Am I Answering The Prompts Properly?

[ArdentMed]

Hey guys,

 

I have recently begun preparing for the MMI and thought that reading essays on healthcare complications in addition to applying my knowledge through answering prompts would be a viable way to get started. However, I am lost as to how I should go about structuring my answers. I read a few responses to prompts posted here as well as Trojan's guide. Am I on the right track?

 

 

1. Due to the shortage of physical therapists in rural communities, it has been suggested that medical programs preferentially admit students who are willing to commit to a 2 or 3 year tenure in an underserviced area upon graduation. Consider the broad implications of this policy for health and consider the broad implications of this policy for health and health care costs. For example, do you think the approach will be effective? At what expense?

Answer – The approach is viable and effective.

Pros –

Easy access for rural citizens who provide the livelihood of agricultural businesses. Tending large farms on a daily basis restricts opportunities to travel into the city for receiving healthcare services.

There is less need for seniors in these rural communities to surmount the burdens of transportation. Potentially life-threatening diseases that may have gone unnoticed in these seniors may be palliated by physicians.

Providing healthcare for low socioeconomic status (SES) individuals living in these rural areas will equilibrate taxpayer dollars and the quality of health of Canada’s entire population in a more balanced manner. Healthcare need not be so strongly correlated with SES.

Maintaining a constant supply of physicians is favorable for families who may otherwise avoid visiting healthcare practitioners due to logistical challenges.

Cons –

More use is not necessarily more effective. According to a healthcare study performed in BC, the general population has been gradually increasing its use of healthcare services since 1990 and has little to show for its efforts. Expanding easy-access to rural citizens may potentially abet excessive usage of healthcare services.

In other words, if rural citizens reflect the habits and trends of the general population, costs will rise based on excessive usage and over-referrals to specialists as suggested by studies performed in BC.

Furthermore, while the family physicians may be present, the specialist may not necessarily be located in the same rural area. Therefore, the rural citizen must surmount the same challenges as before in terms of transportation.

Conclusion – Although there are nuances in introducing more physicians in rural areas such as over-usage of healthcare services, the benefits of providing equal healthcare opportunities to citizens of varying SES and demographic profiles with the added benefit of reduced time commitments required from rural families to visit physicians suggests that the approach is viable.

 

Thanks in advance.

[next.med88]

One main flaw, the question is talking about physical therapist and NOT physicians!! Make sure you read the prompt carefully (unless that was just a typo)!

 

Secondly, the first pro and last pro are kinda the same point...maybe if you somehow managed to put them together would make more sense

 

Overall, I think that is a good response!

 

Edit: I have done miserably bad on my two past interviews so I don't know how good my advice is

[next.med88]

Another con I can think of is that by having these recent graduates practicing rurally, it seems that the rural people would still have lower quality of care since these physicians (or physical therapist) would not be as experienced since they have just graduated.

Another con: It only seems like a temporary solution as these graduates might just return back to urban areas after completing their commitment.

[a7x]

IMO some unsolicited advice

 

1) practice opening and closing; ie go in shake hands introduce yourself and coming up with a simple one line way to introduce your answer. Also practice how to end off when the bell rings

2) practice land-marking; outlining your answer (structure, structure, structure); literally tell them what you are going to say, "im going to talk about pros and then cons before giving my decision"

3) MOST IMPORTANT Try to get away from these overly medically/health related prompts, they aren't that common. Practice mainly with outside of the box questions, it is how you will differentiate yourself from cookie cutter applicants.

[older]

First of all, next.med88 point: make sure you read question correctly!  

 

Next, the structure of your answer. It would probably play better if you first consider all pros and cons, then come (or not) to your answer. This way it looks you formed a definite opinion and then try to justify it - although you see some cons too. The answer would naturally follow the discussion and conclusion.

 

Of course there is no right or wrong answer to  such questions, the important thing is that you thoroughly consider and discuss all aspects . You did some of it , but  not  all. For example, what about preferential admission?  It would certainly cause controversy, and might backfire. People sign up for anything to get in, and then will run away after their sentence in rural area is over.  Other solutions, such as financial incentives for graduates or quotas for "local" applicants (which have been tried before) might be  preferable.

The risk of excessive use should not be mitigated through reduced access. IMO,  it would not  be a "con"  in  the issue of equitable distribution of services. There are better ways to restrain usage.

As other posters mentioned, instability of such rotational arrangement is an obvious disadvantage.  

[InstantRamen]

Wow! Thats a thorough answer! Another point to add!

 

Underlying intention of physical therapist/doctor. Are they actually passionate about rural health? I would suggest that if this stream exists, maybe a panel interview to ask questions to see why they are applying through this stream or an additional portion on the application.

 

Structure is super important! But I would caution that if there is too much land marking, it may sound rehearsed and canned. So be sure to find the happy medium between structured and rehearsed!!

 

Obviously take this post with a grain of salt. What works for one person might not work for another, vice versa.

 

Keep it up! If you're coming up with these awesome points so early on, then I'm sure you'll do excellent on the actual interview.

[Artier]

Cons –

More use is not necessarily more effective. According to a healthcare study performed in BC, the general population has been gradually increasing its use of healthcare services since 1990 and has little to show for its efforts. Expanding easy-access to rural citizens may potentially abet excessive usage of healthcare services.

In other words, if rural citizens reflect the habits and trends of the general population, costs will rise based on excessive usage and over-referrals to specialists as suggested by studies performed in BC.

Hmm personally I feel this is a weak point. Is your argument that since studies show that more healthcare opportunities doesn't result in greater health outcomes, healthcare opportunities should be limited for those in rural communities but not in urban ones? This doesn't bridge the disparity that exists and is inconsistent with the values of the Canadian health system (we don't create barriers for people to access care to prevent overuse, i.e. instituting co-pays, etc.) If you support geographical barriers to obtaining medical care to prevent overuse, would you support co-pays in Canada for the same reason as a financial barrier?

