Practice Interview Question Thread

[velvetthundr]

My answer to this prompt was basically verbatim as I used the dictation tool on my laptop to directly record my spoken answer, so it didn't come out as smooth or polished as I would have liked...please offer advice and tips on how to improve, thanks!!

You are a doctor and your patient has been taking pain medication for his condition which caused numerous side effects. A new drug came out which is safer and the patient seems to be managing better and can almost function normally that he has considered starting work. However, this drug is expensive and the patient is concerned about affording this drug. The government subsidizes this drug to patients with epilepsy only. If you write on the prescription that the patient has epilepsy, he can get the drug subsidized. What would you do? What are the ethical implications? What should be the consequences if the doctor wrote the prescription as having epilepsy?

In this scenario I'm going to assume that my patient doesn't have epilepsy. In that case, there are two main courses of action that I would probably consider as a doctor. One course of action would be me writing on the prescription that my patient has epilepsy and getting the drug subsidized, and the other alternative course of action that I could take would be to not write on the prescription that he has epilepsy. If I take the first course of action, then I would be lying; however my patient would be able to get the drug at a much cheaper price. Furthermore, in the scenario it's stated that the drug is safer to use than the one he's currently using. As such, acquiring the drug would be beneficial for the patient and in his best interests. However the ethical issues with this course of action is that I would be committing a violation of hospital policy and possibly legal violations as well. There's a certain amount of trust that’s put into me as a doctor to be honest and open when prescribing medicine and treatments. On the other hand, if I didn't write on the prescription that my patient has epilepsy, then he would still be able to acquire the drug but at a much more expensive price. Of course, as my patient is currently concerned about the price of the drug, acquiring at a cheaper price would be preferable as compared to this alternative. However, not lying on my patient’s prescription would mean that I would maintain a certain level of honesty and trustworthiness that's expected of me as a doctor. After considering these two options I would most likely not lie on the prescription and take the second course of action. I would first discuss with my patient about his concerns particularly those regarding the cost of the medication and I would attempt to find alternative drugs that are both safer and cheaper than the drug he’s currently using. However, if none exist, then I would prescribe the new drug to the patient and attempt to find alternative methods to subsidize the drug. Even if no alternatives exist, I would still prescribe this drug because it's safer for my patient and there's a smaller chance of negative side effects. Having my patients well-being in mind, I would prefer not to risk his health with the current medication. All in all, this scenario presents an ethical conflict between my duty towards beneficence versus my duties to administer justice. On one hand, acquiring the drug for a cheaper price would benefit my patient; however, it would be a violation of hospital policy as well as the law. As a doctor I have a responsibility to not abuse my power and uphold the law while being fair and just when interacting with others.
If the doctor wrote the prescription as having epilepsy, and he was found out, I believe that the doctor should receive punishment for violation of hospital policy as well as his duties as a doctor to call justice. I think that the doctor should undergo behavioral review and his actions should be reported to the medical board to receive punishment as they see fit, possibly stripping him of his medical license. This may seem harsh, but I think that it’s necessary because the doctor should never abuse his power and his right to prescribe medicine two patients regardless of the circumstances. To me it seems that if the doctor were to be allowed to violate hospital policy in this case, then there would be an inherent issue with the hospital policy itself and the doctor’s actions would set a precedent for any future cases of policy violation.

 

[Crow]

I'll first recommend: can you please use paragraphs or separate your answers by question? It makes readability far easier and thus would make it easier to provide feedback.

Overall, I think you've addressed the key components of the question. Some feedback:

I would first discuss with my patient about his concerns particularly those regarding the cost of the medication and I would attempt to find alternative drugs that are both safer and cheaper than the drug he’s currently using. However, if none exist, then I would prescribe the new drug to the patient and attempt to find alternative methods to subsidize the drug. Even if no alternatives exist, I would still prescribe this drug because it's safer for my patient and there's a smaller chance of negative side effects.

You need to consider the facts of the scenario here and explore the financial situation of the patient and whether or not it's feasible for them. This is the essence of patient-centered care: if your patient cannot afford the drug then choosing to prescribe it to them may very well do more harm than good - they may just not take it at all because they can't afford it, or they may take it less frequently than they are meant to, or they may reduce the dose that's been prescribed etc (these are common occurrences in reality and definitely something to be aware of). I think the scenario presents the opportunity to explore the patient's exact financial situation and whether there are other avenues that could be taken in their life to reduce expenditure.

The scenario also states the patient is now considering starting work because of how effective the drug is at managing his condition; this is definitely a point to include in your answer, as it may be that working will allow him to afford the drug and mitigate the financial issues entirely. Essentially you need to balance the cost of the medication and its affordability for the patient with the benefits it will bring to his life.

All in all, this scenario presents an ethical conflict between my duty towards beneficence versus my duties to administer justice.

This sentence sounds like you've tried to shoe-horn in components of Principlism; by all means, use these where you can, but make sure they are used appropriately and naturally.

If the doctor wrote the prescription as having epilepsy, and he was found out, I believe that the doctor should receive punishment for violation of hospital policy as well as his duties as a doctor to call justice. I think that the doctor should undergo behavioral review and his actions should be reported to the medical board to receive punishment as they see fit, possibly stripping him of his medical license. This may seem harsh, but I think that it’s necessary because the doctor should never abuse his power and his right to prescribe medicine two patients regardless of the circumstances. To me it seems that if the doctor were to be allowed to violate hospital policy in this case, then there would be an inherent issue with the hospital policy itself and the doctor’s actions would set a precedent for any future cases of policy violation.

This is probably nit-picky but be careful assuming gender of a stakeholder in any scenario when it's not actually stated in the stem; depending on the circumstances it could come across as though you have certain intrinsic biases.

 

[kotoloper]

Hi guys, feeling a bit nervous with exams in a week and interview invites potentially in a few weeks and actual interviews in a month and a bit gaah. I used the google doc speech to text tool for this one, and then I organised the gibberish into legitimate paragraphs - I'm getting there! Any feedback would be appreciated, not sure if I covered enough things or if I took the right course of action.

You are a genetic counselor. One of your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carry the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda's husband. In other words, the boy's biological father is someone else, who is unaware that he carries the mutation. You suspect that Linda nor her husband are aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family?

