Interview Question Time!

Discussion in 'Interviews' started by Matt, Nov 23, 2007.

Thread Status:
Not open for further replies.
  1. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    Along the same lines as the dos and don'ts thread, this one is intended to help people think through interview questions and how they might go about providing well thought-out answers. The way to get the most out of this is to offer your opinions on answers so they can be discussed.

    With UWS and Monash interviews coming up (which tend to do the scenario thing a bit) these should be worthwhile questions.

    Station 1: Placebo (Ethical Decision Making)

    Dr Cheung recommends homeopathic medicines to
    his patients. There is no scientific evidence or
    widely accepted theory to suggest that homeopathic
    medicines work, and Dr Cheung doesn’t believe
    them to. He recommends homeopathic medicine
    to people with mild and non-specific symptoms
    such as fatigue, headaches and muscle aches,
    because he believes that it will do no harm, but will
    give them reassurance.


    Consider the ethical problems that Dr Cheung’s
    behaviour might pose. Discuss these issues with the
    interviewer.

    The above was taken from:
    Kevin W Eva, Jack Rosenfeld, Harold I Reiter, Geoffrey R Norman (2004)
    An admissions OSCE: the multiple mini-interview
    Medical Education 38 (3), 314–326.


    How would you answer this?
     
    Last edited: Nov 23, 2007
  2. Season

    Season Emeritus MSO Staff Emeritus

    Messages:
    1,765
    Likes Received:
    1
    Trophy Points:
    36
    Well to give a placebo effectively you are essentially lying to the patient, and lying is never ethical :p

    so you've got

    a) lying for the good of the patient, which is paternalistic
    or
    b) telling them the truth, but their health could suffer

    Finally what if it isn't "all in their head" would this make them lose faith in doctors/health/cures?
     
  3. _philanderer_

    _philanderer_ Regular Member

    Messages:
    262
    Likes Received:
    0
    Trophy Points:
    0
    "He recommends homeopathic medicine
    to people with mild and non-specific symptoms

    such as fatigue, headaches and muscle aches,
    because he believes that it will do no harm, but will
    give them reassurance."

    This is the part I have a problem with. He BELIEVES it will do no harm, whatever happened to evidence based practice? What evidence does he have that it will do no harm? Is it possible that it could harm them physiologically/psychologically? He doesn't believe it will work, but he also doesn't 'believe' that it will harm...since when did medicine become a field to practice 'beliefs'. Experimenting with his patients is definately not ethical especially when all he has to support his behaviour is a set of unfounded 'beliefs'. (Especially in light of the nuremburg code etc)

    However that is my brief 2 mins worth of thinking after a very long day of 21sts and working, so forgive me if it sounds a bit unpolished.
     
  4. Superbad

    Superbad New Member

    Messages:
    25
    Likes Received:
    1
    Trophy Points:
    0
    Here's what I would say to the interviewer:

    My initial reaction was to think Dr. Cheung was ethically wrong, since he himself didn't believe in homeopathic medicines. However, if he informs the patient that his recommendations aren't strongly supported by scientific method, I think there is no ethical problem.

    This way, the patient is able to choose to follow the homeopathic approach, rather than solely western medicine. In fact, I would go so far as to say Dr. Cheung is being unethical to not recommend alternative medicines, because he should appreciate that western medicine, for all its wonders, is still limited, and other approaches may have a better result for the patient.

    Of course, you could argue that recommendations not supported by evidence is unethical/unprofessional. Being doctors means you should treat patients first and foremost on a scientific basis, but I see no ethical problem if Dr. Cheung recommends homeopathic medicines, provided he informs them that they may not help at all.

    I sort of repeat myself at the end. What do you folks think?

    Also, do you know where I can find more of these type of scenarios?
     
    7staroperetta likes this.
  5. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    Good responses team!

    Interestingly though, my initial response to the question hasn't come up :confused:.

    The ethical problem here seems to be that the recommendations that Dr Cheung is making go against society's view of doctors. The opinion of a doctor is considered in the community to be one based on a sound scientific basis, reliable clinical experience and evidence based medicine. In recommending the homeopathic medicine Dr Cheug is jeopardising the authority of the medical profession and taking the patients trust in that authority for granted.

