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MMI & CASPer Prep by popular demand Part I of II

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See: http://www.premed101.com/forums/showthread.php?p=671433&posted=1#post671433



Health Care in Canada 2010



good overview of health care in Canada and role of physician (even though meant for Que)


CanMEDS: http://




PANEL INTERVIEWS: http://www.grenfell.mun.ca/learning-centre/Documents/files/medical_booklet.pdf


ontariostudent's abbreviated posts re MMI are found below, as are insightful comments of members relating to CASPer.


MMI – A Possible Blueprint to Solving Problems Raised in Each Scenario


Assess the facts in terms of what is normally expected, including social & legal standards and norms of responsible conduct, look to ripple effects to persons involved, their family, the institution involved if any, society, including others in similar circumstances


Diagnose the moral and other problems. Determine what the parties believe to have happened and the impact upon them


Determine purpose of this scenario for you


Consider what, if any, ethical considerations are involved for the parties and wider society, and how these issues may be addressed by persons in authority


Determine what, if any, legal, bioethical or medical ethics problems or practical problems exist. Consider these as unexpressed facts in your analysis to come to a satisfactory or creative solution


Consider and discuss:


the options of actions of the participants and authorities


Consider fully the ethical principles for each option and conclude with persuasive argument supporting your plan of attack


Establish and discuss the goal you set for resolution of the ethical problem. Convince them that your plan of action (decision) will be acceptable in resolving the problem on a practical level, while addressing the ethical issues involved.


Justify the solution in terms of practicality and ethical considerations – both with the decision made AND the process of reaching and implementing the solution


Remember your ability to master a new situation in a time sensitive manner, while considering all factors that are not obvious and maintaining your composure, is what is being assessed.



















This appears to be good guidance. The interviewers mark you from a ‘structured checklist’ ranging from “excellent”, “good”, “satisfactory” to “unsatisfactory”. Below is also an additional List of Skills and Behaviours that are specifically marked in one of the below categories:

4=Excellent, 3=Good, 2=Satisfactory, 1=Unsatisfactory Top Score=20


- Has a sense of establishing the facts to ensure fairness


- Demonstrates an awareness of the dilemma from a range of perspectives


- Ability to balance conflicting interests to come to a judgment about what is right


- Appreciates the need for students to consider the consequences of personal



- Is able to draw lessons from experience to inform future learning


Excellent shows a degree of originality and creativity, including showing a good appreciation of the general issues in the context of professionalism. There is good coverage of the topic with relevant and reasoned argument. The answers demonstrate a clear view of how the various aspects of the topic relate to one another. There is reasonable evidence of critical reflection on professionalism on both the interviewee and that of others. The answers appear authentic and honest.


Good is the same as Excellent without the originality and creativity.


Satisfactory the answers are relevant but do not address all aspects of the topic. There is demonstration of understanding of the issue being considered and just enough evidence that a reasonable argument has been advanced. There is evidence of critical reflection on professionalism but the answers are more descriptive than analytical. The answers indicate a modest understanding of the topic but appear authentic and honest.


Unsatisfactory the discussion is not always accurate and relevant and key points are missed. The attempt at reasoned argument is of doubtful quality. Strategy is misfired.


Strength of your arguments, your communication skills, how you defend your position n/w/s provocation and the interviewer’s overall assessment of your performance and suitability to study of medicine and being a doctor are all factors.


