Multiple Mini Interview (MMI) Questions

You are seeing a patient who is a gymnast and currently training for the Olympics, the patients mother is upset because teh patient recently gained 3 pound. Enter the room and address the situation?

- enter the room in a calm manner and I would advocate for the patient by informaing mother of patients weight in relation to weight chart compared to age. If it healthy weight gained I would in for a that out the mother. I would also say that weight fluctuates and it is normal to go up and down then I would say that she is growing and gain weight. I would manage through jhalthy balanced diet if she keeps gaining unhealthy weight

How does Canadian health care system compare to that of Britain's system vs. the American system?

-Canada: publicly funded, universal coverage for medically necessary health services provided on the basis of need, rather than the ability to pay -Britain: government-sponsored universal healthcare system called the National Health Service (NHS) -US: publicly and privately-funded patchwork of fragmented systems and programs. Insured Americans are covered by both public and private health insurance, with a majority covered by private insurance plans through their employers. Government funded programs, such as Medicaid and Medicare, provide healthcare coverage to some vulnerable population groups

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?

-I do believe that the physician's actions can be justified. First by the principle of deontology. As a medical provider it is your duty to do no harm to your patients. The physician's decision can be justified by this principle because he/she knew that the patient would die without the procedure, and effectively saved her life. -A second principle that comes into play here would be the patient's competence. The physician did not believe that the patient was fully competent in that situation and did not have the capacity to assess/understand and act upon the information that was critical to making the decision. This alone makes the patient not competent, and therefore can take away their autonomy to make their own decision in this situation. -Therefore, the physician applied the reasonable person decision which makes the assumption that a reasonable person would choose what is in his or her best interest, which in this case would be to have the life-saving procedure.

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?

-I don't think there should be a blanket age in which we should make older drivers give up their driving privileges. People age at very different rates due to genetic and lifestyle factors, and one's age alone is not a great determiner of their overall health status. For example, my great grandmother lived to be 106 years old and was extremely healthy and active up until the last 3 months of her life. She did yoga and Pilates until she was 101, and drove until she was 102. She had excellent vision and hearing, and was still very cognitively sharp until she was 105. So if there was a benchmark age of say for example, 80, in which we cut people off of driving, she would have not been able to drive for 20 more years, when she was still very well able to do so. I do understand that this can be very drastically for other individuals, for example, my grandfather on the other side had to stop driving when he was 78 because of physical limitations such as his vision, and cognitive abilities. -So, overall, I do not think that there should be a cut off age in which we revoke licenses because everyone ages differently. Some people may need to stop driving at a much earlier age, while some remain very healthy and able into older ages, and this would not be fair. -What we should continue to do as medical staff and family members as well is continue to be aware and test vision and response times as people age, in order to determine when each individual should stop driving.

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

-I think that both aspects are important. -Preventing disease: I think that preventable treatment is a newer concept, at least within the U.S. that we are still learning so much on every day. This involves aspects of lifestyle, nutrition, socialization, and relationships. We know that these have great impacts on our health, yet so many people choose to ignore them and suffer from them. The two leading killers in the US include heart disease and cancer. Heart disease we know can be largely limited or avoided by a healthy diet with limited red meat and salt, and maintaining a good moderate exercise plan to work the heart and boost our immune systems. We are continuing to learn more about the role of nutrition in preventing disease, something that I personally am very interested in, but still have so far to go with this. -Treating existing disease: On the other side, treating existing diseases is at the base of our model of healthcare and has been for many years. It's largely how we provide healthcare, someone comes in with signs and symptoms, and we try and figure out what's going on and how to treat it. While I do believe that that will remain the main behavior within our healthcare system because a change in culture would take significant time, I do think that preventative care is growing in importance because we're finding that many of the leading killers in the U.S. can largely be prevented if the proper actions are taken. While there are exceptions to this such as genetically inherited sex-linked diseases, such as Parkinson's, that no amount of change or preventative care could help you with, for the majority of our general health problems (other than accidents or traumas), we could make changes to help prevent them.

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 approach this situation with a lot of empathy and compassion because this would be a very difficult discussion to have. The first thing I would take into consideration would be that as a medical provider, I have the duty to do no harm. In this situation this can mean a few different things. -I first have the duty to do no harm to my patients, in this case Linda and her husband. From my point of view, not informing them that neither of them are carriers of this genetic defect would be doing them harm, because knowing this information, they would not have to worry about future children having this defect. However, this is also going to create conflict between them since they're not aware of this non-paternity, and could cause them to potentially split. -The other side of doing no harm would also apply to the greater public, in this situation the boy's biological father, because he is unaware he carries the mutation. Not informing this man that he carries this mutation is harming him and the greater public, because knowledge of this could potentially impact his decision to have more children in the future. -Overall, it would be my duty to disclose this information openly and honestly about the boy's biological father because it is their right to know the full truth of the situation, and it would also be my duty to the biological father to inform him of his mutation he carries, so that he is aware of the possible implications of having another child in the future.

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?

-If the patient is emancipated or not financially dependent on his parents, and is living independently physically and financially, then no he does not need his parents' permission to participate in the study.

