Top 5 Tips for Medical Interview Success

1. Knowledge Base

Medicine is a career that encompasses a very large number of skills, including but not limited to ethical reasoning and strict adherence to protocol. Doctors and other healthcare practitioners are often in positions of power relative to their patients due to the nature of the occupation, and are therefore expected to act in certain ways and follow certain behaviours. Understanding their ethical and logical guidelines is therefore a fantastic place to start - I recommend reading ‘Tomorrow’s Doctors’ and ‘Good Medical Practice’, as well as getting to grips with the four pillars of medical ethics. Understanding these core elements will help you approach most questions from first principles instead of having to rely on learned answers.

Alongside this, be able to talk about a couple of medical cases from research papers or the news that interest you - that will demonstrate your initiative and willingness to further your own knowledge.

2. Practice Answering Questions

Just like the UKCAT, BMAT, GAMSAT or any other exam, the best form of revision is to practice doing questions. There are a ton of free resources out there in this area, look at places like The Medic Portal, my own website (postgradmedic.com) or (dare I say it) The Student Room. Have your friends or family members ask you random questions so you’re forced to think on your feet - even if you don’t think they’re likely to come up. Sometimes being put on the defensive and into an uncomfortable scenario is the best way to get used to thinking and answering in a more structured way.

3. Practice Under Pressure

Of course the other element of medical interviews (as with most assessments) is the aspect of time pressure. This is particularly true in MMI format interviews where you may have no more than a few minutes to answer a particular question, particularly if it’s a probing question rather than the stem of a discussion. With this in mind, when practicing with family or friends make sure to have them time you for 2-3 minutes per individual question - this will make it very hard in some cases, but if you can achieve that then on the day it should be easy.

4. Reflective Thinking

Doctors (and medical students) are required to perform reflections throughout their careers to consolidate what they have learned and set action plans for self-improvement. Furthermore, most medical schools (particularly at graduate-entry level) demand some level of work experience or exposure to a healthcare setting. The reason for this is to give you a chance to evaluate if medicine is truly the right career for you. Based on your experiences at school or university, at work, while volunteering - why do you think you would make a good doctor? What have you observed? What do healthcare professionals do every day? What did you like about what you saw, or conversely what was shocking or disappointing?

Gaining insight into your own thought processes will be enormously helpful for your interview and for your time at medical school and beyond.

5. Relax

Probably the last thing any of you wanted to hear, but it’s vitally important. Remember, you’ve made it to interview now, so there’s a very good chance that you are completely suitable for medicine. The role of the interviewer is not to grill you so you can be eliminated, but instead to allow you to demonstrate your competence and allow them to get a feel for ‘the real you’. Let your personality come out and answer everything honestly. A medical interview is fundamentally a discussion and that’s how you should approach it.

Make sure to get a good night's sleep the night before (stay overnight close by if necessary) and have something to eat. I'm sure you'll do great - good luck!

Medical Interview Question Bank

Here's a list of practice medical interview questions I've devised for you, very typical of the types of things you might be asked at either a traditional interview or an MMI. Writing structure guides for these questions is going to be a long-term project for me, but I'll link each one to my thoughts on it as each article is completed.

They are sorted very roughly by theme, but at this point are intended as prompts, interesting ideas that you might want to think about. If you end up writing your answers down (which I suggest), I'd love to hear from you so I can add new ideas to the existing articles so more people can make use of them. Enjoy!

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MOTIVATION & BACKGROUND

What will you do if you are unsuccessful in gaining a place at medical school during this application cycle?

Talk about a time in your life when you experienced an academic failure, and then what you did to overcome it.

How have your current studies (be it A levels or university education) prepared you for medical school?

Where would you like to practice medicine after you qualify?

Do you have any personal experience with the death of friends or family members? What was it like to deal with that loss?

Medical school requires a lot of revision and independent study outside the classroom. Do you feel that you would be able to cope with this?

Have you overcome any biases in your life?

Who are your heroes and why?

If you were not successful in gaining a place at medical school this year, would you apply again, and if so how many more times?

We have received 3,000 applicants for 150 places at this medical school. Why should we pick you?

What area of medicine or medical specialty interests you the most, and why?

What elements beyond simply providing healthcare to patients do you think the role of a doctor in society holds?

If you could watch any medical procedure being performed, what would it be and why?

Medicine has a reputation for being a stressful career. What will you do as a medical student to relax and reduce your stress when things get difficult?

What is your greatest strength, and why does it make you suitable for a career in medicine?

