Class of 2008--Interview Qs (situational and ethical questions)

[BMBiology]

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It has almost been a year since I applied for pharmacy schools. Before the interview, I was told to expect a lot of situational and especially ethical questions. I think it would be extremely useful for upcoming pharmacy applicants to get a sense of the type of questions that they will be asked. Please feel free to contribute to this list.

At UCSD:
Lets say there is this party you want to go on thursday. However, your friend has this huge project due on friday and she has asked you to help her. Do you go to the party or help out your friend?

At Western:
If you were George W. Bush, how would you change the health care system?

At USC:
How will the staggering economy hurt the way you practice the profession of pharmacy?

At UCSF:
Lets say a few of your friends are asking other friends about the type of questions on the exam. This is not illegal, but it is somewhat unethical. What do you do?


These questions were fun, but they were also very challenging.

 

[LVPharm]

Another problem solving question....you can guess where it's from 😉

You are a pharmacist on rounds with the medical team. You make a recommendation to the physician to change an antibiotic order to a more cost effective antibiotic. The physician sarcastically replies, "I am the physician and you are the pharmacist." How will you go about building respect and trust from this health care professional?

Remember boys and girls, it's all in HOW you answer these types of questions!

 

[neonam11]

1. Alone, you are working the grave yard shift at your retail pharmacy, and a mother, carrying a small child comes into the store. She claims that she is from another state, the mother having no identification or money. However, she holds a prescription bottle that is empty and tells you she urgently needs the medication for her child. And, oh, she does not have the original prescription. What do you do?

2. It's late at night (UCSF pharmacists work their butts off as you can tell. Either that or they have no life.) at the in-patient pharmacy, and you get a call from a physician screaming at you as he wants to know why his prescription hasn't been filled yet. However, you know that the prescription the physician filled out is wrong. What do you do?

3. What special gift(s) do you have that you can contribute to the pharmacy profession? To improve pharmacy, what do you think needs improvement or changing?

4. What is it about pharmacy that you find appealing? What do you not find appealing?

5. To become a competent and caring pharmacist requires committment and sacrafice. What are you willing to go without, and what are you not willing to sacrafice?

6. Explain how pharmacogenomics, a burgeoning field that promises one day to tailor drug therapy to each person's genetic make-up, will affect the number of drugs listed on a formulary, or will it just render it, the formulary, useless? (Actually, this was my question to the resident pharmacist. I don't know if she was impressed or not, but I just wanted to show the admission committee that I really researched pharmacy and in particular, pharmacogenomics, before I decided to apply.)

 

[Mercuric1]

This newbie is hoping some of the senior members will post suggested answers to these different scenarios....or would that be unethical? 😉

 

[Modnar]

Originally posted by Mercuric1
This newbie is hoping some of the senior members will post suggested answers to these different scenarios....or would that be unethical? 😉

If it is, then I shall join you in being unethical. 🙂

 

[BMBiology]

There is usually no "best answer". It is not only what you say, it is also how u deliver it. You have to believe in what you say.

 

[Modnar]

Originally posted by BMBiology
There is usually no "best answer". It is not only what you say, it is only how u deliver it. You have to believe in what you say.

I realize that. I just want to know how *you* responded.

 

[pomelolover]

exactly, i've got some answers formulated in my mind to these. but some of these questions are so expansive- i.e. if you were George W. Bush how you you change the healthcare system etc. that even with a major in sociology i feel as if i need the knowledge of a politician or a social scientist, to be able to answer with validity and throughly.

so how do you go about answering these questions in a decent manner? please share a rough outline of your answers just to share opinions.😍 😍 😍

 

[LVPharm]

Politicians themselves would have difficulty answering the "healthcare system" question (and I really wouldn't do too well with that question either). But, chances are the interviewers want to see the "gears turning in your head" and want you to show your familiarity with issues that are part of the "healthcare system" problem. Of particular importance to you, the prospective pharm student, is the issue of a "prescription drug benefit"...should that be built into Medicare? Should it be delivered through private insurance plans? Make an intelligent, sound argument...you can also tackle "universal healthcare" (but I wouldn't 😉 ). They don't expect you to talk like some sort of Washington DC "policy wonk"....