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

-If the physician feels the patient has a full understanding of the situation, the benefits, risks and reasonings for doing the surgery, and is competent to make their own medical decisions, then yes I would say the patient can give consent. Mental illness on its own is not a reason for a patient to not have autonomy over their decisions. And schizophrenia is a widely variable condition, and people with it can have completely different levels of functioning or cognition. -Competence for decision-making is situational. Even if a schizophrenic patient can't make an informed decision about other aspects of their medical care, if they demonstrate they have an understanding of this situation, then they can provide informed consent independently.

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?

-In this situation, the doctor has the responsibility to remain open and transparent with the patient, and also ensure that they maintain a high level of professionalism to maintain trust with the patient and his family. -Option 1: The first extreme option in this situation would be to ignore the parents and tell the boy about his prognosis. This would however deteriorate the trust between you and the family. -Option 2: The other extreme option would be to listen to the parents and not tell the boy. This option is also bad, because they're not being honest and transparent with the patient. -Conclusion: So to make my decision, I would like to first ask the parents why they don't want me to tell their son about his condition. If they're concerned about his reaction, then I will assure them that the disclosure will be done in a sensitive manner. If they're concerned about potential negative impacts on other aspects of his health, then I would take their request more seriously, but since the boy already has a terminal illness, I don't think it's as important in this case. If the parents still say no, then I would look to address the patient's maturity and competency in making their own medical decisions. If I then deem them mature and competent, and he asks me to tell him about his prognosis, then I likely would at this point in time.

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?

-In this situation, the physician should discuss with them the reasonings behind why they would like to select the sex of the child. Sex selection should never be made based on preference, as this is unethical. The physician should not play the role of God, and should let nature run its course. -However, if they're asking because they are aware of a sex-linked inheritable disease within their family, then this may be appropriate and warrant further discussion.

What is the difference between Medicare and Medicaid?

-Medicare: a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income -Medicaid: a state and federal program that provides health coverage to very low income individuals

The City of Vancouver has taken great measures to increase access 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?

-Negative: cost a lot of money, takes a long time, not sure if they will be utilized by the public enough to support the cost of building them -Positive: increases access of transportation to those without cars, more environmentally friendly because of sharing transportation

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?

-No, it is not ethical under any circumstance for a physician to become sexually involved with their patient. This relationship should be strictly professional, and have no outside engagements -It is only okay when the physician terminates the doctor-patient relationship and that individual is no longer a patient of that provider for them to become involved, but still is not advised.

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?

-One possible implication of this could be that while 2 or 3-year tenure helps in the short-term of the rural physician shortage, this may or may not contribute to the shortage long-term. -If this preference is released to the students applying to medical programs, students could use this information in their interviews to seem appealing to the interviewers, when in reality this is not their long-term goal. -I do not believe that this policy will be effective because it could negatively "motivate" students to use it as an incentive to get into medical school, work in a rural community for a few years, and then move back to where they're originally from if that's suburban or urban areas. -What I do think would help with this shortage would be to increase education and programs within these rural communities. If there's an attitude change in the communities and incentives for locals to go to medical programs and return to their hometowns, then I believe this could have a greater impact on the shortage long term.

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

-Option 1: I have the duty to fulfill my patient's wishes which would require me to maintain the patient's confidentiality and not tell her parents about her request for birth control. Depending on state laws, I may not be able to freely share with the parent this information because of HIPAA regulations and the patient's request. -Option 2: The patient is a minor so I would need to understand the state laws surrounding the issue, what I am held to under HIPAA, and what I would obligated to tell the parents. -Option 3: If the patient is willing and comfortable, I would offer to facilitate a conversation involving everyone together, to talk about the reasonings behind the contraceptive request. -Conclusion: In this situation, I would really try to have that conversation with the young patient and her parents, if she's willing, because there are many reasonings behind contraceptive use. It's very common to prescribe oral contraceptives for acne, and if this were the reasoning behind why she requested birth control pills, I would explain the complications of insurance and that the pharmacy may inform her parents of the medication. Ultimately, I would encourage the patient to involve their parents in the discussion just to make sure everyone's all on the same page. If she does not agree to have this conversation with her parents, then I as the medical provider would have the duty to maintain the patient's wishes and confidentiality, and would not share that information with her parents, although they likely will find out one way or another.

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

-Option 1: On one side, I understand that everyone has their own autonomy and the right to ultimately make their own decisions on their healthcare, so while as a PA and having a family member depend solely on alternative medicine would be very difficult, I would have to accept that at the end of the day it is their decision what they decide to do. -Option 2: On the other side, I would have the duty as a PA to educate and inform this family member of the more traditional medical side of the illness, and present that family member with the data supporting the use of traditional medicine to treat this illness, and to really push that they do not use alternative medicine for treatment. -Option 3: The other option here would be to offer a more middle ground approach when talking with this family member about their treatment. I could offer to have those conversations regarding the data behind the traditional medical treatments for their illness, so that they have all of the information regarding treatment options and can make an informed decision. With this, I would also have that discussion with them on why they want to use alternative medicine for their treatment, and why they believe it could work, and really just encourage them to use it as supplemental treatment in addition to traditional medical treatment, as long as whatever they are choosing to do does not put them at harm. -Conclusion: Overall, in this situation I would ultimately decide to approach my family member with a warm and supportive attitude because this is a sensitive situation. I would offer to talk to them about the data regarding traditional medical treatment options for their illness and help them understand how they work and why they can be successful. I would also in this conversation speak with them about why they want to use alternative medicine and why they believe they would work on their own. Ultimately, as a medical provider it would be my duty to encourage my family member to still use traditional medical treatments as the base of their treatment. But to please them, I would encourage them to still use the alternative medicine as supplemental treatment in addition to their traditional treatment, as long as I knew it would do no harm.

