MMI Mock Case

[momo]

Ok, so this may be lame as it's late and I've been studying but....

 

let's keep it current...

 

So you come up to the door, all nervous and excited, and the time keepers ring the bell that tells you you have two minutes to read the case. This is a scenario i.e. when you come in you will be speaking to a panel of actors who are representing the public health officials you're making your case to. An evaluator will be evaluating your performance. Here's the case...

 

Recently a drug company has been aggressively marketing their HPV vaccine for young girls (11 or 12) as designed to protect young women from cervical cancer. A few states and provinces have already considered or are considering paying for this vaccine and making it mandatory for all girls in that age range. Detractors suggest that a mandatory vaccine usurps parental rights and detracts from medicine's principle of autonomy for the patient - where physicians must promote and respect the free right of patients to make own choices. Others maintain that it has not been sufficiently trial tested. Finally, some people think it's a great idea that will allow girls to be protected from a potentially deadly, and very costly, disease, while going beyond wealth issues since it will be offered at low or no cost. Consider the gender issues in this - it has yet not been approved for boys.

 

you're a public health physician who has been asked to make a recommendation to the local government regarding it's distribution i.e. whether it should be mandatory and why? State your position and discuss pros and cons (support your argument).

 

Your time is up!! You enter the room and have 8 minutes!

 

Some background reading: http://content.nejm.org/cgi/content/full/355/23/2389

 

Any takers?

 

P.S. I totally made this up btw i.e. I picked bits and pieces of information, so I am sorry for any mistakes!

[UofS2010]

I think this is a very good case, let me ask a few Q to get the discussion started.

What are the advantages/disadvantages of taking this vaccine?

How does the wealth values play a role in different (ours vs other) societies?

Why are things (in general) made mandatory?

What are the gender issues in a cervical cancer preventative treatment?

[IamYourFriend]

HI,

 

I have to go to bed soon, but I am definitely interested in participating in this. Momo, you're definitely going out of your way to get us going. I will also try to come up with some scenerios too. But I will answer it tomorrow.

 

I dont know if this sounds right, but I believe if you take the scenerios and speak it out loud before doing anything, more so to stimulate the interview, I think it will be more beneficial. Then write down what you just orally conveyed. Then others can give feedback or provide additional input, to give a greater insight to the answer. Then if you are given a scenerio that is remotely close to the scenerios we created, then we can draw upon what we understand with the issues involved in such scenerio and provide an answer that we can feel confidence with. I am just an applicant, so I dont know if this though process is correct.

[snplow]

Hi Momo,

 

Thanks for posting up these scenarios! Anyways, here's my answer (I'm trying to type for 8 min, so I'm not going back to correct any mistakes, so you'll have to forgive me if it is a bit incoherent at times )

 

I believe it is important to examine the ethics of implementing mandatory vaccination against the HPV. I agree that with the increasing costs of Canada's Health Care system, with the implementation of manditory vaccination against HPV, costs may be reduced in the future because the vaccine may prevent the development of cervical cancer. The cost of the vaccine for one person is far less than the cost necessary to treat a cancer patient. Also by preventing cancer in the public, the standard of health of the public increases.

 

However, by implementating mandatory vaccination programs against the HPV, it violates one of the fundamental principles of biomedical ethics and the concept of patient autonomy. While from a physician's point of view we can see the health benefits that come from mandatory vaccinations, there may be certain points that we might be blinded to. For example, to my knowledge HPV is a communicable disease therefore can be transferred through sex. However, certain cultures and religions view sex as a taboo subject, especially at such a young age. Therefore, to by having mandatory vaccination there are two choices when approaching this subject. You can either tell the truth by why you are doing the vaccination - because it is a disease that is transferred by sex, this vaccination can prevent cervical cancer, but this may offend the patient's culture or relgion. Conversely, you can lie about the subject and make up an excuse about the vaccination, but this would also be unethical because physicians have a duty to tell the truth to the patients, and if we told a lie, it would be very paternalistic of us.