Essential characteristics of Applicant:

Show ethical thinking and ethical decision making

Show professionalism, i.e. honesty, compassion, team working, ethical understanding knowledge of health care system

Dress conservatively, and note that your body language is important throughout interview

Bond with Interviewers if possible, in appropriate fashion

Effective communicator – ability to convey your ideas clearly and concisely. Listen to any explanations and statements given throughout the process

Eye contact and shake hands upon entering each MMI

Good interpersonal skills with Interviewers

Always appear calm and in control

Show quiet confidence as a person

Think before opening your mouth

Understanding – know why you are there

Ability to understand the principal issue of the situation and other important issues

Complete the answer before the time runs out

(wear watch in case no clock in sight)

Give an accurate overall portrayal of who you are

Be clear and unambiguous in your answers

Time Management is of the essence – not all applicants finish all answers. The ability to complete the task in a timely manner demonstrates an important skill


Show no nervousness or anxiety no matter what

Thank Interviewers when each session is over (perhaps shaking hand again)


Behaviours having the following attributes:


*Integrity – having moral courage and honesty, being deserving of trust

*Sensitivity to the needs of others – kindness, empathy, understanding, benevolence, recognizing the physical and emotional vulnerabilities of others in situations

*Understanding the difficulties of others

*Responding sensitively and appropriately to situations given


*Seeing the larger picture and the impact of the situation upon others of similar or other vulnerabilities and upon the great community, seeing how to create practical or innovative solutions


*Information Manager – sift the information given so as to focus on solutions to all issues, including those not apparent on the surface

*Effective Decision maker – being able to identify the problem, break it down and to identify the steps in problem solving

*Self-directed Learner – Inquiring mind to further knowledge and skills

*Ability to make a shared plan – your solution may involve cooperation of many parties for its success

*Understanding of health professionals in society

*Explanation in Context – as a communicator, Interviewers must know clearly why you have come to the decisions you have made, leave nothing for granted

*Ability to make shared plan in best interests of patient


People who will, in their professional relationships:

Take responsibility for their actions

Act ethically

Act in a congenial and collaborative manner

Be reflexive

Be reliable

Be trustworthy and honest

Demonstrate respect for others

Have commitment to help others

Maintain confidences


Mental processes that include:

Ability to summarize your position as your first statements

Ability to assimilate and evaluate information in time sensitive fashion

Critical problem solving abilities in time sensitive manner

Prioritize and manage solutions in a sensible fashion

Ability to communicate decisions to others in appropriate manner

Ability to defend your position or ideas expressed – be prepared for interviewers to rigorously challenge you

Ability to apply your general knowledge


Seeking students who will:

Be self-directed learners

Be an integral part of an interprofessional healthcare team

Be willing to self-assess

Be willing to work hard

Communicate effectively

Demonstrate ethical thinking

Demonstrate ability to manage time

Demonstrate ability to tolerate stress

Demonstrate good judgment

Demonstrate insight and empathy

Recognize and respect the benefits of science and role of others healthcare disciplines



Comments from those invited to Mac Interview, in part based upon the new Casper Questions - which may be compared to a written and faster MMI (computer based questions that must be answered quickly as opposed to autiobiographical answers made over time):








Theres no way to prepare for caper ideally. The best way to do it is having life experience. You can't fake your way through it really. You need to know how to handle stressful situations, resolve conflicts, utilize team work, problem solving, these sorts of things. You can spend hours studying these concepts, butt he best way i think is to have life experience in handling these situations either in your volunteer, research, EC's, whatever.


I used my own personal experiences to answer most questions on CASPer. In the end, I ended up having a lot of fun taking on the challenge of solving the different scenarios we were given. If I could give you two things to do to prepare, it would be to 1) briefly go over bioethics (i.e. read doing right), 2) practice MMI scenarios, because essentially CASPer is just an online MMI.





The usual sorts of interview tactics might make sense... Don't have scripted answers but be sure to have examples for the usual sorts of questions... I realize that I'm probably coming across as vague, but I don't want to be too specific since there is a lot of variability and I don't want to give away what questions I had....


More specifically for the sort of typical interview questions, I mean things like leadership, teamwork, deadlines etc. For example describe a circumstance where you couldnt seek help, what was it, how did you cope. Response should emphasis that you sought help, but then made the decision that would minimize the possibility of negative outcome, and consult an expert asap. A hypothetical example of that would be a medical emergency where you cant consult an expert right away, but you can do what you know to save their life at minimal risk, then consult the relevant expert.


