Interview Question Time #2

[Season]

Nuts whered my answer go? Ok. Well...ten minutes, right? For typing, which on this computer is a bit slower that talking. go...

This article starts out with a reminder of the fairly well accepted fact that smoking has negative health effects, and that quitting smoking is beneficial before going on to discuss so -called natural approaches to quiting smoking by replacing cigarreet smoking with other forms of tobacco use. The article seems to suggest that pipe smoking and cigar smoking are less addictive, although they continue to have significant health risks nearly as high as smoking. The article states that some people belive spit tobacco causes less lung diseases, but notes that it causes more oral health problems including serious diseases such as cancer, and is addictive.

A real problem with this article seems to be that it doesn';t define it's terms: switching from cigarettes to cigars may infact be a strategy some people attenpt to quit cigarrette smoking, but the article doesn't provide any information on whether this leads to quitting smoking, or merely to a different form of smoking. The article doesn't say waht it means when it refers to concepts like "äddictive" (whether they mean physical or psychological dependance), or how they would measure this. I can't tell whether the article is presenting the views that these are forms of smoking cessation, or merely something people attempt, in the way people will try all sorts of ideas. No real comparitive data is presented here and no sources. Is the risk of bronchitis in cigar smokers high compared to the population, or compared to cigareette smokers, etc. No comparitive data or the risks, benefits and success of other quite smoking methods such as nicotine replacement, going cold turkey, cutting down, or pharmacological treatments is given

I think there is something inherently inconsistent is talking about "natural methods to quite smoking", anf then going on to talk about other forms of smoking. There isn't enough information here to make an asset of the risks and benefits of "switching smoking", at best this article describes approaches some people might attempt, and points out that there are risks involved with these forms of tobacco use.

12 minutes,but I got the washing off the ;line midway...

Very good analysis, and may I say you did it a lot briefer then you did before. You identify relevant points which are problematic throughout the passage and sum them up very well. I liked the flow of it all.

Again like my feedback above, you just need investigate it further. Who knows, this might be real.

Again I should have posted something which had at least some academic quoting stuff to make it seem like it was based on some sort of evidence.

 

[happyjuju]

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?

"

Aaaaaaand take 2!

Hopefully this is better than my last effort! Tried to cut down my response and also do it in a more appropriate time frame...(8 mins)

Ultimately, the concern here is that aboriginal patients may not have equal access to the health clinic due to the deliberate double booking.

I think it is important to not be immediately judgemental. The receptionists role is to manage the administrative side of the clinic and through their experience, have come to the conclusion that aboriginal patients are less likely to turn up to their booked appointments. Therefore, they have taken the action of double booking them, with the interest of filling the doctor’s appointments for the day. I am a student and still learning.

I would undertake a process of observation to determine exactly what was happening at the clinic. If possible, I could monitor the waiting room. Indeed, do half the people booked actually turn up? If so, why? Perhaps they have had previous negative experiences before as a result of the overbooking and therefore expect the doctor to be late/unavailable and so therefore don’t bother with their appointments sometimes? Or perhaps there is some other cultural or community reason affecting this particular group of people that needs to be addressed (Eg. Difficulty of transport). Alternatively, perhaps I would observe the majority of booked aboriginal patients turn up and some of them have to be turned away or told to wait. In this instance I might make a casual comment like “Gee the clinic waiting room was busy today! It must be hard to turn some of those patients away, maybe we should try not double booking as many”.

I would not make a scene and challenge the reception staff because as I noted before, this is their job and they have some "organisational wisdom" that has led them to this conclusion. That’s why I would undertake the observation process above and also casually discuss the issue with someone I trust and feel comfortable with who also works in the clinic (Eg. My supervising doctor).

***Further note. I didn't really make clear that, if it were noted that the aboriginal patients were indeed less likely to turn up to their appt, ideally there would be some research into this to ensure that this group of people are recieving equitable healthcare. This may involve identifying barriers (Eg. like transport as i said above/financial/cultural) and problem solving so that they can be addressed at a community level. Perhaps I could sugges this to my supervisor or contact.