    That is to say it is ethically wrong for Dr Cheung to use his position of authority to recommend questionable treatment when society has so much invested trust in his opinion as a doctor.

    What other ethical problems are there? Has anyone got any other ideas or should I post up station 2?
     
    7staroperetta likes this.
  6. tupperwear

    tupperwear New Member

    Messages:
    86
    Likes Received:
    0
    Trophy Points:
    0
    I think the main issue here lies in defining what the role of a doctor is.
    Some may argue that it is to ensure, through whatever means necessary or possible, that the patient's health is maintained at a maximum. If this was the case, there would be no problem with Dr Cheung giving his patients homeopathic remedies just to give them reassurance.
    However, I think the role of doctors has come a long way from times when a doctor is given so called "authority" over a patient as it is relevant to this case.
    It is still about the health of the patient, but it is also about the patient's wishes, and their right to autonomy over their own body. A doctor shouldnt be seen as a power yielding role, but it should be about service - perhaps "councelling" or "consulting" is a better word - so rather than it being solely about the patient's health, it is about offering the patient as many different options as possible about what to do to improve their health.
    So now, it seems clear that Dr Cheung's actions in this instance are not ethically sound, and, I think were I to be in the same situation as him I would explain to my patients that the remedies may or may not be effective, offering them the choice of taking them or not, leaving the decision up to them.


    ... It sounds ramble-y doesn't it? :( Did anyone think parts of it were repetitive?

    Reading it for the first time, (after writing it) it sounds like I advocate euthanasia near the end, the thing about patients having a right to choose over their own body. Did anyone else notice that? :confused: (Disclaimer: I am saying it sounds like I am, I am not saying that I do advocate it)
     
  7. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    woops, double post
     
    Last edited: Nov 25, 2007
  8. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    I think, when it comes to interviews, it's important to think about how you're building and articulating your argument. A lot of people say it's not your answer that matters it's more how you justify it (which is probably fairly true).

    So, all the typical stuff. Clear and concise (you should probably be able to sum it up in one sentence) and all the other statements should follow logically. In the above example, it should be obvious in your argument why there is an ethical problem with the doctors behavior. Make sure you're answering the question.

    All that stuff is particularly important with the next station. Which I think is kinda fun.

    Station 2: Aspartame (Critical Thinking)

    A message that recently appeared on the Web
    warned readers of the dangers of aspartame
    (artificial sweetener – Nutrasweet, Equal) as a
    cause of an epidemic of multiple sclerosis (a
    progressive chronic disease of the nervous system)
    and systemic lupus (a multisystem auto-immune
    disease). The biological explanation provided was
    that, at body temperature, aspartame releases wood
    alcohol (methanol), which turns into formic acid,
    which ​
    is in the same class of drugs as cyanide and
    arsenic.
    Formic acid, they argued, causes metabolic
    acidosis. Clinically, aspartame poisoning was
    argued to be a cause of joint pain, numbness,
    cramps, vertigo, headaches, depression, anxiety,
    slurred speech and blurred vision. The authors
    claimed that aspartame remains on the market
    because the food and drug industries have powerful
    lobbies in Congress. They quoted Dr Russell
    Blaylock, who said,
    The ingredients stimulate the
    neurons of the brain to death, causing brain
    damage of varying degrees.

    Critique this message, in terms of the strength of the
    arguments presented and their logical consistency.
    Your critique might include an indication of the
    issues that you would like to delve into further before
    assessing the validity of these claims

     
  9. _philanderer_

    _philanderer_ Regular Member

    Messages:
    262
    Likes Received:
    0
    Trophy Points:
    0
    Having just read this paragraph. Is it a realistic representation of the kind of scenario that we'll get in the interview, it's very wordy, long and scientific with a lot to take in given we'd have to think on the spot? I'm only asking so that I can choose to practice more of the same kind of questions or not to.
     
  10. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    It's taken from the Journal of Medical Education in a paper describing the Multi Mini-Station Interview system for med applications. The questions are in the appendix of said paper and are used as examples. Some of the questions from this paper were actually used in the USyd interviews last year.

    That said, I'd be surprised if you got a questions a long and wordy as this at UWS.
     
