MMI Interview (65 practice Qs)

Should people have the right to euthanasia?

Whatever the question, the key is to weigh both sides of ethical scenarios, considering all angles, before coming to a balanced conclusion. If the first word out of your mouth is a definitive 'yes' or 'no', does it really look like you've weighed the debate properly? Or that you have appreciated the subtlety and the shades of grey involved? Perhaps not. It can be tempting to blurt out an instinctive response, especially if it's something that you feel strongly about. But you need to keep your emotional response in check. * 4 PILLARS -It's often helpful to start with some points of fact in ethical scenarios, before entering the murkier waters of subjective opinion. This lends itself best to Justice, and the question of legality. Assisting suicide is against the law in the UK under the Suicide Act (1961). In other words, euthanasia is illegal on these shores. That's a very important point and an excellent one to start with because it is clear. Rule of Law is important for the safe running of society, so both as a law-abiding citizen and a doctor you would have to obey it. However, there are places where euthanasia is not illegal. The Dignitas Clinic in Switzerland helps many people commit suicide each year, and does so perfectly within the Rule of Law. Moreover, the UK's Director of Public Prosecutions decreed in 2010 that family and friends who visit Dignitas to aid in this process will not be prosecuted in the UK. Legally, it is clear that an NHS doctor clearly should not be assisting suicide in the UK as it stands today. But other jurisdictions have said otherwise, and the chances are high that others will follow. So, this alone does not provide a clear answer to the wider point. -Autonomy is absolutely central to the debate around euthanasia — and many other ethical scenarios, including, for example, DNAR. It is about the right of the patient to decide. If a patient decides they want to die, shouldn't they be allowed to? Were autonomy the only factor, perhaps the answer would be yes. But the four pillars must be constantly weighed and checked against each other. In this case, assisting suicide is illegal, destabilising the Justice pillar. -They are also asking, you might say, for the doctor to 'harm' them. Suddenly, then, the 'non-maleficence' pillar is also creaking. Appreciating these interlinked consequences will help you come up with a refined answer to ethical scenarios. A lot comes down to the subjectivity involved in defining 'harm' for the purpose of establishing 'non-maleficence', and 'benefit' in order to decide upon 'beneficence'. Faced with the same circumstances, one person might say that helping someone to die was harming them and not in their interest. Another may argue that keeping them alive in a vegetative or painful condition was doing the harm, and that ending their life would be highly beneficial. -In the case of Euthanasia, the law is clear in the UK — but that might change, as it has in other parts of the world. If it were to be legalised the challenge would be in creating clearly defined criteria to capture when and how it would be permitted, making the inherent subjectivity of 'harm' and 'benefit' as objective as humanly possible.

You are given details of 15 individuals, including their age, sex and occupation. A nuclear attack is imminent and you are only allowed to save 5 of them from destruction. Which ones and why? A prioritisation exercise. The emphasis is on problem solving and rational thinking under pressure.

Doesnt matter their details, random, who am I to choose

24. A patient requests needles and syringes at his/her local pharmacy. They do not present with a prescription, and based on the records you can access, they are not receiving treatment for diabetes. Do you sell the syringes or not?

And what type of syringe they would need. I know syringe account is limited in specific states and their limited to insulin types of syringes only. However most people would need a prescription for a type of syringe in order to limit the unnecessary use of street drugs such as opioids and heroin

34. Do you think medicine should be more about changing behaviour to prevent disease or treating existing disease?

Both sides. Behavior - preventative care, listening and spending more time with patients, doing physicals and mammograms - proven that catching breast cancer in the early stages can lead to 70% chance of recovery. Treating - expensive research and surgery, surgery should be a last resort as it involves invasive measures. Shouldn't get so bad as to get the actual disease

Beneficience

Doing good or causing good to be done; kindly action; All medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient. n 8 year-old child has been admitted to hospital with a significant open fracture to their left leg. The limb is deformed with significant bleeding and the patient is extremely distressed. The parents are demanding immediate action be taken. There are a number of options for treatment here, but let's take an extreme one - amputation. If the bleeding is life threatening, the limb injured sufficiently and the risk of infection extremely high then amputation could be a treatment option. It would be "good" for the patient in as much as the injury would be resolved and the threat to life from bleeding or infection somewhat reduced. But let's consider the implications of amputation. The treatment would result in a life-changing injury and the risks of infection or massive bleeding aren't proportionate. The limitations to their physical movement also carry other future risks that could inadvertently result in further physical and mental health issues. Most important of all, there are other interventions available to us that have better outcomes attached. Using blood products to manage the bleeding, reducing the fracture if possible and orthopaedic surgery if necessary will have better outcomes for this patient. That course of action is "more good" than amputation. It's a rather silly example, but I use it to demonstrate an important point. Beneficence asks us to promote a course of action, but in practice we also need to de-promote certain courses of action if there are better options available.

You are told that this weekend you're going on a camping trip. Before you is a table of random objects. You have 20 seconds to pick 5 objects you deem to be of the most importance and value, and explain. This station is testing your ability to make time pressured decisions and be able to defend them, it's also testing your ability to think practically.

Go through each item, briefly explaining why you picked it What use is it? What situations would it help you navigate? Is it going to be a hindrance e.g. heavy to carry, or is it conveniently sized? You could explain why you didn't pick some of the other items on the table

98. Tell me about yourself.

Graduate, degree, work now, goals future, why

25. Dr. Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Blair doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches, and muscle aches, because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr. Blair's behaviour might pose. Discuss.

Homeopathic drugs could have a placebo affect yes however this goes against patient metonymy as the patient isn't rightfully choosing whether or not to receive homeopathic drugs or not. There's been research that homeopathic drugs lead to less side effects and this is doing no harm to the patient which is nonmaleficence however it is not just to force the patient into making a decision without seen all of the potential options of the patient can go down in order to treat their problems

1. A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?

Introduce, Ask, educate, affirm patient confidentiality, ask if any more questions

14. A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?

It is never OK for a doctor to become involved sexually with the patient. This violates patient and Dr. relationship and trust. The doctor has a higher power and can manipulate the patient because of their influence over their medical records and treatment. The patient might feel obligated to sexual contact because of this relationship.