 

[Dr Worm]

Not an actual answer just my thoughts. If you see what I mean. Interview tommorrow and need to go to sleep.

Well the lanuguege ("those people") isn't encouraging, but it is likely that the practice need to see (bill) enough pateinets to stay i buisness. If it was a nn issue they'd find themselves double booked and running behind. So let's assume the comment has some truth in it. I don't want to upset, debate, or assume I know more than the secretary/practise manager, or offend him/her. I imagine I SAY something like Ï guess there are lots of reasons people know show for appointments, it must be hard to deal with, why do you think that happens? (is there anouther way to address the probelm?/ that's really hard...there must be some way to encourage people to access healthcare...if appropriate).

other health issues/beliefs can ake getting to appts tricky, as can large families, carer responsibilities, no credit on phone to call and cancel, no transport etc.

Reminder/confirmation calls (from the [ractise) the day of the appointment could help if the practise was open to the idea

I'd want to push the idea of considering other approaches without presuming I knew better...

 

[Matt]

Great work everyone! I apologise that my response is too long…any feedback about whether I am on the right track or how to cut down my waffle would be greatly appreciated

This article outlines the dangers associated with tobacco use, and discusses different methods of intake. Firstly, I noticed a lack of references and authorship, so the reader is left unaware as to the context or purpose of the text. I would be interested to know who the author was and who the intended audience was, and also the references behind the stated statistics. This would be helpful in understanding the purpose of the text and also in critically appraising the information provided. Moving on...
The first point relates to cigarette smoking, and some statistics are given to demonstrate the harmful effects of this behaviour. Various comparisons are made between ciggarette smokers (note that no further clasification is given, eg. "a pack a day smoker") and non ciggarette smokers in terms of their morbidity and disease rates. Specifically, cigarette smokers experience worse health outcomes than do non smokers. The general trend presented is that quitting earlier is most favourable, and that quitting when older is still favourable, but less effective. In psychology, this is a technique frequently used in health promotions whereby the audience is firstly presented with an unfavourable consequence, and subsequently told that their change in behaviour WILL make a positive difference.
The next point relates to tobacco intake via cigar and pipe smoking. The author calls these “natural ways to quite smoking”. I have not heard of this terminology before so would be interested to know about this classification of “natural”. Perhaps it is in the absence of medication (in which case going cold turkey would also be considered natural) or whether it represents some lessened intake of tobacco (which arguably, is not really quitting smoking). I make this point because the word natural has pleasant and healthy connotations associated with it and it is used throughout the text. Furthermore, I am unsure whether someone who switches their daily cigarette intake to a daily cigar intake is actually “quitting” smoking. Moving on, the article identifies both cigar smoking and pipe smoking as natural ways of quitting smoking, which presents them in a positive light. It then goes on to demonstrate the harmful effects of cigar and pipe smoking, saying they are “less addictive” ( I would like to know more about this) than cigarettes, but making the concession “they are not completely safe” (newsflash!! hehe). Various statistics are provided to demonstrate that the harmful effects of this type of smoking are “nearly the same” as cigarette smoking. I would like to know whether any of these differences are statistically significant and how this has been determined, and whether specific diseases and things like frequency of smoking behaviour have been taken into consideration. Is the comparison in the final sentence comparing these pipe/cigar smokers with non smokers or with cigarette smokers? Seemingly the comparison is between pipe/cigar smokers but this is unclear.
The next point relates to spit and smokeless tobacco and labels them “other natural ways to quit smoking” and reports that smoke-related tobacco intake is the most harmful, and yet these smokeless methods are as addictive as cigarettes (how was this determined?). The author then goes on to list various health problems associated with the intake of smokeless tobacco, seemingly making comparisons between non-smokers and smokless-smokers (does that make sense?), but once again, this is unclear. Smokeless tobacco intake is presented as being less harmful than smoking tobacco intake, and yet the necessary statistical comparisons needed to make this inference are not offered. The proposed statement that smokeless intake of tobacco is less harmful than smoking intake of tobacco is not supported by a comparison in health outcomes with the smoking groups previously discussed.
The overall structure of the argument is logical, in that the author discusses tobacco intake in a supposed perceived descending order of harmfulness. The statistical comparisons are for the most part meaningless, as there is no evidence offered that cigar/pipe smokers experience better outcomes than cigarette smokers, or that smokeless-smokers experience better outcomes than cigar/pipe smokers. Overall, the article outlines the harmful effects of all types of tobacco use and says that as a group, tobacco users have worse health related outcomes than non-tobacco users. This claim, despite a lack of references, I believe to be accurate. The supposed grading of harmfulness remains unsupported by appropriate comparisons and in the absence of referencing I am unsure of the accuracy of this interpretation.
If the purpose of this article is to dispel the myth that these “natural ways to quit smoking” are actually particularly harmful, it may benefit from making some appropriate group comparisons, breaking down the perceived “natural” label rather than referring to it throughout the article, and offering non-tobacco quitting alternatives in a final paragraph.