For any (there were VERY FEW) medical questions, try to remember your obligations, primarily to the patient, giving them the information they need for informed consent.


When it comes to more general ethics, really just speak from your heart... care about free trade? sweatshop free? anything like that could be a good thing to lean on if you are short for time.


I hope this vagueness helps!



some ontariostudent (abbreviated) posts


I did not actually prepare for the MMI other than reading "Doing Right". I am good at improvising and thinking on my feet, and I think that practicing might actually have been detrimental for me. The answers you practice aren't necessarily going to correspond with the situations you'll have, and if you try to remember how you dealt with a situation in the past you might lose focus on what you're actually dealing with. If you're not good at thinking on your feet I guess it's useful to have people throw random scenarios at you and give you a time limit, so that you get used to coming up with things to say under pressure. Have a parent or older person do it instead of a peer, so you have more pressure. I really think that is the only thing that would help, and it would only be useful if you get flustered when you're under pressure.


I had 1 actor station where I felt like I ran out of things to say after about 5 minutes. The actor kept saying the same thing over and over again, and I just kept reiterating my position in different words. I guess there's really no situation where you'd completely run out of things to say before time is up. I always got cut off. If you find that you have run out of things to say, try to come up with more arguments for whatever you are saying, or just reiterate it.


Don't be nervous. Just be confident and you should be able to deal with whatever situation arises. I'm not a nervous interviewee and I usually improvise well, and that's probably what helped me the most. I don't think there's any real practice to be done.








Third year accepted applicant at U/C:

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what would you do if two individuals needed a liver transplant, and one individual is an alcoholic and/or drug abuser and the other a hard working middle class citizen that does not abuse drugs and/or alcohol, but has been diagnosed with cancer. Who would you give the transplant to granted you only have one liver? One of the individuals will die if they don't receive the transplant. The individual that has a history of abusing drugs pleads that he is wanting to change his life around and he can only do that if he recieves the transplant.


Everyone has a different system of course - for starters I think it is important to just flat out list all the considerations for the usual two parties affected and also the hidden third party - here we have two people in play and also society at large (no ethical decision made ever just affects the two - there are always broader ramifications. Don't miss that :) ).


As phoenix pointed out beneficence, non-maleficence, justice, and autonomy are key areas to explain. I would add privacy to that list as well since it often comes up. Break down each person's position in these terms (and also the third position as well). Simply explaining to the interviewers you know the terms, can apply them and logically determine all of the factors and all of the players gets you pretty far along in the process.


Next with all of the positions out there you are going to have to make a choice based on your personal ethical framework - what do you think is more important (does beneficence trump privacy? How about autonomy? and so on). How much does society get to play a role in this (that third player again - and often that is actually the tie breaker - actually in the case you present people often argue that the impact to society overall tips the scales one way or the other. For instance it might be in society's best interest to not allow for any form of age, race, religious discrimination - sounds good but if truly believed it means that you cannot introduce an age bias in your decision here because the impact overall is a negative one ). Breaking a law by the way impacts yourself, the profession and society - so you can just include the impact of that in any ethical consideration as well. The ability of other doctors' to do their jobs is impacted when any other doctor breaks rules - you still may have to but you also have to factor that in.


Once you make your choice they may challenge you - by pushing on some of the pillars of your argument. you can also simply look at things as a new problem, restate the changes to your analysis of key factors and draw a conclusion as well. In any case you show you think through things and don't just fly by the seat of your pants. This prevents you from being inconsistent.


Two other considerations - they will always make it sound like you have to act alone in this - that is silly. There is always a hospital ethicist, colleagues, social workers etc to help you - 24/7. Basically pull the big support button. Make sure you are still saying you will make the decision but the advice of others is important to you. It will be in the real world and shows you actually know how the system works.