Pros of universal health care

LOWERS HEALTH CARE COSTS Universal health care lowers health care costs for an economy. The government controls the price of medication and medical services through negotiation and regulation. EASIER INSURANCE BILLING PROCESS. It eliminates the administrative costs of dealing with different private health insurers. Doctors only deal with one government agency. U.S. doctors must deal with many private insurance companies, Medicare, and Medicaid. It standardizes billing procedures and coverage rules. SAME STANDARD OF SERVICE. It forces hospitals and doctors to provide the same standard of service at a low cost. In a competitive environment like the United States, health care providers focus on new technology. They offer expensive services and pay doctors more. They try to compete by targeting the wealthy. They charge more to get a higher profit. It leads to higher costs. HEALTHIER COMMUNITY Universal health care creates a healthier workforce. Studies show that preventive care reduces the need for expensive emergency room usage. DECREASING THE ER AS USE FOR PCP Before Obamacare, 46 percent of emergency room patients went because they had no other place to go. They used the emergency room as their primary care physician. DECREASES FUTURE SOCIETAL PROBLEMS Early childhood care prevents future social costs. These include crime, welfare dependency, and health issues. Health education teaches families how to make healthy lifestyle choices, preventing chronic diseases. INCREASE SOCIETAL HEALTH BY IMPOSING TAXES ON UNHEALTHY HABITS; STILL ALLOWING THEM TO BE OPTIONAL Governments can impose regulations and taxes to guide the population toward healthier choices. Regulations make unhealthy choices, such as drugs, illegal. Sin taxes, such as those on cigarettes and alcohol, make them more expensive.

Universal Health care cons

MAKE THE HEALTH PAY FOR UNHEALTHY; NOT FAIR Universal health care forces healthy people to pay for others' medical care. Chronic diseases, like diabetes and heart disease, make up 85 percent of health care costs. These diseases can often be prevented with lifestyle choices. The sickest 5 percent of the population consumes 50 percent of total health care costs. The healthiest 50 percent consume only 3 percent of the nation's health care costs. OVERUSE With free universal health care, people may not be as careful with their health. They don't have the financial incentive to do so. Without a copay, people might overuse emergency rooms and doctors. LONG WAIT Most universal health systems report long wait times for elective procedures. The government focuses on providing basic and emergency health care. DOCTORS HAVE LESS TIME PER PATIENT TO KEEP COSTS LOW Governments limit payment amounts to keep costs low. Doctors have less incentive to provide quality care if they aren't well paid. They might spend less time per patient to keep their costs down. They have less funding for new life-saving technologies. EXPENSIVE FOR THE GOVERNMENT LIST OF PROCDEDURES LIMITED To cut costs, the government may limit services with a low probability of success. It may not cover drugs for rare conditions. It may prefer palliative care over expensive end-of-life care.

Universal health care systems now

Out of the 33 developed countries, 32 have universal health care. They adopt one of the following three models. In a single-payer system, the government taxes its citizens to pay for health care. Twelve of the 32 countries have this system. The United Kingdom is an example of single-payer socialized medicine. Services are government-owned and service providers are government employees. Other countries use a combination of government and private service providers. Six countries enforce an insurance mandate. It requires everyone to buy insurance, either through their employer or the government. Germany is the best example of this system. The nine remaining countries use a two-tier approach. The government taxes its citizens to pay for basic government health services. Citizens can also opt for better services with supplemental private insurance. France is the best example.

29. Due to a shortage of physicians in rural communities, some policy-makers have suggested that medical programs preferentially admit students who are willing to commit to a 2 or 3 year tenure in rural areas after graduation. Consider the broad implications of this policy for health care and the costs associated. Will this policy be effective?

Positive for health care - serving an underserved community - creating a healthier society overall - promoting the community to seek medical help since it is now convenient for them to - once settled down for 2-3 years after graduation, will most likely live there

An actor plays the role of your elderly neighbour. You have just accidentally run over your neighbour's cat whilst reversing your car. You have 5 minutes to break the bad news to her. This role-play tests insight, integrity, communication skills and empathy.

Say hello, explain situation, apologize, be empathic, ask if you can do anything

ACA

The law has 3 primary goals: Make affordable health insurance available to more people. The law provides consumers with subsidies ("premium tax credits") that lower costs for households with incomes between 100% and 400% of the federal poverty level. Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.) Support innovative medical care delivery methods designed to lower the costs of health care generally.

distribution problem

do you offer the treatment that maximises the number of years of life, regardless of how many people benefit, or do you offer the treatment that treats the maximum number of people, regardless of how many more years those people will live as a result? Arriving at a morally acceptable answer to this distribution problem is particularly tricky in a system which is publically funded (i.e. almost everyone has paid into the system). But let's assume for argument's sake that British culture is such that we believe in attempting to save the lives of anyone, no matter the cost, because that is the morally right thing to do. We could bolster our counter-argument further by saying if we fail to treat a patient suffering from cancer, we will ultimately spend more money on treating that patient for the co-morbidities associated with the cancer itself. Therefore, unless we are prepared to remove all rights to treatment for that patient, it is ethically and objectively better to treat them early. Now, it's important to note that while treating patients with suspected cancer is hard to argue with, we cannot simply say that it's a "no brainer" without going through the pro's and con's of the medical ethics involved. You must be able to justify your ethical position by first having considered all sides of the argument!

Autonomy

The right for the patient to decide A 26 year old male has been involved in a high-speed collision in which he sustained blunt force trauma to his head as his head hit the front windscreen of his car. He did not lose consciousness, he is fully responsive and has no indications of neurological damage. He does, however, have a significant head wound which is bleeding continuously. This patient has refused treatment on the grounds that he feels "fine" and is refusing to have sutures to close his head wound. He would like to leave the Department. Even though the best interests of this patient would be served by undergoing a CT scan and having sutures, as he is an adult with full mental capacity, we must respect his autonomy in choosing to leave the Department. We cannot prevent him from leaving, and if we did it would be unlawful detainment.

Justice

principle states that when considering whether an action is ethical or otherwise, we must consider whether it is compatible with the law and the rights of the individual, and whether it is fair and balanced from a societal perspective. Patients suspected of having cancer are prioritised within the NHS with the maximum waiting time for referral being two weeks (as opposed to eighteen weeks for non-urgent referrals). Patients diagnosed with cancer are entitled to a range of treatments including radio- and chemotherapy. These treatments are expensive and treat a small, but significant proportion of patients. First, let's analyse the counter-arguments to prioritisation of patients with suspected cancer. One could argue that the prioritisation of these patients over others perhaps infringes the universal right of all patients to receive timely access to healthcare services - in particular access to GP services. One could also argue that the public expenditure on radio- and chemotherapy treatments could be spent on less expensive treatments that would treat a greater number of people, such as an increase in statins for those at risk of cardiovascular disease. Regardless of whether you agree or disagree with these two points morally, they are valid points nonetheless and need to be considered from a neutral position.

Non-Malificence

to do no harm (attributed to the Hyperaractic Oath) a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. A 52-year-old man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is on the brink of rupturing his appendix. The surgeon decides the best course of action is to remove the appendix in situ, using his trusty pen-knife. From a beneficence perspective, a successful removal of the appendix in situ would certainly improve the patient's life. But from a non-maleficence perspective, let's examine the potential harms to the patient. First of all, the environment is unlikely to be sterile (as is that manky pen-knife) and so the risk of infection is extremely high. Second, the surgeon has no other clinical staff available or surgical equipment meaning that the chances of a successful operation are already lower than in normal circumstances. Third, assuming that the surgeon has performed an appendectomy before, they have almost certainly never done it at the roadside - and so their experience is decontextualized and therefore not wholly appropriate. Fourth, unless there isn't a hospital around for miles this is an incredibly disproportionate intervention. Again this is a rather silly example but it is important to remember that before leaping to action, we need to consider the implications and risks of intervening at all. As we will see in future articles, in many cases the most harm is often caused with the absolute best of intentions.