 

Furthermore, we must also examine the parties that want to push the vaccinations. In the passage, it was noted that it was a drug company who was heavily marketing the HPV vaccine. Drug companies, unlike health care providers (in Canada) are motivated by profit. Are we not doing a dis-service to our patients to bend to the will of the drug companies?

 

Therefore, I would recommend that we do not implement mandatory HPV vaccinations. While I would advocate physicians to discuss the option with their patients to let them know about the benefits, the decision should ultimately be left to the patient in order to respect their autonomy

 

How was it?

[momo]

It's great snowplow, I have a huge day today, I'm out from 10 a.m. and I don't get home until 11 p.m. but I will take a look when I am back and comment on what I can. But I am REALLY glad you guys are doing this:) And you're right IAmYourFriend...it's best to sort of do it out loud to yourself first.

[momo]

Hi snplow, you know what I was thinking - you make a lot of really good points i.e. bringing cultural issues into the debate is very good, but what would deepen your good understanding of issues to me, if I was an interviewer, would be your linking of these ideas to your own life. SO...as you say that this is a good vs bad idea, give an example of what it is about YOU that brings you to hold these views...do you know what I mean?

 

For example, your answer tells me that you have an awareness of cultural diversity, which is amazingly good, but now I want to know why? This is agreat place to prove to the interviewer where you got this sensitivity to cultural issues for eg. I worked as a volunteer at a clinic that saw many recent immigrants and so I have an understanding of some of the difficulties they have with mandatory vaccinations eitheir because a.) they just escaped a regime where everything is mandatory, so this leads to a visceral reaction of not again! or b.) this goes against a cultural belief i.e. vaccinations are bad for the spirit (I apologize to medical anthropologists out there!).

 

I think it would help to put more YOU in the answer...does that make sense?

[snplow]

Hi snplow, you know what I was thinking - you make a lot of really good points i.e. bringing cultural issues into the debate is very good, but what would deepen your good understanding of issues to me, if I was an interviewer, would be your linking of these ideas to your own life. SO...as you say that this is a good vs bad idea, give an example of what it is about YOU that brings you to hold these views...do you know what I mean?

 

For example, your answer tells me that you have an awareness of cultural diversity, which is amazingly good, but now I want to know why? This is agreat place to prove to the interviewer where you got this sensitivity to cultural issues for eg. I worked as a volunteer at a clinic that saw many recent immigrants and so I have an understanding of some of the difficulties they have with mandatory vaccinations eitheir because a.) they just escaped a regime where everything is mandatory, so this leads to a visceral reaction of not again! or b.) this goes against a cultural belief i.e. vaccinations are bad for the spirit (I apologize to medical anthropologists out there!).

 

I think it would help to put more YOU in the answer...does that make sense?

 

Wow, thats a really good point! Thanks!

 

Unfortunately, I'm procrastinating here on the board instead of studying for a midterm I have coming in 2 days so I should get back to that, or else I would post a little more here. Thanks for the input, I think that it really adds to the answer!

[UofS2010]

I would also like to point out the importance of autonomy:

 

In a society like Canada vs other societies, there are in respect very few things that are mandatory, and I do not believe that there are any vaccinations that fit under the criteria of 'mandatory' for the general public (not even the ones babies get after childbirth cuz the parents still have to consent to that...but lets just focus on the scenarios when you are able to make an informed decision).

Now if you are a healthcare worker, thats a different story, and thats why its important to consider when something should be made mandatory.

 

If you are a healthcare worker, it is pretty obvious that one of the main reasons for mandatory vaccination is to protect yourself, but also to protect all the other people/patients/workers in the hospital (so u're not spreading the disease around). How do we define what is mandatory then--well of course there are many factors, but one important point for sure is when we pose a significant danger/harm to others. How do we measure this?

