Practice Interview Question Thread

[whoartthou]

There are indeed! I just added an edit to my post above, but yeah, there are way too many nuances in medical law!

Back on topic, now, sorry folks!

All good. I think legally it would be acceptable but if they force it against the family wishes there will be too many issues such as the possibility of court processes, media coverage etc. which might result in negative stigma behind organ donation which then would result in reduced donations rates in the future.

 

[worldno8]

From an ethical perspective you can easily empathise with the family. Discuss the issues behind the consent process was Mrs. Jones cognitively intact when she signed the form or was she pressured? What did she tell her family? Was there any discussion regarding what will happen to the body after death? What are the families worries? Is there cultural or religious reasons why? You could ask so many questions and explore these in your discussion.

Students seem to always pigeon hole themselves into a black and white answer in scenarios instead of exploring the perspectives of the individual parties that have come to the decision.

I'll keep these in mind! Thanks. I might've just been a little overwhelmed by the scenario.

 

[DrDrLMG!]

That’s interesting - I am assuming a donor card is different to an AHD? This is contrary to what we’ve learned, as advanced consent provided by the patient when they had capacity trumps the wishes of the family members in these circumstances, doesn’t it?

ETA: This is QLD-specific, but from the Transplantation and Anatomy Act 1979:

The purposes under (1)(c) are:

https://www.legislation.qld.gov.au/view/pdf/2016-03-24/act-1979-074

Pages 21-22 if interested.

Though, I guess it doesn't specify that next of kin can't override the decision.

Yeah, we’ve definitely been strongly taught that families withdrawing consent trumps all at the end of the day, regardless of what the donor specified as their preferences in life.

ETA: advances health directives are legal documents, the organ donor register (ie ‘donor card’) is just that, a place to record your preferences. To make it a legal document, it’d likely need to be in the person’s will or similar.

Also, in the scenario in question, the organ donor register consent recording is absolutely irrelevant as that’s not what’s happening. The deceased has ‘donated her body to science’ and the proposed use is for medical students to practice organ removal (no medical student is doing actual organ retrieval for actual organ transplantation!). UTAS has a body bequeathment program and we’ve received a couple of presentations on how it works. The family decision making is absolutely the last step, regardless of whether the deceased has expressed interest. This is a completely separate process to the organ donation register.

Finally: a perhaps more useful scenario to consider is one that was proposed to us during a lecture on the topic:

Should Australia move to an opt-out organ donation system, rather than the current opt-in system? Why? Why not? Explore both sides.

 

[worldno8]

I have a scenario that I'm unsure about.

Say there's a heavily pregnant woman who is 'in term'. The doctors instruct her that a C-section is required in order to save her baby's life. Without the C-section, the baby would almost definitely die. The woman is informed of the risks of not undergoing a C-section but still refuses to do so. What would you do as the doctor?

My approach would go something like - I would ask her why she is reluctant to undergo a C-section and if there are any underlying concerns about the procedure (e.g. she could have a severe phobia of needles or if she upholds certain religious beliefs). In any case, I would console her and reassure her that the team would do our best to perform the procedure to preserve the life of both her and her baby. I would determine if she's competent to make a rational decision (i.e. if she is able to fully comprehend the risks of this procedure, weigh up the benefits and consequences of undertaking the C-section, and that the physical pain of labour hasn't impaired her judgement) and alert her to possible side-effects to the procedure (e.g. infection) to ensure full transparency in my doctor-patient relationship. If she has given valid consent for the refusal to this procedure, I would respect patient autonomy and choose to not perform the C-section.

The italicised section is what I'm unsure about. In medical emergencies such as this one, would you still respect patient autonomy?

Also please suggest anything that I can add to my answer.

 

[Crow]

he italicised section is what I'm unsure about. In medical emergencies such as this one, would you still respect patient autonomy?

Absolutely. If it's deemed that the patient is competent, then they have the right to make their own healthcare decisions. They don't even need to provide a rational reason for denying life-saving treatment.

 

[worldno8]

Absolutely. If it's deemed that the patient is competent, then they have the right to make their own healthcare decisions. They don't even need to provide a rational reason for denying life-saving treatment.

