Interview Advice & Case Studies

[terriblemedstudent]

Hi everyone,

I hope all your interview preparations are going well. 

 

I'm currently a 2nd year med student at UBC. Awhile ago, after the faculty decided to matriculate me, I found myself with a large stash of notes from my own interview prep. It felt criminal to let all that go to waste so I decided to type some of it up. Of course, I then promptly forgot about the whole thing until recently when I found out that my page was getting an enormous of hits from I presume, anxious med applicants.  

 

So here's some tips/advice/case studies. When I was applying I found that the vast majority of information on the internet were either inaccurate, speculation or too anxiety-ridden to be reliable. The sieving process was unpleasant to say in the least and I don't wish the same fate on you guys. To the best of my knowledge, the information here is accurate and is borne largely from my own experiences applying. I'm not sure I would answer some of the questions the same way nowadays, but nevertheless, here it is. I hope this helps you during your prep. 

 

http://terriblemedstudent.blogspot.ca

 

Best of luck. 

 

Ted

[terriblemedstudent]

Here's a sample:
 

***

 

Some general tips for MMIs

 

Bring something to eat.

An MMI is mentally taxing. It’s two hours of being “on”. It’s normal to be tired, or start to lose focus midway through the stations. I found it helpful to bring a granola bar, or some chocolate to re-energize during your rest station. If you’re a coffee drinker, make sure to eat something salty beforehand to balance out the diuretic effects.

 

Re-iterate the question to buy time. 
If you need more time after the bell rings to ponder the question, go in the room, introduce yourself, and re-word the question. Some questions may be worded awkwardly or is excessively long. Doing this will give you extra time to think and to make sure you’re answering the right question. (Alternately, you can just take more time before entering the room. I did this quite a bit during my interviews. It’s normal).

 

You’re allowed a few bad stations.

The beauty of an MMI is that the stations will average out. If you get completely obliterated at one station, shake it off and keep going. At my Manitoba interview, I actually had one interviewer tell me at the 6 minutes mark that: “I can either say something meaningful, or just sit there and ride it out.” At my UBC interview, I had one station where I did not understand the question at all and at one point the interviewer told me my answer didn’t make sense. I think everyone has a terrible interview story. Keep calm and carry on.

 

Use gender/race neutral language.

MMI questions are almost always gender neutral. If not specified in the scenario, use “they” instead of “he” or “she” when possible. Also be aware of terminology, for example - “First Nations”, and not “Indians” (I learnt this the hard way…)

 

Silence is okay.

If you feel like you’ve stated your points and made your argument - make a concluding statement and stop talking. The silence may be uncomfortable, but it’s normal. Do not keep talking because you need to fill the gap. Excessive points may weaken your argument. Strive for quality, not quantity. At one of my stations in Queen’s, I finished talking after about a minute. The rest of the station was the most uncomfortable 7 minutes of my life. (Some schools, like Manitoba, will not have a policy on this, so you may chat with the interviewer afterwards).

 

Have a strong opening statement.

During your two minutes in the hallway, spend at least some of the time thinking about a strong opening statement. “In this specific case, Jacqueline’s right to refuse blood transfusions is a cornerstone of modern medicine” sounds much better than “uh… I think… autonomy is important.”

 

Introduce yourself. 
Knock before you enter a room. Shake hands (if appropriate in your culture), and introduce yourself. And smile. Always smile. Some stations may have an actor or an observer in them. Opinions differ on this, but I think it is important to at least acknowledge everyone in the room, even if it’s just a smile and a nod. It’s polite, and it shows that you care about everyone involved, not just the roles they play.

 

Address all the points. 
Some stations will have multiple points that you need to address. For example, you may get a question like: “Discuss the implications of a fee-for-service policy, who will the affected the most?” You need to address both of the points. This may sound obvious, but in a high-pressure setting, it’s easy to get absorbed in your first point that you completely miss the second.

 

Post-Interview.

How you feel after the interview does NOT correlate to how you actually did. Even if you feel like you did horribly, truth to be told, it probably wasn’t that bad. Don’t stress, just relax and focus on other things during the waiting time. I felt like I absolutely bombed my Manitoba and Queen’s interview. I would not admit me. And guess what? They did. At most schools, even if you had a terrible interview, other factors like GPA, extracurriculars will balance your application out. 

[terriblemedstudent]

You are a family physician. One of your patients, Mark, did not attend one of his classes and missed an important exam. He told you that his teacher would like a doctor’s note explaining his absence from class; otherwise, he will receive zero. He wants you to write a note for him, indicating that he was not feeling well enough to write the exam. Not being able to find any physical symptoms, explain how you would deal with this situation. 
 

This is a standard MMI-type question. We’ll go through it using the Doing Right algorithm.

 

1. What is the case?

A patient comes in asking for a doctor’s note. However, you do not find any symptoms.