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?

-Option 1: The first option would be to give the transplant to the successful elderly member of the community because they have done well with their life, and have made positive contributions to the community, and deserve that transplanted organ. -Option 2: The second option would be to give the transplant to the 20-year-old drug addict because they have more life left to live, and maybe this organ transplant is what they need in order to get their life back on track and act as really a wake up call to change the way they're living, since they're so young. -Conclusion: Ultimately, while this is a very difficult decision to make, I think in this situation I would choose to give the transplant to the 20-year old because they still have a lot of life left to live, and have the most potential in their remaining life to make the most positive impacts within the community. I understand that the transplant may not be in the long run worth it if this individual continually makes those decisions and would ultimately run down that organ again. However, I also understand that sometimes a transplant is what some people need as a wake up call to change their lives, and to really turn things around. And also this individual is so young, and has not fully developed their higher thinking, and did not understand the impacts on their body that their decisions were having. This could then lead to the highest greater good within the community, and have the greatest positive impact for that individual and those surrounding them.

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?

-Option 1: The principle I would have to consider is it's my duty as a medical provider to do no harm, which in this situation could mean different things. The first option I would have here would be to do the blood transfusion to do no harm because I know it will ultimately save this individual's life. However, violating the patient's autonomy is doing harm unto them, and this decision would not be following the patient's wishes, and would go against their autonomy and freedom to make their own decisions regarding their healthcare. -Option 2: The other side would be to not do the transfusion because I understand that while I know this transfusion would save their life, it would be going against their strong religious beliefs and their autonomy to make their own decisions. -Conclusion: Overall, this would be a very difficult decision to make because there's strong arguments for both sides. However, in this situation I think I would ultimately decide to not do the transfusion. While this would be very difficult, I would understand that this would follow the patient's wishes and maintain their autonomy. This patient is 18 years old and a legal adult, which therefore gives her the right to make her own decisions, and the card clearly indicates no blood transfusions under any circumstance. If I were to go through with the blood transfusion and she lives, there is the potential of her being very upset with the situation because of her strong religious beliefs, and that I could even potentially get sued because I didn't follow her orders.

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

-Positive: increases revenue for the hospital which allows them to have more tools and resources to provide a higher quality of care; also increases revenue which could increase their pay for staff which will increase staff satisfaction and ultimately also lead to a better work environment and higher quality of care -Negative: greater cost for the patients which could lead to financial burdens for many people; what happens when someone can't afford to pay that?

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

-Pros: help eliminate the black market for marijuana; can control what goes into it and THC levels; people can have more confidence in what they're actually getting; no lacing of other drugs; decrease in crime and violence over production and selling of the drug; proven medical benefits over a wide variety of diseases such as cancers, AIDS, and glaucoma. -Cons: long-term use can have negative health implications; second-hand smoke can be harmful to others such as cigarette smoke; harder to gauge and set a level for driving standards -Impact physician's ability to write out a prescription for medical marijuana: If marijuana is legalized for recreational use, then one might be less inclined to go to the doctor to get it prescribed for their condition when they could just go buy some themselves. This then could lead to complications because there's less education and control of the drug for the use of treatment of the disease, and could lead to further health problems. -Impact on cost in healthcare: I'm not fully educated on the topic, but I do remember reading in an article that cannabis related emergency department visits have tripled since the state legalized recreational use in 2014.

Help this student complete the following task...

-Scenarios are common in MMI, and there might be a person waiting in the room that you have to direct -the task evaluates your communication skills to determine if you can effectively give directions -You CANNOT be too detailed in your instructions -To practice: start thinking through every step of your mundane tasks (brushing your teeth); give directions for putting on a pair of gloves, give instructions for making a PB&J sandwich; practice explaining tasks in simple terms

A boat is sinking. There is a lifeboat for one person. The passengers include a 75 year-old physician, a 50 year-old arm officer, 24 year old teacher, and a 6 year old. Who gets the spot?

-The 75 year old physician would probably be the most equipped to care for any sick or injured passengers. However, as the oldest on the boat it's probably fair to say they've lived most of their life and should sacrifice their position on the lifeboat -The 50 year old army officer likely has the most survival skills and would probably be the most likely to make it to shore, however, these skills could also come in handy if he stayed on the boat with the other people to keep them alive until help came -The 24 year old teacher has a lot of potential because they teach the future physicians and army officers, and could arguably have the biggest impact if they survive -The 6 year old would usually be the easiest to assume who should get the lifeboat as the youngest member with the most life left to live. However, it probably isn't likely that they could navigate the lifeboat independently and make it to shore. -This is a tough call, but I would likely say that the 24 year old should get the lifeboat because he/she is likely able to make it to shore to call for help, and would have the greatest impact within the society. The army officer and physician combined could work together to survive until help came and keep the child alive as well

Discuss one of these health care issues: human genome project, AIDS, abortion, the right to die, the cost of health care, and genetic engineering.

