“3 people are dying and you can only save one, which one do you pick?” interview question

[deleted853480]

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The whole point of this question is testing out how well you manage resources. I disagree with these types of questions. Also you want to reflect on what caused the situation and try and avoid it from happening again.

 

[Cornfed101]

Also you want to reflect on what caused the situation and try and avoid it from happening again.

Maybe the people in the scenario spent the afternoon at Action Park

 

[FISTMCLARGEHUGE]

I feel like I'm in a minority of people who like these MMI questions.

It's a hard question and based on the types of people you include, you can easily draw out bais in whoever you are interviewing. It's also nice to have a question that can be researched beforehand because you can change it enough to toss a twist in there but still identify people who took the time to prepare.

I'll use this example from my old unit when we were looking at taking on new guys. The basis was "you have these two people, 1 in group X and 1 in group Y from the region Z. One of them knows an incredibly vital bit of information that will save many lives. How do you get that?" The correct answer is to ask. Very few people even asked what group in the situation was allied and if they did that they could have just asked for a translator and gotten the info in about 2 minutes. What it did do was identify people who were bais and assumed anything from region X = bad. It separated those who couldn't take a step back and start from ground 0. It made it incredibly easy to find bais and a lack of critical thinking.
Ethical MMIs want to see the same thing. Can you assess the situation with needed information and make a logical decision free of basis or flagrant mistakes.

 

[Goro]

How do you correctly answer this question? What would give one person obvious priority over another?

Only you can answer this question. It's one of judgement. There is not right answer...that's why it's asked.

 

[DNAJB6]

You ask your kindergarten age kids who they want to let die? Weird.

Lol. harsh but it proves how bad a kindergarten teacher I would be. But I remember being asked that question when I was a kid. seriously.

@notsobabydoc
You definitely picked the right avatar (Dr. Seuss Grinch). 😛

Twas the night before Christmas and the trauma unit at the ER was stirring...

 

[notsobabydoc]

@notsobabydoc
You definitely picked the right avatar (Dr. Seuss Grinch). 😛

Twas the night before Christmas and the trauma unit at the ER was stirring...

Kids love the grinch lol

 

[DNAJB6]

Key questions:
Which patient has the best prognosis?
Is there a loophole in the question that would allow me to pick more than one patient?
Which death would expose me to the most potential tort liability?

 

[Goro]

empathy can only be shown by talking about YOUR OWN experience, not some MMI crap that's completely standardized. Medicine should not be standardized, nor should the interview process. MMI's are designed by lazy admissions office which doesn't want to invest in the process of really getting to know their candidates. It's a shame that CASPER and MMI are a thing at all.

Hmmm..Banhammer smack. I'm guessing sock puppet account?

FYI, there is published data that shows that MMI can select for people with more empathy.

 

[TakotsuboOkazaki]

Easy. Let them all die. Keeps it fair. Plus, no survivor’s guilt for any of them.

Thh it would be easier to tell three parents that I watched all of their children die, then tell two of those three parents that I just decided not to pick their child.

Honestly, if I was feeling sadistic and giving this MMI to interviewees, I would phrase it like this: “You made the decision to save person X over persons Y and Z. How would you communicate your reasoning to the parents of both the living and the deceased?”

I feel like there may be something in the Geneva convention about asking questions like that on school interviews.

 

[Aktak]

Hmmm... Maybe I’d ask the patients. In the military, sometimes you have a mission with a much higher risk than an alternative. In some cases, someone will volunteer because their buddy has a wife and kids at home and they don’t.

Given similar ages, outcomes, etc.. If I asked the three of them and one was willing to die so another could live, I’d probably save that person. Someone willing to sacrifice in such a manner is the kind of person who makes the world a better place.

 

[DNAJB6]

Honestly, if I was feeling sadistic and giving this MMI to interviewees, I would phrase it like this: “You made the decision to save person X over persons Y and Z. How would you communicate your reasoning to the parents of both the living and the deceased?”

The other families would never know.

 

[Goro]

The other families would never know.

Yup...HIPAA and all that.

 

[Matthew9Thirtyfive]

Hmmm... Maybe I’d ask the patients. In the military, sometimes you have a mission with a much higher risk than an alternative. In some cases, someone will volunteer because their buddy has a wife and kids at home and they don’t.

Given similar ages, outcomes, etc.. If I asked the three of them and one was willing to die so another could live, I’d probably save that person. Someone willing to sacrifice in such a manner is the kind of person who makes the world a better place.

