Are medical school interview ethics questions from USMLE?

[aegistitan]

Let's use an example question: If a 14 year old child needs a blood transfusion, but his Jehovah's witness parents refuse treatment, what would you do?

The following response is from this thread: http://forums.studentdoctor.net/thr...saving-treatment-on-religious-grounds.526695/

If competent parents refuse lifesaving treatment for their child on religious grounds, you ignore the parents' refusal and treat the child anyway. Parents don't have the legal right to refuse life saving treatment for a minor.

So would an appropriate response during an interview be, "I would begin treatment because parents don't have the legal right to refuse life saving treatment for a minor"?

So if common medical school interview questions are from USMLE ethics (are they?), then are we as applicants who are not familiar with USMLE be expected to answer according to what the USMLE would say is right, or would it be better for us to be "truthful" to ourselves and answer the ethical question in whatever way our own morals guide us? In the above circumstance I would have never known that parents don't have the legal right to refuse life saving treatment for a minor without looking it up.

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[WingedOx]

The real life answer is always "first, page your hospital's legal/risk team."

what happens on a test question is a different story.

 

[palatopharyngeus]

So if common medical school interview questions are from USMLE ethics (are they?), then are we as applicants who are not familiar with USMLE be expected to answer according to what the USMLE would say is right, or would it be better for us to be "truthful" to ourselves and answer the ethical question in whatever way our own morals guide us?

neither. you're approaching this all wrong. instead of asking yourself what the USMLE deems correct or what would be "truthful" to your "own morals", think about what would be in the best interest of the patient.

"do right by the patient, and you'll do no wrong." --> this is the golden rule of medicine as far as I'm concerned

 

[Chipster.]

neither. you're approaching this all wrong. instead of asking yourself what the USMLE deems correct or what would be "truthful" to your "own morals", think about what would be in the best interest of the patient.

"do right by the patient, and you'll do no wrong." --> this is the golden rule of medicine as far as I'm concerned

I mean it's a nice sentiment and all, but it doesn't mean you can treat a competent adult if they refuse treatment.

 

[aegistitan]

I mean it's a nice sentiment and all, but it doesn't mean you can treat a competent adult if they refuse treatment.

Yeah that's what I was thinking. So would the interviewers prefer hearing an answer for the adult refusing treatment something along the lines of, "Although my own morals guide me towards wanting to treat the patient and putting him first, legally I think there would be an issue so I would refer to the hospital's lawyer"

 

[palatopharyngeus]

I mean it's a nice sentiment and all, but it doesn't mean you can treat a competent adult if they refuse treatment.

"There is no exception to the rule that every rule has an exception." ~ James Thurber

 

[palatopharyngeus]

Yeah that's what I was thinking. So would the interviewers prefer hearing an answer for the adult refusing treatment something along the lines of, "Although my own morals guide me towards wanting to treat the patient and putting him first, legally I think there would be an issue so I would refer to the hospital's lawyer"

i think the best answer in this situation would be to say that you would explain to the patient THOROUGHLY and EXACTLY why treatment is in his/her best interest, and that you would at least TRY to convince the patient to make the appropriate decision from a medical standpoint. now if the patient STILL resists, then you should respect that choice.

 

[WinslowPringle]

Just answer the question as you normally would. They want to see that you can think on your feet, perform ethical reasoning, and not behave poorly under pressure. Good answers include sentiments of: doing what's best for the patient, being considerate of the family's beliefs, providing appropriate medical care. Bad answers include sentiments of: mocking other's beliefs, providing inappropriate medical care, not doing what's best for the patient, forcing medical treatment without consideration of legal precedent or the situation's ethics, or saying "That's a dumb question and wouldn't happen."

 

[palatopharyngeus]

...or saying "That's a dumb question and wouldn't happen."

lmao, yeah don't say that

 

[xffan624]

Let's use an example question: If a 14 year old child needs a blood transfusion, but his Jehovah's witness parents refuse treatment, what would you do?

The following response is from this thread: http://forums.studentdoctor.net/thr...saving-treatment-on-religious-grounds.526695/

If competent parents refuse lifesaving treatment for their child on religious grounds, you ignore the parents' refusal and treat the child anyway. Parents don't have the legal right to refuse life saving treatment for a minor.

So would an appropriate response during an interview be, "I would begin treatment because parents don't have the legal right to refuse life saving treatment for a minor"?

So if common medical school interview questions are from USMLE ethics (are they?), then are we as applicants who are not familiar with USMLE be expected to answer according to what the USMLE would say is right, or would it be better for us to be "truthful" to ourselves and answer the ethical question in whatever way our own morals guide us? In the above circumstance I would have never known that parents don't have the legal right to refuse life saving treatment for a minor without looking it up.

They're not expecting you to know the USMLE stock answer in medical school interviews. They are expecting you to have some semblance of humanity and ethics and to be able to justify any answer you give. And also to recognize and respect different viewpoints and why conflicts may arise.

The questions are talking points designed to gauge you as an applicant. They're not designed to test your knowledge of medical ethics.

 

[wondergirl3]

Are these ethical type questions common in regular interviews?

 

[Goro]

Many good ethics questions sometimes have no correct answer.