First, I would take into account the family’s situation; it is possible that Linda and her husband had used alternative methods to have the child, such as surrogacy, adoption or using the sperm of another male if her husband was infertile. I would need to ensure that I have not come to a misunderstanding of the boy’s heritage to ensure that I have all the information and not come to a wrongful and potentially accusatory conclusion.

I would not disclose the results immediately with the whole family together; if possible, I would try to have separate meetings with the mother first as I do not want to confuse the child or impact their mental health in anyway as this can be a big revelation, and also to avoid any potential outburst or conflict that may occur upon hearing the analysis, which is highly probable due to the nature of the scenario. I would sit down with Linda and disclose the results in a gentle but factual manner, clearly getting across that her husband is most likely not the father of the boy. As this could be the result of an affair or a secret, she would likely be uncomfortable and reluctant to share any information with me. However, I would try to ensure that she understands that this is something she should tell her husband about, whatever the reason.

I would also need to inform her that I will disclose these results to her husband as well if she is reluctant to do so, as he needs to be informed about the truth and his son’s health. I would encourage her to initiate a peaceful conversation with her husband - since this is a private matter, it is likely that she would not want to make this revelation in a meeting with me - however, if this is the path she wants to take, I would initiate the meeting with the whole family and disclose the results. The child should be present in the giving of information about his genetic defect and anything he needs to be aware of his condition, but I would then speak with Linda and her husband privately about the situation with paternity, and act as a mediator.

 

[Scorpion]

Hi guys, feeling a bit nervous with exams in a week and interview invites potentially in a few weeks and actual interviews in a month and a bit gaah. I used the google doc speech to text tool for this one, and then I organised the gibberish into legitimate paragraphs - I'm getting there! Any feedback would be appreciated, not sure if I covered enough things or if I took the right course of action.

You are a genetic counselor. One of your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carry the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda's husband. In other words, the boy's biological father is someone else, who is unaware that he carries the mutation. You suspect that Linda nor her husband are aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family?

First, I would take into account the family’s situation; it is possible that Linda and her husband had used alternative methods to have the child, such as surrogacy, adoption or using the sperm of another male if her husband was infertile. I would need to ensure that I have not come to a misunderstanding of the boy’s heritage to ensure that I have all the information and not come to a wrongful and potentially accusatory conclusion.

I would not disclose the results immediately with the whole family together; if possible, I would try to have separate meetings with the mother first as I do not want to confuse the child or impact their mental health in anyway as this can be a big revelation, and also to avoid any potential outburst or conflict that may occur upon hearing the analysis, which is highly probable due to the nature of the scenario. I would sit down with Linda and disclose the results in a gentle but factual manner, clearly getting across that her husband is most likely not the father of the boy. As this could be the result of an affair or a secret, she would likely be uncomfortable and reluctant to share any information with me. However, I would try to ensure that she understands that this is something she should tell her husband about, whatever the reason.

I would also need to inform her that I will disclose these results to her husband as well if she is reluctant to do so, as he needs to be informed about the truth and his son’s health. I would encourage her to initiate a peaceful conversation with her husband - since this is a private matter, it is likely that she would not want to make this revelation in a meeting with me - however, if this is the path she wants to take, I would initiate the meeting with the whole family and disclose the results. The child should be present in the giving of information about his genetic defect and anything he needs to be aware of his condition, but I would then speak with Linda and her husband privately about the situation with paternity, and act as a mediator.

Right there with you in regards to the nerves- but as far as I can tell, you're doing well with interview prep! I stared at this for a long time but I only have a couple of very minor points:

When telling Linda you must inform her husband of the non-paternity, you could add that it is your responsibility as a genetic counselor and health professional to be honest with your patients who have placed trust in you.

You could also discuss different outcomes: what if Linda confesses to you that she did have an affair, but was scared of how her husband would react? You could use this as a segue into suggesting she tells him during an appointment with you. You could also discuss the fact that the family relationships may be strained by this new information, and this could not only harm the parents but also to boy's upbringing, but ultimately bring it back to the fact that Linda's husband must be informed.

Also, I have a separate question: would the biological father of the child need to be informed of this development? On one hand, if he knew he was the carrier of a genetic disease, he may decide not to have any more children to avoid passing on the defect. However, he may not know he has a child and the family may want it to stay that way for their own privacy and potentially safety. This isn't what the prompt asked for but it's interesting.

 

[velvetthundr]

Posting another verbatim answer, please give feedback!! Also, does anyone have any sites for reading up on issues regarding rural/indigenous medicine and healthcare? Thanks!

You are a medical student undertaking placements in the medical ward. Your good friend is assigned to the surgical ward for his placements but you see him sitting alone in the common room all the time. You decide to approach him and ask if everything is alright. He reveals that on the first day of his placement, the surgical consultant yelled at him and said ‘Medical students are always in my way. You are not allowed to attend the wards!’ What are the issues involved in this scenario? What would you say to your friend?
Your classmate later reveals that he has been feeling very low lately. How would you approach the situation?
Your friend casually mentions ideas of suicide. Does this change the way you approach his situation?

There are a few issues in this scenario. Firstly, there is the issue of the seniority of the consultant versus our right to attend wards. As medical students undertaking placements in this medical ward, we are allowed to attend wards and observe the consultants at work. We also have the responsibility to help out the consultants and doctors with whatever they need as medical students undertaking placement. However the consultant has insisted that that my friend is not allowed to attend the wards as medical students are always in his way. The consultant in this case is not correct; however the consultant is indeed more senior than us, as we are only medical students and a consultant is fully qualified. Thus, there is a conflict between obeying the consultants orders as our senior, and exercising our right to attend the wards.

Another issue when deciding how to respond to the situation is the feelings of my friend versus the feelings of the consultant. The consultant has probably made my friend upset, and my friend is most likely feeling stressed and frustrated about the conflict between fulfilling his placement duties and following the orders of a consultant. The consultant was not right to speak to him in this fashion. Even though the consultant may be feeling angry (perhaps from his prior interactions with medical students) and he might be feeling frustrated about something else, that does not give him the right to speak disrespectfully to a medical student or anyone else in this way.