And if this is your argument, then at what point does more healthcare opportunity result in no more gain in patient outcomes? Surely many rural communities have not yet reached whatever threshold this is?

 

I personally feel that this argument cannot stand to scrutiny, but that is up for you to decide.

I think a more valid assessment of cons would simply encompass the "revolving door" effect leading to the lack of continuity of care, as well as possibly the lack of clinic and hospital infrastructure to support additional physicians (i.e. what's the point of bringing in a radiologist if you are limited by available diagnostic imaging services, or a surgeon if you are limited by OR space and availability?). But I think you sort of addressed the latter point.

 

Providing healthcare for low socioeconomic status (SES) individuals living in these rural areas will equilibrate taxpayer dollars and the quality of health of Canada’s entire population in a more balanced manner. Healthcare need not be so strongly correlated with SES.

 

Can this not be provided for low SES individuals in urban environments? Does rural imply low SES?

 

I think that it's important in MMI's to be critical about the strength of the argument you present, i.e. not saying anything for the sake of filling up space and what not.

 

Perhaps you do have points to back up your claims and they can hold up to scrutiny. But don't be afraid to be selective in what you say - sitting for two minutes in silence in an MMI is not a bad thing, it would be much better than needlessly trying to fill it up with points you cannot fully stand by just for the sake of "having enough cons", etc.

 

That's just my 2 cents. Take from it what you will.

 

All the best with your practice. Just do as much as you can, reflect on your answers, gain feedback and you will improve! 

[ArdentMed]

Thanks for the insightful feedback, guys. I took all of the constructive criticism stated thus far and am incorporating them into my new answers.

 

With that said, I grappling with structuring my answers with these "critical thinking" questions. Can I get some feedback for my response? Thanks in advance.

 

Prompt - A message that recently appeared on the Web warned readers of the dangers of aspartame (artificial sweetener – Nutrasweet, Equal) as a cause of an epidemic of multiple sclerosis (a progressive chronic disease of the nervous system) and systemic lupus (a multisystem auto-immune disease). The biological explanation provided was that, at body temperature, aspartame releases wood alcohol (methanol), which turns into formic acid, which 'is in the same class of drugs as cyanide and arsenic.' Formic acid, they argued, causes metabolic acidosis. Clinically, aspartame poisoning was argued to be a cause of joint pain, numbness, cramps, vertigo, headaches, depression, anxiety, slurred speech and blurred vision. The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress. They quoted Dr Rhonda Blaylock, who said, 'The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees.' 

Critique this message, in terms of the strength of the arguments presented and their logical consistency. Your critique might include an indication of the issues that you would like to delve into further before assessing the validity of these claims. 

 

Answer – Prior to addressing the strength of the arguments, there are numerous questions that arise that have gone unanswered in the claim. Many of these questions relate to the consequences that aspartame may have on the determinants of healthcare.

-First, if neuronal death is purported to be an effect of Aspartame usage, then what is the relative time frame of the effects, short term, long term, or both? Since Aspartame is available in everyday food products, does this claim suggest that the long term consequences can cause neurobiological  degeneration potentially leading to Alzheimer’s? If so, this is a claim similar in scope to the prevalence of smoking throughout the 1900s where the average intake for an American citizen was 11 cigarettes per day. Citizens were unknowingly exposing themselves to lung cancer in the long term, similar to how Aspartame may expose individuals to an increased risk of Alzheimer’s disease. Since the claim does not explore the longevity of the effects in detail, but the long term effects would impose a lot of stress on taxpayer’s and the healthcare system.

-Also, the claim does not mention the cultural impact of aspartame. In North American societies, the percentage of the population that is overweight is over 30%. Does Aspartate use increase as a diet tool for the overweight population that attempts to lose weight? The claim does not address this. But if usage is widespread, then the claim should be addressed by healthcare regulators.

 

Pros – The mechanism of toxic product formation was clearly provided, which is in accord with evidence-based reasoning.

-The symptoms listed may be observable and quantified through experimental studies. The claim can legitimately be explored and tested via the experimental method. For instance, a longitudinal study with subjects who lead lifestyles with and without Aspartame intake may be observed to record both short and long term symptoms of the chemical and its byproduct, if any.

 

Cons –

-There are no cited studies on the pernicious effects of Aspartame. Further experimental testing may be required to make claims on the dangers of Aspartame. With that said, the symptoms mentioned, if they are internally valid, may serve as good dependent variables to test the effects of Aspartame.

-On the other hand, if it is known that Aspartame has dangerous side effects, then perhaps administering the drug to an experimental group would be viewed as unethical. In this case, non-experimental methods may be needed, but the nature of non-experimental methods reduce their validity.

-While powerful lobbies in Congress may be the cause of this chemical’s perpetuating presence in the marketplace, the claim has gone unsubstantiated. The true underlying reason for the product’s continual presence on store shelves must be made apparent. Otherwise, even a weakly supported conspiracy theory may present unsubstantiated reasons for an argument.

-If the reason regarding lobbies in Congress is not valid, then one could postulate that the reason for the product’s presence in today’s marketplace is that the formic acid is not ingested in appreciable amounts to the point of posing as a threat to the body.

 

Conclusion – Although the claim lacks cited studies and proof for Aspartame’s continued usage, the claims can be further supported by experimentation. The fact that such a chemical is potentially widespread in North American societies and that the long term effects may pose a burden in terms of health care costs for taxpayers merits exploring these claims further.

[a7x]

 

Thanks for the insightful feedback, guys. I took all of the constructive criticism stated thus far and am incorporating them into my new answers.

 

With that said, I grappling with structuring my answers with these "critical thinking" questions. Can I get some feedback for my response? Thanks in advance.

