosis. Either way, their intentions are likely pure. To make a decision here, I would have two separate conversations, one with the parents and one with the patient. WIth the patient alone, I will ask her if I have news about her health, would she want to hear it from me or from her parents or not want to know. I will ask her how she makes decisions at home. Whether she consults her parents, whether she is mostly independent, or whether her parents make decisions for her. I will have the same conversation with her parents and ask the same questions. With these questions, I want to assess what is their normal culture at home. There are many cultures around the world where it is believed that the sick should not be burdened with news about their health so my goal is to understand the culture at home. I will also ask the parents why they believe that this information should not be shared with their daughter. The answers to my questions will ultimately help me make a decision. If the pt says that she wants to know what is going on, then I will advocate for her and have an pen conversation with ehr parents about why she should know her prognosis. Hopefully with our conversation, they will agree. However, if she does not want to know, I will support her parents if they decide to tell her by offering to be present during/after their conversation to answer questions, depending on whether or not they would like the privacy and offer any advise on what to expect, hospice care, and how to best spend their last few weeks or months together as painfree and symptom free as possible.

A 21-year-old female presents to the emergency room with vomiting, fever, and headaches. You realize that this is not the common flu but is likely bacterial meningitis. She doesn't believe you as her symptoms have gotten better after resting for a bit. She refuses treatment and decides that she going back to her college dormitory. What should you do as the physician in this situation knowing that bacterial meningitis can lead to death or permanent disability?

In this scenario, I have a young pt who I suspect to have bacterial meningitis but it sounds like she wants to not receive treatment but rather would like to leave against medical advise. My biggest concern in this situation are the consequences of leaving this ilness untreated- as the prompt say, this illness is known to cause permanent disabilities and even death. If I let this pt go, there is a chance that she will face these consequences when I could have prevented them. I am not sure right now whether this illness is contagious but as a physician I will have that knowledge. But contagiousness will be another concern of mine. However, she is 21 and mature enough to make her own medical decisions at least legally. It would be against her autonomy for me to provide treatment against her wishes. My approach in this situation would be to have an open and honest conversation with her where I explain my reasoning and express the severity of the consequences. I will assume that this illness is not contagious for our purposes right now. I will make sure in this conversation to assess her competency. I want to make sure she understands the consequences, is able to make a sound judgment and express her wishes to me. Lets say that I determine that she is competent. In this case, I will make sure that she is educated on worsening symptoms to look out for. Her autonomy will weigh against my duty to not do harm by letting her leave without treatment. I will make sure she understands the care she can provide herself and when she should return. I will also offer all this information in written form so that she can refer to it later rather than remembering it in her mind.

You are currently taking care of an 80-year-old woman after she fell walking down the stairs. As you enter the room to tell her the diagnosis, her son stops you and asks that you do not tell her. He is worried that it will upset his mom and make her recovery more difficult

In this scenario, I have an elderly woman who is injured. I have some new medical news about her injuries but her son does not want me to tell her to prevent his mom undue stress and distress. In this situation, I would be in a dilemma- as my duty is towards my patient, I would want to make sure that she receives full information about her medical care so that she is able to make informed decisions about her treatment. However, her son's intentions are pure and if there is a chance that this news would put tremendous emotional and mental stress on the pt and would interfere with her recovery, then I would be doing her more harm than good in breaking the news. In this case, I would have two conversations- one with the patient and one with the son alone. I will ask the patient if she would like me to tell her any bad news about her illness, even if I think it would make her upset. I would assess as well whether she is competent enough to understand her illness and treatments and is able to make sound judgments about them and express her judgment to me. I will have the same conversation with her son, where I would ask him what the normal culture is at their house. Does his mom live and make decisions independently or if he takes care of her and makes decisions for her. Lets say that I reach the conclusion that the patient although competent would like her son to take care of any deicisons and news. In that case, my patients mental health would be a priority over her autonomy and right for information. In fact, there are many cultures in which sick people are not burdened with medical decisions, it is common for their family to take care of everything while they recover.

An individual requests needles and syringes at their local pharmacy. They do not present with a prescription, and based on the records you can access, they are not receiving treatment for diabetes. When you refuse to sell him needles, he threatens that he will go do heroine with needles he found. What do you do?