However, we must also consider the reasons behind the frustration of my consultant, who may be going through something personal or he might be under large stress from hospital duties. This must be taken into account when speaking to the consultant. While confronting the consultant is necessary and perfectly justified due to the way he spoke to my friend, the consultant’s feelings must also be taken into account during this confrontation. Furthermore it might be better for us to reach out to our supervisor instead of directly confronting the consultant, as our supervisor has a higher level of seniority than us and may be better able to deal with the situation.

I would tell my friend not to be too stressed about it and that the consultant is probably under a large amount of stress due to his workload. I would comfort my friend and reassure him that he wasn't doing anything wrong. I would encourage him to go with me to see our supervisor and tell him what happened so that he can talk to the consultant about his behavior.

I would tell my classmate not to worry, and I would inquire into the reasons behind his sadness. While doing so I would remain aware that the reasons may be very personal to him and he may not be willing to share them openly; I would be careful not to probe too deep if he doesn't feel up to talking about it. If he seems depressed or has mentioned suicide, then discussing his emotional struggles with someone else - perhaps a supervisor or a member of the faculty - might be wise. Even though this violates the privacy and trust between my friend and I and he might be angry at me for doing so, if my friend’s life is legitimately at risk and he is not emotionally or mentally well, then getting him help would be the most important thing to do which takes precedence over the implicit agreement of confidentiality in our friendship.

 

[kotoloper]

Posting another verbatim answer, please give feedback!! Also, does anyone have any sites for reading up on issues regarding rural/indigenous medicine and healthcare? Thanks!

You are a medical student undertaking placements in the medical ward. Your good friend is assigned to the surgical ward for his placements but you see him sitting alone in the common room all the time. You decide to approach him and ask if everything is alright. He reveals that on the first day of his placement, the surgical consultant yelled at him and said ‘Medical students are always in my way. You are not allowed to attend the wards!’ What are the issues involved in this scenario? What would you say to your friend?
Your classmate later reveals that he has been feeling very low lately. How would you approach the situation?
Your friend casually mentions ideas of suicide. Does this change the way you approach his situation?

There are a few issues in this scenario. Firstly, there is the issue of the seniority of the consultant versus our right to attend wards. As medical students undertaking placements in this medical ward, we are allowed to attend wards and observe the consultants at work. We also have the responsibility to help out the consultants and doctors with whatever they need as medical students undertaking placement. However the consultant has insisted that that my friend is not allowed to attend the wards as medical students are always in his way. The consultant in this case is not correct; however the consultant is indeed more senior than us, as we are only medical students and a consultant is fully qualified. Thus, there is a conflict between obeying the consultants orders as our senior, and exercising our right to attend the wards.

Another issue when deciding how to respond to the situation is the feelings of my friend versus the feelings of the consultant. The consultant has probably made my friend upset, and my friend is most likely feeling stressed and frustrated about the conflict between fulfilling his placement duties and following the orders of a consultant. The consultant was not right to speak to him in this fashion. Even though the consultant may be feeling angry (perhaps from his prior interactions with medical students) and he might be feeling frustrated about something else, that does not give him the right to speak disrespectfully to a medical student or anyone else in this way.

However, we must also consider the reasons behind the frustration of my consultant, who may be going through something personal or he might be under large stress from hospital duties. This must be taken into account when speaking to the consultant. While confronting the consultant is necessary and perfectly justified due to the way he spoke to my friend, the consultant’s feelings must also be taken into account during this confrontation. Furthermore it might be better for us to reach out to our supervisor instead of directly confronting the consultant, as our supervisor has a higher level of seniority than us and may be better able to deal with the situation.

I would tell my friend not to be too stressed about it and that the consultant is probably under a large amount of stress due to his workload. I would comfort my friend and reassure him that he wasn't doing anything wrong. I would encourage him to go with me to see our supervisor and tell him what happened so that he can talk to the consultant about his behavior.

I would tell my classmate not to worry, and I would inquire into the reasons behind his sadness. While doing so I would remain aware that the reasons may be very personal to him and he may not be willing to share them openly; I would be careful not to probe too deep if he doesn't feel up to talking about it. If he seems depressed or has mentioned suicide, then discussing his emotional struggles with someone else - perhaps a supervisor or a member of the faculty - might be wise. Even though this violates the privacy and trust between my friend and I and he might be angry at me for doing so, if my friend’s life is legitimately at risk and he is not emotionally or mentally well, then getting him help would be the most important thing to do which takes precedence over the implicit agreement of confidentiality in our friendship.

Disclaimer: year 12 student, again just brain vomit after reading your response. Overall you bring up some good points, here's just a few more things you might like to consider

• You could mention that students undertake placements on wards to learn - this is a valuable learning experience to see theoretical skills taught in the classroom being applied in the real world.
• When you talk about the consultant being a senior, I think the role dynamic here is more of a medical student versus actual qualified medical consultant
• I'm not sure if this is relevant, but what if the student was actually being disruptive/interfering with the activities of the ward, whether intentional or not? This could be a basis for the consultant's anger, even though it does not justify his reaction, and be something to consider and address in the future
• When you say that it is justified to 'confront' the consultant, perhaps be careful about the choice of words; confront = angry and hostile, and suggests an inability to work respectfully with others. Also, I like how you brought up speaking to the supervisor first, but maybe just also throw in the reasons of medical students having little authority against consultants and thus will most likely be afraid/unwilling to speak to them and rectify issues
• When you comfort the friend and reassure they haven't done anything wrong, again just back to my previous point - actually make sure they didn't do anything wrong
• Mental health is a serious issue that needs to be considered; have they had these feelings for a long time? Is there a serious risk to their health? It's important to offer your support as a friend, and emphasis to the classmate that they are not alone and you are there for them; especially as fellow students, if any part contributing to their feelings are related to their status as a medical student, you are equipped to understand them as you are going through the same experiences. Universities normally offer numerous support services, so you should encourage them to talk to them; you kinda mentioned this but veered into you yourself talking to them; you need to have a conversation with the classmate first, rather 'discussing his emotional struggles with someone else' - you sort of skipped over the step of making sure the classmate is okay and getting help and jumping straight to breaching confidentiality for the sake of their health.

 

[IQ ™]

Hey everyone, this is my first practice question that I'm attempting, while it obviously won't be perfect, I have to start from somewhere. I feel like this is a little too much and maybe some points have been elaborated more than I'd need to. Thanks guys for all the help!

You are watching over your friends house/cat while they are on vacation and in their absence you accidentally break their favourite ornament/run over their cat. Your friend has just returned and you have to break this news to them.

