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Interview Question Time 3#

Eunoia

New Member
Let's say a cart has 2 paths, and either you can let the cart go down it's current path and kill 10 people, or you can change the cart of the path and kill 2 people. Personally, and i know some people will disagree with me, i'd change the path of the cart, because surely you want to ensure the best outcomes for as many people as possible.

However,
If the scenario is changed to: You're a medical practitioner and a person is unconscious and may die, but if you take his organs out now, you can save 20 other people who would die if you didn't.
For the first scenario: There is no 'right' thing to do in this kind of situation. On one hand, I can change the path of the cart and save more people, but do I have the right to decide that 10 lives are worth more than 2 lives? On the other hand, if I keep the cart on the same path, I end up killing more people and saving less lives. Sitting here, right now, I tell myself that I would choose to let the cart continue along the same track, as I feel as if I'd be intervening in a situation that is already set in motion. I mean, those two people were lucky enough to be on the other path on that particular day, why should I be the one to affect that? But, I believe that if I was actually in this situation, I would choose to change the path, as I would not want to be the reason for 10 deaths over 2. So, in response to this scenario, I will go with changing the path.

Modified Scenario: The first question is whether or not this person is my patient. If they are my patient, then my duty is to this person and preserving their life, before the 20 people that I will assume aren't. Even if they are my patients, I will have to find other ways to treat them, that aren't at the expense of another one of my patients. If this person is not my patient, I would still choose to save him, or at least try, that way if he does die, I know that I tried everything I can and the other 20 people will live, but not because I took someone else's life.

I don't even know if this makes sense (especially the second paragraph), but I'm starting to try these kinds of questions now, so that in the amazing occurrence that I get an interview for medicine at JCU (I haven't even applied yet. I know, I'm a freak who over plans things.), I won't have to stress out about it then. Hah.
 

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Medman

New Member
For the first scenario: There is no 'right' thing to do in this kind of situation. On one hand, I can change the path of the cart and save more people, but do I have the right to decide that 10 lives are worth more than 2 lives? On the other hand, if I keep the cart on the same path, I end up killing more people and saving less lives. Sitting here, right now, I tell myself that I would choose to let the cart continue along the same track, as I feel as if I'd be intervening in a situation that is already set in motion. I mean, those two people were lucky enough to be on the other path on that particular day, why should I be the one to affect that? But, I believe that if I was actually in this situation, I would choose to change the path, as I would not want to be the reason for 10 deaths over 2. So, in response to this scenario, I will go with changing the path.

Modified Scenario: The first question is whether or not this person is my patient. If they are my patient, then my duty is to this person and preserving their life, before the 20 people that I will assume aren't. Even if they are my patients, I will have to find other ways to treat them, that aren't at the expense of another one of my patients. If this person is not my patient, I would still choose to save him, or at least try, that way if he does die, I know that I tried everything I can and the other 20 people will live, but not because I took someone else's life.

I don't even know if this makes sense (especially the second paragraph), but I'm starting to try these kinds of questions now, so that in the amazing occurrence that I get an interview for medicine at JCU (I haven't even applied yet. I know, I'm a freak who over plans things.), I won't have to stress out about it then. Hah.
^Too simplistic in analyzing the question. You must identify the issues at hand first and give reasons as to why you would pick one over the other.

Take for example the modified scenario. One of the ethical principles of medicine is non-maleficence, it is ethically wrong to harm one person to help other people. This being said there are scenarios where this is possible if the person is close to death but has made the wishes to donate their organs. Yes you do not have an ethical obligation to the 20 people but it may be up to your patient to decide. Why? Another ethical principle called patient autonomy, if you feel the patient has a poor chance of survival you may suggest to palliate the patient hence allowing them to donate their organs once they have passed. You should also identify the need to consult with the patient's family about the process of donation. You should state the organs belong to the patient and without specific consent cannot be taken. You can also state without prior consent you may be legally liable to a law suit. There are many many issues to identify. The process of the interview is not to talk about the solutions but to identify the issues and then reach a solution (critical thinking). This is the process where most students fall into trouble.

P.S I know this is very medical. You don't need to put such medical detail in but you need to talk about ethics. You must also know that sometimes you cannot help everyone.
 

Hollasino

New Member
Hello
I would like to ask for some advice on how to answer scenario questions, perhaps a basic approach/structure to answer these types of scenario questions would be highly appreciated. ^_^


Here is a scenario question that I've been struggling to answer:

You are a volunteer at a homeless shelter. One day you meet a 42 year old woman who is dying from alcohol-related liver disease. She tells you that she hasn't had a drink in days and wants to "get hammered" before she dies but cannot get the last bottle of vodka from her locker at the shelter. You know that alcohol is not permitted at the shelter. What do you do?