Just answer the question as you normally would. They want to see that you can think on your feet, perform ethical reasoning, and not behave poorly under pressure. Good answers include sentiments of: doing what's best for the patient, being considerate of the family's beliefs, providing appropriate medical care. Bad answers include sentiments of: mocking other's beliefs, providing inappropriate medical care, not doing what's best for the patient, forcing medical treatment without consideration of legal precedent or the situation's ethics, or saying "That's a dumb question and wouldn't happen."

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Are these ethical type questions common in regular interviews?

 

[sliceofbread136]

This is a key point.

When they ask you an ethics question, it's not a secret test that they are expecting you to have the "right" answer to. Part of what they are looking for is your ability to recognize the complexity of the issues and the possibility that multiple "right" answers may exist.

So you actually don't want to be too declarative/absolute in your response; that makes it seem like you are either arrogant or don't understand all the issues. Of course the counterpoint is that at the same time you don't want to appear wishy-washy.

This, it has zero to do with the usmle

 

[aegistitan]

Saying you'd refer to a lawyer is not a good idea in an interview setting.

Just curious, why would saying I'd refer to the hospital lawyer be bad in an interview setting?

 

[Vain Brother]

with respect to @SouthernSurgeon, i think you could definitely say something like "well the first thing i'd do would be to page the ethics committee", as long as it's said in a sort of knowing, I've-worked-in-hospitals-before kind of way. but you'd have to follow that up with a serious answer about your view on the ethical question at hand, obviously

 

[caffeinemia]

If he's drank, but not drunk, is it freegal?

 

[caffeinemia]

These questions are typically to see if you have a backbone and a general idea of ethical principles in medicine. Another one I heard often was:

if you senior /resident does something wrong for the patient, is it your responsibility to do something? and if so, what would you do -- tell the attending? call the hospital? talk to the resident?

 

[CherryRedDracul]

I think it's worthwhile to look into the cornerstone of medical ethics, the "Four Principles" by Beauchamp & Childress: autonomy, beneficence, non-maleficence, and justice.

 

[aegistitan]

These questions are typically to see if you have a backbone and a general idea of ethical principles in medicine. Another one I heard often was:

if you senior /resident does something wrong for the patient, is it your responsibility to do something? and if so, what would you do -- tell the attending? call the hospital? talk to the resident?

Would this be the correct thinking in answering the question:

The patient comes first always, therefore if something were to harm the patient in any way I would want to help them in any way possible, therefore I would talk to the resident/attending whoever was available.

Where can I get the mindset to answer medical school interview ethics questions? Is there some sort of guide on this?

 

[NickNaylor]

Just curious, why would saying I'd refer to the hospital lawyer be bad in an interview setting?

This question is also never the correct answer on the USMLE exams. You are expected to make a decision, not refer to some other body and defer responsibility (just as "refer to ____ specialty" is also never an answer on USMLE questions asking about medical management, even though - moreso than the ethics questions - this is actually what is done in real life). The scenarios you are provided are very rarely actually complicated enough to warrant something like an ethics consult or discussion with the legal department.

 

[caffeinemia]

Honestly I think you need to read a medical ethics book, because your examples answers so far are so concrete and lacking what interviewers are looking for.

@SouthernSurgeon : It's not like his answer to my question was completely wrong. He just needs clearer understanding of principles in medical ethics.

I think it's important to note that as a physician you have taken an oath to first do no harm (and a number of other oaths). If you see harm being done to a patient in your care, you do have a responsibilty to stop it. The question of what constitutes harm
is important. Are you harming someone by cutting into them to take out a cancer? Probably an acceptable harm if it's going to save their life. But what if they have mets? Is it just too aggressive or would it be palliative? Etc etc.

As a medical student, you may not have the authority to directly intervene or decide in many situations (and you shouldn't), however if you see somethig so obviously inappropriate, then should notify your supervisor/chief/attending/dean/etc about your concerns. The key is not to be accusatory or unprofessional in doing so - because sometimes your understanding may be incomplete. So no, you weren't completely off base, because most people do have an intrinsic moral/ethical compass, but your answer could be more sophisticated and grounded in an understanding of our professional obligations. As cyanidedracula said up there - benificence, non-malificence, autonomy, justice, etc.

 

[wondergirl3]

@aegistitan Are these ethical questions relevant to the FlexMed interview? Your post history shows that you also applied there, and I too wanted to know if one needs to prepare for the FlexMed interview with ethical dilemma knowledge

 

[aegistitan]

Honestly I think you need to read a medical ethics book, because your examples answers so far are so concrete and lacking what interviewers are looking for.

Any recommendations? Is there some form of compressed guide that can tell me about the mentality I need to portray, as opposed to an entire book?

 

[NickNaylor]

Any recommendations? Is there some form of compressed guide that can tell me about the mentality I need to portray, as opposed to an entire book?

This is the text we used for our ethics course (disclosure: one of the authors, Dr. Siegler, also served as our professor). I found it to be an accessible and easy read and could be easily understood by just about anyone. This is not a primer on interview questions, so I'm not sure if that will fulfill your needs. However, you will come away from the text with a pretty solid understanding of the basics of medical ethics and can tackle any ethics question you might get with relative ease.

http://goo.gl/Eukkpl (apologies for the link shortener, Amazon links aren't displaying correctly)