Lastly people just end the discussion without talking about fall out. You don't just abandon the person that didn't get the liver - again optimally manage that care, comfort them, make sure that they are kept alive so they get potentially the next liver. Show some compassion, some knowledge of what is available to help. I call this "going gently" - someone will always not get what they want in any ethics argument but that doesn't mean you cannot help them still. Remember again you are in a hospital - you have supports.


This takes practise to get fast and good at. Still I think it is valuable :)



With regards to the MMI, I think I did very well on the MMI because I expressed a pretty solid grasp of psychosocial aspect of ethics. Whenever I was asked something about what I would do, instead of saying that I would do "X", I said it depends on the context. E.g. If the question asked about a family where the mom and the dad were divided on whether or not to fund for their kids' tuition... and was asked who's side I would take... instead of saying I would help "X" because of "Y"...I talked about how it depends on the cultural background of the family and then expanded on that by talking about the difference between Eastern (more holistic and family oriented) and Western cultures (promote independence)...and talked about how I'd have to take into consideration the family dynamics and beliefs blah blah blah. So I often answered questions bearing in mind the importance of culture, psychology, resource allocation, etc.


In another MMI station where two interviewees had to cooperate to build a block figure together under a time limit, I did horrible...we didn't complete any figures together. BUT, the important thing from that station (imo) was not necessarily looking at just how well you cooperate with others...or how patient you are... but whether you are able to see what you did wrong. The questions asked for that station were something like...what did you do well in? What did you do bad in? Why? And I talked about how I was good at being patient and calm in a more stressful situation, clear at giving instructions, asked for feedback, etc. but wasn't able to realize the importance of recognizing that the framework that I had used to go about the task didn't work for the other person and thus use a different method to better communicate with the other person.


Be calm. In a lot of my MMI answers, I mentioned short-term and long-term solutions. E.g. There was a quote said by Edison and I had to say what the role and responsibilities of doctors were. I made sure that I interpreted the quote...talking about medicine was being more individualized, how medicine was steering towards preventive measures while maintaining the importance of curative approaches, how medicine was steering towards taking a comprehensive approach to health emotionally, mentally and physically, bla bla bla. And I remember one of the follow up questions was something about HOW the role of a doctor would change in the future... and I talked about their greater role in advocacy and education bla bla bla.


What helped me with interview was to look at CANMEDs as a guideline and only a guideline and know how to apply them to your experiences. It helped when I looked at CANMEDs and though what experiences I have that demonstrate those qualities. If you google interview questions from Colorado University, they have an excellent set of interview questions. In fact, a lot of my questions from Ottawa (panel) interview were in that list. And after knowing your sketch and experiences really well, know how to slightly tweak the questions thrown at you to ones that you already know how to answer already.


In your MMI station about what did not work out well, I would have done what you did - talk about the situation, how I dealt with it well, etc but also expand on why the situation may have been how it was. Why did it not work out well? Was there a lack of communication? Was there a lack of preparation from both parties' ends? Then expand all these points. Also talk about how you approached it (which you did), and talk about whether or not it worked. If it did, explain. If not, explain how you realized that your mindset/framework didn't work, how you made a change, etc. And also talk about what you gained from this experience. How can you apply this in the future? How is it related to medicine? How has it influenced you? A lot of MMI questions require a lot of extrapolation.


If it helps, you can practice writing down the points you would say to mock questions




Also see:



Medical schools are interested in knowing about your journey, motivations and expectations for the future. Be prepared to give specific examples of instances in your life that demonstrate certain qualities which are considered desirable in a successful student and practicing physician. To prepare for this, I thought of examples from my life which highlighted things such as leadership, conflict resolution, adaptability etc. I wrote out the stories from my experiences which I felt best exemplified these traits and also those which I felt were particularly relevant experiences in working with others and being exposed to medicine. The purpose of writing them down was so that I myself would be freshly reminded of these instances and not at a loss for words ... while in the hot seat. I also asked my friends what they thought my weaknesses were and chose the ones that came up the most to focus on, this proved helpful.