-The Right to Die: Physician Assisted Death -From my understanding this is a hot topic in healthcare right now with more and more states in the past 10-15 years passing Physician Assisted Death, and we're now up to 9 states that have legalized it. -Pros: 1. Respect for Patient Autonomy allows them to make their own medical decisions 2. Relief of Suffering at its core, medicine aims to relieve suffering of patients from illnesses 3. Safe Medical Practice doctors can ensure that suicide by other means cannot -Cons: 1. Suicide Contagion after high profile suicide, society has been found to witness a broad spike in suicides 2. Slippery Slope There needs to be strict guidelines, documentation and witnesses because slippery slopes and relaxations in rules such as those that occurred in Belgium and the Netherlands could occur

Imagine your friend's father is 70 years old and has lived in major North American City his whole life. He is taken to the emergency department at the local General Hospital. He has had good health until now and this is the first time he has been to a hospital of any kind since he was 20 years old. What changes in the healthcare system and environment in the hospital do you think he would notice?

-The obvious factors that will stand out to him are going to be the advances within medical technology. Everything is done and documented on the computer now, rather than paper. Technology has advanced our abilities to treat a vast amount of illnesses with higher quality and precision. -More of a cultural shift would be that 50 years ago there likely were very few female doctors. While numbers are still not equal, there are significantly more female doctors than before. Likewise, there's also more male nurses. The more traditional gender roles within the healthcare system are being defied and challenged, for the betterment of the environment within healthcare.

A physician went on vacation for 2 weeks. He did not find another physician to cover him. One of his patients with hypertension developed severe headaches. 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 hemorrhage. Is the physician responsible for this patient?

-The physician has a legal obligation to arrange for coverage by another physician during their time off. One question for this situation would be did he give his patients fair warning before going on vacation, so that they could make plans to see another provider during this time? Also, was the patient left in a manner that could have led to a state of emergency? If so, did the doctor inform them on what contingencies to take if their condition worsened? If the doctor left them in that condition and did not inform them what to do if their conditioned worsened, then yes the physician is responsible for that patient. However, if he did give fair warning of his time off, and did discuss with that patient what to do if their conditioned worsened, and had a plan in place, but the patient did not follow that plan, then no the physician is not responsible.

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 very tricky situation that would require a lot of caution and sensitivity. When discussing cultural practices, a physician needs to approach it with sensitivity and understanding, but still be able to know when the boundary is for stepping in. I think the right step for the physician in this situation would be to have an open conversation with the mother about your concerns of the bruises. The physician should ask about the frequency of the practice, and possibly offer the option of scaling it back to see if there is less physical harm being done. They should have the patient check back within a month to see if there were any changes, and if not, then that's the point the physician should really step in and report the situation. Just because it's a cultural practice that's been practiced for years, does not mean that it can't be physical abuse towards a child, and when bruises and pain are reported to a physician, it is their duty to report that.

Interpret the graph displayed in the room.

-Use the "think out loud" technique for this situation -show your thought process of working through the graph instead of walking in and jumping right to an answer -discuss what the y- and x-axis indicate -Interpret data points on the graph and explain what they mean -Discuss any outliers

What are the 3 most important aspects in evaluating a PA program?

1. 2. 3.

What are the 3 most important aspects in evaluating a PA student?

1. Strong work ethic - they need to be able to handle the rigorous schedule and demands of PA school, and of the profession 2 Personable - they have to be personable because connecting with your patients, being able to communicate clearly with them, and showing compassion to ensure they're comfortable with you is critical to being able to provide the best care, and making your room feel like a safe space 3. Team driven attitude - being able to work well with others is a desirable trait to have when working in healthcare because you're going to be working with others, you're going to be a part of a healthcare team, and you have to be able to work together to ensure the best quality care for the patient

A boat is sinking. There is a lifeboat for one person. The passengers include a 75-year-old physician, 50 year old army officer, 24 year old teacher, 6 year old. Who gets the spot?

75-year-old physician - A physician may be most equipped to care for any sick or injured passengers, but that knowledge may enable them to survive if they ran into trouble on the lifeboat. As the oldest option, is it fair to say they have lived the most life and should sacrifice their position on the lifeboat? 50-year-old army officer - This person would arguably have the most survival training, and potentially be most qualified to make it to shore and try to get assistance for the sinking boat. Those same principles could be argued for why the officer should stay and help remaining members survive. 24-year-old teacher- As a young person, a teacher has potential because they teach the next physicians and army officers, so could they have the biggest impact if they survive? Would they have the necessary skills to make it though? 6-year-old - It's easy to assume the child should get first dibs on the lifeboat as the youngest member with the most life left to live. To play the devil's advocate, do you truly think a 6-year-old could navigate a small lifeboat to dry land independently? Would fear or lack of strength get in the way? In my mind, that would be a tough call.