In this scenario, it sounds like I have a patient who is requesting needles at a pharmacy but there is no medical indication for their need for needles. He is threatening that he will do heroin with needles he found somewhere if I do not give him needles. Based on this info, it is clear the reason why he is asking for needles. He himself has admitted to substance abuse. Here I would be in a dilemma- if I give him needles, then I would be going against my duty to do no harm to patients by assisting him with his substance use disorder. However, if he uses needles he found, there is a chance that those needles would be contaminated and he is at risk for getting serious illness like HIV. Either way, there is risk for harm to this patient and that is against my duty. Personally, I would not feel comfortable giving him the needles because I would not be comfortable with furthering his drug abuse problem. Instead, I will hold an open, non-judgmental and empathetic conversation with him where I will try to assess his drug use. There is significant research that shows that drug addicts are often aware of the consequences of drug use and want to quit; but their altered brain chemistry prevents them. There is a good chance that this patient would want to quit. I would use our conversation as an opportunity to educate him on the risks of using contaminated needles and substance abuse. Hopefully, our conversation will motivate him to quit using drugs. I will equip him with local resources such as narcotics anonymous programs, rehab programs. If he is not ready to take that step yet, I would empathize with him and tell him that I am there to help when he ready, that he can trust me and that I only want the best for him and also share any needle exchange programs because ultimately I do not want this pt to contract HIV or hepatitis virus.

Your maternal grandfather is 65 years old and has been diagnosed with a slow developing cancer that will kill him within the next few years. There is a procedure that will remove the tumor with no long-term side effects or problems, but the procedure has a 25% mortality rate. He wants to have the surgery, but your mother is worried and would rather he forgo the surgery. How will you solve this problem?

In this scenario, my grandafther wants to undergo a procedure that has a 25% mortality rate as he is diagnosed with a tumor that will end his life in a couple years. It is common for patients to want to undergo a procedure but their families be opposed to this. In resolving this situation, I will keep a couple things in mind- one, whether my grandfather is competent in making his deciison, his right tto have autonomy over his treatments, and the emotional nature of the situation which is affecting my mother. As a physiicna, I would determine if a patient is competnet by making sure he is able to understand all of the info regarding thier treatment/procedure, make a judgement about it, and clearly express their judgment and views and decision. I am going to assume that my gradnfather is competent. In this case, the dilemma is between my grandpa's autonomy over choosing his own medical treaments vs being coerced by my mother to not undergo the treatment. Firstly, I would approach my mom and empathize and validate her feelings. I would tell her that it is normal and natural to feel worried. Then I would ask her why she is worried. If sh eis worried because she doesnt fully understand the procedure, I would make sure that she does. If she is worried about the procedure's mortality rate, I would empathize with her. I would approach my grandfather and ask him whether he is adamant on making decisions or whether he is open to a discussion and the opinions of other family members. I will also make sure he understands the procedure properly and understands what that mortality rate number means. I am going to assume that my grandfather deginitely still wants to undergo the procedure. Because he is a competent individual, his autonomy weighs over the opinions of other family members. I will support my grandpa while explaining his side and advocating for him to my mother in the most compassionate and empathetic way.

A chronically ill patient has requested that she would like to have her code status changed to DNR. As she is eating dinner, she suddenly enters cardiac arrest and her daughter who is visiting requests CPR to resuscitate her mother. Enter the room.

In this situation, my chronically ill patient has requested to be DNR. However, once she entered cardiac arrest, her duaghter requested me to perform CPR. In this situation, there are a few things I will consider- firstly I will make sure to familiarize myself with the pts advanced directive. In particular I woudl be looking for any information on her daughter being her power of attorney. If yes, that means that this pt has given her daughter legal power for medical decisions if she is incompetent. I will check with the legal team at my hospital whether power of attorney can revoke a DNR agreement. If she can, then I would consider performing CPR. However, I also have to keep the pt's illnesses and trajectory of her illnesses in mind. If she is a 90 year old cachectic woman, then there is a chance that these extraordinary measures would cause more harm to her body than good. After taking these two things in consideration, I will make my decision on leaning or not leaning towards CPR. If her daughter is not her power of attorney, then the pt's wishes and autonomy will weigh over her family's needs. However, this doesn't mean that her family wouldnt want everything possible to save her. I will convey her wishes to her family and explain her reasoning and the medical reasoning for not performing CPR in the most compassionate and empathetic manner.

You are a physician who has just finished your long day at work and are finally able to go home at an appropriate time for the first time in weeks. You have already promised to meet your family for dinner. You suddenly receive a phone call from Mrs. Johnson, an 87-year-old patient in a nursing home who has been a patient of yours for 20 years. She's in need of medical attention, but refuses to see another doctor. How would you approach this situation?