What traits or qualities would you look for in a doctor if they were treating you?

Why do you want to be a doctor?

What would you do if you couldn’t go to medical school and had to pick another career?

Why do you not want to be a nurse, paramedic or another form of healthcare practitioner?

Give an example (based on your work experience) where you had to solve a conflict, and explain how you did so.

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WORK EXPERIENCE

Give an example (based on your work experience) where you displayed useful initiative.

Give an example of when you demonstrated leadership skills during your work experience.

What do the terms ‘empathy’ and ‘sympathy’ mean, and how do they differ?

Give an example (based on your work experience) when you had to work as part of a team and were not the leader.

Give an example of a time during your work experience where you handled a stressful situation.

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MEDICAL AWARENESS

How has the public perception of doctors changed over the last 50 years?

“Lawyers say if you never get sued, you’re not a good doctor” - Dr Ranjana Srivastava
Do you think this is true?

Discuss what is meant by Autonomy, and give an example of it in a healthcare scenario.

Discuss what is meant by Beneficence, and give an example of it in a healthcare scenario.

Discuss what is meant by Non-maleficence, and give an example of it in a healthcare scenario.

Discuss what is meant by Justice, and give an example of it in a healthcare scenario.

What are the consequences of an ageing population for the NHS?

Should doctors or politicians be in charge of running the NHS?

What do you think about the recent doctors’ strikes, particularly when emergency care was withdrawn?

Why might the practise of medicine be different in the UK and developing countries?

What do you think about the ethics of private healthcare?

You have recently qualified as a doctor, and your friend asks you to take a look at a rash they have developed over the last week. Do you agree to do this?

Is it correct that people can be detained under the Mental Capacity Act?

Is it more important for a doctor to be highly knowledgeable, or to be able to communicate well with their patients?

Should surgeons get to know their patients before operating on them?

Talk about a medical case in the news recently that interested you.

What do you think about the phenomenon of the ‘postcode lottery’, and is it fair?

Do you think we need more nurses or doctors?

If you became a doctor, do you think your friends or family would be okay with you treating them, and would this be acceptable?

Do you think that newly qualified junior doctors should have a minimum term of service in the NHS, and if so how long should it be?

What is the placebo effect, and should NHS doctors be allowed to use it on their patients?

As of 2016, only 52% of junior doctors that finished their two years of foundation training proceeded straight into GP or specialist training programmes with NHS England. Why do you think this is?

If you could change one thing about healthcare in the UK, what would it be?

Why do some medical students drop out before finishing their course?

Is there an area of medicine that you know for certain does not appeal to you, and if so why is that?

Do you have a favourite medical-themed TV series or book? What do you think about the representation of doctors in the media?

Why is ‘bedside manner’ important for doctors?

Should euthanasia be available through the NHS for all patients?

Do you think that the lives and social responsibilities of a GP and a heart surgeon are very different?

Should cosmetic surgery be available through the NHS, such as breast implants or nose alterations?

Do you think doctors are overpaid?

Why is doctor-patient confidentiality important?

If you were one day placed in charge of the NHS, how would you allocate the budget for the coming year?

Doctors display a higher prevalence of mental illnesses than the background rate in the general population, particularly among young members of the profession. Why do you think this might be?

Do you think that teamwork is important for the NHS to function properly?

With increasingly accurate anatomical models and computer simulations, do you think that cadavers are still necessary for medical education?

What is the difference between a junior doctor and a consultant?

How many attempts at in-vitro-fertilisation (IVF) treatment should women receive on the NHS, and should we continue to offer it for free?

Should homeopathic treatments and alternative therapies be provided by the NHS?

Give an issue that is important to the NHS today and discuss it.

What are the four pillars of medical ethics, and how do they relate to healthcare?

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SCIENCE

What is blood for?

Why is Huntington’s disease maintained in the general population, when it kills those who suffer from it?

How does antibiotic resistance work and why is it a problem for the NHS?

Tell me about the MMR controversy and what the subsequent effects on public wellbeing were like.

What are the limitations of medical research?

Which are more dangerous, bacteria or viruses?

What is pain?

What consequences does the practice of medicine have in terms of human evolution?

Why are stem cells useful for medical treatments, and why might their use be controversial?

How do vaccines work, and should they be compulsory in the UK for children?

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ROLEPLAY SCENARIOS

You are a surgeon in charge of assigning organs to transplant patients. A donor heart has become available, but there are two patients that need it. One is a 20 year old homeless man who is a regular drug user, and the other is a 40 year old woman with two children. Who gets the heart?