In my interview, do I need to say how we determine competency? Or is it OK to just leave it as "if they're deemed competent"?

 

[DrDrLMG!]

In my interview, do I need to say how we determine competency? Or is it OK to just leave it as "if they're deemed competent"?

I very much doubt they're going to expect you to know the steps involved in undertaking a competency(/capacity) assessment. As someone who used to do them as part of my job, I can confirm that most* practicing doctors don't seem to know how they 'work' either!

(*of the doctors I was working with at the time)

 

[Crow]

In my interview, do I need to say how we determine competency? Or is it OK to just leave it as "if they're deemed competent"?

I think that's outside the scope and would probably just use up your time, but happy for others to disagree. IMO you could also explore the perspectives of the doctor and the unborn child in the scenario above too, for a more complete answer.

 

[worldno8]

I think that's outside the scope and would probably just use up your time, but happy for others to disagree. IMO you could also explore the perspectives of the doctor and the unborn child in the scenario above too, for a more complete answer.

Could you please briefly describe how you would explore their perspectives?

 

[hahahahaxd]

here's a scenario question i've come across a few times and wondering how people would go about it (what criteria do you go off if their medical conditions are all equally as severe - this question was initially who would you save if only 1 person, but i changed it to order them from 1-4 because in interviews they don't expect you to have medical knowledge so not sure what other criteria to base it off)

You work in a small hospital that doesn't have many resources at hand, including ICU beds. Four patients come into the ICU department needing serious management from life threatening health issues, however there is only one ICU bed available at the moment, so you will have to choose one person to save first, before helping another. Assume that all four patients are of equivalent medical severity. What order would you save the patients in?

•1. Anthony, a 16 year old male, was part of a car crash as the passenger. He was found, loosing blood profusely from his scalp at the scene. As well as this, both driver and passenger was found to be over the legal alcohol limit. He is a school student from the top school in the state and has also received a medical research scholarship that allows Anthony to go into the research pathway.

•2. Marcia, a 56 year old childcare worker, was part of a barbecue accident which resulted in burns to almost 90% of her body. She currently has three children who are all in university. You also find out that she has a DNR order (Do not resuscitate order), which means that in certain life threatening situations, the doctor in charge is legally not allowed to save the patient.

•3. Ashley, a 33 year old accountant, who was admitted due to a knife wound which she attained whilst she fought with her boyfriends-ex in her apartment. She has a punctured lung and a fractured rib from the scuffle. She also currently 25 weeks pregnant and if she were to die, the unborn child will too.

•4. Matthew, a 48 year old businessman, who was admitted due to an AMI. He has often had a bad habit of eating fatty fast food and smoking many packs of cigarettes. You also know that as a businessman, Matthew is a sponsor for the hospital and donates a large quantity of money each year to the hospital, and is willing to pay more if you save him first.

I've read somewhere that you prioritise people based on not just severity but age, smoking status & lifestyle, comorbidities, mental status and familial responsibilities.

With this in mind, I'd go in order Ashley (saves 2 lives + mother, 2nd youngest) --> Anthony (youngest)--> Matthew (2nd oldest, lifestyle choices) --> Marcia (DNR, oldest)

But i'd also get someone more knowledgeable to have a go at this too ahha just my 2c

 

[Crow]

Could you please briefly describe how you would explore their perspectives?

Sure. Note these are NOT necessarily my personal views, but simply things that I would personally discuss in an interview, with time permitting.

The doctor might consider this to be paramount to murder (of the unborn child) and have a significant ethical conflict between doing no harm (to the unborn child) and respecting the autonomy of the mother. When they pursued a medical career they made a commitment to preserving life and doing no harm to others. This could be a really difficult decision for them, having to effectively choose between the autonomy of the mother and the principle of beneficence for the child (*in reality they don't legally have a "choice" but this is about ethics rather than law). Dependent on the woman's reasoning behind not wanting a C-section, the doctor may also be in disagreement with this (or not share the woman's beliefs if it was for a specific reason) and this could further perpetuate the strain on them and their decision.