Breaking bad news to a person is a very difficult situation to be in partly due to the adversities experienced when trying to respond to that person's immediate reaction to the bad news, where the outburst of strong emotion from the person may put us in an uncomfortable position. As a result, it is important that the news is delivered to the person in a sensitive way, in a way that makes them feel as best as they possibly can. This can be done through being empathetic, and showing empathy as much as possible throughout the communication process. The news being delivered will likely make the person upset and that would be obvious to you. Naturally it would make any human feel sad as well so acknowledging their feelings and letting the person know that you care about their situation, as well as expressing that sadness through your body language, demeanour, and tone can go a long way towards showing that empathy towards the friend. If I was at fault for the accident it is important that I be apologetic throughout, without making them feel like it was their fault and that they had something to do with it through taking responsibility for the situation.
I'd never want to push them and tell them how to feel or try to move their feelings in a different direction than what they are going through or tell them to hurry up or sort of get over it, "don't worry it's going to be okay you'll be fine you'll get over it".

Initially upon the friend returning from their vacation, I would engage in "small" talk without immediately breaking the bad news by asking them a bit about how their holiday went so that they can be eased back into their normal lifestyle/routine before the bad news is broken. Depending on how close I am with my friend I could choose the second option of getting straight into the matter at hand, though this decision would be made after I read their body language and see what feels best in that current situation. Before breaking the news, I'd signpost to my friend that I may be saying something that could be upsetting to them and may be difficult, while making clear that we are moving on from the conversation we were just having and now I'm about to do something that is different. Signposting is very crucial to breaking the bad news as it lets the friend know that there's something coming letting them to prepare themselves a little bit for what they are about to hear. After signposting and preparing the friend that I'm going to be breaking bad news, I would break the news to them without beating around the bush, saying any lies, or attempting to lighten the situation by saying it as clearly and simply as possible so that they can understand what I am saying.

Once the bad news has been broken it is essential that I give the friend a little bit of space, time, and silence so that they can understand what it is that I've said. When consoling my friend, it is important that I validate their experience by telling them things like
"you have every right to feel this way", "I know that I would feel extremely upset as well if I was in a similar situation", "something like this must be very hard for you" to validate their experience to let them know that what they're feeling and what they're going through is okay. I'd also suggest that they reach out for help if they need it through any family or friends that can help in this situation and of course I can also offer myself as a means of support by telling them "if you're ever upset and you ever need to talk to someone of course I'm there for you I want to talk to you and help you through this as much as possible like please feel free to talk to me I would never be judgmental you know I always want to help" while also suggesting attending counselling sessions or engaging in support groups in order to help them overcome their loss.

I'd try to find the balance between asking them lots of questions and leaving enough room for silence and for them to sort of soak in
and understand and for them to talk and initiate conversation so I do think it's good to ask lots of questions in order to get them maybe talking about how they feel or just expressing themselves. Generally talking will help get things off their chest and will make them feel better but giving them silence as well and I can see how my friend is acting and their body language and demeanour and what they are saying would help in striking that balance.

 

[chinaski]

Would you not apologise for breaking their property or killing their cat? You don't seem to acknowledge your part in the situation, nor have any contingencies in place for the not unreasonable possibility that your friend may be very angry with you and hence, you may be the last person they want offering what might be inferred as platitudes and unwelcome offers of support.

 

[IQ ™]

H

Would you not apologise for breaking their property or killing their cat? You don't seem to acknowledge your part in the situation, nor have any contingencies in place for the not unreasonable possibility that your friend may be very angry with you and hence, you may be the last person they want offering what might be inferred as platitudes and unwelcome offers of support.

Hmmm yeah I see what you mean. I was so caught up on how to break the news and how to console the friend afterwards that I didn't cover the responsibility part. Though would this response have been more appropriate for breaking bad news to a patient in revealing a medical condition etc?

 

[cocodreams]

Hi Guys,
I found this question on the internet:
You are faced with an actor playing a 65 year old man who has just been diagnosed with Alzheimer’s disease. He is coming to his GP for advice on how to cope with his diagnosis as he has heard a lot of stigma over the years about dementia and its burden on both his family and the healthcare service. Whilst talking to you he breaks down into tears.
(In this scenario, I am not clear about my exact role but I have assumed to take on a role of a stranger or friend - someone who is not in the medical field)

Firstly, I would acknowledge that it is okay to feel stressed and anxious about this issue and provide him comfort as I let him calm down. I would ask what exactly does he fear and do my best to understand his point of view is. Due to my limitations, I would address his worries by providing non medical advice and suggestions. For instance, since he is concerned that this may be a burden on his family, I would suggest him to clearly communicate with them and work together on how they can handle this news and move forwards. If he feels uncomfortable discussing, he could request the GP to notify his family and explain the issue in a more professional and objective way. He also seems to be worried about the side effects and stigma surrounding dementia. I would suggest him in addition to the resources the GP gives, he should try explore more about dementia on the internet and what support is available. He shouldn’t necessarily search more information as it could increase his anxiety, but he can still use the internet as a tool to see if there are support groups and connect with other elderly people with the same experience. This would also indicate that he is not being a burden on the healthcare system as many many individuals go through this and the healthcare system is well equipped to support him.

sorry it’s a bit short, but I really had no idea what else to add and plus it’s a role play scenario so I assumed I would be providing more or less comforting words and empathy

 

[JL538]

Hi Guys,
I found this question on the internet:
You are faced with an actor playing a 65 year old man who has just been diagnosed with Alzheimer’s disease. He is coming to his GP for advice on how to cope with his diagnosis as he has heard a lot of stigma over the years about dementia and its burden on both his family and the healthcare service. Whilst talking to you he breaks down into tears.
(In this scenario, I am not clear about my exact role but I have assumed to take on a role of a stranger or friend - someone who is not in the medical field)

Firstly, I would acknowledge that it is okay to feel stressed and anxious about this issue and provide him comfort as I let him calm down. I would ask what exactly does he fear and do my best to understand his point of view is. Due to my limitations, I would address his worries by providing non medical advice and suggestions. For instance, since he is concerned that this may be a burden on his family, I would suggest him to clearly communicate with them and work together on how they can handle this news and move forwards. If he feels uncomfortable discussing, he could request the GP to notify his family and explain the issue in a more professional and objective way. He also seems to be worried about the side effects and stigma surrounding dementia. I would suggest him in addition to the resources the GP gives, he should try explore more about dementia on the internet and what support is available. He shouldn’t necessarily search more information as it could increase his anxiety, but he can still use the internet as a tool to see if there are support groups and connect with other elderly people with the same experience. This would also indicate that he is not being a burden on the healthcare system as many many individuals go through this and the healthcare system is well equipped to support him.

sorry it’s a bit short, but I really had no idea what else to add and plus it’s a role play scenario so I assumed I would be providing more or less comforting words and empathy

I think you are supposed to play the role of the GP here because it says he is coming to his GP for advice?