  11. xpatryot

    xpatryot New Member

    Messages:
    13
    Likes Received:
    0
    Trophy Points:
    0
    Wordy it is. Let me try to 'analyze' this to the 'best' of my 'ability'. Here's my take:

    OK, I think we're being asked to judge the claim that 'aspartame as a cause of an epidemic of MS and systemic lupus'. The first thing I noticed is the lack of clinical studies or evidence. They give reasons for the clinical effects of aspartame without citing the sources and studies they used.

    Also, I'm thinking whether the symptoms they have listed are actual indications for MS or lupus. Does aspartame actually affect the central nervous system, that then causes these symptoms to be evident, or is it other factors? They just assumed because of the exhibited symptoms of 'joint pain, numbness etc.', it is an indication of MS/lupus.

    Claims of the industry lobbies in congress is irrelevant to the question posed, makes it seem sensationalist, so I'd pass that off. And the quote from 'Dr Russell Blaylock'. I have no idea who he is (nothing given, except the title 'doctor'), and his statement given is both out of context and seemingly irrelevant, seeing how aspartame hasn't been credibly linked with actual brain damage. I'd skip that.

    In conclusion, I would say there isn't enough evidence here that supports the claim that aspartame is a cause of MS/lupus epidemic. Just to summarize, I think:

    - more info on observed effects of aspartame on CNS/brain/immune system please, not just symptoms.
    - cite sources to increase credibility of claims.
    - numbers maybe? Such as year of introduction of aspartame, stats on its use, epidemic numbers? Who knows, maybe this epidemic is caused by something else, and it's all coincidence.

    P.S. If I was in the actual interview, I'd have avoided commenting on 'metabolic acidosis' mainly because I haven't the faintest clue what it is. I wouldn't have access to Wikipedia.

    What do you think? I need to sharpen up my 'critical thinking skills', so I'm interested in other perspectives, and gaps in my own reasoning ^_^.
     
  12. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    I think those critical reasoning skills are pretty decent xpatryot, you'd probably score pretty highly on this station.

    The only thing I'd say is to make sure you're quite clearly answering the question, make it obvious so to speak.



    So in a real interview you would make a point of saying, as well of there being a lack of clinical evidence, that you would like to see some of the evidence that the source is alluding to. Make it obvious.

    As far as the symptoms being seemingly unrelated to MS and Lupus. Don't assume that they're meant to be, they could just be random symptoms that don't have anything to do with the development of MS or Lupus. However, if the argument is presenting a series of seemingly unrelated symptoms (and conditions - MS and Lupus) it doesn't say much for logical consistency. Espeically when they don't really seem to relate to the 'biological explanation'.

    Your point about Dr. Russel is important. The opinion of someone who's position is unclear isn't worth much.

    [offtopic] This thread is for meds students as well those with interviews coming up [/offtopic]
     
  13. rocketwow

    rocketwow New Member

    Messages:
    90
    Likes Received:
    0
    Trophy Points:
    0
    A query about these types of questions.

    Usually, will the interviewer just read the question to you, or give you a piece of paper to read? Or both?

    And since it's quite wordy, if they decide to only read it aloud to you, would it be OK to ask for a copy to read yourself without losing marks? I'm afraid they'll take marks off because they think your listening skills aren't too good if you ask for a copy.
     
  14. kareem

    kareem Regular Member

    Messages:
    597
    Likes Received:
    0
    Trophy Points:
    16
    i heard that one universituy hands out the paper for you to read then ask for it back???
     
  15. _philanderer_

    _philanderer_ Regular Member

    Messages:
    262
    Likes Received:
    0
    Trophy Points:
    0
    well UNCLE gave us the scenario to read ourselves and it wasn't even remotely as wordy as the one given here.
     