2. A member of your family decides to depend solely on alternative medicine for treatment of his or her significant illness. What would you do?

Consider both sides of the argument. Alternative medicines have less side affects from pharmaceuticals. Are not proven to help cure or help the symptoms of the disease. Ask, educate, and see if you can help.

20. A 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation?

For the safe for the community I would have to notify the school and the department of health and human safety since meningitis is very contagious and deadly. .Even though he refused service I would have to tell him of the consequences of his decisions and recommend that he seeks treatment in order to help prevent disease and other people

18. A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient's condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence?

Good Samaritan laws, which are also known as "volunteer protection laws," are state laws that are enacted to protect healthcare providers and other rescue personnel from being sued as a result of providing help to a victim during an emergency situation. A good example is a law that provides immunity from liability to a an off-duty physician who stops to help someone on the side of the road. Generally speaking, as long as you use reasonable care in assisting a person during an emergency, based on the resources that you have available to you at the time, you cannot be sued for any injuries that the person sustains during the incident. Thing needed to be done would be to get consent verbally from the patient The mere existence of a Good Samaritan law, however, does not mean that you cannot be sued. If you act negligently or recklessly in light of applicable professional standards, you might still be liable for damages, despite a Good Samaritan law. Plus, Good Samaritan laws are state laws, not federal laws. Therefore, a state Good Samaritan law will not protect you from liability in a federal civil rights lawsuit.

15. A 17-year old boy lives independently. He is married and has one child. He wants to participate in a medical research study. Does he need his parents' permission?

No, he can give informed consent on his own without parent permission if aged 14-17

17. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent?

Overall, these data suggest that professionals who are doing research with people with mental illness need to be especially careful in getting consent from their subjects. However it is clear that having a mental illness is not synonymous with being incompetent to make decisions about treatment for oneself. Indeed, the presumption should be that people with mental illness, like everyone else, have the right to make informed decisions about their treatment and their participation or nonparticipation in research.

16. A physician went to vacation for 2 weeks. He did not find another physician to cover him. One of his patients with hypertension developed severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial haemorrhage. Is the physician responsible for this patient?

The doctor should of had a Nother doctor cover him while on vacation. The doctor should've notified all their patients that he was going on vacation and given them resources for contacting other doctors and emergency resources. The physician is responsible for this patient to an extent because the doctor did not give resources to patients in need.

You are a medical student in a GP surgery, shadowing one of the GP partners, who is also your supervisor. Your next patient is Mrs Collins, a 30 year old secretary who your supervisor states is a 'typical hypochondriac...always coming in with new concerns, with no real medical problems'. Your GP supervisor advises you that placebo medications (sugar pills) are the best treatment for these patients, and 'always do the trick'. ​ Outline the main issues raised. ​

There are two sides to consider: By effectively deceiving patients and giving them placebo medications rather than actual medications, you are undermining patient autonomy Slippery slope argument: If this doctor is prepared to deceive this 'category' of patients, they are likely to feel comfortable acting similarly towards other patients for example 'self-inflicted conditions' (eg. Smokers/alcoholics/sporting injuries). Attempting to categorise patients (eg. 'hypochondriacs') may lead to missing more serious diagnosis, as you will consistently ignore potentially sinister red flag symptoms. Another issue raised is whether this doctor be allowed to practice medicine, let alone train future medical professionals. ​On the other hand, it may be argued: Placebo medications (Sugar pills) are likely to have less side effects than prescribing stronger alternative medications which are unlikely to be required, if there is no underlying medical condition. With patients often reporting some benefit from the placebo medications, you are fulfilling your duty of beneficence as a doctor. This GP is effectively managing the patient with limited resources, hence not placing additional strain on the resource-stricken National Health Service

19. As a physician at a local hospital you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitizer offered at the hand sanitizer stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitizer for public use. What do you do? Do you remove/change location of hand sanitizer stands? Do you approach him?

Thing to do in the situation is to educate the patient. I would walk up to the patient and talk to them normally in order not to make the defensive. I would then ask the patient what he was doing earlier and noticed that I saw him eating dance in a Tyser. I would then tell him that there are many different groups for alcohol dependency and I would love to help him get into one. I would recommend us talking at a later time after work and maybe I could give him more resources. I would also tell him that the Hanson a Tyser is for the hospitals use in order to help prevent illness and other people and it would be really great if he didn't consume it so that we could keep a clean hospital. Hopefully then we wouldn't have to Change the location of the Hansina Tyser stands and I could help and alcohol dependent person at the treatment that he needs

33. In recent years, there has been an increase in popularity of full contact sports, such as Ultimate Fighting Championship (UFC) and boxing. Should doctors have a role in regulating such sports?

Yes there should be a medical professional present to prevent unnecessary roughness such as blows to the head. Prevention of concussion is important in sports as well. Having a doctor regulate these sports would lead to a safer environment and protect the athlete.

Without using your hands, explain how to tie shoe laces. Tests verbal communication skills, the ability to break down the task into a series of small steps and your ability to check that the interlocutor is understanding what you are saying.

be as specific as possible

​Review the graph enclosed and explain your findings:

(graph of two lines, diabetic blood sugar higher than the non-diabetic) Data Title (if present) 'x' axis and 'y' axis Graphical/tabular progression shown Physiological correlation (How can this pattern be explained biologically?) Anomolies/additional information of note Critical analysis of data/data source 'This is a graph comparing mealtime blood sugars in a diabetic and non-diabetic individual. On the 'x' axis is the time in hours with blood sugars represented on the 'y' axis. The time '0' is likely to signify the commencement of mealtime. The graph shows that at baseline, diabetic individuals, represented by the red line have higher blood sugars than non-diabetic individuals, who are represented by the blue line. Additionally, in response to food, diabetic individuals demonstrate a greater rise in blood sugar compared to non-diabetic individuals with peaks of 215 and 140 respectively. Thereafter the normalisation of blood sugars in non-diabetic individuals takes a maximum of two hours to return to baseline, compared to almost six hours in diabetic individuals. ​The higher baseline blood sugar and slower return to normal levels in diabetics can be explained by an absolute deficiency of insulin in Type 1 Diabetics and a relative insensitivity to insulin in Type 2 Diabetics. With insulin's important role in lowering blood sugars through transport of sugars into storage organs and conversion of glucose to glycogen, an absolute or relative lack of insulin will result in generally higher blood sugars. There are no anomalies demonstrated, and the data is from a reputable source (Diabetes Daily), however it would be beneficial to note the units used to measure blood sugars on the 'y' axis.'