You are a second year medical student and have just finished your final exam of the term. On your way out of the venue, you hear several classmates talking and it becomes clear that they are writing down the questions and answers to give to the students taking the exam next year. What do you do?

You are working as a junior doctor on a hospital ward, and you hear shouting from the next room. Upon further investigation, you learn that a patient was shouting at one of your colleagues, who is a foreign doctor and trained in India. The patient is using racial slurs and demanding to see an English doctor. How do you approach this situation?

Imagine you’re a doctor and a parent brings their child into A&E. The current waiting time is more than an hour, and they are angry that the wait is so long. How do you deal with this situation to calm them down?

You are a medical student shadowing a consultant surgeon, and you are both scrubbing up to enter the operating theatre. You are ready to go inside, but catch a glimpse of the surgeon taking a swig from a bottle in his locker, which he hastily returns when he sees you looking. What do you do?

Place your hands by your sides or in your pockets. Without moving them, explain to someone how to tie their shoelaces.

You are a doctor treating a young child who has suffered damage to the insides of their ears and has lost most of their hearing. The ward consultant recommends they be fitted with a cochlear implant, but the child’s mother is also deaf and does not want the child to have the implant. What do you do?

While backing your car out of the driveway, you accidentally ran over your neighbour, Mr Collins’ new puppy which had gotten into the road. You have 5 minutes in which to break the news to Mr Collins.

Imagine that two parents have asked that their son be given a genetic scan for Huntington’s disease, as the father has recently begun to suffer from symptoms of it. The test returns positive, but the parents decide that they will never tell the child. Do you intervene and tell the child yourself?

Imagine that you and your best friend have both applied for the medical course at this university. We have one place left to allocate, for which the two of you are competing. You have been offered the place, which you may accept or reject. Your best friend will be devastated if they do not gain entry. What do you do?

Imagine that you’re a medical student on placement or junior doctor on a hospital ward. A patient’s blood sample has gone missing, and you need to explain to them that another one needs to be taken.

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ABSTRACT

What should the penalty be for falsely impersonating a doctor in the UK?

If you could change one aspect of yourself, what would it be and why?

The development of new genetic engineering tools such as the CRISPR-Cas system could potentially allow for genetic abnormalities to be fixed before a baby is born. Is this ethically right, and should we continue research into this area?

With the rise of automation, could all doctors one day be replaced by robots?

Should previously convicted criminals be allowed to become doctors?

Do you think that entrance exams like the UKCAT and BMAT ensure that the best people become doctors, and should we continue to use them?

How would your life change if you suddenly became unable to read?

What risks do doctors pose to the public?

Is it wrong for doctors to be smokers?

Is it better (in terms of ethics) to provide healthcare to foreign nations that need aid, or simply send them money?

Medical doctors, dentists and veterinarians can all use the title ‘Dr’, as can those who hold PhDs. What do you think about this, and should the situation be changed?

Tell me about one of your friends that you think would make a good doctor, regardless of their interest (or lack thereof) in a medical career.

Do you think there should be an upper limit on the number of times one person can apply to medical school?

Do males or females make better doctors?

Can you tolerate the sight of blood or wounds? Why do you think they make some people uncomfortable?

It is widely accepted that ‘everyone makes mistakes’, but sometimes when doctors and surgeons make mistakes, people can get hurt. Should doctors be immune to prosecution in the UK when this happens?

Why is medicine sometimes referred to as an ‘art’?

Should doctors get involved in politics?

Who was Hippocrates and why was he important?

Why is entry to medical school so competitive?

If you could instantly cure one illness all across the world in all people suffering from it, what illness would you choose?

Should military doctors have to treat enemy combatants?

Should you give money to beggars?

Do doctors make good life partners?

How would you describe what medicine was to an alien that knew nothing about it?

Why are bandages usually white?

If you could choose a way in which to die, what would it be?

What are the most important elements of communication?

If you had to write the questions for medical school interviews, what would you ask the candidates and why?

What invention or discovery from history do you think changed medicine the most?

Why do so many people find the Abstract Reasoning section of the UKCAT difficult?

What excites you the most about gaining a place at medical school, and equally what frightens you the most?

Is it okay for doctors to diagnose and treat themselves?

Do you think that cannabis should be legalised in the UK?

Should the sale of cigarettes be banned in the UK?

Should the religious convictions of patients be taken into account when delivering their healthcare?