In this scenario, my patient of 20 years called me for advise right as I was about to go home and meet my family. Here, my dilemma would be to stay behind and help my patient vs going home and being with my family. On one hand, my relationships with my patients are importnat and for me and this pt has clearly had a trusting and longstanding relationship with me, which is why she refuses to see another doctor. If I am completely unavailable, then our relationship may become strained. However, having a work life balance is so important to me as well. Although medicine is a service field, medicla education and job itself is known to burn out physicians. it is important for me to make sure that I spend time with my family, not only because I have responsiilities towards my personal relationships but also because this is a great coping strategy from burnout. If I dont take time out for self care, I will risk providing less than stellar care to my patients. In this scenario, i will stay behind to do an initial examination on my pt, assess her illness and then make sure that I sign off to a physician I lnow this pt will trust. I will make sure she knows that I care about her as my pt and that I would not leave her in anything but good hands and then head home to my family.

You are an emergency room physician taking care of a patient who has come in requesting painkillers for his back. After a physical examination, you find no injuries or other causes of pain. You review his medical chart and realize that he frequently comes to the hospital requesting painkillers. You politely tell the patient that you cannot provide painkillers. He tells you that he will inject himself with heroin if he does not get the painkillers. What do you do? Enter the room and proceed with the conversation.

In this scenario, there are many things I would want to consider. Firstly, it sounds like this patient has requested pain killers many times and there is no pathology I was able to find- this makes me suspect that this pt could be addicted to pain meds and may be looking to gather more. He may be suffering from substance abuse. However, at the same time, it is my duty to make sure that if a pt is complaining of pain then I believe them and provide relief. Denying a pt pain meds if they are under pain is a violation of their autonomy and basic dignity to be leaving them in suffering. I would have to consider that there could be severe negative consequences of this pt being in pain. He could have depressed breathing, stroke or heart attack from pain being so severe. My duty is to make sure that there is no harm that happens to my patients. Lastly, this pt is threatening to use heroin to subside his pain. In this case, I would have an open conversation with him. Want to help him out and only want the best for him, I do not want him to suffer but I cannot offer him meds if he is bluffing. Also threatening to take heroin. When approaching him, make sure I explain my side, non judgmentally, reporter or not will have to check with ethics or law boards at my hospital. I am here to get you the help you need. Happy to give NSAIDs, call the pain management specialist,

A patient has just been diagnosed with stage IV cancer with a terrible prognosis. You know that he will most likely die within 9 months regardless of course of treatment. The patient is visibly upset and concern for his future. What do you tell the patient? How do you go about this difficult situation?

In this situation I have a patient with a terrible prognosis and he is likely going to die in about 9 months I'm supposed to have a conversation with him about his prognosis. In approaching this conversation I would like to keep a few things in mind first of all death is a very anxiety inducing depression inducing hopelessness and hopelessness inducing outcome thought this patient is facing and so I would want to make sure that I am being as respectful empathetic and compassionate as possible. After discussing that there are no treatments available I would express to him how sorry I am and how upsetting this diagnosis can be I would allow him to take some time to process this. I am happy to talk to him about what the next nine months would look like whenever he is. I would also make sure that he has comfort and love'd ones support as he is processing this prognosis. I will ask him if he would like to have his loved ones be present or any conversations in the future. All of this is so that he does not feel alone in and feels as comforted and supported as possible. When he's ready to have the conversation I will empathetically talk to him about what his body and mind will be going through to best prepare him. I will explain to him the interventions we can provide to keep him as comfortable and pain free as possible by discussing hospice care. I will also make sure that we focus on how to keep his mental health as healthy as possible during this time. Explaining all of this this I would ask him Hospice and palliative care is something that he is interested in right of the bat or if he would like to spend time with his friends and family at home. pretty much I would like for him to tell me how he would want to spend his last few months. After educating him on his options, I will let him know that I am always there for him for any support any emotional and medical support as possible I am in there to educate him on any other options that are present for him. Although I've been focusing on educating the patient so far in our conversation right now I do think that it's really important but we do not burden this person with all these decisions right now and think ultimately his mental health and his emotions are the most important at this point. I've been working at the crisis counselor for the past almost three years and I have experience working with people for cities one of the most common things that we have seen is done a lot of times people fall into unhealthy coping mechanisms. I would make sure that I use this experience and knowledge of mine to educate my patient on healthy ways to cope with this grief and any of the feelings that will come with his death.

You have a patient with CF, a terrible autosomal recessive disease. As a geneticist, you have decided to do a DNA screen of the mother, father, and child to determine which genes are mutated and assess risk chances. Upon screening, you realize that the father does not have any mutations that could cause CF - the husband is not the boy's biological father. What do you do as the physician?