You are asked to assist the nursing staff in giving medication to a patient weighing 70kg. The recommended medication dose is 1mg/kg. A syringe is prepared containing 280mg in 2ml. What volume of the solution in the syringe do you need to administer? ​

1mg/kg 70kg = 70mg (70mg = total dose of medical that needs to be given) 70/280 = 0.25 ​(ie. 25% of the 2ml syringe needs to be administered) 0.25 x 2 = 0.5ml

Dr. Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Blair doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches, and muscle aches, because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr. Blair's behaviour might pose. Discuss these issues with the interviewer.

2. Discuss some of the following issues with the applicant. Some background information is given on the following pages. A. What's wrong with the way Dr. Blair treats his patients? Why is that wrong? B. Why do you think Dr. Blair does it? C. Can you see any circumstances under which recommending a placebo might be the appropriate action? D. What is the difference between (C) and Dr. Blair's practice? E. What action would you take regarding Dr. Blair? 3. The student has 8 minutes to discuss these issues with you. After 8 minutes a bell will sound and you will have 2 minutes to complete the score sheet. Do not give the applicants feedback. 4. In assessing the student, consider the following issues. Note, however, that these are just a guideline and should not be considered comprehensive. A. Did the applicant express balance and sympathy for both intellectual positions? B. Was there a clear analysis of the ethical problems paternalism raises? C. Did the applicant suggest a course of action that is defensible and moderate? Background and Theory of Question Placebos are still commonly used in research, and they have been used for centuries in clinical practice. The simple fact that Dr. Blair uses placebos, then, is not what makes this case unpleasant. The ethical issues in this case arise because the doctor is behaving paternalistically. He is treating his patient much as a parent would treat a child, and he is deciding a course of care for the patient based on what he perceives the patient's needs to be. This entails deceiving his patients, and making them do what is good for them. Paternalism is only one model of the doctor/patient relationship. Others see the relationship as one between colleagues who share a common goal (the health of the patient), one between rational contractors (who agree on a contract leading to health), or one between a technician and a consumer of medical expertise. Each metaphor for the relationship has some descriptive failings and some serious normative failings. Needless to say, the paternalistic model of health care has been severely criticized in the past half-century or so. Paternalistic doctors may provide no worse care, but they provide it at a very serious price: patient autonomy rights. This brings up an important distinction in this OSCE: that between consequentialist and duty ethics. Consequentialists judge actions by consequences; if the consequences are good, the action is good, and vice versa. Many consequentialists would see little wrong with Blair's behaviour in this case because only good is done to the patient - the doctor is probably right in his assessments, and is probably even choosing treatment that brings the best results in the shortest time.Judged, then, strictly by the consequences of his actions, he has been acting ethically. But duty ethicists would argue that the doctor has not been treating his patients as fully rational, capable people, and hence has been acting unethically. Resolution of these viewpoints might happen if we take a long-term perspective. It may be the case that giving placebos has more harmful than beneficial consequences if we consider the damage done to the medical profession. If Dr. Blair's patients were to become aware of their deception, they might come to doubt the honesty and usefulness of doctors. Paternalism, while no longer considered a good model of interaction, is necessary under certain circumstances. A paternalistic attitude is, of course, the only possible relationship in cases where a patient is incompetent, and it is sometimes recommended when the knowledge of a diagnosis might cause more harm than good. Paternalism and deception (both of which must be justified if we are to allow placebo use) might be allowable when the doctor cannot treat the patient as a capable person, when no harm will be done to the reputation of the profession, and when the benefits outweigh the harms. It is difficult to decide what action the applicant should take. Some options are: reporting Blair to the college, speaking to him in private, and ignoring this minor transgression. In their quest to appear ethical, though, and especially in a trying environment such as this, people sometimes suffer from excessive piety (this is the endless political capital of everything from anti-drug campaigns to oil wars). Applicants should, I think, have a more measured and considered response, one which is neither zealous nor laissez-faire. Perhaps the best solution is further consultation - the applicant, being relatively inexperienced, should probably seek out more professional opinions. A. Dr Blair is treating all of his patients paternalistically. This is acceptable in rare circumstances (when the patient is mentally incompetent), but not in most. B. Dr. Blair presumably does it because it leads to the best (short-term) consequences with the fewest difficulties. C. Recommending a placebo should probably only be done when no real medicine is suitable and: a) the doctor can't treat the patient as a capable person. b) no long-term damage to her reputation will result c) the benefits will outweigh the harms D. Obvious E. Measured and considered response-maybe more consultation.

What it takes to be a good doctor (qualities)

Act these out during your responses.

13. A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation?

Action is a lot of the United States because of pre-implantation genetic diagnosis which is a popular add onto IVF treatments. If a couple decides to use sex selection in their RV I treatment and the physician has to agree to it because it is a medical procedure although it is optional it is something that is allowed in the United States and available to patients, no matter what the dr believes in ethically

26. The City of Vancouver has taken great measures to increase accessibility to alternative forms of transportation (Canada Line, Hornby and Dunsmuir Bike Lanes, Proposed Evergreen Line, and Burrard Street Bridge closures). Discuss the impacts (both positive and negative) of these decisions?

Alternate forms of transportation are great because they decrease the amount of pollution in the air from natural gas in cars being released into the atmosphere this decreases the greenhouse effect and decreases pollution that are put back into the water through the water cycle into fish and animals that we eat on a regular basis. It is positive and that this will allow for the people and the environment to have less side effects from pollution such as asthma. Also this promotes a healthy lifestyle by protein people to use their bikes and walk more outside and this increase cardiovascular health which decreases heart disease and obesity and type two diabetes. This can also decrease the risk of motor vehicle accidents which are very common and can lead to life-threatening situations. The negative impact of this decision could lead to increase in costs and time to get from one place to another.

12. A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation?

Although the patient is just 12 years old he does have the right to patient privacy and I would tell the boy about his prognosis and I would tell the patient's parents that although they want me to lie to the patient that is something I'm unable to do. Say since these parents have access to the medical record the boy has signed off on allowing parents to know about his prognosis. However they do not have any power in what is said to the patient. It is the patients right to make your own decisions and it is the patients right to know all medical information gathered about them it is the just thing

21. Is it ethical for doctors to strike? If so, under what conditions?

As a doctor we have an obligation to work for patients in order to help heal them and give them of the best healthcare experience they can have. Doctors are awesome human beings and have their own opinions and causes that concern them. It is OK and ethical for doctors to go on strike when they're off duty and living their civilian life. However when they are on the Job they should be aware and conscientious of their duties to the society at large

22. There is an outbreak of an incredibly contagious life-threatening disease. The disease is spreading across the country at a rapid rate and the survival rate is less than 50%. You are a senior health care administrator, and when the vaccine is developed, you have priority to receive the drug. Do you take the vaccine yourself or give it to another person? Why or why not?