 

Prompt - A message that recently appeared on the Web warned readers of the dangers of aspartame (artificial sweetener – Nutrasweet, Equal) as a cause of an epidemic of multiple sclerosis (a progressive chronic disease of the nervous system) and systemic lupus (a multisystem auto-immune disease). The biological explanation provided was that, at body temperature, aspartame releases wood alcohol (methanol), which turns into formic acid, which 'is in the same class of drugs as cyanide and arsenic.' Formic acid, they argued, causes metabolic acidosis. Clinically, aspartame poisoning was argued to be a cause of joint pain, numbness, cramps, vertigo, headaches, depression, anxiety, slurred speech and blurred vision. The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress. They quoted Dr Rhonda Blaylock, who said, 'The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees.' 

Critique this message, in terms of the strength of the arguments presented and their logical consistency. Your critique might include an indication of the issues that you would like to delve into further before assessing the validity of these claims. 

 

Answer – Prior to addressing the strength of the arguments, there are numerous questions that arise that have gone unanswered in the claim. Many of these questions relate to the consequences that aspartame may have on the determinants of healthcare.

-First, if neuronal death is purported to be an effect of Aspartame usage, then what is the relative time frame of the effects, short term, long term, or both? Since Aspartame is available in everyday food products, does this claim suggest that the long term consequences can cause neurobiological  degeneration potentially leading to Alzheimer’s? If so, this is a claim similar in scope to the prevalence of smoking throughout the 1900s where the average intake for an American citizen was 11 cigarettes per day. Citizens were unknowingly exposing themselves to lung cancer in the long term, similar to how Aspartame may expose individuals to an increased risk of Alzheimer’s disease. Since the claim does not explore the longevity of the effects in detail, but the long term effects would impose a lot of stress on taxpayer’s and the healthcare system.

-Also, the claim does not mention the cultural impact of aspartame. In North American societies, the percentage of the population that is overweight is over 30%. Does Aspartate use increase as a diet tool for the overweight population that attempts to lose weight? The claim does not address this. But if usage is widespread, then the claim should be addressed by healthcare regulators.

 

Pros – The mechanism of toxic product formation was clearly provided, which is in accord with evidence-based reasoning.

-The symptoms listed may be observable and quantified through experimental studies. The claim can legitimately be explored and tested via the experimental method. For instance, a longitudinal study with subjects who lead lifestyles with and without Aspartame intake may be observed to record both short and long term symptoms of the chemical and its byproduct, if any.

 

Cons –

-There are no cited studies on the pernicious effects of Aspartame. Further experimental testing may be required to make claims on the dangers of Aspartame. With that said, the symptoms mentioned, if they are internally valid, may serve as good dependent variables to test the effects of Aspartame.

-On the other hand, if it is known that Aspartame has dangerous side effects, then perhaps administering the drug to an experimental group would be viewed as unethical. In this case, non-experimental methods may be needed, but the nature of non-experimental methods reduce their validity.

-While powerful lobbies in Congress may be the cause of this chemical’s perpetuating presence in the marketplace, the claim has gone unsubstantiated. The true underlying reason for the product’s continual presence on store shelves must be made apparent. Otherwise, even a weakly supported conspiracy theory may present unsubstantiated reasons for an argument.

-If the reason regarding lobbies in Congress is not valid, then one could postulate that the reason for the product’s presence in today’s marketplace is that the formic acid is not ingested in appreciable amounts to the point of posing as a threat to the body.

 

Conclusion – Although the claim lacks cited studies and proof for Aspartame’s continued usage, the claims can be further supported by experimentation. The fact that such a chemical is potentially widespread in North American societies and that the long term effects may pose a burden in terms of health care costs for taxpayers merits exploring these claims further.

personally, I think you're missing a couple of areas to touch on and getting bogged down in a bit of rambling (eg the cultural point, which isn't really relevant to the direct question).

 

Stuff you might also want to consider

The 'medium is the message' so to speak so i might talk about how anyone can post something on the internet and that diminishes credibility.

- furthermore, consider source, what authority does Dr Rhonda have (for all we know she might be a naturopath), also what website is this from. Moreover, what about the context of the quote it could mean something completely different when read in context

 

Other things i see

They say "The ingredients 'stimulate" - but what does this really mean? There's no specificity, and in scientific claims specificity and falsifiability = strength

- 'same class of drugs' but what does this mean? Again there's no specificity. This message plays on people's fear of the unknown using a veneer of scientific credibility. Using scientific language without evidence isn't science.

 

my 2 cents

[easytiger]

I've been through 2 MMI's, and I would agree with what others have suggested that these types of overly detailed health questions aren't very common, especially the aspartame one.

 

In regard to your answers, it is definitely a good idea to be aware of the pros and cons of rural physician shortages, but I wanted to say be sure not to equate "rural" with "farmers". You will definitely lose points for generalizing and "stereotyping" like that. Not all people in rural settings work on farms, and even if you feel the work they do is important, it doesn't entitle them to have better access to healthcare than anyone else, which seems to be implied by your statement (whether intentional or not). You should also discuss the impacts on First Nations communities who may not have access to physicians. I would also agree with artier that your main argument on the con slide doesnt quite hold up. But I also don't think the issue of overuse of services really applies to the situation of rural health.

 

When looking at a question like this you want to think about pros and cons for each group affected. In this case that would not only be community residents, but doctors and governments as well. What might happen to the skills of a specialist if they go to a remote community and see the same cases everyday? What happens to the health of the community if they have a new doctor coming in every 6 months or every year? and if services are increased in remote areas, how do we ensure that there's enough money to cover costs in larger urban areas.

You don't have to be an expert in any of these issues but demonstrating that you appreciate the depth of the challenge and how the issues are interrelated will go a long way in supporting your answer.

[next.med88]

I've been through 2 MMI's, and I would agree with what others have suggested that these types of overly detailed health questions aren't very common, especially the aspartame one.

 

In regard to your answers, it is definitely a good idea to be aware of the pros and cons of rural physician shortages, but I wanted to say be sure not to equate "rural" with "farmers". You will definitely lose points for generalizing and "stereotyping" like that. Not all people in rural settings work on farms, and even if you feel the work they do is important, it doesn't entitle them to have better access to healthcare than anyone else, which seems to be implied by your statement (whether intentional or not). You should also discuss the impacts on First Nations communities who may not have access to physicians. I would also agree with artier that your main argument on the con slide doesnt quite hold up. But I also don't think the issue of overuse of services really applies to the situation of rural health.