Also can I ask, how common or likely is it to get a roleplay scenario as opposed to just a situation scenario (so the above scenario but it just asks you what would you do, instead of having to roleplay as a GP) because it seems very awkward to do

 

[dande]

Hi Guys,
I found this question on the internet:
You are faced with an actor playing a 65 year old man who has just been diagnosed with Alzheimer’s disease. He is coming to his GP for advice on how to cope with his diagnosis as he has heard a lot of stigma over the years about dementia and its burden on both his family and the healthcare service. Whilst talking to you he breaks down into tears.
(In this scenario, I am not clear about my exact role but I have assumed to take on a role of a stranger or friend - someone who is not in the medical field)

Firstly, I would acknowledge that it is okay to feel stressed and anxious about this issue and provide him comfort as I let him calm down. I would ask what exactly does he fear and do my best to understand his point of view is. Due to my limitations, I would address his worries by providing non medical advice and suggestions. For instance, since he is concerned that this may be a burden on his family, I would suggest him to clearly communicate with them and work together on how they can handle this news and move forwards. If he feels uncomfortable discussing, he could request the GP to notify his family and explain the issue in a more professional and objective way. He also seems to be worried about the side effects and stigma surrounding dementia. I would suggest him in addition to the resources the GP gives, he should try explore more about dementia on the internet and what support is available. He shouldn’t necessarily search more information as it could increase his anxiety, but he can still use the internet as a tool to see if there are support groups and connect with other elderly people with the same experience. This would also indicate that he is not being a burden on the healthcare system as many many individuals go through this and the healthcare system is well equipped to support him.

sorry it’s a bit short, but I really had no idea what else to add and plus it’s a role play scenario so I assumed I would be providing more or less comforting words and empathy

*Disclaimer* Year 12

even though its a role play scenario (so in the real thing you'd want to act like the GP like jdog said. I still do like your answer and what you do.
The empathy was quite good and I like the fact that you demonstrated it (by actively taking steps) rather then just saying"I would express empathy"
The fact that you give an option of discussing the topic in a professional capacity with the family member is a really good idea in my opinion.
I also think it may be beneficial to talk about how in recent years this stigma has slowly began to be broken down as the general public has become more educated regarding these sorts of issues.
I do think though in this sort of situation since he has broken down crying it may not be beneficial to throw lots of information at him for the time being as it is unlikely to remember it as he is likely quite upset.
Overall, good response in my opinion (other than the fact its a role play).

 

[velvetthundr]

Any advice on how to structure and organize my thoughts better? Thanks!!

You are employed to lead a team of highly skilled researchers from a wide variety of fields. The previous team leader was fired because the team was not meeting deadlines. The team members are not welcoming you as their new team leader. What would you do about this?
The key issue I'll be facing in this scenario is getting the team to accept me as a leader to work together with them. In this scenario, I’m the new leader of a team of researchers who does not accept me or welcome me as their leader. The first thing I’d do would be to find out why exactly they reject me as a new team leader. This could be for a number of underlying reasons; for example, they could have had personal issues with the previous team leader and subsequently be skeptical of me as a new team leader. Conversely, they could have been very loyal to the previous team leader and be dissatisfied with his firing/my subsequent hiring. As such, I would introduce myself to the team amicably. I'd be patient with them and encourage open communication with me. I would encourage team members to tell me if they had any issues with my leadership and to openly voice their opinions in the group without fear of judgment. I would also be aware and respectful of their individual emotions and opinions. As all the researchers are highly skilled in their individual fields of research, they might not take well to me telling them what to do. While leading them, I would constantly encourage them to share their opinions in a group or individually, and I would be careful to take into account their opinions and feelings while making my decisions as a leader. This would hopefully encourage them to begin to accept me as their new leader. Furthermore, the reason the previous team leader was fired was because the team was not meeting deadlines. This may have been because the previous leader was too complacent with the team and did not push each member of the team to reach their full potential. It would be wise of me to consider the leadership style of the previous leader and learn from his strengths and weaknesses. By doing so, I could learn why the team accepted him as a leader and adapt my leadership style accordingly.

As part of your plan to improve team work, you set up weekly meetings with the whole team to discuss work progress. Two team members repeatedly failed to attend. How would you approach this situation?
I would approach those team members individually and ask them how they're doing. I’d try to find out the reason why they were missing the meeting while being aware that they might be going through something personal and have a very valid reason for not attending the weekly meetings. Regardless of the reason, I wouldn't be judgmental and I’d be sensitive to their feelings and their reasons. If they refuse to tell me the reason, then I would acknowledge that they might be going through something private right now, and reassure them that I am available to speak with them if they need me before encouraging them to attend the meeting for the sake of the team.

You find out that both of the team members who don’t attend the regular meetings actually finish their part of the work to a high standard in their own time. What would you do in this case?
Even if the team members can complete their part of the work to high standard, they are still part of a team and as such, have a responsibility to come to these weekly meetings. Regardless of their personal capabilities, I believe that a team can do greater things together than as individuals. I would go to these individuals and - as I mentioned previously - try to find out why they weren't attending the meetings. If it was for a personal or private reason, then I would understand and acknowledge that they might need some time alone. I’d still encourage them to come to the meetings nonetheless, before explaining the situation to the team. If they weren't attending the meeting because they have a personal problem with my leadership or because or arrogance, then I would try to impress upon them the importance of working in a team and how cooperation between team members can produce greater results than individual team members.

 

[cocodreams]

I think you are supposed to play the role of the GP here because it says he is coming to his GP for advice?