 

Well this is when we have to bring in wealth issues as this is definteily a factor. For a fairly wealthy nation/society, it may be ok to not make vaccinations like this one mandatory, b/c we have the resources to treat the disease even if it arises. However, for a poorer society, not making a cheap alternative such as this vaccine mandatory may pose significant harm to the society -- an phenomenol spending on healthcare treatments that is desperately needed for other facilities such as housing, food, water, schools, etc.

 

So yes autonomy is very very important, but it is not limitless either(to make an extreme sample....u can't just go kill a person b/c u feel like it without suffering any consequences)

 

I think i rambled on and it mite not make a lot of sense....but hopefully there is another way of thinking presented here!

[momo]

No UofS it's great to see another side. I was thinking about something I've heard about based on my friend's experience though.

 

She has two little kids, and in canada you can't go to school without your basic vaccinations for kids. They ARE mandatory, if you don't get them, public health will hound you - at least they did her. What happened though is that she does not believe in immunizations - both religious and cultural reasons, and the fact that she has experienced a very different type of health care than we have here in Canada. She went to a physician to DISCUSS vaccinations, not get them, she wanted to present her point of view....well according to her, the physician basically threatened her with what will happen if she does not have them, and he had the nurse give the boys vaccines there and then...my friend felt violated, not listened to - she thought this was way worse than where she came from, and she lost a lot of her trust in the public health care system.

 

Thing is, after living for years in a communist country, one where supposedly you had no autonomy, she felt Canada was a thousand times more paternalistic under the guise of democracy for the greater good.

 

It's an interesting story I think, and one that certainly has deeply affected how she feels about her adopted country which, in all other ways, she very much loves.

 

I think that mandatory vaccinations do in a way violate a person's right to choose. Plus more than we think, kids do have bad reactions to vaccines, that can make you very very ill. Some people are simply terrified of vaccinations, and about 80% of people I know think that vaccines have real live viruses floating around instead of specific antigens, for example, or a killed version (I know some vaccines say they contain "weakened" types of viruses, does anyone know what that means? I'd like to find out as I am unclear on what that means exactly). Perhaps it's a problem of informed consent? The vaccines are not explained enough, not enough research findings are done to show they really help, and if research is done, it is nto explained in laymen's terms or it's explained by people with a particular agenda.

 

LOL sorry for this, just thought I'd play devil's advocate

[UofS2010]

hm...thats very intersting....cuz i remember these vaccinations in gr 9.....u have to sign a waiver...b/c there is a potential that these vaccines could have serious adverse effects aka cause death 1 in 20 mil or sth. I dont remember it being mandatory if you didnt sign the waiver....does neone have ne input and knowledge about this topic?

[momo]

I know, I remember getting them in highschool too....but we had to...you weren't given a choice, unless your parents were?

 

This article is interesting http://www.alive.com/1965a5a2.php?subject_bread_cramb=641

 

It certainly provides an alternative view on things...apparently vaccinations are NOT mandatory, but they are significantly frowned on if they are not taken. I am 100% sure that my friend was told her kid could not go to JK without them (even though apparently legislation says otherwise), and a significant pressure on the part of the physician and public health nurse!

 

UofS I echo you! - is there anyone who knows for sure?

[saskmed]

FYI...vaccines are not mandatory...100%

[momo]

Thanks a bunch Saskmed!!! ...I've researched so much about this since yesterday I think I am ready for a question about this one:)

[UofS2010]

Thanks a bunch Saskmed!!! ...I've researched so much about this since yesterday I think I am ready for a question about this one:)

 

haha lol i know eh...or u feel like u wanna bring it up even if they dont ask

[momo]

LOL I know...."I know we're talking about the differences in private vs. public health care, but I really really NEED to tell you about the HPV vaccine issue" LOL...Depending on his/her sense of humour the interviewer would either die laughing or tell me to leave LOL.

[SevenAges]

Okay. Mock case number 2! I hope this is okay.