 

When looking at a question like this you want to think about pros and cons for each group affected. In this case that would not only be community residents, but doctors and governments as well. What might happen to the skills of a specialist if they go to a remote community and see the same cases everyday? What happens to the health of the community if they have a new doctor coming in every 6 months or every year? and if services are increased in remote areas, how do we ensure that there's enough money to cover costs in larger urban areas.

You don't have to be an expert in any of these issues but demonstrating that you appreciate the depth of the challenge and how the issues are interrelated will go a long way in supporting your answer.

 

 

I think it really depends on where you interview, because I have been in two MMI's and there are many more of these type of questions than ethical ones that people keep talking about

[_ _]

Hey guys,

 

I have recently begun preparing for the MMI and thought that reading essays on healthcare complications in addition to applying my knowledge through answering prompts would be a viable way to get started. However, I am lost as to how I should go about structuring my answers. I read a few responses to prompts posted here as well as Trojan's guide. Am I on the right track?

 

 

1. Due to the shortage of physical therapists in rural communities, it has been suggested that medical programs preferentially admit students who are willing to commit to a 2 or 3 year tenure in an underserviced area upon graduation. Consider the broad implications of this policy for health and consider the broad implications of this policy for health and health care costs. For example, do you think the approach will be effective? At what expense?

Answer – The approach is viable and effective.

Pros –

Easy access for rural citizens who provide the livelihood of agricultural businesses. Tending large farms on a daily basis restricts opportunities to travel into the city for receiving healthcare services.

There is less need for seniors in these rural communities to surmount the burdens of transportation. Potentially life-threatening diseases that may have gone unnoticed in these seniors may be palliated by physicians.

Providing healthcare for low socioeconomic status (SES) individuals living in these rural areas will equilibrate taxpayer dollars and the quality of health of Canada’s entire population in a more balanced manner. Healthcare need not be so strongly correlated with SES.

Maintaining a constant supply of physicians is favorable for families who may otherwise avoid visiting healthcare practitioners due to logistical challenges.

Cons –

More use is not necessarily more effective. According to a healthcare study performed in BC, the general population has been gradually increasing its use of healthcare services since 1990 and has little to show for its efforts. Expanding easy-access to rural citizens may potentially abet excessive usage of healthcare services.

In other words, if rural citizens reflect the habits and trends of the general population, costs will rise based on excessive usage and over-referrals to specialists as suggested by studies performed in BC.

Furthermore, while the family physicians may be present, the specialist may not necessarily be located in the same rural area. Therefore, the rural citizen must surmount the same challenges as before in terms of transportation.

Conclusion – Although there are nuances in introducing more physicians in rural areas such as over-usage of healthcare services, the benefits of providing equal healthcare opportunities to citizens of varying SES and demographic profiles with the added benefit of reduced time commitments required from rural families to visit physicians suggests that the approach is viable.

 

Thanks in advance.

My first reaction to this answer (and I'm going to be 100% honest) is:

 

You totally missed the point. You rambled about issues with access to healthcare in rural areas using broad generalizations that show not just a lack of understanding of rural challenges, but an unawareness of your own stereotyping. 

 

But that's less concerning than your complete failure to actually address the question being asked anywhere in your answer. They asked about what the effect of preferential admission of medical students would be. You just restated that there's unequal access to healthcare in rural areas. You never once mentioned anything about what specific effects preferential admission of medical students would have. You just assumed it would 100% solve the problem.

 

I think the biggest issue to address here is IF these initiatives would actually work as intended, and the effects they-as in preferential admission- would have long-term on the community. Do NOT assume it would work perfectly-because it wouldn't. Explain why/why not. That is answering the question being asked. 

 

This, to me, is a classic trap people fall into. You saw 'rural' and went on a rant about rural healthcare challenged without ever coming close to even answering the question being asked. It's the danger of preparing in the wrong way, because you saw a buzzword (rural) and went off on a tangent without ever once mentioning the specific scenario. 

 

Ideally, you would talk about if preferential admission would/would not work. Why? Why not? Do you really think someone from the GTA wouldn't just use this as a loophole to get into med school (seriously...look at the crazy things people do already) and then peace out to Toronto the second 2 years was up? Leaving rural towns with a constant rotation of 2-3 year term fam docs who really don't give a crap about the population and don't understand the actual challenges of rural health access, as you demonstrated for us above with the generalization of "rural=farmers and low SES"

 

Read about the baby who died last winter up north because a similar approach is already being used there-and failing miserably. People are on 6 month-1 year incentive-based contracts (even less appealing then the elusive admission to medical school) and it's created a terrible cycle of dis-continuous primary care by people who don't understand, or care to understand the population

[sdj78we9jtf2o3mgfvj298j]

Prompt - A message that recently appeared on the Web warned readers of the dangers of aspartame (artificial sweetener – Nutrasweet, Equal) as a cause of an epidemic of multiple sclerosis (a progressive chronic disease of the nervous system) and systemic lupus (a multisystem auto-immune disease). The biological explanation provided was that, at body temperature, aspartame releases wood alcohol (methanol), which turns into formic acid, which 'is in the same class of drugs as cyanide and arsenic.' Formic acid, they argued, causes metabolic acidosis. Clinically, aspartame poisoning was argued to be a cause of joint pain, numbness, cramps, vertigo, headaches, depression, anxiety, slurred speech and blurred vision. The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress. They quoted Dr Rhonda Blaylock, who said, 'The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees.' 

Critique this message, in terms of the strength of the arguments presented and their logical consistency. Your critique might include an indication of the issues that you would like to delve into further before assessing the validity of these claims. 