  16. Season

    Season Emeritus MSO Staff Emeritus

    Messages:
    1,765
    Likes Received:
    1
    Trophy Points:
    36
    Station 2: Aspartame (Critical Thinking)

    A message that recently appeared on the Web
    warned readers of the dangers of aspartame
    (artificial sweetener – Nutrasweet, Equal) as a
    cause of an epidemic of multiple sclerosis (a
    progressive chronic disease of the nervous system)
    and systemic lupus (a multisystem auto-immune
    disease). The biological explanation provided was
    that, at body temperature, aspartame releases wood
    alcohol (methanol), which turns into formic acid,
    which ​
    is in the same class of drugs as cyanide and
    arsenic.
    Formic acid, they argued, causes metabolic
    acidosis. Clinically, aspartame poisoning was
    argued to be a cause of joint pain, numbness,
    cramps, vertigo, headaches, depression, anxiety,
    slurred speech and blurred vision. The authors
    claimed that aspartame remains on the market
    because the food and drug industries have powerful
    lobbies in Congress. They quoted Dr Russell
    Blaylock, who said,
    The ingredients stimulate the
    neurons of the brain to death, causing brain
    damage of varying degrees.

    Critique this message, in terms of the strength of the
    arguments presented and their logical consistency.
    Your critique might include an indication of the
    issues that you would like to delve into further before
    assessing the validity of these claims

    Okay I saw this the other day but my mind went... later

    but now is the time

    Things that need questioning
    "A message that recently appeared on the Web"

    The web is a very large place, was it on WHO or FDA? Or was it on a message board raging against substitutes for sugars

    "Formic acid, they argued, causes metabolic acidosis. "

    Proof?? Studies?? How was this argued, any stats to back up this claim. Furthermore how does metabolic acidosis link to MS or lupus? Is it once metabolic acidosis occurs MS and Lupus follows... for life?

    "
    Clinically, aspartame poisoning was argued to be a cause of joint pain, numbness,
    cramps, vertigo, headaches, depression, anxiety, slurred speech and blurred vision."

    Again are these symptoms of MS or Lupus? Its not very clear, are these symptoms for life or temporary? Are there different degrees of aspartame poisoning, how much is too much? Where are the studies to back this up?

    "
    The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress."

    "which turns into formic acid, whichis in the same class of drugs as cyanide and arsenic."

    These two comments are irrelevant to the science side of things and are obviously aimed to shock people, since after all not only are people ingesting poison similar to other poisons, but there is also a "conspiracy" going on by evil food and drug industries. Which obviously infers what type of website this was posted on, most likely not a scientific one if it thought its audience would easily be shocked by comparisons to "arsenic and cyanide" and a mention of a conspiracy as well.

    "
    Dr Russell Blaylock, who said, The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees."

    Who is this Dr. Russell Blaylock? He could be a doctor of philosophy for all we know, additionally how does brain damage as a symptom relate to MS and Lupus? How was he quoted, was he giving a speech to the FDA? Is this his personal opinion?

    Overall while this piece uses some big words in a complicated fashion, it is unsubstantiated by any data or clinical studies. The one reference mentioned Dr. Russell Blaylock we know nothing about, what he does, if he is a specialist or even a medical doctor. Additionally it is obviously aimed not at a scientific audience but at one who believe that their is a "conspiracy" behind the FDA

    Until there is some clinical results to back this up, it is not very valid. However it is an interesting idea and worth doing studies on it.

     
  17. xpatryot

    xpatryot New Member

    Messages:
    13
    Likes Received:
    0
    Trophy Points:
    0
    Duly noted. I do have a tendency to ramble/elaborate/vomit. So for questions like these, don't assume anything. Maybe that's the key to rational objectivity.

    And I agree with Season, a lot of it felt like it was trying to be 'scandalous'. And there was a heap of scientific mumbo-jumbo that in the end didn't seem to prove anything. But it's very fitting for Today Tonight, or ACA. What with their experiments with a sample space of two. :rolleyes:

    Thanks for the questions and tips, anima! Made me think in my holiday stupor.
     
  18. Matt

    Matt Emeritus MSO Staff Emeritus

    Messages:
    5,352
    Likes Received:
    7
    Trophy Points:
    38
    Season, I thought your answer to station 2 was excellent.

    Station 3: Air Travel (Communication Skills)

    Your company needs both you and a co-worker (Sara,
    a colleague from another branch of the company) to
    attend a critical business meeting in San Diego. You
    have just arrived to drive Sara to the airport.

    Sara is in the room.