In the military, we prioritize the people we can get back in the fight and people who have a shot at survival. If someone is telling you to let them die to save their buddy but their triage category is expected, you’re not going to waste an evac opportunity, which are limited, on someone unlikely to even survive the transport when you have someone who can be evacuated as an urgent or urgent/surgical and could survive. Asking who is willing to die and basing your triage on that is ludicrous.

People say and do all kinds of things under stress and when injured.

 

[QueenAudrey]

In the military, we prioritize the people we can get back in the fight and people who have a shot at survival.

Not exactly. At least, not in the Army. Army goes by who is the most severely injured, even if that person is the enemy insurgent who caused the other casualties. (I think it might have been Moko who said the sickest first; same idea here.) Ethical calculus like which among the patients is an ally, good person or “deserves” to live, or whose return to health can continue the fight/benefit others never comes into play. You specify their combatant status on the radio call but the chopper still comes for them. New recruits find this an extremely hard pill to swallow. I feel like this translates well to the civilian world, though, because we may find ourselves with patients who are drug dealers, human traffickers, child molesters, etc (I certainly have, even as an MA), and must provide care exactly as competent and compassionate as we would for a saintly patient.

 

[theKingLT]

In the military, we prioritize the people we can get back in the fight and people who have a shot at survival. If someone is telling you to let them die to save their buddy but their triage category is expected, you’re not going to waste an evac opportunity, which are limited, on someone unlikely to even survive the transport when you have someone who can be evacuated as an urgent or urgent/surgical and could survive. Asking who is willing to die and basing your triage on that is ludicrous.

People say and do all kinds of things under stress and when injured.

My paramedic instructor used to run mass casualty training sims and she said the most common reason people fail is for treating the expectant, especially for hospital based personel including EM physicians! Its a hard thing to look at an infant (real or sim) thats not breathing and decide your going to leave it to die

 

[Matthew9Thirtyfive]

Not exactly. At least, not in the Army. Army goes by who is the most severely injured, even if that person is the enemy insurgent who caused the other casualties. (I think it might have been Moko who said the sickest first; same idea here.) Ethical calculus like which among the patients is an ally, good person or “deserves” to live, or whose return to health can continue the fight/benefit others never comes into play. You specify their combatant status on the radio call but the chopper still comes for them. New recruits find this an extremely hard pill to swallow. I feel like this translates well to the civilian world, though, because we may find ourselves with patients who are drug dealers, human traffickers, child molesters, etc (I certainly have, even as an MA), and must provide care exactly as competent and compassionate as we would for a saintly patient.

I go to USUHS where the triage stuff is mostly taught Army style. I’ve also been in the Navy for 7 years involved in TCCC and CLS, so I have a little experience (though less with the Army). We don’t triage exclusively by severity of injury. Let me clarify. When I say we go by survivability, what I mean is that we triage people based on the severity of injury and whether or not they are expected to survive.

If you have 3 patients from a IED, and one of them has minor trauma, one has a lower extremity amputation but is otherwise stable, and one of them has bilateral extremity amputations plus a distended abdomen, unstable pelvis, is unresponsive and is not responding to a fluid challenge with no peripheral pulses and a barely palpable pulse in the carotids and extremely shallow breathing, and maybe some seizing from late stage hemorrhaging, that third patient might be more severely injured, but they are probably not surviving the trip. You’re sending that stable lower leg amp back first because they will survive the trip and have a shot at surviving. Patient three will be lucky to survive for a few more minutes in a BAS.

It is similar to the civilian world but not identical. In the civilian world you typically don’t have to worry about blast injuries, nor are you essentially evacing every patient out of your aid station because you don’t have the capability to do much more than a surgical airway, chest tubes, and give some blood. Survivability and resource management becomes more of an issue in a deployed setting.

And I’m not the one who said ethical calculus comes into play. I said it doesn’t and triaging based on who “deserves” it more is ridiculous.

 

[Matthew9Thirtyfive]

My paramedic instructor used to run mass casualty training sims and she said the most common reason people fail is for treating the expectant, especially for hospital based personel including EM physicians! Its a hard thing to look at an infant (real or sim) thats not breathing and decide your going to leave it to die

Yes. It is not quite the same. In the states we will treat the worst first because we can. When you have few resources and have to consider how to best use them to save the most people, you have to make awful choices that may cause someone to die who may have survived in a resource rich location.

But in the vast majority of these questions I think the questioner is probably referring to a facility in the US where you have more than a couple units of blood and actual surgical capabilities.