From the perspective of the baby: the baby's rights are effectively being overlooked in this situation; there is nobody to advocate for the baby other than the mother. If one considered life to begin at conception (for example) then, as above, this could be considered paramount to murder on part of the mother and/or doctor.

Happy for anyone to critique or disagree with the above, though!

 

[whoartthou]

I very much doubt they're going to expect you to know the steps involved in undertaking a competency(/capacity) assessment. As someone who used to do them as part of my job, I can confirm that most* practicing doctors don't seem to know how they 'work' either!

(*of the doctors I was working with at the time)

Nope don't expect to do this. It is much too difficult even as doctors sometimes it is hard.

Sure. Note these are NOT necessarily my personal views, but simply things that I would personally discuss in an interview, with time permitting.

The doctor might consider this to be paramount to murder (of the unborn child) and have a significant ethical conflict between doing no harm (to the unborn child) and respecting the autonomy of the mother. When they pursued a medical career they made a commitment to preserving life and doing no harm to others. This could be a really difficult decision for them, having to effectively choose between the autonomy of the mother and the principle of beneficence for the child (*in reality they don't legally have a "choice" but this is about ethics rather than law). Dependent on the woman's reasoning behind not wanting a C-section, the doctor may also be in disagreement with this (or not share the woman's beliefs if it was for a specific reason) and this could further perpetuate the strain on them and their decision.

From the perspective of the baby: the baby's rights are effectively being overlooked in this situation; there is nobody to advocate for the baby other than the mother. If one considered life to begin at conception (for example) then, as above, this could be considered paramount to murder on part of the mother and/or doctor.

Happy for anyone to critique or disagree with the above, though!

Definitely agree with wehat Crow said here. Essentially if you try to save the baby you are committing assault on the mother who is refusing intervention. In complex ethical scenarios you would usually consult the legal team for their advice and guidance.

I wish I used my medical defence organisation more to be completely honest. They are an especially useful source of information.

Regarding the HIV station if you are a doctor. The legal defence organisation did state you have to respect privacy regardless of what the patient tells you. Although if they put someone else at significant risk of harm you could discuss it with the Public Health Department who may then intervene and contact their sexual partners.

 

[H2.]

Mrs. Jones has signed a donor card indicating that she is willing to donate her body to science without notifying her husband and son. She gets into an accident and it is determined she is brain dead. The family doctor, who is on call that afternoon, reviews the chart and determines that she would be perfect for medical students to practice the removal of organs for transplantation purposes. The doctor then talks to the family to discuss the procedure and to confirm their consent. They both oppose the procedure and refuse to allow their doctor to move forward. The doctor points out that Mrs. Jones could be helping hundreds of people by educating the medical students and that technically consent has already been provided. The husband understands how beneficial the educational experience is but is too emotional to allow them to continue. The son, a medical student, refuses because he knows the bodies are not treated with dignity. If you were the doctor, how would you proceed? Why?

Son:

• Feels bodies won’t be treated with dignity. This isn’t necessarily true, the doctor could ensure that the medical students treat the body with respect and conduct the procedures carefully.

Husband:

• Doesn’t necessarily have anything against it, just too emotional for this to occur.
• If he is given time, he might think more rationally and honour his wife’s decision. However, by this time the body may deteriorate and thus not be suitable for the student’s learning.

Mrs. Jones.

• Assuming Mrs. Jones was mentally competent when she signed a donor card, she wants to donate her bond to science.
• Her donation “would help hundreds of people.”
• Hence, we can assume that if she were alive today, she would want both Husband and son to give consent. This should be pointed out to them.
• Given that it is her body, I believe her decision should be honoured, irrespective of her family’s feelings.

Thus, if I were a doctor, I would go ahead with the procedure regardless. Nevertheless, it would be ideal if both are comfortable with the procedure, and consent obtained. Part of the reason why the family is resisting is perhaps because they feel that the doctor is manipulative or unsympathetic e.g. they may feel that he doesn’t care for Mrs. Jones, he just wants to use her. Hence, to minimise resentment, they should be empathised with and sympathy should be expressed towards them e.g. “I’m very sorry for your loss.” Moreover, I would encourage the family to ask questions and express their concerns so that I can address them and make them more at ease. I would also give them the maximum amount of time to reconsider their stance and I would reassure them the body will be treated with dignity. Further, counseling support would be offered before and after the procedure.