Being aware with the fundamental principles of medical ethics (beneficence, non-maleficence, justice and autonomy) is really all you need when weighing and thinking through ethical dilemmas.


Also, relax. Keep composure....It is much better to pause and form your thoughts rather than talking in circles frantically.............remember that keeping composure is necessary .... and also is something they want to know you will be able to accomplish as a physician!

MMI type questions:


1. You are shift supervisor at McDonalds fast food restaurant. The owner of the franchise has called you over. He is very upset as he has received 3 complaints in the last 30 minutes about the meat in the hamburgers being poorly cooked. There are two people (one male, one female both 15 years old) who have been cooking the meat for the past two hours. The female is the owner’s daughter. How would you handle the situation?


2. Your older sister tells you that she values her career and is reluctant to take time away to have a baby. Her husband agrees with her. They have arranged to conceive an embryo through in vitro fertilization. A company in India will implant the embryo in a surrogate mother from a nearby village who will be paid $5,000. Two weeks after the baby is born, the company will deliver the baby to your sister and her husband. Your mother is opposed to this arrangement whereas your father supports her decision. Your sister asks for your support. How would you respond to your sister?


3. Your best friend is an identical twin. The other twin has been sick with a variety of illnesses most of their lives. Several times, the other twin has been so ill that your best friend has supplied tissue (e.g., blood, bone marrow) sometimes to help their sibling stay alive. The other twin now needs a kidney transplant to stay alive. Their parents have assumed that your best friend will automatically donate the kidney as usual when tissue has been needed. However, your friend is now balking at this automatic assumption of donation and is considering saying ‘no’. What would you say to your friend to convince him to donate the kidney?


4. Your best friend and partner are undergoing in vitro fertilization to have a baby. The technique allows for the selection of certain characteristics for the child by identifying them in the embryo before implantation. Your friend asks for advice on the characteristics they should select. How would you respond to your friend?


5. Your friend is of Chinese descent and fluent in Mandarin. You both want to get into medicine. She registers for Mandarin 101, a course in Chinese language for beginners. The course coordinator asks that students who can already speak just a little bit of Mandarin should leave because this is a course for beginners. Your friend remains but makes a sufficient number of deliberate mistakes in the classroom discussions, in the required homework and in the examinations that she will not be detected and yet still receive an excellent grade. What would you do in this situation?


6. If the Prime Minister of Canada were to ask your advice on one change that could be applied to the healthcare system in Canada that would improve it enormously and have the greatest positive effect, what would it be?


7. The daughter of the interviewer is 16 years old. She is adamant that she have a tattoo next week. The interviewer is against letting her daughter have a tattoo and this is causing much friction in the household. What advice would you give the interviewer?


8.. At the beginning of your last year of undergraduate studies, the Dean of your Faculty has offered to all of you the opportunity to swallow a ‘red’ pill. If swallowed, this pill would increase enormously your ability to ‘absorb’ all the educational material being presented to you in all your courses. In fact, this pill would basically guarantee that you would receive an A+ in all your future courses with a significantly reduced workload. Would you take the red pill?


9. 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 cost for his injury?


10. Class Size (Critical Thinking) Universities are commonly faced with the complicated task of balancing the educational needs of their students and the cost required to provide learning resources to a large number of individuals. As a result of this tension, there has been much debate regarding the optimal size of classes. One side argues that smaller classes provide a more educationally effective setting for students, while others argue that it makes no difference, so larger classes should be used to minimize the number of instructors required. Discuss your opinion with the examiner


11. Circumcision (Ethical Decision Making) The Canadian Pediatric Assoociation has recommended that circumcisions ‘not be routinely performed’. They base this recommendation on their determination that ‘the benefits have not been shown to 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. Ontario Health Insurance Plan (OHIP) no longer pays for unnecessary circumcisions. Consider the ethical problems that exist in this case. Discuss these issues with the Interviewer.