Hey, good critique and good answer. You correctly point out that your answer is too long and therefore impractical for an interview situation but you did do a very good job of pointing out the key problems with this piece - namely a lack of referencing, no clear details on who the author is, and no context for the statistics quoted which would be needed to assess the validity and further usefulness of their claims.

I have italicised and highlighted in red the sentence above in order to highlight the importance of summarising. I only realised this point was important after I wrote the sentence above but its clearly missing from many of the posts so far in this thread.

Summarising and paraphrasing are related but ultimately different terms. Paraphrasing is putting the meaning of something into your own words while summarising is identifying the main substance of a lengthy piece of information. It is useful in this sort of question to be able to summarise in one or two sentences what the article is trying to say and what the problems with the article are. My sentence above summarises the important criticisms, for example

What a lot of posters have done is paraphrase each of the sentences/paragraphs in turn (without actually summarising them) and then have gone on to critique those paragraphs. This is essentially a doubling up of information and it is why some of the replies are so long. A better way would be to summarise the major points, summarise the major critiques, and then go on to nitpick details in your critical analysis. This is a hugely important communicative skill to develop with massive relevance for medicine. When presented with a lot of information you have to make sense of, its important to identify and summarise the major points in your first couple of sentences then go through the detail in order of most important to least important.

Going through the article in the order in which it is written helps you not to miss anything but is relatively simple to do and does not give you the chance to show how well you can synthesise and interpret data.

That last bit was more general advice for the whole thread. To go on for this particular post I would mention, as Season has done, that its worth pointing out what this article has done well as well as what is not so good about it. You might perhaps make the comment that this article is likely not written for an audience of healthcare professionals which might explain some of its failings.

Similarly, when discussing things you'd like to look into, its worth considering summarising those things at the end. This is simply another method to avoid a 'nitpicking' response and instead give one that is structured and clear.

In fact this response only mentions one or two things that it'd like to know more about. Again, a clear and structured way to do this is as such: the article makes the claim that xyz, but what is not clear is how x was determined, whether y was statistically significant or what the comparison group for z was. I'd need to know more about these issues before I could really gauge the usefulness of these claims - i.e. a summary.

Nevertheless this reply clearly demonstrates very good critical analysis skills, I don't think I have any suggestions for improvement there, they are quite simply very good. The area for improvement is presenting these excellent critical analysis skills in a clear and structured manner.

 

[Matt]

The piece seems to be suggesting that the risk of an early death due to smoking is high, although it can be reduced by quitting early. It then discusses a number of natural ways to quit smoking that are used by people, and are claimed to be less harmful but are far from risk free.

There is a little structure to the argument contained in the article, as it presents alternatives to smoking that may be interpreted as a good option to increase life expectancy (given that quitting smoking as early as possible is presented as the best possible option), but then identifies similar health problems between the options such as addiction and forms of mouth cancer. The article does not then identify the impacts on life expectancy of these illnesses.