Any feedback is appreciated

 

[H2.]

Genetic Counseling (Ethical Decision Making, Communication Skills)

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?

• What principles and who do you have to take into consideration in this case?

 

[LAV2]

Genetic Counseling (Ethical Decision Making, Communication Skills)

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?

• What principles and who do you have to take into consideration in this case?

• How would you disclose the results of this genetic analysis to Linda and her family?

This is a very sensitive issue that has a high chance of negatively impacting the family dynamic. As such before I make decisions in disclosing this information, I would first cross-check the report to ensure the results were not an error. If it remains consistent, then I will arrange separate, private, confidential sessions for each parent with regards to breaking this news to them. I will mention overall the test results have come back negative for the gene mutation, however the data indicates of the child's biological father is not the father in this family. I would advise that the parents seek a formal paternity test to confirm these results nevertheless, and were either parent to become upset I would refer them to a therapist and/or marriage counselling services. Further, I will avoid breaking this information to the child, allowing the parents to do so.

• What principles and who do you have to take into consideration in this case?

In this scenario their are numerous principles to consider. Confidentiality is an important principle especially as this scenario details a sensitive issue regarding biological parentage. As such, while I discuss these results with each parent individually, I must reassure them that confidentiality will be maintained and any information confirming these results, such as if the mother had an extramarital affair, will not be revealed to her husband without her consent.
However, I also have the duty of not hiding the results that have came with the genetic tests, of which all members of the family had consented to. As such, I am obliged to inform her husband of the results, and its suggestion of a mismatch in paternity.

The key parties involved in this issue are the parents, which I will personally address of the results; the child, which I will not share the implication of mismatching paternity, allowing the parents to do so; and the biological father in question who is unaware they carry this mutation, which I will need find out who they are and inform them of the genetic mutation they possess (either by making contact directly or advising them to take a genetic test for this disease), but maintaining confidentiality of where the circumstances had originated from.

PS: This is honestly a terrible situation to be in for the family, and to break news of as the counselor as well :/

 

[H2.]

• How would you disclose the results of this genetic analysis to Linda and her family?

This is a very sensitive issue that has a high chance of negatively impacting the family dynamic. As such before I make decisions in disclosing this information, I would first cross-check the report to ensure the results were not an error. If it remains consistent, then I will arrange separate, private, confidential sessions for each parent with regards to breaking this news to them. I will mention overall the test results have come back negative for the gene mutation, however the data indicates of the child's biological father is not the father in this family. I would advise that the parents seek a formal paternity test to confirm these results nevertheless, and were either parent to become upset I would refer them to a therapist and/or marriage counselling services. Further, I will avoid breaking this information to the child, allowing the parents to do so.

• What principles and who do you have to take into consideration in this case?

In this scenario their are numerous principles to consider. Confidentiality is an important principle especially as this scenario details a sensitive issue regarding biological parentage. As such, while I discuss these results with each parent individually, I must reassure them that confidentiality will be maintained and any information confirming these results, such as if the mother had an extramarital affair, will not be revealed to her husband without her consent.
However, I also have the duty of not hiding the results that have came with the genetic tests, of which all members of the family had consented to. As such, I am obliged to inform her husband of the results, and its suggestion of a mismatch in paternity.

The key parties involved in this issue are the parents, which I will personally address of the results; the child, which I will not share the implication of mismatching paternity, allowing the parents to do so; and the biological father in question who is unaware they carry this mutation, which I will need find out who they are and inform them of the genetic mutation they possess (either by making contact directly or advising them to take a genetic test for this disease), but maintaining confidentiality of where the circumstances had originated from.

PS: This is honestly a terrible situation to be in for the family, and to break news of as the counselor as well :/

I think that you answered this well. I just don't understand why you would need to refer them to other therapists/counselors given your a counselor yourself and already understand their situation. Would a family counselor in particular be able to deal with this issue more effectively?
Also what are the legalities behind contacting the biological father? Is Linda allowed to give away contact informaton etc.?