As far as the question I posted, the correct answer is one that strikes a conciliatory tone, and shows you trying to "educate" the physician in a subtle manner about HOW you arrived at your recommendation. "I would talk to the physician AFTER we are done rounding, and speak to him out of earshot of his colleagues (recognizing that the physician may have said what he said because he was in the presence of his peers, residents, and students). I would try to explain to him my rationale behind my recommendation. Whether or not I change his mind, I hope to simply share my knowledge in a manner that would hopefully help build trust and respect between us."

 

[lord999]

Every time I've been asked to panel, I've always asked a question about ethics. These questions have actually come up in working for CRW...

1. You receive a routine prescription for Viagra. You fill it, finish it, and as you are verifying it, three drugs come up in the profile: 3TC, AZT, and Kaletra (anti-retrovirals). Is it ethical to dispense or refuse dispensing? Does society or the patient have the overriding authority? Why? (The pharmacist ended up dispensing it in my case)

2. It's been a grueling day at CRW. A rx. comes in for Coumadin (anticouagulant) 4 mg #30 1 tab by mouth daily. It is filled, verified, and sold correctly. Upon closer examination by a different pharmacist the next day, the rx. turns out to be a VERY poorly writting Avandia 4 mg (antidiabetic drug). Do you tell the pt? What do you do? Why?

3. Everytime a particular pharmacist does the CII recouncilation report (counts), the pharmacy always seems to come up low on Dilaudid and Actiq lollypops. One day, you decide to take matters into your own hands and check the counts. They are correct. The next day, the pharmacist comes in and declares that the Dilaudid is short again. This happens three times and then you catch him on candid camera. Although this is a guaranteed way to lose your license in AZ and is considered by almost all pharmacies to be an immediate termination, do you report him to the board or just fire the SOB? Any other alternatives...?

Hope this helps!

 

[lord999]

I want to take a shot at answering one the above questions, the pharmacogenomics one. A related science, Pharmacokinetics deals at the macroscopic level (receptors, drug transporters, distribution parameters) that pharmacogenomics deals at the intracellular level (genetics, transcription rates, AA differences in receptor types)

When PK first was a developing sciences in the late 50s to the early 70s, PK promised that exact therapeutic dosage requirements would end Clinical Toxicology as a relevant science, since exact dosages could be determined. It has not happened, but other VERY useful applications came out of the science.

Even if pharmacogenomics or pharmacokinetics could make medication selection a deterministic one by the classical philosophy definition, the science of drug dosage design (industrial pharmaceutics) is nowhere near the point where designer dosages can be customised per pt. To be reasonably economic, most drug dosage forms must be manufactured at the kilogram level. A designed drug for 1 pt. would only be benificial if the medications involved were truly expensive, or the damage incurred by using a drug haphazardly would be more costly than to choose a drug based on genetics. On another matter, formulary removal would not be irrevant because in actuality, formulary managment would become extremely restrictive under a pure pharmacogenomics model since a pt. would be tagged with the exact medications that could be utilized in a cost-effective manner. Pharmacogenomics will change but not eliminate the way drugs are utilized today. They probably will certainly change the ways that drugs work. Pharmacogenomics has driven a shift from the traditional macrosystem receptor interaction methods that pharmacology has dealt with to an up and close look at microsystem of gene regulation as a basic of therapeutics.

BTW, the programs at UCSF, Oregon, and Washington are the best Pharmacogenomics operations in the nation...

 

[LVPharm]

Good questions, lord999...I might just try a couple on next year's admissions interview panels...either a candidate will see the ethical dilemma at hand, or will get "caught up" on the "scary" drug names...I'd probably have to explicitly state the indications for the drugs I mention (I wouldn't expect a candidate for admission to know that Avandia is used for NIDDM).