Given that the title of the article is ‘Dangers of cigarettes, cigars and smokeless tobacco’, it is within its rights to deal with the dangers of each of them individually. However a more useful analysis, given the flow of the article and the suggestion that people seeking to quit smoking often take up other forms of tobacco, would be a comparative analysis of the relative risk of developing identified diseases for each form of tobacco and impacts on life expectancy.

I don’t know if we should be worried about references within an interview scenario. If they said – “this article appeared on the internet” or something, then I might raise the issue of reliability of information. The biggest concern with the claims to me is the lack of quantitative information regarding the forms of tobacco and relative risks depending on how long one had used them and to what degree. I would want to explore those two issues further before giving the article too much credit, as it is far too general as it stands.

You raise a very good point about the lack of direct comparison between the three groups and the difficulty in comparing the claims made as a result. You're quite right in that there needs to be some reference point in order to make the claims.

Nevertheless, you should identify fairly early on that the article has no author (and you therefore have no idea what their qualification/background is), that the claims are not referenced and that you don't know the context for any of the statistics quoted (and therefore the author could be quoting them outiside of their origianlly intended context). Its true that this article is probably not intended for health professionals and therefore needn't be of high quality but you need to put point these key issues out or comment on them in any critical analysis. This can be done in one sentence at the beginning: e.g. Firstly I notice neither the author nor their relevant qualifications are recorded, there are no references to back up the claims, the claims themselves are without context. A sentence such as this quickly gives the listener an appreciation for the approximate quality of the article.

 

[Matt]

hi there. heres what i think - i havent looked at the other responses.



Smoking reduces the overall life expectancy of people, with people quitting earlier reducing the reduction their own life expectancy. Cigars, pipe tobacco and forms of smokeless tobacco use that are deemed "natural" ways to quite, still lead to many health problem.

This passage lacks a clear sense of an argument in the way that it initially provides statistics and then proceeds to attack "natural" ways to quit, and does not seem to be arguing for a clear purpose. This transition breaks the train of thought and its logical consistancy. Furthermore, the claims that are made are in no way compared against each other not allowing for someone to objectively compare their detrimental effects making it hard for a choice of a "natural" way to quit smoking to be chosen by someone who may want to quit smoking. Also the statistics provided do not seem to be supported by clinical evidence and thus may not be valid. Furthermore, i believe a recommendation of a method of quitting should be recommended to potential smoking quitters.

This is actually a very good reply, one of the best in the thread despite being short.


The first paragraph is a good summary of what the article is all about, perhaps a little too concise, but you did a good job of picking out points in this article are important. You first sentence in the second paragraph is a very good point but could have been delivered simpler - e.g. The article doesn't seem to have a final point, it uses descriptive statistics and attacks the so-called 'natural' ways of quitting but doesn't tie the two together in order to arrive at any meaningful conclusion.

It's good that you acknowledge the fact that none of the claims are supported by any evidence but you shouln't say 'clinical evidence', just keep to evidence - 'clinical' has no relevance here and might confuse the listener by implying something more specific than evidence which is what you mean.

As I said though, this is quite a good reply in that it really does summarise what the article's trying to say and what's wrong with it rather than paraphrasing and nitpicking. In the latter the most important details get lost in the sheer mass of detail, but you've been able to identify the most important parts and that's very important in these questions.

 

[Matt]

I originally didn't think it'd be helpful for me to contribute my own answer to this question but in light of my feedback I feel I ought to so here it is.

This article makes the point that those who smoke are much more likely to die early when compared to those who don't and at all ages, though the younger the better, life expectancy can be improved by quitting smoking. It describes three so-called 'natural' methods of quitting smoking - cigars, pipes, and chewing tobacco the first two being described as less addictive and the latter being described as less harmful. Nevertheless the article makes the point that each of these 'natural' alternatives have their own health-related consequences which seem to be comparable with cigarette smoking.

The first thing to note about this article is that there is no author listed and no references are provided for the claims that are made. There is no effective comparison between the various alternatives to cigarettes, or between the alternatives and cigarettes themselves. Futhermore, there is no context for the claims made and without references its difficult to know whether they can be applied in this comparison.