Also can I ask, how common or likely is it to get a roleplay scenario as opposed to just a situation scenario (so the above scenario but it just asks you what would you do, instead of having to roleplay as a GP) because it seems very awkward to do

oh oops haha I assumed I was a random patient at the GP practice and he was saying all this to a stranger in the waiting room. My bad, I misread it

 

[Scorpion]

Any advice on how to structure and organize my thoughts better? Thanks!!

You are employed to lead a team of highly skilled researchers from a wide variety of fields. The previous team leader was fired because the team was not meeting deadlines. The team members are not welcoming you as their new team leader. What would you do about this?
The key issue I'll be facing in this scenario is getting the team to accept me as a leader to work together with them. In this scenario, I’m the new leader of a team of researchers who does not accept me or welcome me as their leader. The first thing I’d do would be to find out why exactly they reject me as a new team leader. This could be for a number of underlying reasons; for example, they could have had personal issues with the previous team leader and subsequently be skeptical of me as a new team leader. Conversely, they could have been very loyal to the previous team leader and be dissatisfied with his firing/my subsequent hiring. As such, I would introduce myself to the team amicably. I'd be patient with them and encourage open communication with me. I would encourage team members to tell me if they had any issues with my leadership and to openly voice their opinions in the group without fear of judgment. I would also be aware and respectful of their individual emotions and opinions. As all the researchers are highly skilled in their individual fields of research, they might not take well to me telling them what to do. While leading them, I would constantly encourage them to share their opinions in a group or individually, and I would be careful to take into account their opinions and feelings while making my decisions as a leader. This would hopefully encourage them to begin to accept me as their new leader. Furthermore, the reason the previous team leader was fired was because the team was not meeting deadlines. This may have been because the previous leader was too complacent with the team and did not push each member of the team to reach their full potential. It would be wise of me to consider the leadership style of the previous leader and learn from his strengths and weaknesses. By doing so, I could learn why the team accepted him as a leader and adapt my leadership style accordingly.

As part of your plan to improve team work, you set up weekly meetings with the whole team to discuss work progress. Two team members repeatedly failed to attend. How would you approach this situation?
I would approach those team members individually and ask them how they're doing. I’d try to find out the reason why they were missing the meeting while being aware that they might be going through something personal and have a very valid reason for not attending the weekly meetings. Regardless of the reason, I wouldn't be judgmental and I’d be sensitive to their feelings and their reasons. If they refuse to tell me the reason, then I would acknowledge that they might be going through something private right now, and reassure them that I am available to speak with them if they need me before encouraging them to attend the meeting for the sake of the team.

You find out that both of the team members who don’t attend the regular meetings actually finish their part of the work to a high standard in their own time. What would you do in this case?
Even if the team members can complete their part of the work to high standard, they are still part of a team and as such, have a responsibility to come to these weekly meetings. Regardless of their personal capabilities, I believe that a team can do greater things together than as individuals. I would go to these individuals and - as I mentioned previously - try to find out why they weren't attending the meetings. If it was for a personal or private reason, then I would understand and acknowledge that they might need some time alone. I’d still encourage them to come to the meetings nonetheless, before explaining the situation to the team. If they weren't attending the meeting because they have a personal problem with my leadership or because or arrogance, then I would try to impress upon them the importance of working in a team and how cooperation between team members can produce greater results than individual team members.

I think the quality of some of these responses are really improving- It's becoming more and more difficult to find major points missed! Please bear in mind a lot of what I've written here are minor suggestions to improve the way your answer was delivered rather than problems with the content.

When you're in an interview setting, you will not have much time to think about how to 'structure' your answer as rather than taking the time to write it down, you will need to just say the ideas that come to your head. If you can structure your answer like you have here (in my very unprofessional, inexperienced, yr 12 opinion) I'd say you're doing well in that aspect. I think the most logical thought progression is (as you have done) is saying the steps you would take in the order you would take them.

1. I liked that you considered several possibilities for the team's reluctance to accept you. When you say you would 'find out' why they don't welcome you, I think it becomes a little vague. Would you approach the team as a group or individually (at least at first) to figure this out? You could say that you would make time to speak to and get to know each individual team member soon after arriving. You could approach them in a non-confrontational manner and discuss their role in the team and their vision for the project(s) they are working on. Meeting them one on one as colleagues may help you and the team develop mutual respect and I think you could touch on the importance of this. Your concerns about the organisation of your response may be remedied by more specificity in your actions. Showing the interviewers the clear steps you would take could bring your answer from one that touches on the right points and uses the right words to one that is practical. In many areas you have done this so just keep up the practice.

2. I think you are going very easy on the two team members here. The empathy you showed is good but you need to be direct and confident in your leadership, informing them that as part of a team, it is their responsibility to regularly attend meetings and failing to do so can negatively impact not only themselves but the rest of the team. You could discuss with them what you believe is achieved in the meetings. If you allow these team members to be absent during meetings, they may be viewed as optional or pointless by other team members, leading to lower attendance and participation, which could negatively affect productivity. However, this could also be a chance to evaluate the effectiveness of the meetings. Do they actually achieve what the team needs? In part 3. you touched on some of this information but in hindsight, it probably could have gone here.

3. Again this could be an option to discuss the effectiveness of the meetings- these team members are high achievers despite skipping the meetings. However, it's possible that other members may be suffering the consequences of their non-attendance. You could discuss the idea of a multi-disciplinary team here and the importance of collaboration. Instead of just saying, "A team can do greater things together"- why is this the case? Could it be that the strengths of individual members can complement each other, causing them to have greater efficiency? I think this would make your answer seem that little bit more well-reasoned.

 

[cocodreams]

A close friend in one of your university classes tells you that his mother was recently diagnosed with breast cancer. He feels overwhelmed by his studies and is considering dropping his courses to spend more time with his mother. How do you counsel your friend?

hey guys, had another go at an MMI question. Any feedback is appreciated Thanks in advance!