 

[Cornfed101]

I go to USUHS where the triage stuff is mostly taught Army style. I’ve also been in the Navy for 7 years involved in TCCC and CLS, so I have a little experience (though less with the Army). We don’t triage exclusively by severity of injury. Let me clarify. When I say we go by survivability, what I mean is that we triage people based on the severity of injury and whether or not they are expected to survive.

If you have 3 patients from a IED, and one of them has minor trauma, one has a lower extremity amputation but is otherwise stable, and one of them has bilateral extremity amputations plus a distended abdomen, unstable pelvis, is unresponsive and is not responding to a fluid challenge with no peripheral pulses and a barely palpable pulse in the carotids and extremely shallow breathing, and maybe some seizing from late stage hemorrhaging, that third patient might be more severely injured, but they are probably not surviving the trip. You’re sending that stable lower leg amp back first because they will survive the trip and have a shot at surviving. Patient three will be lucky to survive for a few more minutes in a BAS.

It is similar to the civilian world but not identical. In the civilian world you typically don’t have to worry about blast injuries, nor are you essentially evacing every patient out of your aid station because you don’t have the capability to do much more than a surgical airway, chest tubes, and give some blood. Survivability and resource management becomes more of an issue in a deployed setting.

And I’m not the one who said ethical calculus comes into play. I said it doesn’t and triaging based on who “deserves” it more is ridiculous.

But I think that’s the difficulty with these ethical situations as a premed. Most premeds wouldn’t know not to chose based on who “deserves” to live. It’s definitely an easy trap to fall into, even after training!

 

[Matthew9Thirtyfive]

But I think that’s the difficulty with these ethical situations as a premed. Most premeds wouldn’t know not to chose based on who “deserves” to live. It’s definitely an easy trap to fall into, even after training!

It gets dicey. If you have a corpsman with a survivable injury and an enemy combatant with a worse but potentially survivable injury, the right answer in the military is you prioritize the corpsman. That doesn’t mean you don’t treat the enemy, but strategy plays a part. If you’re letting your corpsman or soldier die to save an enemy, you’re not supporting the line, which is our whole job.

A lot of people are uncomfortable with that because it’s not PC. It also doesn’t translate to the civilian sector, because again if you have two patients and one is a fire fighter and the other is a criminal who just committed a shooting, if the criminal is worse off that’s who you treat first. Or at least that’s what’s supposed to happen.

 

[deleted966164]

But I think that’s the difficulty with these ethical situations as a premed. Most premeds wouldn’t know not to chose based on who “deserves” to live. It’s definitely an easy trap to fall into, even after training!

I can only reiterate. The adcoms are not expecting the premeds to know the principle of triage. That is what medical school is for. These questions are meant to see how you reason about things and how you word things.

If you start your answer with “Well, in the Army they taught us to...” then you’re actually not really answering the question. In that case you’re just demonstrating what would you do based on your prior training. Your answer would also apply mostly to field setting and not necessarily to the ED.

 

[Cornfed101]

I can only reiterate. The adcoms are not expecting the premeds to know the principle of triage. That is what medical school is for. These questions are meant to see how you reason about things and how you word things.

If you start your answer with “Well, in the Army they taught us to...” then you’re actually not really answering the question. In that case you’re just demonstrating what would you do based on your prior training. Your answer would also apply mostly to field setting and not necessarily to the ED.

Oh definitely. I think it would be a mistake to do that as well. But if I were conducting the interview it would be very easy to throw someone off who was only choosing based on the merits of those in danger/injured. It would be easier to defend if you said you would help the most injured person first because it isn’t based on emotions.

 

[Matthew9Thirtyfive]

I can only reiterate. The adcoms are not expecting the premeds to know the principle of triage. That is what medical school is for. These questions are meant to see how you reason about things and how you word things.

If you start your answer with “Well, in the Army they taught us to...” then you’re actually not really answering the question. In that case you’re just demonstrating what would you do based on your prior training. Your answer would also apply mostly to field setting and not necessarily to the ED.

I had zero problems answering questions based on my prior training. In fact, most were impressed with the experience and asked further questions about it. I got accepted at all those schools.

 

[deleted966164]

I had zero problems answering questions based on my prior training. In fact, most were impressed with the experience and asked further questions about it. I got accepted at all those schools.

I can only congratulate you.

 

[907914]

I had zero problems answering questions based on my prior training. In fact, most were impressed with the experience and asked further questions about it. I got accepted at all those schools.

N=2, I answered almost every question I could using prior training as an example and have thus far received positive results...so imma second this and say that there is absolutely nothing wrong with using practical training as a means of answering the question.

 

[QueenAudrey]

Dang, I guess things have changed since Obama’s Army. At any rate, quite an interesting discussion.