 

Your answer focuses far too much on the research aspect of the question and you should focus more on the validity of the source. What type of webpage was this (news article, blog, a legitimate scientific article)? Did they provide sources? You could also argue that the article appears to be sensationalist (especially with the conspiracy theory that food/drug industries have powerful lobbies in Congress). You could move your response into a larger discussion regarding the usage of the internet in health. You could talk about how articles like this, if not scientifically backed, could have detrimental impacts on patient health (you touched on this idea when discussing aspartame as a diet tool. What happens to obese/diabetic patients who use aspartame products if they were to read an article like this? It could have significant impacts on their health!). 

 

You got very bogged down on the research aspect of the question and discussing the science of the neurons. While research is important, most of the time it could be left to "more research should be done on this topic" but not necessarily the experimental design like you have. Think about why this question is important in medicine and try to answer it from that angle.

[ArdentMed]

Your answer focuses far too much on the research aspect of the question and you should focus more on the validity of the source. What type of webpage was this (news article, blog, a legitimate scientific article)? Did they provide sources?

 

 

My first reaction to this answer (and I'm going to be 100% honest) is:

 

You totally missed the point. You rambled about issues with access to healthcare in rural areas using broad generalizations that show not just a lack of understanding of rural challenges, but an unawareness of your own stereotyping.

 

 

Thanks for the insightful feedback, guys. I really appreciate it. I must learn to view the world with a broader perspective and extirpate any traces of stereotyping in my thought processes.

 

I recently encountered a prompt which I felt I was hard-pressed in generating an argument for. Is my argument too narrow? Am I missing another key idea? I am noting all of your guys' constructive feedback and am trying my utmost best to apply them as I practice with more prompts.

 

Prompt

You are an occupational therapist that works with a population with complex psychiatric histories. One of your older clients has been recently diagnosed with neurodegenerative disease, and she has schizophrenia. There is a history of the client’s children neglecting her needs and taking advantage of the client financially. Nevertheless, the client has a relationship with her family and they want to be named the primary decision maker for the client. How do you work with the client and her family knowing the past history of neglect and present needs of your client?

 

Past history – With regards to the patient’s schizophrenia, the degree of severity for the symptoms such as delusions should be gauged. This would be one way of assessing their degree of accountability for their actions. In the case that the delusions are severe to the point of obstructing decision making skills, then perhaps the family would be more apt in handling decisions for them.

In addition, the severity of neurological damage and memory loss from Alzheimer’s disease should be measured. Since the diagnosis is recent, it may interact with the family’s past history of financial abuse for an unfavorable outcome for the patient (such as further financial loss). 

 

Present needs – Both Schizophrenia and Alzheimer’s disease require continual palliative care and patients with mental disorders tend to consume a great deal of time and resources as the top 5% of users of healthcare services in Canada. One reason for their high cost of care is that the palliative care provided is continual and requires constant monitoring of the patient. As a medical professional, one must ensure that the family understands the amount of responsibility required to care for such an individual. A history of neglect on the family’s part is not in accord with the high level of constant care that the patient requires. By extension, if they cannot care for the patient and are neglectful towards them, then perhaps they are not apt to make decisions for them.

In the case that the family is unable to care for the patient, a palliative care facility should be considered. The symptoms of Alzheimer’s is wrought by forgetfulness. It would be more wise to emphasize to the family that the patient’s finances would be best invested towards long term treatment that would lessen the burden for the family in terms of time commitments.

In the case that the patient is unaware of reality to such an extent that their symptoms of delusions and forgetfulness (assuming that they manifest the typical symptoms of their disorder) distort their sense of reality and their ability to make judgements, then the family members would be deemed more suitable to make rational decisions for the patient.

 

Conclusion – Decisively, one must discuss the severity of the patient’s condition with the family and emphasize the time commitment required and responsibilities expected from decision makers. This may offset attempts to take advantage of the patient’s finances. Long term palliative care at a facility would be discussed with the patient and family as the severity of the mental disorders merits continual attention.

[next.med88]

I am also just learning to answer prompts properly, so here are my two cents and take what you wish from it.

 

The major flaw that I see is that you are not truly answering the question.

 

You talk about the option of putting the patient in palliative care facility and about the high care of cost for these facilities, but that truly has nothing to do with who becomes the primary decision maker, since people in palliative care can still make their own choices or have somebody appointed to make decisions for them. Palliative care is more about treating the physical symptoms of the disease, yet this question has no mention that the patient's treatment is not working.

 

Also, there is no mention anywhere that this patient has Alzheimer's and/or suffering from memory loss. The prompt only mentions that this patient is suffering from a neurodegenerative disorder, which can be something like Parkinson's disease (which has nothing to do with memory). I advise that you do not read to much into the medical diseases that they mention since they truly don't expect you to know the signs and symptoms of the diseases and coming to false conclusions like you did here can be detrimental to your answer. Don't ever change what the prompt is telling you (sometimes you may need to read between the lines a bit to get more information, but I feel that in this case you read into it way too much)!

 

I think the point of this question is more along the line of how will you decide who becomes the primary decision maker for this patient, which you only skimmed the surface. 

You should be focusing more your answer on:

- what does the patient truly want and the ability of the patient to make a decision (the passage says the family wants to be primary decision maker, yet the patient thought on this is not shared)

- the relationship the patient has with her family. The passage says she has a relationship with her family, therefore you should consider whether or not denying them becoming the primary decision maker will affect their relationship

- As a medical professional, your actions should always be for the best of the patient and society. You should make your decision on what is best for the patient and society!

 

Edit: your structure is also difficult to follow, I had a hard time following your thought process

[easytiger]

next.med88 is right. The prompt doesn't say Alzheimer's so don't assume that's what is meant. Also neither Alz or schizophrenia require palliative care, at least not until very advanced in the case of Alz, so I don't know why that is being discussed. I would say you missed the point of what this question is asking.