12. Standard Interview. Why do you want to be a physician? Discuss this question with the interviewer.


13. Deterrent Fees (Knowledge of the Health Care System) Recently, the Prime Minister of Canada raised the issue of deterrent fees (a small charge, say $10, which everyone who initiates a visit to a health professional would have to pay at the first contact) as a way to control health care costs. The assumption is that this will deter people from visiting their doctor for unnecessary reasons. Consider the broad implication of this policy for health and healthy carecosts. For example, do you think this approach will save health care costs? At what expense? Discuss this issue with the interviewer.


14. Placebo (Ethical Decision Making) Dr. Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Cheung 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. Cheung ‘s behaviour might pose. Discuss these issues with the interviewer.


15. Student Created Mock Questions. A man has been responsible for taking care of his wife who is in a vegetative state for 6 years after a car accident She can breathe on her own but that is the extent of her abilities. He requests that her feeding tube be removed. What should you, as her physician do?


16. A student is working in a clinic, where the office double book aboriginal patients. The student asks their reasoning and the receptionist replies that “These people never show up for their appointments.” How would you deal with this situation?


17. You are working on a group project with 5 other students. One of the students doesn’t show up for meetings or if they do show up - they are late and leave early. They have put no effort into the group project but show up on the day of the presentation and try to take credit for the project. What do you do in this situation?


18. Mrs. Jones has signed a donor card indicating that she is willing to donate her body to science without notifying her husband and son. She gets into an accident and it is determined that she is brain dead. The family doctor, who is on call that afternoon, reviews the chart and determines that she would be perfect for medical students to practice the removal of organs for transplantation purposes. The doctor then talks to the family to discuss the procedure and to confirm their consent. They both oppose the procedure and refuse to allow their doctor to move forward. The doctor points out that Mrs. Jones could be helping hundreds of people by educating the medical students and that technically consent has already been provided. The husband understands how beneficial the educational experience is but is too emotional to allow them to continue. The son, a medical student, refuses because he knows the bodies are not treated with dignity. If you were the doctor, how would you proceed? Why?


19. You are spending your evening as a volunteer in the hospital. It is late and you see a number of staff duck into the supply closet with an empty bag and reappear in a few minutes with it appearing full. You have heard other staff members discussing that supplies are missing on a regular basis that can not be accounted for. After observing the actions of the other staff members, what do you do?


20. You are a second year student shadowing a doctor in the O.R. Once the patient, an obese female has been given general anesthetic and the procedure is under way the doctors start to make comments about her weight and call her names that you find inappropriate but most of all unprofessional. Do you talk to the doctor about his comments or do you keep your comments to yourself? Why?


21. Two patients need a liver transplant, but there is only one liver available at the time. Tell the interviewer how you would decide between a 64 year old politician who happens to be an alcoholic or, a 26 year old mother of three who is on welfare.


22. You are part of a committee to decide where the money for health care in our province is spent. It is your turn to inform the committee of your opinion on what you think is the single most important area requiring funding.


23. Discuss the social, legal, medical implications of a needle-exchange program with the interviewer. Follow up question: What are some viable alternatives?


24. You tell a mother her two year old child has leukemia, but she refuses chemo but insists upon seeing her family physician who is a naturopath. What do you tell her, how do you handle this so that you may continue to have some influence as regards the treatment of her child? [The child’s life is in the balance as the naturopath will be unable to save the child’s life and you have an obligation to your patient, the child, who cannot make an informed decision. In pediatrics, its beneficence and “the rule of rescue” that takes precedence.

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Thanks for putting this together! It's funny to go back and read my posts from so long ago. I wouldn't change any of my advice but I like to think I would say it better now :). Good luck everyone!



You said it as it is and could not have said it better! Thank you so much for your contribution.


Memories..................... :)

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The prime purpose of this marvelous site is self-help and so many of us make our own positive contribution, paying forward. Everything I know about the application process and matters leading up to it, I learned right here. Our guardian angel, rmorelan, deserves praise for his help to us all these many years. :)

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