 

[lord999]

Actually, one of the reasons I used that terminology is my way of testing how a candidate seeks information. Pharmacy is one of those fields that requires extensive information management, and a candidate's ability to be comfortable saying the rotation classic: "I don't know, but I'll know tomorrow," or "What is X drug?" means a lot to me in an interview. If they sit there like an ignorant, or far worse, try to BS their way in the question, make me uneasy about their character.

 

[LVPharm]

VERY good point! 🙂

 

[Modnar]

I'll try to answer that last question of lord999's but before I do, what are Dilaudid and Actiq?

 

[LVPharm]

Actiq is fentanyl, Dilaudid is hydromorphone...both schedule II narcotics for pain management.

 

[Modnar]

Originally posted by LVPharm
Actiq is fentanyl, Dilaudid is hydromorphone...both schedule II narcotics for pain management.

Thanks. In that case, I'd fire his arse, report him to the board, and refer him to a drug treatment program. If he's desperate enough to steal stuff from work, he needs professional help.

 

[jdpharmd?]

In some instances, you can work WITH him/her to voluntarily go into treatment. Usually if somone volunteers, and admits that they have a probelem, their licensing penalties will be much less harsh when the board comes around. A pharmacist who loses their job and their license, and therfore all sources of income for the forseeable future is not a good thing (unless there are major problems). Statistically, pharmacists have a high incidence of drug abuse/dependance because of the easy access and the extensive knowledge that they posess (ie. "I don't need a Dr, just some vicodin for this sore foot"). Last I checked, they also had the second-highest suicide rate in the country. Don't get me wrong, I don't want a drug-addicted pharmacist, but hopefully there are ways to deal with the problem other than completely taking away a person's livelihood. I would think that the AD committee wants to hear about your ethics and problem solving ability on this question. Remember, you like to solve problems through cooperation, not confrontation. 😀

 

[Modnar]

Originally posted by jdpharmd?
Remember, you like to solve problems through cooperation, not confrontation. 😀

True, but if he's repeatedly denied stealing, a good confrontation may be just what he needs.

 

[LVPharm]

...it's always best to attempt to solve the problem in a cooperative, nonconfrontational manner. There will come a time when you'll need to be confrontational, because the interests of the patient supercedes the need to find a face-saving solution for the pharmacist's problem.

What would you do if a police officer came into your pharmacy and you suspected that she had an addiction to prescription painkillers? Is she a threat to public safety? Should you call up the police department and report her? An object lesson from here in Vegas... http://www.reviewjournal.com/lvrj_home/2001/Jul-27-Fri-2001/news/16634649.html

Even when you're tempted to do what you (in your own mind) think is the right thing to do...check with the BOP first. 😉

 

[Modnar]

Originally posted by LVPharm
What would you do if a police officer came into your pharmacy and you suspected that she had an addiction to prescription painkillers? Is she a threat to public safety? Should you call up the police department and report her?

To be honest, I'm not sure what I'd do. I don't think I'd call the police. Since I don't work closely with the officer, I can't say for sure if she is addicted or not. Instead, I might call her doctor and ask if s/he's noticed anything odd about the patient. I wouldn't report the officer unless I was 100% sure that she had a problem.

 

[LVPharm]

I think the correct course of action is ANY that respects patient confidentiality. In this case, confronting the patient with your concern is a justified action, so is consulting the BOP since they were the ones who suspected the individual to begin with. Talking to the prescribing physician may alert him/her to the patient's suspected problem...maybe the physician missed the fax, but most probably was a NEW doctor the patient saw to evade detection as a possible habitual user and get the med she wants ("doctor shopper"). If there ever is a situation in which you would feel tempted to violate a patient's confidentiality, it's probably best to talk to the state BOP first to see if you've got a legal "leg to stand on"...you're here to help the patient (and, in this case, the public as well), but it's your license on the line.