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

Doctor and healthcare worker strikes are a difficult debate to divulge into. Under the Hippocratic Oath doctors have the duty to do no harm to their patients and to the greater public, so by deadlocking healthcare this is violating that oath. By going on strike they are putting people at risk and could potentially be putting many lives at risk. However, I also believe that the vast majority of physicians would agree that they have a moral obligation to at least provide at least emergency services at all times. But to deny any group of workers, including "essential workers" the right to strike is also ethically wrong. I do believe that doctors have the right to strike if their reasonings in doing so was because they've exhausted all other avenues of negotiations.

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?

First, I would want to look into the laws regarding the requirement of wearing a helmet while biking, because this could potentially play into my decision. However, I do not think it is reasonable to ask him to contribute towards his treatment costs because this is one of the reasons what insurance coverage is there for, our mistakes or accidents. Nobody tries to fall off of their bike and hit their head, it's an accident. Yes he should have been wearing his helmet, especially with children around watching. However, it was an accident and I do not think it would be reasonable to ask him to contribute to his treatment costs.

You are seeing a patient who is a gymnast and currently training for the Olympics. The patient's mother is upset because the patient recently gained 3 pounds. Enter the room and address the situation.

Hi there, my name is Kendall and I'm the PA who's caring for you daughter today. What concerns do you have coming in today? "My daughter recently gained 3 pounds." Okay, well I'm not too concerned about that because there's a lot of different factors that can fluctuate the weight 3 or so pounds throughout the day. First is that water weight can cause slight fluctuations in weight on a daily basis. Her body is also under a lot of physical stress as a high performance athlete, and is likely building muscle as well, which requires more nutrients to be able to sustain a high level of gymnastics, raising her metabolism and causing her to want to eat slightly more. The time of the day when you get weighed also can impact your weight, because if you weigh yourself first thing in the morning you're going to be lighter than you would be right now in the middle of the afternoon because you've hopefully had breakfast and lunch already, and water mixed in there. Overall, slight fluctuations in weight such as this are really not too concerning, and nothing that should cause distress or preoccupation over.

You are caring for an obese patient on multiple medications, some of which are causing side effects. Would you recommend a changes in medication or lifestyle?

I am assuming I am a PA caring for a patient. I need to determine if this obese patient on multiple medications should change their lifestyle or medication becasue they are experiencing side effect from some medications. Pros and cons - lifestyle changes include weight loss, overall increased health with a healthier diet and focus on excessive. And possibly the need for less medications which leads to fewer side effects Cons: - this is a difficult decision requiring patient compliance and cooperation and it may take time for the patient to gradually transition off of any medication - Prost of changing medication - possible decrease in bothersome side effe3cts , while on the flip side the new medications could also have negative side effects I would first encouratye lifestyle changes for a set period of time before changing medications , unless the particular side effect were debilitating or preventing the patient from making lifestyle changes.

You are caring for an obese patient on multiple medications, some of which are causing side effects. Would you recommend a change in medications or lifestyle?

I am assuming I am the PA caring for the patient in this scenario. I need to determine if this obese patient on multiple medications should change their lifestyle or medications because they are experiencing side effects from some medications. Pros of lifestyle changes would include weight loss, overall increased health with a healthier diet, and focus on exercise, which all could possibly lead to less of a need for medications, which could ultimately lead to fewer side effects. Cons of lifestyle changes would be that this would require patient compliance and cooperation with the lifestyle recommendations, and it may take time for the patient to gradually transition off medications. Pros of changing medications would be that it could lead to a decrease in bothersome side effects faster. Cons would be that the new medications could potentially have negative side effects for the patient as well. Personally, I would encourage lifestyle changes for a set period of time, say a 3-6 months, before changing medications, unless the particular side effects were debilitating or preventing the patient from making lifestyle changes. I say this because in the long run, this could transition the patient off of medications long term, and lead to a healthier lifestyle.

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

I do not think that doctors should have a role in regulating UFC and boxing because at the end of the day it is the decision of these individuals to participate in these sports, and put their bodies at the risks they do. They have their autonomy to make decisions for themselves, and can participate in dangerous sports if they'd like. If doctors did have a role in regulating such sports, then there's a vast amount of other sports and activities that could turn into a slippery slope of control of doctors such as hangliding, surfing, skydiving, and so many more, that put one at risk. However, we cannot begin to control everything that's dangerous for people, they have to make those decisions for themselves, and live with the consequences.

Discuss a pastime outside of school and how the skills acquired will help you in your career.