In this situation, I am a geneticist who is assessing a patient for risk factor for CF. Because CF is an autonomal recessive illness, each parent must be a carrier. In my investigation, I find out that the father does not have the CF gene, which means that he is not the biological father of the paitnet. To continue assessing the pts risk, I wold need to obtain a DNA test on his biological father. At this point, I do not know whether each of the three parties involved that his information afects severely- the mom, the father, and the patient, whether any of them know that the father is not the real father. I am assuming that if they knew, they would not have asked the non-biological father to undergo the DNA test. So out of the three people that this information affects, I would approach the mother to discuss this situation and this is because she is most likely the one to know who the real father is or be able to guess based on her sexual history. I will approach her privately and in person. To begin the conversation, I will ask her to sit down and tell her that I am going to be discussing something serious with her so that she is mentally prepared. I would break the news to her but make sure that I do so in a non-judgmental and non-accusatory manner. If this info comes as a surprise to her, I am sure that she would be going through an emotional roller coaster. I would empathize and validate her feelings and let her know that i am there to support her. I would let her know that I would maintain the confidential nature of this information. I would not feel comfortable with breaking this news to the remainder of the family because it is a very private matter that is between the family. I would explain to her that in order for us to find the risk of her child developing CF, we would need to do a DNA test on the real father. I would encourage her to locate him, express the situation. However, if she is not comfortable with doing that, Iwill do my best to calculate the risk factor with the information that I have. Lastly, I would express to her that I am there to support her in any way that she needs. I would be happy to refer her to a psychologist or a therapist and offer to research support groups or any local mental health services so that she is able to seek professional help in processing this life changing information and dealing with the consequences of it,

The night after college graduation, you attend a party with your best friend Julia and some other friends. Midway through the night, you see her leaving the party with a group. The next morning, Julia calls you and reveals that she drove home despite drinking that night. What would you talk to Julia about?

It sounds like Julia was drinking at this party and she drove home while she was under the influence. There are a few things in this scenario that I have to consider. Firstly, it looks like Julia drove and therefore put her own life in danger and that of others who were on the road, or even pedestrians on the sidewalk. It is an irresponsible thing to do not only put your own life at risk but also that of others. I would definitely want to make sure that Julia is cognizant of this and I would also ask her why she chose to drive while she was under the influence. Maybe there was an emergency at home; she had to rush home; maybe she was unable to call an uber or a cab. Maybe her phone battery died. There's a lot that could have happened that made her chose this decision, despite knowing that it was not the best decision. In approaching her, I would make sure that I have an empathetic and nurturing tone, not condescending or accusatory at all. Explain the situation, let her explain her side, make sure it doesn't feel like an interrogation, and rather she understands that I deeply and genuinely care about her wellbeing. Offer to have her call in the future if she need a ride home etc.

You are a third-year medical student doing your rotation in OBGYN. You notice that a fellow classmate, Michael, often shows up late or slightly hungover. One day you find him in the break room alone. You decide that you want to talk to Michael about this. What would you talk to Michael about?

It sounds like my classmate Michael has been showing up late or looks like he is slightly hungover when he arrives. In this scenario, there are a few things that I have to consider. Firstly, as student doctors and as professionals, we have duty to behave in public in a way that follows a code of ethic. Showing up hungover violates that and also compromises our ability to perform our best. Even if we were not physicians, making a mistake because our judgment was clouded or because we were under the influence has serious consequences. Not to mention, as physicians, we would be jeopardizing patient's health. On the other hand, there could be something going on in michael's life that is making him show up late to our rotation. Maybe he is a new parent, maybe there is a personal adversity he is dealing with. It sounds like he is hungover quite often, which suggests to may that there is a possibility that michael is suffering from substance abuse disorder. If I had to approach michael, I would ask him what's going on, empathize with him, validate his feelings, make sure he is okay. Offer to help him find a solution- therapy, find different coping mechanisms, find therapy groups or grief support groups.

Tell me about your greatest academic achievement and why.

My greatest academic achievement is the progress I made in improving my grades in my junior and senior year of college. I am an international student who moved to the US in 11th grade. I had already completed a majority of the high school coursework in my home country so I didn't really face any cultural shock until college. When I was in college, I was challenged by the different educational system. I had to transition from a memorization based education system to the one in US where analysis and critical thinking is valued. I didn't have any idea how to do this and I wasn't doing so well in my classes. Then i sought help from my peers. I asked them for education resources they could share. They offered me online resources like khan academy, shared videos demonstrating problem solving, introduced me to TAs and advised me on building relationships with professors. I was really able to improve my grades and I was amazed at how good a resource my peers can be. Ever since then I have never hesitated to reach out to my peers when I need help.