As a senior healthcare administrator I see a lot of patients on a regular basis and I have contact with a lot of people in society. If I have the vaccine then I am less likely to pass on the disease to people who have low immunity. Therefore I would give the vaccine to myself in order to prevent the disease from spreading to the community around me and the community that has low unity and is more susceptible to disease

An actor hands you a card which states that you are playing the role of a GP and they are a 16-year-old girl who has come to ask for information about getting tested for STIs but is worried about her parents finding out. This station is testing your ability to communicate and show empathy as well as your understanding of doctor-patient confidentiality.

As you are playing the role of the GP, it is up to you to lead the role play. Begin by introducing yourself. Ask the patient their name and how they are before moving on to why they are there. Ask questions that you think are relevant to the scenario such as: "Are you sexually active?", "Have you been tested for STIs before?", "Have you had unprotected sex?", and "Have you been experiencing any symptoms?" Respond appropriately any time the patient expresses a concern. As this scenario involves a young person, this could be their first time getting tested and they might be nervous about it or they might be scared if they suspect that they have contracted an STI. It is important to demonstrate empathy and to attempt to reassure them. When the patient mentions that they are worried about their parents finding out about them seeking advice on this subject, explain that everything you have discussed will remain confidential. You should be aware of the principle of doctor-patient confidentiality and how it applies in a situation like this. Conclude the role play by asking the patient if they have any further questions and then thanking them for their visit. This gives the actor an opportunity to prompt you if you have missed out anything important.

4 pillars

Autonomy — Does it show respect for the patient and their right to make decisions? Non-maleficence — Does it harm the patient? Justice — Are there consequences in the wider community? Beneficence — Does it benefit the patient?

6. A biotech company was hired by the Military to develop a cure for Ebola. They successfully developed a vaccine to treat the symptoms of the virus and lowered the mortality rate for infected patients. Discuss the implications of this on a global scale.

Creating a vaccine for any disease is an amazing feat. But vaccines aren't always the solution. Example is polio, many people refused it in India and it was difficult to eradicate it. Eradicated in 2011, when it was founded in 1955. But it is possible as seen in India, even in poor hygeiene and sanitation environments. Ebola vaccine would work quite similarly. Tracking down patient zero in specific regions and vaccinating all of those in the area that could be affected, leading to herd immunity (the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination).

You are faced with an actor playing a 65 year old man who has just been diagnosed with Alzheimer's disease. He is coming to his GP for advice on how to cope with his diagnosis as he has heard a lot of stigma over the years about dementia and its burden on both his family and the healthcare service. Whilst talking to you he breaks down into tears. This station is testing your ability to empathise with patients, knowledge of the problem of an ageing population, communication skills

Console the patient in an empathetic way Advise him on latest developments e.g. assistive technology Advise him to joining support groups e.g Alzheimer's Society Reassure him that there is a lot less stigma about dementia now than in the past

32. Statistics have shown that effects of advanced age such as changes in vision and response time may adversely affect elderly drivers' ability to drive safely. As a matter of fact, many doctors discuss the issue of stopping driving with their older patients as a precaution for the safety of theirs as well as the public's. Do you think older drivers have to give up driving when they reach a certain age?

Depends on the independence, vision quality, and response time of the patient. They should be tested annually with their annual doctor visit. If there is an age cut off, then some people who still have quality eye sight and good reflexes would then be limited in their transportation options and this could lead to even more problems in the elderly especially because it will limit how much social time they get and lower their self-esteem which can lead to worsening health issues.

The interviewer asks a question: what ethical principle of medicine would you consider to be most important? This station is simply testing your knowledge of the various ethical principles and checking that you appreciate their importance when making decisions.

Don't worry there is no most important one, just pick one of the following, describe its meaning and be able to justify your choice: Autonomy- allows patients to make informed decisions about their own treatment. Beneficence- Doctors must do good and act in best interest of their patients and/or society as a whole. Non-maleficence: Doctors should act in ways that do not cause harm to patients. Justice- Fairness across the population, only discriminating based on clinical need. Confidentiality- whilst not strictly an ethical principle, it's linked to several of them. This list and the explanations are not exhaustive so you need to beef up your explanation, you can look up the principles yourself, there's a lot of literature to look at. Link whatever principle you choose to your work experience by giving an example of how you saw the principle being demonstrated.

On the table there is a graph which shows the plasma insulin levels of several patients over the course of one day with the times that meals were consumed indicated. The interviewer asks you to describe the graph for Patient 1. You are then asked to provide an explanation for the changes in insulin levels at different times of the day. This station is testing your ability to interpret a graph and your scientific knowledge.

Familiarise yourself with the graph before you give your answer. Look at the axes and the key/legend to make sure that you understand the data being presented and also to ensure that you are looking at the data for the correct patient. Describe the data for Patient 1 and point out any trends that you notice. Use the same language as you would when describing a graph for a lab report. This question requires you to use some basic knowledge of human physiology which should have been covered in your biology course (for those who take Biology). For a normal patient, this graph would usually show increases in plasma insulin following meals and you should explain why this is the case using this prior knowledge. There may be follow-up questions at a station like this to further test your scientific knowledge or the interviewer may prompt you if you miss out something important in your explanation. It is important to keep on top of content for the science courses that you take in case a question like this comes up at interview.

11. A patient with Downs Syndrome became pregnant. The patient does not want an abortion. Her mother and husband want the patient to have an abortion. What should a physician do in this situation?

First I would need to know how old this patient if the patient is under 18 then the page since parents would have to make the decision for the patient however if the patients over 18 they can make their own decisions. I would first educate the patient on both options the abortion and having a child when dealing with something like down syndrome I would also tell the patient how likely it would be to pass on Down syndrome to their child and if that is something that they would be willing to deal with. If the patient is under 18 and I would have to talk to the patient's parents I would also educate them on the two options available and I would encourage them to talk to their daughter about raising a child and tell them to make the informed decision together. In the state of California if a patient is over the age of 12 years old they have patient privacy and the parents can only have access to medical information if the patient signs off on it. A minor can consent to an abortion on their own without parents consent

The interviewer is sitting across from you, on the table there is a wrapped up box. You are asked to instruct the interviewer on how to unwrap and open the box, without helping them or using your hands. It's not straight forward as the examiner will be using no assumed knowledge and will be doing what you tell them only, e.g. 'lift up that flap'¦ starts lifting up wrong flap, 'Turn the box around'¦ turns box in wrong direction. This station is testing your communication skills and your patience.