Thus, I can't really draw any meaningful conclusion from this article. In order to better assess the validity of the claims being made I'd need to be able to compare cigarette smoking and the alternatives presented using the same measurement and assessing the primary outcomes of addictive quality and life expectancy.

It might also be useful to compare the how acceptable the alternatives to cigarette smoking are to a cigarette smoking population in order to determine their usefulness as a method to facilitate quitting smoking or improving life expectancy.

As usual, posted in approximately 5 or so minutes, not a model answer, just my own answer and with its own problems. The things it does well though is have a clear structure paragraph one is the summary, two is the critique, three is the conclusion and areas of requiring more information, and four is thinking outside the box and beyond the article.

 

[happyjuju]

Wow!

Thankyou Matt and others for taking the time to provide us with such quality feedback. Your points about paraphrasing and summarising are demonstrated excellently in your last post...and I now feel like I understand how to arrange my answer in a more concise manner and powerful sequence. I do have a tendency to "nitpick" every last detail, especially so when typing a response, and realise that it is a skill to present a logical argument in a shortened yet comprehensive way (my brother, a lawyer, has no trouble doing this hehe). Thanks again!

I am also finding it interesting to read other people's attempts to the scenarios...it's so good to see different approaches and reasoning.

 

[Harry Dresden]

Hey guys I think you've all done a really good job with this question. Makes me wish I'd posted something a bit more challenging, I'll start posting some feedback tonight.


The next question I admittedly stole from the other thread, but Matt and I think its a very interesting situation.


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?

Well first off, I would say that the main issue here is one of generalisation. I would challenge the receptionist's comment simply on the grounds that in the medical profession, any signs of stereotyping or possible discrimination is obviously unethical in terms of duty of care. However, it really would depend on what the receptionist based her comment on. If say, she made the comment because Aboriginal patients often have other obligations which prevent their attendance of their appointments, then it would be acceptable but further questioning about her reasoning should and in my position, would be asked.
However, no matter the reason, her choice of wording was poor, the term "these people" often being regarded as lumping of all individuals in that clique (for lack of a better word) into the same category and labeling of individuals within that community with preconceived notions.
Feedback on this would be greatly appreciated!
Thanks to Matt for the thread!

 

[miss_universe]

On that topic...

As I understand there is a cultural difference to attending clinics with Ingidenous patients, in a less structured way as we understand it.
Maybe the wole system to booking patient is not working for them.

Just a insight (and saying I am not indigenous and neither do I claim to know a lot of their culture...)

 

[Dsquall]

Here's a new one:

You are studying at your university’s library. An hour later another student joins your table, unpacks his bags and reaches for a sandwich even though there are numerous NO FOOD PERMITTED signs posted everywhere. He starts eating right in front of you. What course of action would you take?

 

[DrChopper]

[MENTION=814]Matt[/MENTION]
I was just wondeirng if you'd mind rebooting this threat for 2013 entry? it seems really helpful id i'd love to get some new questions up for discussion!

 

[Matt]

I'd love to DrChopper, I really enjoy this thread, but unfortunately I've committed to too many other things just at the moment. That doesn't mean the thread can't be rebooted though, we'd just need another person or persons to drive it!

 

[DrChopper]

I'd love to DrChopper, I really enjoy this thread, but unfortunately I've committed to too many other things just at the moment. That doesn't mean the thread can't be rebooted though, we'd just need another person or persons to drive it!

I'd love to help out but I don't know where you gather the material from and to be honest i'd like some experienced minds donating their opinions as well not just us newbies dishing it out on the wrong tac.

 

[JeremiahGreenspoon]

I couldn't write any questions, but would be happy to offer any ideas in terms of answers. Exams aren't for weeks!

 

[Havox]

I couldn't write any questions, but would be happy to offer any ideas in terms of answers. Exams aren't for weeks!

They're looming D:

 

[DrChopper]

I couldn't write any questions, but would be happy to offer any ideas in terms of answers. Exams aren't for weeks!

Ive made it! and posted the first question feel free to drop some knowledge.