Firstly, I would assure him that it is justifiable that he is feeling overwhelmed and stress and it’s okay to feel this way after hearing such difficult news. I would ask him in what areas of university does he feel so overwhelmed with that he wants to drop out. Is it that we are nearing exams or are there several deadlines to meet. Or it could be that after hearing the news, he has been so busy with his mum that he has fallen behind on uni work and needs catching up to do. If these or anything similar is an issue, we can come up with a plan to tackle specific issues. This would include suggesting him to to and openly communicate with the faculty that he is having issues in his personal life and he needs extra support. If he feels uncomfortable, I would offer to help him and communicate for him. Maybe the faculty could give him a small break or push back his deadlines so he could spend more time with his mother without worrying about uni work. If he has the opportunity, I would suggest him to plan out what he wants and needs to do with mother to work around this issue and move forward. This may be planning what days he would spend time with her and there may appointments they need to attend. It would also be useful to know whether he has any family or family friends that would be willing to support his mother that could reduce his responsibilities so he can focus on university work.


My friend could get in touch with support groups that would be willing to guide his mother and provide her information about breast cancer. This could possibly save him time from researching or continuously asking for help and in this way, he can spend more time on uni work.

There is a possibility that my friend could be struggling to understand the course content and in that case I would definitely offer some sort of assistance whether it be explaining a few concepts or doing a normal group study session that could give him confidence.

Overall, I would once again reassure my friend that we can work through this together by breaking down everything into smaller aspects and working through them. I would suggest him to reflect again about his decisions and not necessarily take rash decisions such as dropping out of his uni course because there is a way out that would help him balance his uni work and personal responsibilities.

 

[velvetthundr]

does anyone want to take a shot at this one?

Due to the shortage of doctors in rural and Aboriginal communities, it has been suggested that graduate medical programs preferentially admit bonded students who are willing to commit to a 1-year tenure in an under-serviced rural area upon completion of fellowship. Consider and comment on the broad implications of this policy for health and health care costs.

What are the advantages and disadvantages of being a rural doctor?

Do you think the approach will be effective and if so, at what expense? Discuss this issue with the interviewer.

How would you improve the retention rate of doctors who train in rural areas?

 

[yihola7542]

Disclaimer: first time answering an interview question publicly, school leaver

Due to the shortage of doctors in rural and Aboriginal communities, it has been suggested that graduate medical programs preferentially admit bonded students who are willing to commit to a 1-year tenure in an under-serviced rural area upon completion of fellowship. Consider and comment on the broad implications of this policy for health and health care costs.

On the subject of this applying for graduate medical programs (as opposed to, I assume, undergraduate medical programs):
I think that a graduate medical student, being several years older than their comparable undergraduate counterparts, would have more life experience under their belt and be able to consider more wisely for themselves whether they are willing to commit to such a tenure. They may already have experience working away from their families, friends, and other support networks in the past, or have already relocated for their undergraduate degree, thus they are likely to have a better idea of whether this is an arrangement that would work for them or not. However, they would be several years older than a student who went through medical school by the undergraduate route, and by the time that they are subject to the tenure they may have a partner, children, older family members who they need to care for, etc, so this might not be a feasible lifestyle.

On the subject of preferential admission for these students:
This policy has some similarities to the Bonded Medical Places that are currently already in place (however I believe bonded students are not necessarily preferentially admitted, but they would get a place over students of similar academic/interview performance who did not stipulate that they would accept a bonded position). I have some reservations over the idea of preferentially admitting students who are willing to undertake this tenure, as I feel that it could be a bit predatory on those who are desperate to attend medical school and become doctors, as they may say that they are willing to undertake the tenure but afterwards face significant difficulties as doctors. (Actually I was not sure how to address this part of the question, can someone please give advice?)

On the subject of a 1-year tenure:
A 1-year tenure may be too short to have much of an impact on health in rural areas. There is already evidence of high attrition rates for medical professionals in rural communities, as well as a general under-serving of these areas. A 1-year tenure, especially if the doctor had no further plans to continue practising here, could mean that a certain area gets a different doctor every single year, arriving with little knowledge of the healthcare issues in that area, having to take over an entire caseload, and then leaving after only one year and transferring that caseload over to the next 1-year tenure doctor. While this could mean that certain areas could have a doctor, there are negative aspects to such a high turnover of doctors such as poor patient care and lack of good follow-up and preventative medicine being practised.

On the subject of this being after the completion of fellowship:
This is a big problem in this policy for me. Having to undergo a 1-year tenure after the completion of fellowship has both advantages and disadvantages. The advantage is that the doctor has already practised for a few years and is experienced to some extent, so the quality of patient care would be better. They may also already have some experience working in a rural and under-served area However, the big disadvantage is that the imposition of this policy indirectly assumes that a doctor entering medical school (even as a graduate!) has a good idea of what they want to practise after graduation and internship/PGY-x years. This is not true as many students will be exposed to a huge variety of fields in medicine during their time in school, and have varied clinical experiences that hopefully can inform them as to what type of doctor they want to be in the future. However, having to practise in a rural under-served area will restrict the speciality they can go into in the future, as there are simply not the resources in these areas for some specialities. Another issue is that a doctor who has completed fellowship might cost much more to hire than a more junior one, and there are already issues with patients not being able to afford expensive medical care in a rural under-served area, so the patients might not be able to afford to see a doctor even if one is around.

What are the advantages and disadvantages of being a rural doctor?
Advantages:
- Variety of cases/patients
- Practise very independently
- You can develop a good relationship with your patients
- Rural lifestyle which may appeal to some

Disadvantages:
- Large patient population if you're the only doctor around for a great distance and they have no other option but to see you
- Independent practise can be a blessing but also a curse - you won't have as much support from more senior colleagues
- Lack of resources in these areas which can affect effectiveness of practise
- Likelihood of always being on call (as, again, people have no other option but to see you)
- Isolation from support networks


Do you think the approach will be effective and if so, at what expense? Discuss this issue with the interviewer.
I do not think that the approach will be as effective as hoped. Firstly, the 1-year tenure may be too short as it may be difficult after the 1-year tenure to convince the doctor to stay in this rural under-served area, and the turnover rate will be very high, thus affecting patient care and health outcomes. Secondly, making this 1-year tenure happen after fellowship might limit what specialities the future doctor can go into, which might dissuade graduate students from utilising this program particularly as they do not know what speciality they want to go into at the beginning/when applying to medical school. Finally, there is the issue of age, where graduate-entry medical students might not want to commit to such a tenure when at the age that they would have to do the tenure, they may have families to look after so it would not be ideal to have to move to an under-served rural community.