First explain the aim to the interviewer e.g. 'our aim is to open that box, I am going to give you a set of instructions on how to do so, are you ready?' The key is to very specific with your instructions e.g. 'use your left hand to lift the left flap up and outwards to the left'. The interviewer will do what you ask but try to not do what is wanted in order to test you. They are role playing and this could get quite frustrating given the time constraints. You must stay calm; be patient and smile. Important aspects to convey are: changing your communication style to adapt (so rewording instructions), patience and perseverance (you can't just give up) Don't be disheartened/frustrated if you never get the box opened, that's not the main point, it's your approach to the situation that actually matters.

An actor hands you a card, telling you that, in this role play, you are a close friend of theirs. You have been house-sitting whilst 'your friend' has been on holiday and you have to explain to them that you broke their favourite ornament. When informed, the actor becomes hysterical and very angry. This station is testing your communication skills, ability to give bad news, your empathy and willingness to admit to your mistakes.

First make small talk to make the other person comfortable (remember in this scenario you are best friends) - hi, how are you? Then prepare them for the news- I've got something to tell you that may be quite upsetting. Tell them the bad news, making sure you are apologetic and empathise with them (the actor is going to be quite hysterical at this point, doing anything to make you feel uncomfortable). It's your job to stay calm. You should ask if there's anything you can do to remedy the situation e.g. offer to replace it (showing your problem solving skills).

The interviewer tells you that you have 4 minutes to explain the process/purpose of vaccination to them, speaking as you would to any competent adult. When you have finished, they give you another 4 minutes to explain the same thing as if you were speaking to a young child who is about to be vaccinated. This time, you may use a whiteboard and marker to support your explanation if you choose. This station is testing your communication skills.

For this station, it is important to demonstrate good communication and to show that you understand when and how to adapt your communication to suit different types of people. When giving your first explanation, it is important to remember that you are speaking to an adult but not necessarily to someone in the medical field. You should therefore avoid medical jargon such as 'herd immunity'. You have not been given that much time to speak and are therefore not expected to give an in depth explanation of the science behind vaccination. Simply explain how a doctor/nurse would administer an injectable vaccine and how this is intended to protect the patient by preventing them from becoming ill with the disease that the vaccine targets. When giving your second explanation, not only should you avoid medical jargon but you should avoid vocabulary that a typical adult would understand but that a child might not know. This could include terms such as 'syringe' or 'injection'. If you choose, use the whiteboard to enhance your explanation. For example, you might want to draw the syringe going into patients arm and then another picture of an arm with a plaster where the needle went in. However, do not use the whiteboard just for the sake of it and only draw to accompany the parts of the explanation where it will be effective. Remember to keep good eye contact even if you are drawing for part of the time.

4. An eighteen year-old female arrives in the emergency room with a profound nosebleed. You are the physician, and you have stopped the bleeding. She is now in a coma from blood loss and will die without a transfusion. A nurse finds a recent signed card from Jehovah's Witnesses Church in the patient's purse refusing blood transfusions under any circumstance. What would you do?

Her right to decide based on patient autonomy. Would contact others who have the right to make medical decisions when she is in such a state as a coma.

23. You are a health researcher at an academic institution. You have been asked to work on a top-secret vaccine that would treat biomedical weapons or other communicable diseases. Before your break through, you are instructed by the government to stop all research and turn over all materials and copies of your work to be destroyed. You know you are very close to finding a cure. What do you do?

I would ask to speak to the person that is trying to stop the research and I would try to sit down with them and talk to them about the outcomes of the research and give them a timeline of what would be needed to find the cure for the bio medical rep weapons and diseases. Hopefully this sit down conversation could educate the Person and make them consider the options instead of shutting down the program. Especially since many lives are at risk and finding a cure would prevent a lot of deaths this research is important and I would not give up so easily. However once this conversation happened I will leave it up to the person to make the best informed decision that they could

8. You are a genetic counselor. One of your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carry the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda's husband. In other words, the boy's biological father is someone else, who is unaware that he carries the mutation. You suspect that Linda nor her husband are aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family? What principles and who do you have to take into consideration in this case?

I would first talk to Linda individually and explain scientifically but with laypersons terms what happened. For example I would tell her Linda, your genetic test came back clear with no genetic defect however Your husband's genetics were also clear of the genetic defect. However when I looked at your son's genetics the defect was on the paternal gene or genes that you get from your father. ThereforeYour sons father is not your husband. I wanted to consult with you before I went on with this process. I will tell your husband that he does not carry the connect effect and I will tell your son that he does carry the defect so they both know for their future what their genetic profile looks like.

You are a third year medical student on a medical rotation, Your consultant requests your advice on deciding whether to utilise a liver transplant for a 65 year old retired solicitor or a 20 year old Hepatitis B positive intravenous drug user. How would you decide who to give the transplant to?

In deciding who to give the organ to, I would consider a range of mechanical, biological and circumstantial factors. It is important to identify if either, neither or both the patients are a biological match for the donor organ. Whilst my personal opinions may be inclined one way, it is more important to ascertain which patient is the better biological match. Circumstantial factors should also be considered; for example if the 65 year old gentleman previously had received two liver transplants, and continued to pursue non-favourable lifestyle choices (eg. Excess alcohol), I would be more inclined to allocate the organ to the alternative recipient. Despite this, it is important to recognise that lifestyle choices are not the only cause for needing a transplant, and whilst the 20 year old may be an intravenous drug user, they may have contracted Hepatitis at birth rather than as a result of their intravenous drug use. I would also consider mechanical factors although these are arguably less important. For example, placing the liver of a 20 stone donor would be more appropriate in a large recipient rather than a slim-build young adult. Finally, it would be important to compare prognosis for each of the individuals if they were to receive the transplant. Simplistically, this could be through comparing additional life expectancy following transplant, although using measures such as QALY (Quality Adjusted Life Years) would help to assess not only the number of additional years, but also the potential improvement in quality of life.​

You are told that you are entering a hospital staff room 10 prior to performing surgery with Dr 'X'. As you enter, you see Dr 'X' take a swig of a clear drink from a bottle and quickly close their locker, which you suspect is alcohol. Over the course of the conversation, the Dr beings to forget things and slur their words. You have 5 minutes to speak to Dr 'X'. This station is primarily testing your ability to make value judgments regarding patient safety One of the big attributes being tested in this station is the ability to approach emotive situations sensitively and sympathetically.

In this situation, you've found a co-worker in a potentially volatile situation; it's important to approach the situation with humility and without judging your colleague. Initially try and make the surgeon feel comfortable, potentially make 'small talk' about the surgery; first and foremost, they are a friend and a colleague. Try to get to the bottom of what you've just seen - ask questions which may prompt the surgeon to offer up information voluntarily Direct, accusative questions early into the discussion may make Dr 'X' feel judged and may be very detrimental to the relationship between you two However, if you are still worried about them, more 'probing' questions may be necessary - 'I saw you put something into your locker quickly as I entered, do you mind if I ask is everything alright?'. You are as in specifically work and home life? Despite your relationship with the surgeon, you must also consider the safety of the patient and whether it's appropriate to let Dr. 'X' perform surgery on them. Come to an appropriate compromise whereby the surgeon takes the afternoon off and offer a more private chat the next day to discuss further.