I've been tossing back and forth between what to do!!!

My answer would be:



  • Tell a trusted supervisor the situation, and ask if this was acceptable, seeing as she is dying.
  • I would firmly tell the 42 year old woman that alcohol is not permitted at the shelter and tell her the consequences of being found out. (she obviously wouldn't care about the consequences as she is about to die... :cry: )
  • Ask the 42 year old woman if she was absolutely certain that this is how she wants to spend the remaining time of her life. ( If she is certain, then I would go and get the bottle of vodka from her locker for her. )
  • Make sure an ambulance is called so she can get rushed to hospital straight after.


    Is this a weird answer? I seriously can't think of what better to do.
    Any feedback and advice is greatly appreciated!!!

 

Hollasino

New Member
[h=2]Another scenario question[/h]
It is late afternoon and you have four patients left to see. You have promised to be home in time to attend an important family event that evening. Just before you see the remaining four patients, you receive a call informing you that one of your long term patients is failing dramatically. The patient and her family had previously agreed to a Do-Not-Resuscitate order; however the family is now having second thoughts and wants to discuss the situation with you as soon as possible. How will you manage your time?


This is how I would approach the question:


  • Things to consider :
    If I take time after work to discuss the situation with the patient's family, I would not be able to make it back in time to attend the important family event that I promised I would attend.
  • If I reject the family's wish to discuss the situation (about wanting to resuscitate, after preciously agreeing to a DNR order), then the family would be highly distressed because this is a life and death situation for the patient. This would most likely result in the patient's family being disappointed with my role as a doctor and would think that I did not take on my responsibilities properly. However this would mean I get to make it in time to the important family event.
  • Make a decision- How will you manage your time?
    Seeing as I can only choose between one, I would choose to stay behind after work to discuss the situation with the family. This would mean that I'd arrive late/miss out on the family event but unfortunately my patient's situation is a life and death situation so is more important.

    OR

    (If i don't need to choose between one)
    I will first quickly consult the family after work and then quickly rush to the family event.


Ahh.. I'm not sure if this is an okay answer.
Your advice is appreciated.
Thanks!
 

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CCH

Regular Member
Hello
I would like to ask for some advice on how to answer scenario questions, perhaps a basic approach/structure to answer these types of scenario questions would be highly appreciated. ^_^


Mmm, there are many ways of attacking scenario questions, and your future life as a doctor is, in some ways, an endless stream of scenarios questions. Here is a simplified version of my approach.

1. What are they asking? Why are they asking?

We can confidently assume that in an interview, the interviewers are not actually looking for the correct answer or the solution to a real problem. Scenario questions are asked to gauge the mentality of the applicants, i.e. How do they think? What are the values behind their thinking? How do they justify these underlying values? Are they safe?

In the first scenario you posted, at a first glance my thoughts are centred around:
* Medical ethics (autonomy, justice, beneficence, non-maleficence)
* Chain of command
* Professional & personal boundaries
* Safety

In the second scenario you posted, off the top of my head:
* Medical ethics (autonomy, justice, beneficence, non-maleficence)
* Professional & personal boundaries
* Work-life balance
* Basic time & commitment management

2. Use the ethical framework of your choice, and stick with it.
Don't become involved in a moral debate. Don't introduce your own religious or cultural assumptions.
Be consistent in utilising your ethical framework of choice. Back up your reasoning within the boundaries of these ethics. I would suggest using the framework of medical ethics (autonomy, justice, beneficence, non-maleficence) - it's the only one you'd really need for assessment purposes unless you end up in a very specialised field such as psychiatry or palliative care.

3. State your responses in a logical and sequential fashion.
Make it easy for the interviewers, and they will mark you more positively!
The worse thing is when the candidate chops and changes, going back and forth on different tangents.

4. Be ready to explain your decisions. Make sure any decisions or arguments you make can be defended when scrutinised by your peers. Be firm, but not rigid!
Be ready to adapt your thinking to new information or unexpected feedback.

5. Don't feel pressured to give absolute answers. Sometimes, you may have to acknowledge that you are not sure, that you don't know, or that you need help. It would be good if you could phrase these ideas in a positive way to highlight your ability to self-reflect. No one wants a cow-boy doctor!

I would suggest rethinking your responses to the first scenario - they are highly idiosyncratic and somewhat unsafe both for you and the person in your care.
 

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