 

Assuming you're Canadian, I'd say its useful to always have the canmeds roles on your mind when reading a prompt and asking yourself what role you might be able to relate the question to. For example this question starts off by telling you that you're an occupational therapist (not a doctor) yet most people interviewing automatically just put themselves in the position of the Doctor. So why would they ask you to imagine yourself as a lowly OT? Could it be they want you to discuss working as part of a healthcare team? Maybe...

 

And what about advocacy. If this client (notice it doesn't say patient) is being taken advantage of, and can't state her needs or wishes, there must be something that we, as part of this healthcare team, can do to prevent her family of ingrates from gaining access to her finances and being able to make decisions on her behalf. Is it a difficult situation? Absolutely, but don't be afraid to say that in a response

[ArdentMed]

Hey guys,

 

I have a few more prompts I have answered. I have reviewed the feedback I have received thus far and applied them in my response. I would appreciate any further feedback. These ones were written under timed conditions (2 minutes to plan and 8 minutes to respond).

 

Also, if anybody is looking for an MMI partner, I am looking for a dedicated MMI partner who can invest at least 1-2 hours per week for a weekly mock MMI session. I am taking the current application cycle seriously and will work relentlessly to perfect my interviewing skills.I am open to feedback and can also provide critique when requested.Thanks again.

 

Prompts:

 

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

 

Reasons not to tell parents:

-Ethically, a health professional is inclined to respect the patient’s wishes for privacy in the matter. Regardless of whether a decision is made to enclose the information to the parents, the physician must inform the patient themselves about the adverse effects of their decisions. The pros and cons of taking the birth control pills must be discussed in depth with the patient. If the patient wishes to continue her promiscuity, then she should be advised about preventative measures for avoiding sexually transmitted diseases and pregnancy in the future.

-The physician should convey his empathy and compassion for the patient’s situation and express his concern. The psychosocial state of the patient is a matter of concern. For instance, the physician should understand that a fourteen year old girl partaking in sexual activities may not be healthy from a psychological standpoint and may be facing emotional complexes. A suggestion should be made to visit a child therapist.

 

Reasons to tell parents:

-Although a physician should respect the privacy of his patients, the patient in question is under the age of 18 and therefore the parental guardian is able to make decisions for the individual and should have the right to know about the health status of their dependent.  If the parents were to inquire about any peculiarities in the child’s behavior, then this information should be enclosed with the legal guardians as they are deemed as capable of making sound decisions while an individual under 18 is not. 

-The age of the sexual partner is not made apparent. The individual may be over the age of 18. In this case, a crime is taking place. The physician must take a leadership role in the situation and alert the parents to gather more information on the matter.

 

Decision:

-Ultimately, a fourteen year old patient is under the age of consent. Furthermore, the ambiguity of the information given such as the age of the sexual partner suggest the possible occurrence of a crime. Therefore, it would be advisable to alert the parents and request that they monitor the child’s activities in order to protect the child’s own welfare and health.

 

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

Reasons to switch approach:

-Recent studies have suggested that the evidence-based medicine that has been applied in many provinces across Canada such as BC have found that evidence-based medicine is effective in treating patients and lowers healthcare costs in the process. Alternative medicine, if lacking research with established findings and significant results, may not treat the family member’s ailments as effectively as other approaches.

-If the family member believes that he is experiencing an effect with alternative medicine, then the effect may be due to a placebo. As an academic, a physician should advocate sound research with reference to studies that have control and placebo groups to compare results with.

 

Reasons to continue relying on alternative medicine:

-Not all traditional methods of dealing with chronic illnesses are necessarily effective. For instance, studies across Canada have proven that screening for prostate cancer in a sample of approximately 2,500 patients leads to about 70 false positives and one life that is truly saved. The other 69 patients who received a false positive undergo superfluous psychological stress  and other complications due to a false reading. This reason alone, however, does not generalize to all chronic illnesses and would not be enough to fully deter the family member from alternate medicine.

-The remedy from the alternative medicine may very well have an effect on the patient’s health outcomes if not from psychological reassurance alone. The placebo effect is often so strong that the psychological relief experienced from receiving any form of treatment (whether it is alternative medicine or evidence-based) would suffice to feel relief possibly due to lower stress levels.

-The family member is completely autonomous and has the right to choose their healthcare options. However, it would be in their best interest to suggest that they conduct research to confirm that their treatment options in alternative medicine have significant results.

 

Decision:

-As a healthcare practitioner, one must acknowledge that a significant illness such as cancer must be addressed with the goal of prolonging the quality and quantity of life. If the alternative medicine has had statistically insignificant results or less effective results than evidence-based treatment methods such as chemotherapy, then it would be in the family member’s best interests to alter their views and accept better treatment options.

[FeministKilljoy]

Hey guys,

 

I have a few more prompts I have answered. I have reviewed the feedback I have received thus far and applied them in my response. I would appreciate any further feedback. These ones were written under timed conditions (2 minutes to plan and 8 minutes to respond).

 

Also, if anybody is looking for an MMI partner, I am looking for a dedicated MMI partner who can invest at least 1-2 hours per week for a weekly mock MMI session. I am taking the current application cycle seriously and will work relentlessly to perfect my interviewing skills.I am open to feedback and can also provide critique when requested.Thanks again.

 

Prompts:

 

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

 

Reasons not to tell parents:

-Ethically, a health professional is inclined to respect the patient’s wishes for privacy in the matter. Regardless of whether a decision is made to enclose the information to the parents, the physician must inform the patient themselves about the adverse effects of their decisions. The pros and cons of taking the birth control pills must be discussed in depth with the patient. If the patient wishes to continue her promiscuity, then she should be advised about preventative measures for avoiding sexually transmitted diseases and pregnancy in the future.

-The physician should convey his empathy and compassion for the patient’s situation and express his concern. The psychosocial state of the patient is a matter of concern. For instance, the physician should understand that a fourteen year old girl partaking in sexual activities may not be healthy from a psychological standpoint and may be facing emotional complexes. A suggestion should be made to visit a child therapist.