Tell me about your greatest non-academic achievement and why.

My greatest non-academic achievement has to be the personal growth and development I have experienced over the last few years. There are two things I want to talk about in particular- one is my improvement in study habits. During my SMP program at Georgetown where I took medical classes alongside medical studnets, I was able to exprience a medical education and build a very strong work ethic. I began highly organized and was able to compartmentalize different aspects of my life, which has allowed me to focus on my education and also other activities. My strong work ethic is the reason why I was able to balance my medical education alongside leading a healthcare startup as its co-founder to a pilot launch. Speaking of my healthcare startup, I was the co-founder and achieved tremendous personal and professional growth. Specifically, I leanred to step outside of my comfort zone and work in a team with software engineers and business people. I challenged myself to learn about these fields and diversify my knowledge, coming from a science background. I also learned to assert myself confidently in a team. All of these developments have enhanced my leadership potential.

Can you tell me about a significant challenge you had to overcome? How did you handle it?

One of the biggest challenges that I had to overcome was adjusting to education in the United States while focusing on my families particularly my brother who was suffering from mental health challenges so I actually moved to the United States in 11th grade in high school and the cultural shock and the drastically different education system generally hit me until I was in college because in high school I had covered most of the topics in my home country already so when I was in college I really had to transition from rote memorization to analyzing an applying concepts and critical thinking based classes this was really challenging for me like I said I was also very focused on why and my family during this time and I was actually traveling back home every weekend to help up my family so I wasn't able to focus as much on my classes and my grades definitely suffered here so in this case what ultimately helped me out was asking for help from my peers the definitely helped out by sharing the online resources that they were using that hard practice problems or any educational materials that explain how to tackle different classes they also introduced me to tas and pretty much taught me how to maintain relationships with professors I think with all of these resources I was really able to improve my grades and I'm definitely learned that it's totally OK to ask for help and it is it's much better when we work together and improve each other with our strengths.

Tell me about a time when others working with you disagreed with your ideas. How did you handle it?

One particular time when others disagreed with my ideas was when I was the cofounder of my healthcare start up Aermed working with the other cofounders and software engineers and business peopleon our team. Initially the aermed app which is now geared towards cancer patients with actually an emergency medicine app because it was inspired by the issues that I had seen while working as an emergency department scribe. During our research and networking phase we met the team of oncologist who had a similar vision as ours and needed a team to work with to build an app the rest of my team saw this as a wonderful opportunity in a market need and wanted to begin working with oncologist. Whereas I was opposed to this and wanted him to tackle some of the issues that I had seen in the emergency department. At first our disagreement was a little bit disheartening because I had a very clear vision for the app but what made me really get on board with the rest of the team was how we were able to have a respectful debate and exchange of ideas. My teammates who have a business background explain to me how opportunities must be taken advantage of whereas a deeper conversation with the oncologist I myself realize that they had a similar vision as me and emergency medicine or oncology I would be able to make an impact on patients. I learned that whenever we have disagreements it's really important to be able to listen to everybody's perspective and give everybody a chance to explain their perspective. I think that a respectful debate is healthy because it allows you to look at the ideas in a deeper light and that really illuminates the problems with the ideas and opens up an opportunity for improvement of the ideas.

When is physician-assisted suicide appropriate? Please explain your reasoning.

Physician aid in death when is it appropriate. It is when physician helps a patient who has a terminal illness and is on a trajectory to death to obtain medications that will end their life. There is a lot of controversy about this topic especially because some opponents say that physician assisted suicide is against the integrity of our profession in positions where we are supposed to help patients and not do any harm to them and make sure that every medical decision that is being taken is being is benefiting patient. Personally I believe that patience have the right to autonomy in which they decide the manner in which the want to achieve that. I believe that physician aid in death Is appropriate under few conditions first of all on a second there should be no treatment available and patients are on their way to death. Secondly for me the criteria would have to be that the patient is competent in making this decision which means that they are able to understand what the process entails what it means to make this decision not just for themselves but also for their families because as we know death is not a individual experience it is definitely a family and community experience I want to make sure that the patient is competent in understanding the consequences of this decision to not just himself but also his family members competency for me would also entail this patient being able to make a judgment of the situation and express their decision competently to me . I believe that physician aid in death is a compassionate act and it is a dignified act that allows pts to chose their manner of death. Rather than going through the suffering of pain that comes with having a terminal illness, anxiety and depression the helplessness hopelessness that comes with knowing that you are on a way to death and knowing that you cannot control when you die I think it is a compassionate thing for physicians to be able to help out patients overall I think that it is reasonable act if patients are competent and if they understand what it entails for them in their family members and if there is absolutely no treatment left for their illness anymore and they are just simply on the trajectory to death.