I have played soccer my entire life, and continued to play in college at St. Ben's. I also play a special role on the team because I was the goalie. With this position comes extra responsibility and pressure because you're the last defender, so when the ball goes in the net behind you, it's easy to get down on yourself and blame the goal on yourself. However, I look at this a little differently than others. Because soccer is a team sport, I learned to realize that the ball had to get through my other 10 teammates on the field before it could even get to me, which emphasized the importance of good teamwork and communication. One of the largest roles of being a goalie is communicating effectively with your teammates to direct them. Communication has to be clear and precise, because often times you don't have a lot of team to direct them before someone's coming at you full speed ahead on a breakaway. However, with clear communication, this can make all the difference in organizing your defense to prevent those situations. Learning these skills of communication, especially how to communicate in simple and clear ways, will help me in my career as a PA when explaining a diagnosis or a treatment plan to a patient, or also communicating with my colleagues.

If you were a color what color would you be and why?

I think I would be yellow because I'm a pretty positive and optimistic person. I always try to look at the brighter sides of life, and help others find their silver linings as well. With this I think I've built up a lot of resilience against the negative things that could have set me back in my life, but that I didn't let.

If you could have any other job, besides being a PA or working in the medical field, what would you do?

I think it would be very interesting to study and research longevity, from more of an anthropological standpoint, because I'm super interested in the blue zones around the world, and the lifestyle and diet components that can increase our chances of longevity. I think that the standard American diet contributes to our leading killers today such as heart disease and cancer, and could potentially be avoided by changes in our diet and lifestyles. I read the Blue Zones book about 6 months ago, and I found it incredibly interesting as he researched and traveled to these places around the world where people are generally living longer and healthier lives, and he gets to connect with different cultures to learn the different aspects of their lives that they believe have contributed to prolonging their healthy years.

What are you famous for?

I think my friends would say I'm known as the planner or organizer of the group. I was always very organized with my time and knew when assignments were due, when to work on each thing, and developed a way to study that worked for me. I helped my friends with this too and held them accountable as they held me accountable, since we were in most of the same classes, and had dedicated study room times every Sunday afternoon

You are on the committee to hire a new faculty member for the PA program. What characteristics and/or qualities would you look for when selecting an effective teacher?

I think the most important strengths I find not only in a PA and a teacher, but in a person in general as well, includes kindness, approachability, compassion, and a strong work ethic. I like a teacher who's willing to listen to my questions, and wants to see me succeed and receive the best education. I also think that empathy is an important quality, especially for PA faculty, because they have been in this position and understand how hard PA school is, and can be there to offer support when necessary. Finally, extensive experience is also important for PA faculty because they're bringing more knowledge to the program, and would benefit everyone.

You discover a classmate is romantically involved with her preceptor. What should be done, if anything? Enter the room and discuss your position.

I would bring this to the attention to the program because as a part of the program, it would be my responsibility to inform the program of anything that I perceived as unethical. The potential ramifications of this scenario could be that the student loses focus on learning patient care, could be receiving special treatment from the preceptor, and it's overall just a lack of professional judgment on the preceptor and student's parts, which all I believe should be brought to the attention of the program.

A friend in your class confided in you that his mother was recently diagnosed with breast cance. He is overwhelmed and may drop out of school to spend time with his mother. How would you counsel your friend?

I would reassure her that I understand that breast cancer and caring for mother is priority and could be oveerwhelming while going to school. (EMPHATHY) I would also speak on the pros and cons of dropping out of PA school. - I would tell her to talk to me if they are willing , that I am here for you - I would be happy to go to advisor and see if options are available so you can be there for you mom and continue program 0 such as online class - I would make aware of how much effort and money they owe to be where they are at - if need help studying or taking notes, I am available for you as well as our other classmates Talk to mom about it What ever you decide ill stand by you, But I am willing to help in whatever way possible that will help you complete the program

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?

I would say increase measuring safety culture more frequently to foster a supportive and healthy work environment. Measuring of this must be done at the unit level, so at every facility for local change, rather than a higher scale measurement. By increasing measuring of safety culture, this will foster an environment in which healthcare team members have what they need to do their jobs with the highest quality, and have supportive and engaged leadership members with whom they are comfortable speaking up about problems to. By having this healthcare environment in which everyone feels valued and respected, and has open communication, this will effectively lead to the highest quality of care within our facilities.

A friend in your class confides in you that his mother was recently diagnosed with breast cancer. He is overwhelmed and may drop out of school to spend time with his mother. How do you counsel your friend?

I'm glad you cam e to me to talk about this and shared what's going on. I'm so sorry to hear about your mom, and that's a very difficult decision to make. Have you talked to her about what she thinks you should do? You've worked so hard, and your mom may want to see you complete your goals and continue the program. I would be happy to go to your advisor and see if options are available so you can be there for your mom and still continue the program. I also am here if you need help studying or taking notes. Whatever you decide, I'll stand by you, and I'm willing to help in whatever way possible that will help you complete the program.

You are a dermatology PA. A patient states they are out of opioid pain medication and unable to get more from their pain management physician for another few weeks. What do you do?

I'm sorry to hear that you're out of your medication. Could you explain to me the circumstances of why you're taking the pain medication? I ask because if it's not dermatology related, I'm sorry but it would be out of my scope of practice and I cannot write this prescription for you.

If you could do anything else and know you would be successful, what would you do?

