Many believe that the US is facing a number of critical healthcare challenges. Identify what you think these challenges are and how you might address them.
This question offers the opportunity to demonstrate an organized thought by presenting your answers upfront in less than 15 seconds before filling in the details, thereby facilitating interviewer agency, dynamic conversation, and connection. To listen and ensure you answer the exact question, i.e., challenges, not challenge, and to demonstrate that you both have a broad perspective on healthcare policy and a sense that you are best positioned to speak from experience or data. I.e., “While I understand that health in the U.S. could benefit from universal access, higher value, and a culture of common good, working in a free clinic highlighted the number of patients that seek care late and therefore suffer worse outcomes while leading to higher costs.” Once you have provided such a high level answer, you can and should circle back and offer more detail. See additional comments in the traditional interview examples above.
A 19-year old pregnant woman comes to your office with her husband and mother. Her mother and her husband want the patient to have an abortion. She wants to maintain the pregnancy. What should a physician do? The patient has Down syndrome.
This question offers the opportunity to care for the patient, demonstrate a bias toward information gathering, and think comprehensively about clinical bioethics questions. See the answer as presented under the traditional interview question examples.
Dr. Smith recommends homeopathic medicine to this patient. There is no scientific evidence to suggest that homeopathic medicines work, and Dr. Smith does not believe in them either. However, he recommends homeopathic medicine to people with mild and nonspecific illnesses such as fatigue, headaches and muscle aches and he believes that will do no harm to them, but will give them reassurance. Consider the ethical problems that Dr. Smith's behavior might pose. Discuss these issues with the interviewer.
This question offers the opportunity to demonstrate that you have your own moral compass, are willing to question authority, and can do so in a professional manner. The main issues with Dr. Smith’s behavior is that it is possible that he is not fully considering the patient’s condition, that he is subverting patient alliance by engaging in a deceptive practice, that honesty and integrity are central to trust and medical ethics, and that he is not engaged in evidence-based practice. You can speak to Dr. Smith, and if unconvinced by his answers, speak with a peer or superior and bring up your concerns.
A patient Jennifer comes to your office with this message that recently appeared on the web to warn people of the dangers of an artificial sweetener as a cause of multiple sclerosis. The biological explanation provided was that, at body temperature, aspartame releases wood alcohol, which turns into formic acid, which is in the same class of drugs as cyanide and arsenic (poisons). Formic acid, they argued, causes metabolic acidosis. Clinically aspartame poisoning was argued to be the cause of joint pain, numbness, cramps, vertigo, headache, depression, anxiety, slurred speech and blurred vision. The authors claim that aspartame remains on the market because the food and drug industry have powerful political lobbies. They quoted Dr. Smith, who said: "The ingredients stimulated neurons causing brain damage to various degrees." Talk to Jennifer as necessary. You might critique this message in terms of the strength of the arguments presented and their logical consistency.
A wall of text like this can be frightening, but this question is not about knowing organic chemistry or the signs and symptoms of Multiple Sclerosis. During the first 30 seconds of your prep time, you should be thinking, I can demonstrate my ability to care for Jennifer, take action on her behalf, demonstrate an understanding of science and evidence-based practice, and the role of the doctor. Then, if there is time, you can speak to the lack of logical rigor to the bioscience, if it is clear to you.
The answer might sound something like, “Hi Jennifer, thank you for coming in today, what can I help you with?” Then you would ask further questions such as “Thank you for bringing this to my attention, where did you discover this article?” Then, of course, validate her feelings without validating the logic of the piece with a statement like “I can understand how concerning this might seem.” After showing your interest in further information, hearing as much as possible from Jennifer and validating her experience, you can ask about the authorship and discuss your concerns about the lack of information about the study design and methods.
Most importantly you can tell Jennifer, “I want you to know, although I believe you should have little to worry about, I will look more carefully into this article, discuss it with a neurologist and get back to you in 24 hours. Does this sound like a good plan?” By doing so, you have taken clear definitive action and dealt with Jennifer’s main concern and ensured that she understands and agrees with the plan. If Dr. Smith (who may or may not be an MD) or the FDA comes up, it is an opportunity to steer clear of politics and focus on the role of the doctor, to focus on the health and wellbeing of your patient and her family based on the best evidence available.
Your 5-year-old nephew asks you, "Why is the sky blue?” How would you answer him while preserving his curiosity?
You don’t need to know why the sky is blue. This question is about your understanding of science and education. You need to show that education starts with listening, understanding a student's knowledge and understanding and building from there. It also involves building alliances and engaging in a joint adventure of discovery and exploration. In the case of the nephew, this could include asking why he or she thinks the sky is blue, talking about how to study that hypothesis, looking up answers on Wikipedia (literature review), doing experiments, and admitting that it is a tough question that you’d like to know the answer to as well. A bit of humility and a dose of enthusiasm will go a long way.
An athlete who is training for the Olympics admits that he uses anabolic steroids and asks you to monitor his liver function. He would prefer to be under your care, as you are his family physician and you know his history. However, he states that if you do not agree, he will go to a walk-in clinic. What do you do?
In this question, a more mild version of a question about being blackmailed by an opioid addict seeking oxycodone by stating that he will go use heroin if you don’t provide him with an opioid, think of the opportunities to:
Maintain alliance through careful questioning
Discussion of the impact of steroids on the patient’s health
A discussion of the ethical implications of steroid use
A final decision to maintain alliance by doing the liver testing (which is where this question diverges from the opioid version which you would hope to drive toward rehabilitation and consideration of psychiatric holds) and doing what you can for the patient’s health.
There is not a right or wrong answer to this question, only a thoughtful consideration of the factors at play.
What is your opinion about stem cell research using fetal tissue?
This was and is a hot button issue for some communities. Like the previous question, your job is to demonstrate perspective, highlight a range of cultural, ethical, technological, and legal considerations, then discuss your views in light of these considerations. A strong answer might address whether fetal stem cells have unique properties when compare with other types of cells, the time scale for moral decision making and relative versus absolute harms, sensitivity to individual religious beliefs, the progress offered by such research and a balanced take that allows for more than one viewpoint.
In June 2011, the infamous Vancouver riots took place after their hockey team lost in the Stanley Cup Finals. Stores were ransacked and cars were burned. Hundreds of people were injured and sent to overcrowded hospitals. As the police chief in Vancouver, what would you do to make sure this does not happen again?
This is a question that is looking at how you think through big problems from the standpoint of a particular profession. It serves as an analogy to medicine and asks you to consider both your role and a thoughtful approach to problem solving. You have the opportunity to demonstrate a scientific mindset by doing a “literature review,” interviewing other police chiefs, community members, business leaders, and basing your plan and actions on this information. Then you might consider this like a health problem, i.e. from an acute, preventative, and public health standpoint. This might include interventions such as increased police presence and guard rails, community outreach, alternative celebration or decompression areas, ending alcohol sales earlier, and at a more broad level, addressing systemic inequality and police-community relationships. You could also add discussion of the possible limits to the authority and role of the police chief and the need for collaboration with other government, corporate, and community partners. The big idea is to see that the question provides an opportunity to investigate a problem and its solution in a way that demonstrates the mindsets admissions committees are looking for and to recognize the nature of a professional role.