9. A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars. Do you believe that the physician's actions can be justified in any way? Is it ever right to take away someone's autonomy?

Never right to take away someone's the timing. Positions were not justified to do the surgery especially if the patient refused it. The patient was in her right mind and has the right to make her own decisions. Just because her decision is something that position might not want to deal with it is beyond the fit physicians power and the physician needs to leave at the patient with their own decisions

35. Discuss the pros and cons of legalizing marijuana. How does this impact a physician's present ability to write out prescription for 'medical marijuana'? Would legalization cost the health care system more or less after it was passed?

Pros Marijuana is effective in relieving nausea and vomiting. Studies have shown that pharmaceutical cannabis can decrease nausea caused by chemotherapy used to treat cancer and almost completely eliminate vomiting. Marijuana can relieve the spasticity of the muscles that is sometimes associated with multiple sclerosis and paralysis. Marijuana can help treat appetite loss associated with conditions such as HIV/AIDS and certain types of cancers. Marijuana can relieve certain types of chronic pain, including neuropathic pain. Marijuana is safer than some other medications prescribed to treat the same symptoms. For example, it may be used instead of opioids for pain management. Opioids are highly addictive and are typically not recommended for long-term use in treating chronic pain. Studies show that smoking marijuana alone (without the concurrent use of tobacco) does not increase the risk of lung diseases. Cannabis does not need to be smoked to be medically beneficial. Products such as cannabidiol (CBD) oils, topical pain relief treatments, edibles, and other non-smoking applications are now available. As research continues, more of the individual compounds in cannabis are being found to be beneficial. When isolated—such as CBD has been—these may lead to further advancements in medical treatment options without the "high" produced by the compound commonly known as THC. Marijuana has been used for centuries as a natural medicinal agent to good effect CONS Frequent marijuana use can seriously affect your short-term memory. Frequent use can impair your cognitive ability. Smoking anything, whether it's tobacco or marijuana, can seriously damage your lung tissue. Smoked marijuana contains cancer-causing compounds. Marijuana carries a risk of abuse and addiction. Marijuana has been implicated in a high percentage of automobile crashes and workplace accidents. Marijuana is illegal under federal law. It is classified as Schedule I drug in the Controlled Substances Act (CSA), alongside heroin. This classification says that the substances have no currently accepted medicinal value. - very little evidence in research

30. Recently, certain hospitals have been charging patients $29/day for their hospital fee on top of the fees charged to MSP (managed service program). What are the implications of this policy? Discuss both positive and negative impacts with the interviewer.

Pros: fee could be for employees who work overtime during that shift, extra supplies more accounted for Cons: expensive, medical bills cause debt, hidden fee so need to be more transparent about what the fee covers

28. The man who lives next door to you often rides his bicycle in the company of his two young children but without a helmet. In fact, on several occasions you have seen him riding with his helmet hanging by its straps from the handlebars. His young children sometimes wear a helmet, sometimes not. If the man fell off his bicycle and hurt his head in a way that would have been prevented if he had worn a helmet, would it be reasonable to ask him to contribute towards the treatment costs for his injury?

Pt made a choice. People constantly make choices and they know when they do, what the possible consequences will be. It maybe not be just a helmet but perhaps it's a cigarette or a bottle of alcohol - pt made a choice with the knowledge that the choice can lead to a bad consequence - injury. This is patient autonomy in a way; allowing the person to make their own choices, considering they have been educated about it and they will have to face the consequences.

5. Your local Paediatric Association has recommended that circumcisions 'not be routinely performed'. They base this recommendation on their determination that 'the benefits have not been shown to clearly outweigh the risks and costs'. Doctors have no obligation to refer for, or provide, a circumcision, but many do, even when they are clearly not medically necessary. BC Medicare no longer pays for unnecessary circumcisions. Consider the ethical problems that exist in this case. Discuss these issues with the interviewer.

Risks outweigh benefits - association advocating non-maleficence. Association making decisions for the patient is against patient autonomy. Considering that male circumcision is a religious practice in many major religions, it is going against justice to refuse the right to one if the society at large needs it. But if it is doing more harm than good and doctors are ignoring that then doctor's aren't doing good and are going against beneficience.

"You are the only ER doctor on duty and are responsible for all decision making during this shift. This night you have two patients rushed into the ER who desperately require a kidney transplant. One patient is an 80 year old university professor who is suffering from acute kidney failure related to his age; the other patient is a 20 year old university student who has been brought in for yet another episode of kidney problems related to excessive drinking of alcohol at a school party. There is only one kidney available that matches both patients. Who do you give the kidney to?"

So, once you have read the prompt on the door and entered the interview room and have said your hellos and sat down, it is always a good idea to give a quick recap or summary of what you have read outside the door to the interviewer in order to get them on the same page. This also serves as an introduction and helps you to set up the remainder of your answer. Here is an example of a recap: "From what I have read on the door, I understand that I am the only ER physician on duty and in charge of making decisions. Two patients are brought in suffering from kidney pathologies. One is an 80-year-old gentleman with acute kidney failure, which seems to be age related, and the other gentleman is a young university student who has made repeated visits to the ER for kidney issues. His condition seems to be related to alcohol consumption. They both require a transplant but we only have one kidney. And I am asked what I would do in this situation. " This would be considered a good recap of the prompt. It is factually accurate, it is concise, creatively organized and to the point. Once you have given your recap, then you will go ahead and deliver your answer using our BeMo strategy, which was discussed earlier. Here is our response: "Well in this situation as the ER physician, I understand that I have to make a very difficult decision. Of course, I am sympathetic and appreciate that both individuals are suffering immensely with pain as a result of their conditions. However, my decision-making will solely be guided by my expertise, clinical experience, and the scientific literature, and not by the personal backgrounds of the patients. Furthermore, the decision as to who receives the kidney will ultimately be based on which of the two gentlemen will benefit most from this transplant, and will have a better chance of receiving the kidney and surviving the post surgical complications. Immediately, if possible, I would place both of the gentlemen on dialysis in order to buy some time so that I can assess the situation further and gather more information. Since in this case there's only one kidney available that matches both patients, then the decision is tougher and will require further investigation. I can at this point review both patients records, take a detailed history, send for appropriate tests, perhaps consult with other colleagues and specialists in the field, and more importantly examine the current literature on the effects and outcomes of kidney transplants on 80 year old males with acute renal failure vs. those in a 20 year old, for example. Once I have gathered all of the evidence, and objectively analyzed all of the risks and benefits associated with the transplant for both patients, I would then provide the kidney to the individual who, from a scientific and clinical point of view will have a better chance of receiving the kidney and surviving the post surgical complications. If that is the young student then he will be the candidate. If it turns out that the older gentleman will have better outcomes, then the kidney will be given to him. Whoever does not receive the kidney, will continue to be monitored by us and maintained in a stable condition until the next available kidney for transplantation." So, the above would be considered a strong and appropriate response. As you can see, the answer was nicely organized, coherent, concise, and more importantly, was delivered in a systematic manner. As discussed in our earlier strategy, in answering this question, we remained objective and non-judgmental, and did not allow the personal attributes of the patients interfere with our decision-making. We also recognized that further investigation was required and thus we addressed those issues in our answer. Once we had gathered all of the facts, then we came up with practical solutions that we could draw upon to solve this difficult situation. We chose the most rational, objective, and scientifically sound option, which was in the best interest of the patients and caused the least amount of harm to those involved. Now, keep in mind that sometimes once you have delivered your response, the interviewer may ask the following question: "Let's assume that you do not have any time to do any further tests, nor do you have access to any dialysis machines, and the only information you have are those provided to you in the prompt. You must make a decision now. What will you do? Who will you give the kidney to?"