If I could do anything else and know I would be successful, I think it would be very rewarding to run a non-profit for underserved communities to have greater access to better, healthier food options, and for education and promotion of healthy living within those communities. I've learned that many underserved populations frankly don't have access to better foods, or don't have the resources to pay for them since organic foods and Whole Foods tend to be more expensive. With this, I would be interested in finding ways to make healthier food options more attainable for underserved communities, which as a result, would impact every other aspect of their overall wellbeing, since we know how important nutrition is, and how it can impact virtually every aspect of our physical and mental wellbeing's, or can at least be a step in the right direction.

If you were a tree, what kind would you be and why?

If I were a tree, I would probably be a pine tree. I say this because they consistently produce seeds to spread and share with surrounding areas. I think this reflects my personality because I see these seeds as little bits of empathy and compassion. I believe I have so much empathy for others because I've learned throughout my life that you never know what someone's story is by first glance, or even second. Everyone carries a backpack of their experiences throughout life, and they influence the decisions throughout their entire lives. I also am a very compassionate person, because I think this is one of the most important qualities a person can have, especially while working in healthcare. Understanding that you don't know people's backgrounds makes you more aware and cautious of what you say and do because you never know how that could really impact you. So yea, I'd say I would be a pine tree because I try to have my seeds of positivity spread and share them with everyone I come in contact with.

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?

In order to mediate this situation, I would have everyone sit down to talk openly and honestly about their concerns and opinions on the procedure. I would have my mom communicate her concerns with my grandfather about the mortality rate and how that scares her that she could potentially lose him due to it, rather than have a good few years with him which would allow her to prepare for his death. On the other side, I would foster communication from my grandfather about why he wants to do the procedure. With only a 10% mortality rate, that's a 90% chance he'll survive and be able to live a longer, happier life not worrying about when his illness will take him. I personally think while it would be scary to do the procedure, I would side with my grandfather to have the procedure done because there's only a 10% chance he won't survive, and a 90% chance he will survive and be able to live hopefully longer than 5 years. This decision would likely allow us to have more time with him, and would also give him more peace of mind. Ultimately, to mediate this issue though, I would remind my mom that the decision is ultimately up to him. He has his own autonomy to make his own healthcare decisions, and we would have to live with his decision.

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 the location of the hand sanitizer stands? Do you approach him?

In this situation I would definitely approach him. Hand sanitizer is a valuable resource, now more than ever, but is also a health risk to him and a major concern. I would then try to get him to the ER to ensure he hasn't damaged any organs, and make sure he was in stable condition after consuming so much hand sanitizer. If he does not agree to go to the ER, then since he is not a patient and is putting others at risk due to the lack of hand sanitizer, I would have him I removed from the building. If he does agree to go to the ER however, then once stable I would have a licensed drug and alcohol counselor speak with him about his addiction and possible treatment options. I would also have the social worker become involved and reach out to any family that could help him get treatment. Alcoholism is a disease that requires management just like diabetes, and without treatment and a recovery plan, that individual is powerless over the disease and will go to whatever means to get alcohol. I would encourage inpatient treatment options for this individual and for them to begin the steps of AA since these are really the only current treatment options for this disease. In regards to the hand sanitizer stands, I would not move them because they are usually located in higher traffic areas or where the medical staff can easily access.

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?

In this situation, I would need more clarification as to who else is receiving the vaccine at the same time I would be. This is very similar to the situation our world is currently in as well. Those who are most at risk should be receiving the vaccine first, such as the elderly population, and those with underlying health conditions. My first option here would be to take it because I am high up in healthcare administration, and likely have strong influence on how my facility is dealing with this disease, and have potentially the greatest good impact on the community. If I don't take it and I die, this could have negative impacts within my organization and potentially lead to disorganization within the facility, leading to more infection. The other option I would have here would be to not take the vaccine and offer it to another person, who possibly is at a higher risk than I am. As a younger individual in good health, if offered the vaccine I would look into who was receiving the vaccine ahead of me and at the same time as me, because if I believed those at a higher risk of mortality were going to receive it after me, then I would offer it to them. If I took the vaccine and saw the numbers of elderly or immunocompromised who were dying from the disease, I would feel a great amount of guilt because as a young and healthy individual, I likely would have a better chance of survival, and I got the vaccine before someone who didn't have such good prognosis.

An 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?

In this situation, the physician should report this to the college authority and recommend that the man should be isolated during the course of his illness, to prevent further spread within the college dorm and campus.

Discuss any topical health care issue that is unique to the region for Med School you are applying to?

Iowa has a shortage of healthcare workers which is impacting their hospitals and emergency departments during COVID

Your local Pediatric 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.

My understanding of this topic is that unnecessary circumcisions are very costly and do not have clear benefits to support this use of resources. While that makes sense, the debate is not that simple. One ethical problem that could arise from Medicare no longer paying for unnecessary circumcisions would be that this could potentially create an unequal divide between the middle and upper class who could afford the procedure, and the poor who could not. By not covering unnecessary circumcisions, those who could still afford it could still get circumcised, which creates more opportunities for the wealthy than for the poor, which over time could potentially indicate one's wealth class. In addition to this, this is creating more opportunities for the wealthy within healthcare, which is supposed to be equal opportunities and care for all. I also read that the CDC updated their guidelines on this topic and their position on the topic made a good point: "they advise that parents and guardians should have routine access to information about the risks and benefits of circumcision, and that insurance status should not be a barrier." The other ethical problem that this could create would be the aspect of religious viewpoints on circumcision. I understand that there are various religions such as Judaism and Islam, that require circumcision shortly after birth. With no coverage, this would put these families in difficult situations and potentially not allow them to follow this step in their religion if the financial burden is too large.