Tell me about a time when you handled a stressful situation poorly.

Recent experience where I handle a stressful situation poorly was in the middle of the pandemic when I was working as a medical assistant so prior to the pandemic we actually had three medical assistants leave our work leaving me and just one other MA behind so scheduling got really stressful specially because I was a part time employee one particular week the other MA wanted to go on a vacation and she asked me to cover for her on the days that I wasn't going to be present now I was in a dilemma because I had a lot of other things on my plate but I also knew that our physician and physician assistant really relied on us for a majority of patient care. So I reluctantly agreed to her and when the week came around I really just couldn't make it and I had to cancel last minute because I was so burdened with all of my other tasks. I think that canceling last minute put undue stress on the physician and was obviously also unprofessional. I took a big lesson from this incident I realized that it is important to say no when you have to. I know my limitations. If I had told them early in advance they could have made alternative arrangements. I could have prevented the undue stress that waas caused to everyone. Saying no and only taking on tasks that I can capable of will allow me to perform better at the task that I do have.Since then I've made a conscious effort to only sign up for what I am able to do.

Should a doctor's primary aim be to change behavior to prevent disease or treat existing disease? What are your thoughts on upstream and downstream care?

So I think that physicians obviously have a responsibility of treating illness at hand but I do think that educating patients on preventative care can be a big way in which physicians can set up patients for future success in their health and also help prevent some of the illnesses that are big public health concerns. For instance, the leading causes of death in the US, cancer, diabetes, heart disease are all preventable with screenings, education, and lifestyle modifications. Physicians should spend a chuck of their time with patients to ask about patients lives outside of their current illness. Asking patients about their lifestyle in general like what is your diet like what do you do for exercise what do you do to reduce stress what are some things that you do to keep yourself happy can lead to conversations in which physicians can educate patients on the importance of preventative care. I think with this we can definitely reduce some of the incidences of preventative illnesses that we have in the US.

A close co-worker has recently lost their child due to a car accident. Enter the room and talk to your co-worker.

So in this scenario I have a close coworker who has lost their child I cannot imagine what a distressing situation this must be I have been fortunate enough to not experience the death of family member and to lose a child must be devastating and having a conversation with my coworker there are three things that I would really like to focus on one is to empathize and validate their feelings to is to to discover the coping skills that they are working on and to make sure that they were coping in a healthy way and three is to make sure that they understand that they are welcome to seek my help whenever they need to stay home I believe that my conversation would go something along the lines of asking them how they're feeling my goal here would be to be a listening ear if they want to talk out their feelings I would be happy to be there and be a listener if they want to simply have company I might not talk I would be happy to do that to be all in all I want to provide them emotional support if they talk to me about any of their feelings I would validate them and empathize with them I think that they are entitled to the feelings that they're feeling grief anger I am sorrow whatever it is they are extremely valid and I would make sure that they understand that however they're feeling it is OK to feel that way secondly I would ask them how they're coping with the loss of their child it is so important to make sure that during this time of distress they are taking care of themselves as well and not falling into I am really unhealthy coping habits as all mine tends to when they are emotionally overloaded with with anything extreme emotion I would make sure that this person is coping in a healthy way I am I have experiences a crisis counselor previously and I am knowledgeable about local resources government assistant distance with him things like grief groups and what healthy coping mechanisms in general look like I will be sure to utilize my knowledge as a crisis counselor in making sure this person is grieving and coping healthy weight during this time I will make sure that I am not coming off judge mental at all or judging the way that they are coping but rather I am invested in their health and their mental well-being and I am invested in in the best busted in their best interest. I think that a good friend is somebody who is able to support somebody in mind and help them not do something that they would regret in the future and help them cope in the best way possible lost weight I would make sure that our conversation ends with them knowing that they are able to reach me for someFor support whenever and however they want I would be happy to help them in any capacity that I can whether it is just listening again in the future bringing them food or taking care of their other child so they can spend some time alone I would be happy to support them in whatever way possible. I think overall when somebody is going through such a difficult time it is our responsibility as a friend to make sure that they are OK

Mrs. Miller is found brain dead and is determined to be a perfect candidate for organ transplants. The physician contacts her husband and son but is met with stern objection upon asking for consent. What would you do?