 

Reasons to tell parents:

-Although a physician should respect the privacy of his patients, the patient in question is under the age of 18 and therefore the parental guardian is able to make decisions for the individual and should have the right to know about the health status of their dependent.  If the parents were to inquire about any peculiarities in the child’s behavior, then this information should be enclosed with the legal guardians as they are deemed as capable of making sound decisions while an individual under 18 is not. 

-The age of the sexual partner is not made apparent. The individual may be over the age of 18. In this case, a crime is taking place. The physician must take a leadership role in the situation and alert the parents to gather more information on the matter.

 

Decision:

-Ultimately, a fourteen year old patient is under the age of consent. Furthermore, the ambiguity of the information given such as the age of the sexual partner suggest the possible occurrence of a crime. Therefore, it would be advisable to alert the parents and request that they monitor the child’s activities in order to protect the child’s own welfare and health.

 

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

Reasons to switch approach:

-Recent studies have suggested that the evidence-based medicine that has been applied in many provinces across Canada such as BC have found that evidence-based medicine is effective in treating patients and lowers healthcare costs in the process. Alternative medicine, if lacking research with established findings and significant results, may not treat the family member’s ailments as effectively as other approaches.

-If the family member believes that he is experiencing an effect with alternative medicine, then the effect may be due to a placebo. As an academic, a physician should advocate sound research with reference to studies that have control and placebo groups to compare results with.

 

Reasons to continue relying on alternative medicine:

-Not all traditional methods of dealing with chronic illnesses are necessarily effective. For instance, studies across Canada have proven that screening for prostate cancer in a sample of approximately 2,500 patients leads to about 70 false positives and one life that is truly saved. The other 69 patients who received a false positive undergo superfluous psychological stress  and other complications due to a false reading. This reason alone, however, does not generalize to all chronic illnesses and would not be enough to fully deter the family member from alternate medicine.

-The remedy from the alternative medicine may very well have an effect on the patient’s health outcomes if not from psychological reassurance alone. The placebo effect is often so strong that the psychological relief experienced from receiving any form of treatment (whether it is alternative medicine or evidence-based) would suffice to feel relief possibly due to lower stress levels.

-The family member is completely autonomous and has the right to choose their healthcare options. However, it would be in their best interest to suggest that they conduct research to confirm that their treatment options in alternative medicine have significant results.

 

Decision:

-As a healthcare practitioner, one must acknowledge that a significant illness such as cancer must be addressed with the goal of prolonging the quality and quantity of life. If the alternative medicine has had statistically insignificant results or less effective results than evidence-based treatment methods such as chemotherapy, then it would be in the family member’s best interests to alter their views and accept better treatment options.

 

 

If you take a patient-ceentered approach to health care, your role is to keep your patients safe and to arm them with the information to make the best decisions for themselves - many of which you may not agree with. At the end of the day, your patients will be making their own decisions. You can choose to support them, or you can choose to alienate them by pushing your own agenda. 

[_ _]

Hey guys,

 

I have a few more prompts I have answered. I have reviewed the feedback I have received thus far and applied them in my response. I would appreciate any further feedback. These ones were written under timed conditions (2 minutes to plan and 8 minutes to respond).

 

Also, if anybody is looking for an MMI partner, I am looking for a dedicated MMI partner who can invest at least 1-2 hours per week for a weekly mock MMI session. I am taking the current application cycle seriously and will work relentlessly to perfect my interviewing skills.I am open to feedback and can also provide critique when requested.Thanks again.

 

Prompts:

 

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

 

Reasons not to tell parents:

-Ethically, a health professional is inclined to respect the patient’s wishes for privacy in the matter. Regardless of whether a decision is made to enclose the information to the parents, the physician must inform the patient themselves about the adverse effects of their decisions. The pros and cons of taking the birth control pills must be discussed in depth with the patient. If the patient wishes to continue her promiscuity, then she should be advised about preventative measures for avoiding sexually transmitted diseases and pregnancy in the future.

-The physician should convey his empathy and compassion for the patient’s situation and express his concern. The psychosocial state of the patient is a matter of concern. For instance, the physician should understand that a fourteen year old girl partaking in sexual activities may not be healthy from a psychological standpoint and may be facing emotional complexes. A suggestion should be made to visit a child therapist.

 

Reasons to tell parents:

-Although a physician should respect the privacy of his patients, the patient in question is under the age of 18 and therefore the parental guardian is able to make decisions for the individual and should have the right to know about the health status of their dependent.  If the parents were to inquire about any peculiarities in the child’s behavior, then this information should be enclosed with the legal guardians as they are deemed as capable of making sound decisions while an individual under 18 is not. 

-The age of the sexual partner is not made apparent. The individual may be over the age of 18. In this case, a crime is taking place. The physician must take a leadership role in the situation and alert the parents to gather more information on the matter.

 

Decision:

-Ultimately, a fourteen year old patient is under the age of consent. Furthermore, the ambiguity of the information given such as the age of the sexual partner suggest the possible occurrence of a crime. Therefore, it would be advisable to alert the parents and request that they monitor the child’s activities in order to protect the child’s own welfare and health.

 

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

Reasons to switch approach:

-Recent studies have suggested that the evidence-based medicine that has been applied in many provinces across Canada such as BC have found that evidence-based medicine is effective in treating patients and lowers healthcare costs in the process. Alternative medicine, if lacking research with established findings and significant results, may not treat the family member’s ailments as effectively as other approaches.

-If the family member believes that he is experiencing an effect with alternative medicine, then the effect may be due to a placebo. As an academic, a physician should advocate sound research with reference to studies that have control and placebo groups to compare results with.

 

Reasons to continue relying on alternative medicine:

-Not all traditional methods of dealing with chronic illnesses are necessarily effective. For instance, studies across Canada have proven that screening for prostate cancer in a sample of approximately 2,500 patients leads to about 70 false positives and one life that is truly saved. The other 69 patients who received a false positive undergo superfluous psychological stress  and other complications due to a false reading. This reason alone, however, does not generalize to all chronic illnesses and would not be enough to fully deter the family member from alternate medicine.