 

The Canadian population is aging. Healthcare costs are more than double for older individuals than they are for the rest of the population. Furthermore, the young and the old are becoming more and more dependent on the working citizens causing problems such as retirement fund defecits. The future sees larger city population growth while towns decrease. Older individuals stay in the periphery and small towns with limited health services by choice and refuse to move to the bigger cities, where they will have access to such facilities. Discuss the ways in which the healthcare system should cope with increasing medical costs. Discuss the idea of forcing individuals to move out of such remote areas and into more inhabited populations.

[momo]

Wow, there are SO many issues in this one question...i'll tackle a bit of it I think...It's sooo big!

 

So I think that you can never, nor should you try to "force" anyone to move for the sake of access to healthcare that is not at all guaranteed (after all, people in cities often have trouble finding a doctor as well!). I must admit bias before answering this fully, since my background is in geriatrics and gerontology and I think that there are stereotypes and misconceptions about older adults that suffuse the thinking of many people. We do not want to become a paternalistic health care system that doles out care based on whether you "deserve" it i.e. if you choose to move out of the home you've lived in for the last 50 years let's say, nor is it fair to expect older people in rural areas to abandone their homes, where this criterion is not applied to the urban dwellers. Additionally, I have worked providing home care services to adults in rural areas and I have personally found that many small towns, although access to healthcare is generally difficult, do have quite wonderful physicians (and this is based on my own experience only) who will do home visits and such on request. The problem becomes when more serious issues arise and testing is required.

 

I think an example of a great program that utilizes our resources well while keeping costs down is the testing of people with Alzheimer's and other cognitive impairment done in Saskatoon and pioneered by the geriatricians and other health professionals there. People with Alzheimer's tend to have a very hard time travelling over long distances (many issues here!), and so a 10 hour drive by car, for example, for ten tests, every few days is just not feasible nor cost effective. Older adults with suspectd cognitive impairment are screened via telehealth by a registered nurse, and then, they come for ONE day of screening when all the tests they need are done by the various professionals! This cuts down on stress and cost for the patient, and streamlines care for the health care team involved i.e. psychogeriatrician, cardiologist, etc.

 

I think costs can be kept down by using the resources we actually DO have in innovative ways - such as telehealth care, multidisciplinary teams, but I think that all stakeholders in healthcare have to address efficiency issues that come with a public health system. For example, a federal run home care system that has been advocated by many reports such as the Romanow report or the Kirby report, would standardize the provision, costs, and eligibility of people across the country, while both provincial and federal governments share the cost for the programs, thus lessening the pressure on the "poorer" provinces. I think that federal transfers to the provinces for healthcare no longer really work with provinces such as Alberta, who don't need the "carrot" - they can make their own, so we should try to share the health care costs more equally between the provinces.

 

Now, that said, we could get into another discussion of the fact that various provinces have very specific needs because their populations are so different, but that's another MMI question I think:)

 

Also, after practicing for the past two weeks I think my greatest weakness is my tendency to think in a holistic way i.e. I go off on tangents as I grab onto a topic that especially interest me. Anyone have any strategies to be as concise as possible for those of us who are cognitive multi-taskers:) That tendency to think about everythign at once has been the bane of my existance in terms of medical interviews, although in regular life it often saves my skin.

[Zuckman]

Hey Momo,

Just wondering, I've heard that homecare services end up costing the health care system less money than hospital care. Do you know why this is? Also, what exactly is telehealth. Is it actually already included in the health care system? I know that the Romanow Report advocated for this.

 

How will multi-disciplinary teams help? Is it because these teams can give more holistic care and thus prevent major ailments from starting and therefore cost less on the health care system?

 

Momo, I feel that thinking holistically is a good trait for med interviews . I myself am the complete opposite...so I won't be able to help out

 

Zuck

[frenchfrog]

Hey Zuckman, here is an explanation of telehealth:

"Using live, two-way videoconferencing, health care providers can apply the latest tele-diagnostic instruments, including digital stethoscopes, patient examination cameras, and digital imaging, to enable a remote patient to ‘visit’ an out-of-town health care provider from their home community rather than having to travel."