How would you improve the retention rate of doctors who train in rural areas?
- Increase the amount of resources (medical, financial, support services) available in rural areas. Not only will this support doctors more, but it will also lead to better healthcare outcomes in rural areas
- More publicity about the benefits of working in a rural area to medical students
- More clinical exposure so they have more experience working in these rural areas
Ultimately however it will be difficult to retain doctors in rural areas if they continue to be under-served as doctors will find they are not always able to provide the necessary care due to lack of resources, and due to the lack of support for doctors who work in these areas.

 

[N182]

My first MMI scenario, any feedback from anyone is appreciated (no matter how harsh).

A large portion of road accidents are caused by young drivers. A new idea is to image people's brains and only allow people to drive once their brains have matured.

a) Why do you think young drivers have a higher tendency to cause accidents?
There are a multitude of reasons why young drivers have a higher tendency to cause accidents as opposed to older drivers.
1. Lack of Experience- One of the more obvious reasons is young drivers are typically on the road for much less time than older drivers thus have less experience in handling high-pressure situations as well as general control of the car and not remembering or being used to road rule, all of which can contribute to accidents.
2. Social Factors- Many young drivers drive with their friends. Simple actions such as talking, playing games etc. can distract the driver of the car significantly where they pay less attention to the road and more attention to their friends. Also many teens may engage in reckless driving resulting from immaturity such as speeding or quick turns, as a way to 'impress' their friends and in most cases this reason coupled with a lack of experience can cause major accidents.
3. Alcohol use- For a skill such as driving where hand-eye co-ordination and awareness are a must drinking alcohol can be detrimental to road users. Generally teens and adolescents are prone to impulsive behaviour hence are more likely to drink and drive without considering the many life risking consequences this may have.
4. Night Driving- Again driving requires constant awareness of other cars, obstacles and traffic lights road signs etc. Less experienced drivers are more prone to missing these things especially in low light conditions where visibility isn't clear.

b) What do you think of the idea above?
I will assume in my response that all the neccesary science and research on determining how a brain could be rigorously defined as 'mature,' has been completed.
Positives:
- By only allowing people whose brains have developed to drive this pretty much counteracts the reasons for accidents mentioned before relating to immaturity of young drivers. This includes abstaining from drink-driving (e.g.. taking public transport instead of driving after drinking), and avoiding risky or impulsive behaviour.
-Not engaging in risky-behaviour also indirectly counteracts reasons relating to lack of experience. Rational drivers will try their best to avoid high pressure situations. For example a fresh P-plater could opt to take a road other than the motorway until they build more confidence driving by themselves, despite taking longer to reach the destination. Whereas a more impulsive person would opt to take the motorway knowing the risks simply to arrive at their destination sooner.

Negatives:
Most of the negatives for this idea include practicality and implementation.
Cost- Having to image EVERY upcoming road user would cost millions of dollars per year in Australia alone. Assuming individuals would have to pay this would greatly discourage upcoming drivers especially if their brain hasn't fully developed in which case they may need to do many of these expensive scans to obtain their drivers license. If the government pays for or partly pays for these scans, this will result in large amounts of government debt which could be spent on other causes.
Strain on Radiologists and Healthcare System- Having thousands of upcoming drivers come in for scans will lead to radiologists being overloaded with brain imaging. This can be problematic as individuals who may need a brain scan for medical reasons may be put on a waiting list or simply told to go to another clinic. Furthermore Doctors must intepret the scan which can greatly strain the healthcare system.
Time-Now if medical patients were given preference to upcoming drivers, then it might take weeks or months to simply get a learner licenses as the Doctor would give less preference to diagnose the image. Of course if medical patients were given the same amount of preference this could lead to less health-outcomes in patients which would also be detrimental.
Uncertainity- Since this is a new idea it is likely that very little research has been done to determine whether this idea would significantly reduce road accidents hence it would be a risk to compromise the health care system for a chance to reduce road accidents.

Overall whilst this idea seems appealing on paper and may reduce road accidents, the cost of implementating this idea would be too much with an uncertain outcome hence wouldn't be practical in my opinion.


c) What can parents do to help young drivers?
In my opinion parents are one of the most important means of support for young drivers, and can greatly reduce behaviour which could result in an accident.
1. Many young drivers imitate their parents driving hence it is crucial parents practice safe and respectful driving. Parents simply driving safetly behaviour can lead to upcoming drivers subconsciously trying to avoid any altercations or risky behaviour.
2. Also many parents are the first to teach their children how to drive. This is an opportunity to correctly teach new drivers existing road rules and overall safe behaviour when driving. Any new rules that have been changed from when the parents were driving should be learnt to ensure the driver has the most up to date knowledge of road rules. Parent's can also teach things which cannot be learnt theoretically and must be learnt hands on. For example giving way to a reckless driver trying to merging despite 'right of way.' It is also imperative that parents are calm and don't cause unnecessary stress.
2. Parents can also set 'ground rules,' for when the young driver can drive and also the amount of passengers they are allowed to take, once they are an independant driver. This can vary from driver to driver and also how mature they are. At the same time parent's musn't be too forceful as this may seem as 'controlling,' which itself may lead to reckless behaviour.

d) What are ways you could reduce the death toll?
Whilst I previously stated that imaging every upcoming driver is unpractical I believe similar ideas to this that are less costly can greatly reduce the death toll. The driving test could include more scenarios such as:
1. During the driving test simulate high-pressure scenarios in a safe environment. For example in a closed circuit simulate a rude or disrepectful driver and gauge the reaction of the driving student. This can allow examiners to assess the 'maturity,' of the driver and how they would react to that scenario.
2. Add a low light section of driving test (again in a safe environment). This allows examiners to guage the awareness of drivers much better than the current test.
3. In regards to drink-driving, the government could make it a law to have a breathalyzer built into cars such that only alcohol levels below the threshold will start the car. Again this idea could be very costly and impractical hence simply having more breath-tests (especially during the night) could be a more viable alternative.
4. Education- I believe it should be mandatory to attend regular road safety lessons and seminars before getting a learner license, as this will ensure drivers are practicing safe driving from day one.

Sidenote: I feel most of the ideas I have for 4 have already been implemented so went with some more daring answers. Is it a good idea to just say what has already been implemented or should I go with some other ideas like I have done here?

Also felt like I rambled on a bit too much how do I make my answer more concise?

 

[Crow]

Bump: Practice Interview Question Thread