-The remedy from the alternative medicine may very well have an effect on the patient’s health outcomes if not from psychological reassurance alone. The placebo effect is often so strong that the psychological relief experienced from receiving any form of treatment (whether it is alternative medicine or evidence-based) would suffice to feel relief possibly due to lower stress levels.

-The family member is completely autonomous and has the right to choose their healthcare options. However, it would be in their best interest to suggest that they conduct research to confirm that their treatment options in alternative medicine have significant results.

 

Decision:

-As a healthcare practitioner, one must acknowledge that a significant illness such as cancer must be addressed with the goal of prolonging the quality and quantity of life. If the alternative medicine has had statistically insignificant results or less effective results than evidence-based treatment methods such as chemotherapy, then it would be in the family member’s best interests to alter their views and accept better treatment options.

I'm not sure how, but again you have missed the point of the question entirely. 

 

Even if the question asked about an alternatve therapy, you aren't giving them a list of pros/cons and telling them the 'better' choice.' You aren't telling them what their 'best interest' are.  But regardless,  that isn't at all the question here. You are describing what you would do-not telling them what the 'best' choice is.

 

Also, referencing statistics about research studies isn't adding to an answer, and you risk messing up. 

 

And the 14 year old asking for birth control is criminal? Picture yourself as a 14 year old girl. What can happen if you refuse and/or tell her parents? (abuse, pregnancy, illegal abortion, etc.). 14 isn't 4, that's not automatically an incompetent child. You haven't discussed anything here, just wrote off the girl as unable to make a decision because she is 14. 

[nbgirl93]

I'm not sure how, but again you have missed the point of the question entirely. 

 

Even if the question asked about an alternatve therapy, you aren't giving them a list of pros/cons and telling them the 'better' choice.' You aren't telling them what their 'best interest' are.  But regardless,  that isn't at all the question here. You are describing what you would do-not telling them what the 'best' choice is.

 

Also, referencing statistics about research studies isn't adding to an answer, and you risk messing up. 

 

And the 14 year old asking for birth control is criminal? Picture yourself as a 14 year old girl. What can happen if you refuse and/or tell her parents? (abuse, pregnancy, illegal abortion, etc.). 14 isn't 4, that's not automatically an incompetent child. You haven't discussed anything here, just wrote off the girl as unable to make a decision because she is 14. 

 

Not to mention the fact that there are plenty of extremely valid reasons why a 14 year old might want birth control - she could be making a responsible decision by postponing sexual activity until she's on the pill. Or she wants to treat acne, cramps, etc and thinks her parents will judge her for wanting birth control pills. I think using words like "promiscuity" and "criminal" adds an unnecessarily judgmental tone to the answer, but I'll admit this is an issue I'm pretty passionate about so maybe that's just my take

[next.med88]

With regards to the birth control, the actual age that a person is considered independent to make medical decisions is 16 and not 18. But it can be lower if they are deemed competent.

 

I like to approach the "what would you do scenarios" by talking about the two main obvious choices, the pros and cons of those choices and the effects those choices will have on the people.

Lastly, I like to conclude with specifically what I would do, maybe even mentioning an alternative solution.

[next.med88]

And I agree with the fact that all of your statistics, and saying things like "recent-studies show" don't really add to your answer because in the interview, you won't be able to give references for any of these facts, which just make the interviewer think "where in the world is he getting these statistics".

[ArdentMed]

I need to work on placing myself in the patient's shoes. Thanks for the feedback.

[InstantRamen]

I love how gracious you are receiving critique. Seem to be absorbing all of the comments, even the ones that are extremely harsh. Excellent trait to have!

[ArdentMed]

I love how gracious you are receiving critique. Seem to be absorbing all of the comments, even the ones that are extremely harsh. Excellent trait to have!

Thank you, InstantRamen. I feel as if the people who are replying to this thread are genuinely providing constructive feedback. It would be foolish to dismiss perfectly valid constructive criticism. 

 

I have answered another prompt with all of the recent feedback in mind. What do you guys think? I have tried to emphasize empathy over rote facts.

 

Prompt

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?

 

Pros

-My grandfather is likely feeling conflicted about the situation. The mortality rate may be a daunting number to mull over, but he may not want to be a burden. Perhaps he understands that at-home care, since it is oftentimes not covered by Medicare, is costly and will pose financial stress on family members. Assuming that the condition will slowly degenerate his currently functional body’s physiology, he may opt for a surgical procedure to prevent this burden on the family.

-A 10% mortality rate is quite a considerable number. However, if the grandfather chooses to opt for the surgery, he is able to decide for himself.

-To mediate this issue, I would ensure that the grandfather is fully aware of the consequences of the surgery and whether he will be happy with its outcomes should it be successful. Will there be any permanent pain or inconveniences involved for the post-surgery outcome? These are factors he should consider should he want to make a sound decision. I would recommend reading past literature and established research articles on the procedure to expand his breadth of knowledge on the situation.

 

Cons

-My mother is clearly worried about the outcome of the surgery and the possibility of mortality. She is likely not concerned about the financial burden as much as saving her father. Understandably, she wants to keep her father alive for as long as possible due to her emotional attachment to him.

-To reassure my mother of the surgery, I would recommend an evidence-based approach by suggesting that she read past literature and research articles on the surgery.

-I would also have my mother and grandfather discuss the financial situation of the surgery as there are two conflicting views on the matter. While my grandfather wants to avoid becoming a financial burden, my mother is not concerned about in-home care so much as saving my grandfather’s life. Perhaps my mother can communicate to my grandfather than finances are not a factor he should consider for the surgery should that be the case.

 

Decision

-I can understand the reasoning of both my grandfather and my mother so far as considering the surgery is concerned. Ultimately, communicating the factors that each person is considering is necessary to ensure that both of them are placing enough emphasis on the most important factors such as quality of life and post-surgery care. I would personally recommend conducting more research via evidence-based articles to explore these factors based on previous patients who have undergone the surgery.