So it sounds like a patient Mrs. Miller has passed away and she is determined to be a very good candidate for organ donation however her family is refusing to this. In this situation I am going to assume that Mrs. Miller had not registered himself as an organ donor if she had then my conversation with the family would go differently so there's a few things that I would consider here in the conversation that I would have with the family first of all I would want to respect the family's wishes. We know death is not an individual experience but a family experience and if Mrs. Miller had not ever is talked to her family about being an organ donor then I believe that her family has a right to no. I would also believe that by harvesting her organs we could be saving lives of so many patients. So in this conversation my approach would be to first of all try to understand her family side obviously Mrs Miller's family is grieving right now and it is not a pleasant request to ask for organs when somebody is grieving the death of a close and loving family member. I would definitely empathize with them and express my understanding and my condolences for Mrs. Miller passing away I would make sure that they understand that I'm asking for something that you know obviously they weren't prepared for. I would again try to empathize and validate any feelings that they have and I would I would understand their viewpoint. Lets say that the family believes that it intolerable for them to think about Mrs. Miller going through the organ harvesting procedure and it would just add to their grief. I would explain to them just how many lives that they could be saving if Mrs. Miller donates her organs. I would also if if this is allowed after checking with my legal team I will I will ask if it is possible for the family to meet the potential recipients that miss Miller's organs have been matched. I will check with my ethics team to make sure this would not be coercive. Hopefully, with our conversation they will agree however at the end of the day if they are just not willing to go through with this procedure, then I respect their wishes.

From what you understand of medical school, what part of the program will be most difficult for you?

That is a great question I think we all know that medical school is very rigorous and time-consuming and I think the most difficult part for me would be to maintain a work life balance when I am I'm trying to absorb all the information in your lies as much of my time as I can and making sure that I am training myself to be a doctor that will in the future have patients lives at her aunts anything this really makes for our medical school to be taken very very seriously so I think that it would be difficult to maintain a work life balance however I've been training myself in my mind to be OK with maintaining a balance of the day over the last few months I've made it a habit to take out one hour each night to engage in hobbies or activities that I love doing. For instants I really enjoy creating man's lettuce lines while I have some TV show or are you to playing in the background this really helps my brain wind down from the day and just focus on a simple activity I've also been loving nature walks I've been a huge nature lover for the longest time and nature walks have really helped me out in maintaining a balance in my name I have a dog as well that I got during the quarantine and I think that during medical school I would make sure that I keep up with his walking schedule and take time out to spend with him which would definitelyRelieve my stress so I think that just planning and I heard from now and I'm really training my brain to take breaks and maintain a balance lifestyle will help me redo some of the stress of medical school when I get there

What are you doing now to better yourself?

That is a great question and actually one of the things that I've been working on is a weakness of mine which is maintaining a work life balance over the last few years I really understood the value of having a balanced life I realize that by taking one hour of my time every night to engage in a hobby that I love to doing I am able to not only improve my mood by distressing and got a better night of sleep but also I wake up the next morning feeling refreshed and ready to tackle my tablet for the day I think that this was a weakness of mine for a long time because I tend to tend to over commit myself by taking on too many tasks however I realize that it's very important to give your brain a break a little bit I think that medical school will be definitely very rigorous so II am building habits right now to work on my weakness of not having work like balance so currently I have been I've sat in our of my time as relaxed time every single day during this time I'll put on a TV show in the background or some relax and jazz music in the background and I create mandala design with her just as geometric designs that are centered around the circle I think creative activity really gives my brain one thing to vote with Anna and helps you relax my brain alternatively I've been taking nature walks with my dog that I adopted during the quarantine so I definitely been working on this weakness of mine which is having a work life balance and I think that this is definitely a habit that I would love to continue doing medical school.

How will you handle the stress of medical school?

That is a great question for medical school will obviously be stressful not just because of how rigorous the education is but also because of the time commitment that it takes I think that the best way to deal with stress is to make sure that I maintain a work life balance see what I mean by that is that for the last few years I've been making conscious effort to take out at least one hour of my time at night to engage in something that I loved you doing now I'm not saying that I don't love attending school in studying topics that I'm interested in but I need doing some things that I love as a hobby so for instants what I do in that one hour each night is I will either do some man like to science which are in which our designs that I create myself and color them and I and this is a great stress reliever her I also am a big nature lover and I love taking nature hikes I have a dog so I love spending time with my dog and I am walking with him on long walks both of these activities have been incredibly useful in relieving my stress and I think that with these activities I'm able to wake up the next day feeling more refreshed I think that one of the other things that I do as a stress reliever which is in the morning time is to be organize and plan out my day and make sure that I am goal driven for the day this really helps me manage all of my tasks for the day and helps me be stress-free.