Discuss a time you had to resolve conflict.

One example that comes to mind was when I was in Nicaragua on a medical mission trip, we showed up to the abandoned church building where we were going to set up our clinic. The building was just one open room, and we had to set up a medical clinic and a dental clinic, so we needed to separate the room in half. We then shortly found out that the staff member responsible for bringing the top to tie up the sheet to separate the room forgot to bring it. So, everyone was quarreling about what to do and trying to come up with a solution, and I had the idea to tie together all of our shoelaces to create a rope. This then effectively worked to hang the sheet down the middle of the room, connecting it to the two pillars that were on each side.

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?

Personally, I would not sell them the syringes. Without a prescription or record of treatment that would require syringes, there should not be the availability of them to the general public. Our country is experiencing an opioid and drug crisis, and the over selling of needles and syringes are contributing to this epidemic. There should be no need for these tools if the individual does not require them for a medical treatment such as diabetes, and understanding the situation here is important because if sold, this action could be contributing to the drug problem within our country.

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.

The development of an amazing effective vaccine for Ebola would have massive implications on a global scale. However, the mass development and distribution of this vaccine would be the difficult part of this situation. In order to mass produce this vaccine, this will take a lot of time and resources, two things that countries could particularly struggle with. First, the time aspect is tricky. Once producing this vaccine, the ethical problem arises with how one decides who gets it first. Likely those who currently have Ebola will be on the top of the list to receive the vaccine, but who decides on what countries will receive it first and who infected within those countries will receive it first. This could create tension and the ethical problem within that of what age group, gender, geographical location (rural or urban) will receive the vaccine first. On the other side, a mass vaccination of this sort will require a significant amount of funding and resources which for many countries they don't have, and this takes time to develop. It takes time to stock up on the supplies needed to mass vaccinate such as needles, and it also requires a significant amount of medical staff in order to give the vaccinations. Overall, the development of a cure for Ebola would be an incredible discovery and have a massive impact on a global scale, and would ultimately save a lot of lives if it could be mass produced and distributed.

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 behavior might pose. Discuss.

The side supporting Dr. Blair's behavior would argue that patient's do not like coming into the clinic and leaving with no information about their condition. So, by recommending homeopathic medicine, he is satisfying the patient by giving them a sense of hope and reassurance that something could help them. The negative effects of this are that there is no scientific evidence supporting these methods, and it could be providing false hope for the patient. This behavior is also unethical because Dr. Blair is not being open and transparent with his patients, that he is unsure of their conditions, and that homeopathic medicine is not proven to be accepted and is not widely accepted. These behaviors then are unprofessional, and are violating the Hippocratic oath of doing no harm, because giving false hope in something that is not evidence based, and something you don't yourself believe works, is a form of harm in my opinion, and is not the correct way to handle the situation.

You discover a classmate is romantically involved with her preceptor. What should be done, if anything? Enter the room and discuss your position.

This is an inappropriate relationship and I would make the classmate consider the possible ramifications.. 1. I would approach students and explain directly why you dont agree with their choice 2. Explain why - loosing focus on learning patient care - could be receiving special treatment, - the preceptors lack of professional judgement in crossing line to date a student - preceptor and he/she brake up affect classmates 3. Go to advisor or clinical coordinator to make them aware of the situation or offer to go with the student to address this wit ha faculty member -

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 breakthrough, 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?

This situation for me would involve weighing the possible benefits of the creation of a vaccine, to the risks of dealing with the law. I would first ask for the rationale for the stoppage of research, and why they are destroying the research when we're so close. If no rational answer is given, then what I would likely do in this situation is try to lobby through the proper channels to have the research restarted because I know I am finding a cure. If there's no way to continue the research through the government and they're truly stopping the research of this disease, then ultimately I would be required by law to turn in my work and have to try and remember as much as I could to then work possibly with a private research company.

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?

Yes, I believe that the physician should be held liable for this consequence. While it may seem counterintuitive to a physician bystander to wait for an ambulance, but it is very important to not move or handle the victim. Any tiny, minuscule mistake in handling their head or neck can be the difference between paralysis and no paralysis, and the physician should likely have anticipated a spinal injury and know this is outside of their practice or abilities is not right. Even if it is within their scope of practice, they would likely not have the appropriate appliances to move the victim prevent further spinal injuries, and still should call an ambulance. What they should have done was not moved the victim, and called an ambulance and waited there with them.

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, I do think that they have an obligation to report any infectious disease, and to bring it to the awareness of the public health officials so that proper actions can be made to prevent the spread of the disease. Their specific information may or may not be required to be released depending on HIPAA regulations, but overall I do believe that an active infectious disease should be reported because it would be doing harm to the general public if this person were released.