Yes, this is already apart of the Saskatchewan health care system. I recommend you visit http://www.health.gov.sk.ca/ps_telehealth.html for more information.

[momo]

Hey Momo,

Just wondering, I've heard that homecare services end up costing the health care system less money than hospital care. Do you know why this is? Also, what exactly is telehealth. Is it actually already included in the health care system? I know that the Romanow Report advocated for this.

 

How will multi-disciplinary teams help? Is it because these teams can give more holistic care and thus prevent major ailments from starting and therefore cost less on the health care system?

 

Momo, I feel that thinking holistically is a good trait for med interviews . I myself am the complete opposite...so I won't be able to help out

 

Zuck

 

Good questions all... I think when it comes to cost of homecare there is the issue of resources - actute or even tertiary care in a hospital is a lot lot more expensive than home care at home in terms of costs such as 24-hour nursing staff, equipment used, etc. BUT home care has many many "hidden" costs such as the caregiver labour of caregivers who support people who are cared for at home e.g. a caregiver may have to take time off work which is a cost to her/him. SO I've actually seen research articles both PRO and CON costs of home care being less. I think that home care is the PREFERRED way for many patients (not all), because it allows you to stay in a comfortable, familiar environment and to many older people I've cared for, it is really a matter of dignity and autonomy. However, the cost to the PATIENT is higher in home care at the moment since you are paying a lot in private care. The way the Ontario system is set up at the moment, the CCAC case managers dole out home care hours to people based on very stringent criteria - many frail adults need help with daily living such as cooking, bathing, etc. on top of the health related things and these aren't really taken into consideration due to the limited resources of the CCAC. Well, they are considered but most older adults have to hire additional private help and, having worked at a home care company in the past, such additional private help, based on 24-hour rotations can cost up to 5,000 a month and up!!!! I don't know about you, but most older people I know don't have that kind of money on a fixed income.

 

So, I think home care is cheaper to the system in the LONG RUN in terms of, for example, hospital borne infections that tend not to occur as often at home (fewer people, although I remember having a serious problem with C. difficile) and health outcomes as well, since much research says that people do better at home in terms of the psychological determinants of health i.e. they "feel" better in familiar surroundings and that affects their well-being..and that's the problem, governments like to see quick fixes so home care is not a priority (I actually read somewhere the home care recommendation in the Romanow report was later rescinded somewhat in the press).

 

As to multidisciplinary teams again, it's an issue of resources to me. I think there is less pressure on time and availability of any one health professional but a better outcome for the patient if he/she has people address his/her health holistically i.e. from all angles. It's a team working together for a common goal, rather than just advising a physician of what he/she should do with a patient. I actually have heard the word "interdisciplinary" used instead at times, meaning that the whole entire team is working towards the patients' health rather than advising individually.

[frenchfrog]

Momo:

I'm more like Zuckman in the sense that sometimes I have more difficulty thinking holistically, so you can take my suggestion or leave it, 'cause it may not help....Basically, I think the key thing is organization and evaluating the importance of what you have to say. Learn to distinguish between your ideas that are pertinent and those that are interesting, but can be better left out (may take some practice, so test yourself). If a new idea pops into your head that significantly contributes to the question, don't hesitate to stop for 10 secs to re-compose your train of thought. If you really, really, really can't go without mentioning an interesting point, to keep your answer concise, I suggest you briefly, in one/two sentences mention the extra idea (don't fully elaborate)...this shows the interviewer that you are very knowledgeable of the issues involved, but it doesnt have you giving a long winded answer and jumping from topic to topic. If the interviewer is interested in hearing more about what you have to say on this tangent, he/she will ask you about it.

All in all, though, if this is your greatest weakness, I think you will do fabulously on the interview.

 

ps. sorry if I missed the mark and my ideas have nothing at all to do with what you have trouble with

[momo]

LOL oh no frenchfrog, what you say makes total sense!! I think the beauty of having a variety of approaches allows us to make sense of a very convoluted world - I have my best time when I am surrounded by people who think differently, now THOSE are debates!