Tell me about a time you had to assert yourself.

The one particular incident where I had to assert myself was when I was the vice president of finance in my service sorority one of my responsibilities was to collect dues from all of the members and make sure that we received all the dues in time because they mostly funded all of our philanthropic activities the one particular semester a friend of mine was suffering from some mental illness that had lead her to leave her job she was seeking medical care at a psychiatric hospital and I knew about all of this that was going on she requested me to extend the deadline for her dues for this I had to ask for permission from the president the reason why the situation got complicated was because I was adamant on maintaining my friends confidentiality because she did not want other people knowing the personal things that she was going through so I had to give half of the story to the president in explaining why I was requesting an extension for the for the deadline. This point on my integrity was challenged because the president knew that the girl that I was advocating for was one of my closest friends so there was her concern that I could be doing this this special treatment for my one of my close friends however I had to assert myself and let her know thought I am being as professional as possible an I even came up with an alternative budget to support my viewpoints and to be able to effectively advocate for my friend. I asserted that the reasons for which she's asking for an extension were legitimate and I was ultimately able to secure her an extension.

Mr. Anderson is currently dying and is in tremendous pain. You want to give him morphine, but the medication will likely lower his blood pressure and hasten his death. Mr. Anderson is still in pain and wants you to end his life. You've exhausted all your options. What do you do?

This situation inovlves end of life issues and the prescription of a medication, morphine in this case, which although will relieve the patients pain, will hasten his death. In this sutation, I would be weighing my duty to not do any harm to this patient meaning my duty would be to not give morphine to their patient knowing that it will bring him closer to death, vs weighing this against the patient's dignity and autonomy in asking for a medication. If I were to not give any morphien to this patient, I would be cuaisng him undue pain that could be so severe that this patient oculd have serious conseuqences sucha s a heart attack or a stroke because of the pain. To make a decision, I would approach mr anderson in the most compassionate and empathetic manner. After letting him know how sorry I am that he is in the position that he is, I would explain to him the risks and benefits of giving him morphine. I would make sure that he is competent in making the decision that he choses to make, meaning that his cognitive ability to understand,comprehend the informaiton I am giving him and clearly expressing his decision is not compromised. If after our discussion he still chooses to recieve morphine, I woudl give it to him. I do think that his autonomy and dignity weights more than my duty to not do harm. He doenst have any other options left and is on the trajectory of death. If I beleive that i can make the remainder of his time painfree and as comfortable as possible so he can enjoy his remaining moments with his family, then I would be willing and happy to give him additional morphine.

You witness two girls hitting a homeless woman and taking items that belong to her. The victim's nose is bleeding. You approach her after the incident. She tells you that she is fine, and that the same girls have done this before. She promises it is no big deal and not to worry about her. What do you do?

When approaching this homeless lady I would first go ahead and ask her if she is OK it sounds like she says that she is fine but her nose is bleeding in this case I would tell her that I'm really sorry that this incident happened to her it sounds like these girls who stole from her hit her as well and that is an awful situation to be in. from my first impression it sounds like she just kind of wants to be left alone she did she's saying but she does not want me to worry about her but that could just be her being very polite and just not trying not to you know she might think that she's being a burden on me. I would say to her that I am happy to help her I'm here for her and I am I just want to make sure that she is that OK. I would definitely offer to escort her to an emergency Department so that she can get her nose looked at. it sounds like her nose is bleeding she could be in pain and maybe her nose is broken and she would definitely try to get that fixed. I think that I would also recommend her in this situation too inform the police about on these people stealing from her it sounds like she spent present at the same place in these girls often run into her many times and they've stolen from her many times I think Don in this case she should definitely report this to the police and Lastly I would definitely 100% offer to help her find homeless shelter so she can spend her time there and so that she can be safer than she is out on the streets with all this my intention is to make sure that she understands that I'm there for her I'm willing to help her in whatever way that she would like I'm I she is definitely not a burden and she doesn't have to be polite I'm happy to be there for her and happy to help her. At the end of the day if it is that she simply really just wants to be left alone and deal with this on her own that is OK too it could just be that that's what she wants and in that case I would respect her it was respect her choice. I would come back after a few days to check on her and make sure she still OK I would let her know that she is she is welcome to change her mind and seek my help.

Tell me about a time when you were forced to make an unpopular decision.

You can talk about VPf story, say that the exec board recommended me to still charge her rather than taking it to the district manager of the local chapters and involving her

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