 

[H2.]

I've read somewhere that you prioritise people based on not just severity but age, smoking status & lifestyle, comorbidities, mental status and familial responsibilities.

With this in mind, I'd go in order Ashley (saves 2 lives + mother, 2nd youngest) --> Anthony (youngest)--> Matthew (2nd oldest, lifestyle choices) --> Marcia (DNR, oldest)

Can someone please confirm that this reasoning is correct?

 

[LAV2]

I think that you answered this well. I just don't understand why you would need to refer them to other therapists/counselors given your a counselor yourself and already understand their situation. Would a family counselor in particular be able to deal with this issue more effectively?
Also what are the legalities behind contacting the biological father? Is Linda allowed to give away contact informaton etc.?

I wasn't aware the full scope of my couselling abilities, so I wasn't sure if I had the responsibility or competence of counselling the family/their marriage. In terms of legality in contacting the biological father, I'm not entirely sure, as I think it depends on the severity of this genetic disease causing a risk to the wellbeing of other people. Though in this case it isn't an acute condition, I still feel that I can request the contact details of the biological father through Linda.

Can someone please confirm that this reasoning is correct?

From what I know of, the principle behind triaging scenarios is to form an ethical framework from which you order the patients. So if you had previously stated that outside of medical severity, you would prioritise patients on smoking status, familial responsibilities (with an explanation of why you value these specific attributes), then you can justify your order of patients.

 

[amous]

help with this question!

You are working on a group project with 5 other students. One of the students doesn’t show up for meetings or if they do show up – they are late and leave early. They have put no effort into the group project but show up on the day of the presentation and try to take credit for the project. What do you do in this situation?

it looks like the project is already finished and that it might be a little late to talk to the person to get them to play their part, what would be the thing to do in this situation? It doesn't feel appropriate to let them take the credit because that seems like dishonesty from their part, but would telling the assessor be taking it too far as this could have been a matter solved within the team?

 

[Crow]

help with this question!

You are working on a group project with 5 other students. One of the students doesn’t show up for meetings or if they do show up – they are late and leave early. They have put no effort into the group project but show up on the day of the presentation and try to take credit for the project. What do you do in this situation?

it looks like the project is already finished and that it might be a little late to talk to the person to get them to play their part, what would be the thing to do in this situation? It doesn't feel appropriate to let them take the credit because that seems like dishonesty from their part, but would telling the assessor be taking it too far as this could have been a matter solved within the team?

Discuss and flesh out your thoughts if you had a scenario like this - there’s no right or wrong answer.

You could mention that if it was a relatively low stakes project, it might not be worth the confrontation or drama that could be associated with “reporting” them to the assessor, but if it was higher stakes, and them taking the credit has a negative impact on other people in the group, then it would be worth an intervention. Then, you could discuss steps you would take to intervene e.g. 1. Approaching the person directly and asking them why they took the credit and establishing if they’d be willing to turn themselves in themselves, 2. If they refused, you could explain to them that as them stealing the credit has a negative impact on other people in the group, you have an obligation to report this to the assessor if they aren’t willing to do this themselves.

(Note: you could flesh out ideas like the above further, but I’m just offering that as an example)

it looks like the project is already finished and that it might be a little late to talk to the person to get them to play their part

This is true, but you could still approach them and find out why they weren’t able to play their part in the project - maybe they have ongoing personal family/health issues that interfered, and they really need the credit from the project or they may not pass the year. You could then use the possibilities here to inform your potential courses of action i.e. if they had no valid reason and were simply lazy, then you may be more inclined to report them to the assessor and vice versa.

Remember in these types of scenarios there is almost never a black and white right or wrong answer and this isn’t what the question is assessing. You need to explore the various perspectives of those involved in the scenario and your thought processes behind why you may or may not follow a certain course of action - this is more likely what will get you the marks.

I’m sure you could have a completely different approach to my example above and score very well, so long as you explored the scenario in sufficient depth and provide justification for the points that you make and the points you do make are rational.