 

Nevertheless, the idea of taking 10 to compose myself is a great one - I just worry that it would seem that I am not sure of my answer if I hesitate too long. I tend to speak pretty fast, trying to get all those ideas out, so I have been practicing pacing myself, but if I pace myself, all the best ideas just flow out of my brain:) I have been going over questions that have been asked in other interviews, at different schools, any question that I can get my hands on, and trying to come up with 2 arguments or so per question so that perhaps when I get there, I will be able to pull those best two arguments out - which may help me with the tangents, but at the same time, I don't want to seem too rote-like.

 

Thank you for the input:) I'll keep on practicing.

[frenchfrog]

Seeing as I beat him to it, I'm going to attempt to take all the credit for posting these here, but it was really UofS2010's brilliant idea . . .

For all the students who don't live in Saskatoon, here is a copy of the scenarios/questions that the UofS Premed Club used for their MOCK MMIs this year. Keep in mind that the premed club does not know exactly what the College plans to ask. These were just found on the internet no doubt...but hopefully, they will still help!

 

(Unfortunately, I had to leave before the debriefing session after the mock, so I can't let you in on all the goodies/tips that current med students who have gone through MMI shared. . . )

 

1) 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? Why?

 

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

 

3) 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?

 

4) 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 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?

 

 

5)You are spending your evening as a JURSI in the hospital. It is late and you see a member of the 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 member, what do you do?

 

 

6)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 underway 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?

 

7) 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 nonspecific 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 behavior might pose. Discuss these issues with the interviewer.

 

8) The parking garage at your place of work has assigned parking spots. On leaving your spot, you are observed by the garage attendant as you back into a neighboring car, a BMW, knocking out its left front headlight and denting the left front fender. The garage attendant gives you the name and office number of the owner of the neighboring car, telling you that he is calling ahead to the car owner, Tim. The garage attendant tells you

that Tim is expecting your visit. Enter Tim's office.

 

9)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) a 64-year old retired politician who happens to be an alcoholic, or

a 26-year old mother of three who is on welfare.

 

10)You are part of a committee to decide where the money for health care in Saskatchewan 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.

 

11) Discuss the social, legal, medical implications of a needle-exchange program with the interviewer.

Follow up question: What are some viable alternatives?

[hatewaiting]

Hey frenchfrog!

Thanks for posting those questions - I would love to have gone to the mock MMI's but I live in Calgary and couldn't reasonable get to S'toon for the day. I'll admit, I've been lurking on this board for quite some time; I finally started posting on Ian Wong's premed forum when they switched over to here. I applied and was interviewed last year to U of S, and look forward to these new MMI's.

I do have a question: should we be treating the interviewers as "actors" for some of the scenarios: i.e. for the parking garage scenario, would we walk into the office and talk to the person as if it was their car we hit, or should we walk into the room and start outlining what we would say, when, and why. I tend to want to reason through these scenarios like that, but maybe they are wanting us to give a speech where all the communication skills and logic would be apparent.

Any feedback from anyone who's done an MMI or has some insight here would be appreciated. Thanks,

HW

[momo]

Hi there!!

 

I don't know if UofS will do the MMI's the same as McMaster, but here there are two types of things:

 

an ethical scenario which you simply answer

OR

an action scenario i.e. an actor and an evaluator are in the room, your job is to interact with the actor NOT the evaluator...last year some people were told not to pay attention to the evaluator, but just interact. the point was to see how you would react to an escalating crisis for example.

 

Again, I don't know if this is the way they are going to do it at UofS but thought this might help!!

 

THANKS A BUNCH frenchfrog!!! you guys are great!

 

Hey hatewaiting, I have a question - as an OOP who didn't get an invite after interviewing, were you on the waiting list? i guess the rejections come together with the invites? How would you say your experience was last year and where do you think you would improve? you can PM me if you'd like! or post here...I am just curious:) and nosy so don't feel obliged to post or pm.