 

2. What are the ethical dilemmas?

This scenario most involves ethical issues of beneficence and justice.

 

3. What are the alternatives?

There’s a simple choice presented:

Write Mark the note or Don’t write Mark the note.

 

In either case, the underlying question is:

Is Mark lying or telling the truth?

 

4. How do the principles apply?

Beneficence

There’s a simple dichotomy here, if Mark is telling the truth, then we should in all good conscience write Mark a note. If, however, Mark is lying, then we should refuse. The scenario is complicated by the fact that we don’t know and we’re presented with a lack of evidence. The question then becomes should we believe Mark? Or more importantly, should doctors always trust patients? To what degree? These are difficult questions to answer. In our case, consider the consequences if we give Mark a note:

 

Pro’s

-        Mark may be telling the truth. This is an entirely plausible scenario - I got gastroenteritis before an exam once, and by the time I stopped living in the washroom and went to get a doctor’s note, I have zero symptoms remaining.

-        Physicians should not be, and are not, expected to act as the moral police.

-        Builds trust and therapeutic relationship.

-        The consequences of us being wrong is relatively ‘trivial’

 

Con’s

-        Mark may be lying. This is an entirely plausible scenario as well

-        By perpetuating this behavior, we are helping to erode the patient’s character

-        By giving him a note when Mark is lying, we may be encouraging an unprofessional standard

 

Justice

We must consider the greater impact of our actions. Giving Mark a note without symptoms may set a precedent for the future. If Mark is lying, a fake note is unfair for other students and may erode the public perception of physicians.

 

5. What is the context? Who else is involved?

It is important to understand that this is a difficult situation for both parties. Students are under a tremendous amount of stress, and it’s important that physicians empathize with their patients whenever possible. Universities are incredibly harsh when it comes to missed exams, no doctor’s note equates to a mark of zero, and this can completely destroy a student’s academic history. In doing right for the patient, this must be weighed against the possibility that Mark was lying. Another thing to consider is Mark’s past history and if there’s any reason to suspect deception. Has Mark repeatedly done this in the past?

 

6. Propose a resolution

It is important to establish a good communication between you and Mark. If you are his family physician, this shouldn’t be a problem. In this case, not giving him a note may sow the seeds of resentment in the event that he is telling the truth, and may cause strain on your relationship. Listen and ask questions - is Mark stressed? How is he doing in school? All these questions demonstrate empathy and help establish trust. If Mark has no previous history of doing this, then it’s good to assume the patient is telling the truth unless otherwise suspect. A good compromise is to ask for corroborative evidence - is there anyone that saw Mark when he was sick? Finally, I would give Mark the note and advise him to try to see you earlier if possible next time.

 

7. Critical considerations

Many university students ‘doctor-hop’ in order to get doctor’s notes for missed exams. It’s a notoriously exploited and abused system. Physicians play a role in perpetuating this system and it may well be a possibility with Mark. However, it is important to remember that your primary obligation is to the patient and not educational institutions. This is not a fool-proof solution to a complex problem, but its benefits does far outweigh the costs.

 

8. Action

[Hopefullll]

Thanks a lot for taking the time to post. I found it very informative, and I am sure many others will too.

[B3.572A]

It is very nice of you to organize and post all this information. Thank you!

[B3.572A]

Just read from your blog that you were accepted in all 6 schools you interviewed at. How amazing! Thanks again for spending time to distribute all the information.

[SearchingforStarfish]

Thank you for sharing this information! Greatly appreciated, these answers are fabulous!

[amont]

Thanks a lot

[Tacrolimus]

Anyone aware of resources or scenarios out there for "creative" (i.e. totally random) MMI questions? I feel comfortable with the typical MMI questions on ethics/communication/conflict resolution/etc, but schools have innovated quite a bit from ~5-10 years ago. 

[terriblemedstudent]

I think the key to answering some of the more 'creative' questions is realizing that they are simply just dressed up versions of your typical MMI questions. All MMI questions are, in essence, addressing an aspect of the CanMEDS framework. In this light, the more creative questions are in fact, not actually so 'random'. 

 

A question about a wrong Starbucks drink is really one about conflict resolution and professionalism.

A question about Target employees being laid off is really one about advocating for your patients. 
A question about rent disputes is really about collaboration and managing limited resources. 

 

I don't know of any specific resources, but I don't really think they're really necessary either. In most cases, I'd say do the same thing you would do with any other MMI question - break it down and answer it to the best of your abilities. Most questions are guided enough that it won't be completely in the left field. Being aware of what CanMEDS quality is being exemplified by your answer helps, but other than that, I think if you do your normal MMI prep, you'd be just fine. 

Remember, if you can think of something to say, you're already ahead of the game. 

[chronicconic]

Thank you very much for your posts. 

[Fly]

Thanks terriblemedstudent. This is really helpful. 

[terriblemedstudent]

Bump for the coming interview cycle. 

 

Ted