    It isn't stated explicitly but in this station there is an actor playing Sara. Sara has developed a fear of flying as a result of the September 11 tragedy and you have to show off your communication skills. I don't think we'll get much discussion on this one; it's strong point is that it's difficult to prepare for/rehearse. Interesting station though.


    Station 4: Deterrent Fees (Knowledge of the Health
    Care System)


    Recently, the Prime Minister of Canada raised the
    issue of deterrent fees (a small charge, say $10, which
    everyone who initiates a visit to a health professional
    would have to pay at the first contact) as a way to
    control health care costs. The assumption is that this
    will deter people from visiting their doctor for
    unnecessary reasons.

    Consider the broad implications of this policy for
    health and health care costs. For example, do you
    think the approach will save health care costs? At
    what expense? Discuss this issue with the interviewer.

     
  19. rocketwow

    rocketwow New Member

    Messages:
    90
    Likes Received:
    0
    Trophy Points:
    0
    Oh, I am going to die in the interview..! :(



    - $10 each, that will definitely save costs, but it won't save much (I think?).

    - What about all the people with 'real' illnesses who need to see a doctor who are struggling financially?

    - Yes, this may reduce the number of people who show up at health clinics with unnecessary reasons, but does the prime minister expect everyone to have knowledge about their health? Can a person without this kind of knowledge determine if his/her problem is important or not?

    - Many illnesses have symptoms which people think can be ignored. Then they can develop into life-threatening problems. Many lives are saved by early diagnosis. The introduction of this $10 fee may deter people from seeing doctors, and these people could be in the early stages of life-threatening diseases, so is it OK for people to lose their lives just so the government can save some money? Obviously not.

    - Aren't doctors supposed to help anyone and everyone, regardless of the severity of the problem? You can't put a price on a person's health, or a person's life. It's not acceptable to put a person's health at risk to save money.
     
    Last edited: Nov 28, 2007
  20. Season

    Season Emeritus MSO Staff Emeritus

    Messages:
    1,765
    Likes Received:
    1
    Trophy Points:
    36
    General tips for dealing with someone who is angry/scared/worried/upset

    -acknowledge feelings
    -match tone in speech
    -be firm
    -stay calm
    -accept unrealistic fears as normal, ie don't say "but you'd have to be stupid to be scared of planes"
    -let them get the emotion out, this is their bodies way of getting rid of it

    once they're calm
    -talk rationally
    -compare things
    -say you'll be there
    -discuss worst case scenarios
    -discuss options, and pros and cons (in this situation you should put a emphasis on the pros subtly of course)
    -show them how much they've accomplished "look you made it to the airport, we're nearly there


    This policy will definitely save costs, for two main reasons. Firstly that $10 per patient goes straight back into the system, if a doctor managed to see 5 patients an hour, that's an extra $50 per hour, which over time will
    accumulate. Secondly money is saved by deterring people who don't really need to see a doctor and hence giving that money that would have gone to their doctors is given to other patients.

    The idea is that if people really had a problem that needed attention or looking at, they'd have to spend money to see if it was okay. For some people spending money is not an issue, and they will see the doctor for silly reasons no matter what the cost. The reverse is also true, low income earners, students and people on pensions will bear the brunt of this issue where the money is a much stronger deterrent to them even if they are sick, they will carry on with their sickness until it becomes urgent.

    This is poigantly evident in India, many poor families have no money so they put off going to a doctor until they are very advanced in their illnesses, it is not uncommon to see cases of advanced TB, cancer and meningitis. If this ever happened in Australia, instead of saving the health system money it would actually cause it more money trying to support desperately ill people in advanced stages of various diseases, when a simple prescription of antibiotics caught in the early stages could have solved some of these problems. All the money Australia (and possibly this university) puts into preventative medicine would but useless.

    It should also be noted that just because a service may be free, this does not mean everyone will take advantage of it, this is illustrated clearly in the amount of people who do not use public libraries, even though they are completely free.

    So in communities primarily made up of students, low income earners, or pensioners a fee deterrent has the possibility of making the burden on the health system greater rather then less, thus this system is inadvisable. However for areas of higher income so money isn't as valuable this system has the potential to save the health system a lot of money, and free up doctors to treat people who are actually sick.
     
Thread Status:
Not open for further replies.

Share This Page