On the table there is a diagram which shows the layout of a building. The interviewer asks you to give them directions to get from the entrance of the building to Room A. After you have given your answer, the interviewer asks why you think you are being asked this question. This station is testing your communication skills and ability to interpret an image.

Take a look at the diagram. Before you begin your explanation, orientate yourself and locate your starting point and destination. Check whether there is some kind of key that could help you to interpret the image. When giving the examiner directions, split your explanation of the route into steps to help make it clearer and to keep yourself on track. Use words such as first, next, then, etc. Although MMI questions may seem random, they are intended to test you on skills that you would need as a medical student or doctor. The examiner may ask you why you think you are being asked a question to see whether you can identify these skills and why they are relevant to medicine: This question is testing your ability to communicate and give a clear explanation. These skills are clearly important in medicine; for example, doctors must be able to give patients clear instructions when they prescribe them a medication. This question also tests your ability to interpret an image. This skill is important in medicine as doctors are required to interpret images such as x-rays or CTs, for example.

You are a second year medical student preparing for your end of year examinations. One week before your examinations, you have a Molecules, Cells and Diseases (MCD) coursework due. One of your friends has just emailed you a selection of coursework, completed by students in prior years for the same project. Explain your actions in this scenario.

This case raises a number of issues in relation to my actions, my friend's actions as well as those who have completed the coursework in prior years. My first priority would be to arrange a discussion with my friend at the earliest convenience. Whilst I would acknowledge that his intentions were likely good in 'sharing' this work, I would explain that this is not appropriate for a number of reasons. These reasons include: Sharing of coursework undermines the whole assessment process, and may affect our ability to become suitable medical professionals. By sharing coursework, it is possible that a number of our friends would produce similar work, which would likely result in disciplinary action. If my friend understood that their actions were inappropriate, I would leave them to take corrective measures, however if they defended their actions, I would consider discussing my concerns with other friends involved as well as my educational supervisor. Additionally, I would want to establish if the coursework had been distributed with the permission of those in older years, as any plagiarism accusations would likely involve disciplinary action towards them as well. If they were not aware that their coursework had been widely shared, I would inform them of this, and advise that in future they do not disclose their coursework to anyone.

10. You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?

This is a cultural practice and even though I don't understand it I have to respect it. That is the just thing to do. I would talk to the mother and educate her about what I was doing to help her child and although she was trying to help her child that might not be the best thing As of this moment. I would ask the mother how often she does this procedure on her child and I would asked the child if it hurt him every time she did it. I would focus on trying to get the mother to understand what I was doing to help her child and how she can help her child at home without doing a procedure that would hurt her kid. I would ask if there are other procedures that could be done instead of this painful one in order to help his healing. I would explain that since he is in pain it is not allowing him to heal as quickly. I would ask her to educate me and in return I would educate her hopefully this would be a positive experience for the both of us and she would Leave the hospital feeling accepted and return at a later date

An actor hands you a card which states that you are playing the role of a surgeon and they are a patient on whom you recently performed a hip replacement. You must inform them that some nerve damage occurred during surgery which means that they may not regain full use of their leg. This station is testing your communication skills and ability to show empathy.

This scenario involves breaking bad news to a patient so it is extremely important to demonstrate empathy throughout. Prepare the patient for what you are about to tell them. Say something along the lines of "This may be difficult to hear, but..." so that the now they are about to receive some bad news. Explain the complication that occurred during surgery in terms that the patient will understand; this means avoiding medical jargon such as 'nerve lesion'. As hearing this news would be extremely difficult for any patient, be prepared for them to become emotional or angry. It is important that you respond with empathy. Express your apologies and try to reassure the patient that they will receive the support they need. You may want to provide some examples of the care they would be entitled to such as physiotherapy. Ask the patient whether they have any questions for you. This is good practice and will also give the actor a chance to prompt you if you have missed anything out.

27. If the Prime Minister/President were to ask your advice on one change that could be applied to the healthcare system that would improve it enormously and have the greatest positive effect, how would you answer?

Universal health care (also called universal health coverage, universal coverage, universal care, or socialized health care) is a health care system that provides health care and financial protection to all citizens of a particular country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes. - LAC; seen patients without insurance have to pay huge bills - Putting more money into the pot - "compulsatory" health insurance - Cons are that healthy young people normally will have to pay more and this money goes towards older and ill patients - Most universal health care is funded by general income taxes or payroll taxes. So if we lower total health care costs and allow easier access to health care, this will allow the population to be healthier and stay in work - Harps on prevention; HUGE thing that america needs due to increase in type 2 diabetes, heart disease, and obesity. - socialized medicine; medicine funded and provided by the government is in use now thru the army and veterans - so it's working Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.

3. If you have the choice of giving a transplant to a successful elderly member of the community and a 20-year-old drug addict - how do you choose?

You don't choose based on personality, but on which patient's body will accept the transplant and will have the best outcomes afterwards. Consult research on transplants in 80 vs 20 year old, in drug users. Evaluate patient, injuries, illnesses, medications, family history. Consult collegues and get advice, specialists in transplants. Put other on transplant list and keep them on lifesaving medical devices until so.

31. Do you think general practitioners have an obligation to report their patients' health status to a public health agency, if their patients have active infectious diseases?

yes - important that the govt knows of active diseases so they can introduce herd immunity or prepare people who could be in contact and prevent future infection no - patient confidentiality; perhaps can code the name by using the MRN

7. Your mother calls you and asks you to help with a major family decision. Your maternal grandfather is 70 years old and has been diagnosed with a condition that will kill him some time in the next five years. He can have a procedure that will correct the disease and not leave him with any long-term problems, but the procedure has a 10% mortality rate. He wants to have the procedure, but your mother does not want him to. How would you help mediate this issue?

ask, educate, tell mother that he is the patient and she isn't and she has to understand that he needs to make his own medical decisions if he is in his best mind state, be supportive, offer mother support groups