In the USA, the primary medical qualification is the MD, which can only be taken as a graduate student. In the UK, medicine is an undergraduate course that can be taken at 18. What are the advantages and disadvantages to medicine being a graduate-only course?

Do you think that people with major disabilities such as deafness or blindness have any unique advantages or disadvantages when practicing medicine?

How do the healthcare systems differ when comparing the USA and the UK?

Would you prefer to practice medicine in a rural area or in a city?

Why are doctors and dentists different?

If we were to contact one of your teachers/lecturers other than your UCAS referee, what do you think they would say about you?

Should doctors be re-tested after qualification to ensure they are still fit to practise?

How do surgeons differ from doctors?

How does your family feel about your decision to attend medical school and become a doctor?

Why are medical degrees longer than standard undergraduate degrees in the UK? To combat the shortage of doctors we should simply reduce this to four or even three years. Discuss.

When you have personal problems, who do you talk to about them?

Medical interviews and entrance tests are intended to select for positive traits associated with good doctors. What negative traits might the same tests also select for?

How has your upbringing and background prepared you for a career in medicine?

Should experimental treatments be available through the NHS to patients when all other potential options have been explored?

Should doctors or nurses be the first point of contact in primary care?

If you could ask a medical consultant who was about to retire after thirty years service in the NHS one question, what would it be?

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Sponsored Link: MMI Interview Question Bank & Answers from Blackstone Tutors

What to Wear to your Interview

This is a question that causes a lot of people undue stress, and one that thankfully has a fairly simple set of answers. Of course, there is no ‘golden ticket’ dress code, just as there is no perfect answer for interview or infallible revision tip with which to ace the UKCAT. However, I still recommend planning ahead what you’re going to wear on interview day so you have at least one fewer thing to stress over.

You should always dress suitably to the situation you are expecting, so let’s analyse this aspect first. What do you want to communicate about yourself to the interviewer via your clothing, or rather what are they likely to think when seeing you for the first time? The medical school is recruiting for future doctors, so ideally you should look smart, reliable and be generally well-presented. It is better to wear more subdued clothing because that way the interviewer is not provided an instant reason to dislike you - leave the ostentatious items at home.

This is of course even more true if you’ll be attending an MMI-format interview, where you’ll be making a crucial first impression multiple times.

Please note - the following recommendations are not hard-and-fast rules for acing your interview. Instead, they are tried-and-tested fashion combinations that would be appropriate for business wear and considered ‘safe’.

Making a good impression is crucial.

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For Men:

As with most formal occasions, I think men have it much easier, because you should be wearing a suit. Opt for a dark colour, such as black, grey or navy blue. Make sure that the jacket fits well around your shoulders when you’re buying it, because it is extremely difficult to alter the width of the shoulders, whereas the sleeve length is easier for a tailor to fix. Similarly, your trousers should fit you well in the waist, and the length can be fixed afterwards to suit (no pun intended).

A black or grey suit should usually be paired with black shoes, but you could opt for brown as well, particularly if worn with a blue suit. Your shirt should be a light tone that contrasts the jacket - plain white or a light blue is safe. I recommend wearing a tie, the colour of which should again contrast the colour of the jacket. For dark suits, I would recommend a red or blue tie with a simple pattern or no pattern at all, although any plain colour would be ideal.

Accessorise with a watch and tie clip, unless wearing a waistcoat. Your belt should match your shoes. The reason I say this about watches is that pulling out your phone to check the time if you need to looks incredibly unprofessional, even in this age. Make sure that any facial hair is well-groomed, with clean shaven being arguably the safest look, but I think virtually anything (including stubble) can work well as long as it’s tidy. If you wish to wear cologne or aftershave, choose something subtle and not heavily fruity - these are better saved for clubs.

If for some reason you are unable to find a well-fitting suit in time (as I was not, because I received the call to interview during the Christmas holidays) then I would recommend pairing a pair of black formal trousers with a dark V-neck jumper over a collared shirt and tie. All other rules apply as before, and definitely don’t wear a tie clip in this case.

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Female-friendly update coming very soon!

Interview Question: Organ Transplant Dilemma

Suppose you’re a surgical consultant in charge of assigning organs on a transplant list, and a liver becomes available. Your hospital currently has two patients that urgently need the transplant; a 14 year old girl, and a 33 year old man with two infant children who is a regular drinker.

This is a pretty dire situation, because whatever your choice, someone is going to die and you might feel you like you have indirectly condemned them. However, without treatment, it is likely that both patients will die anyway, and therefore it is important that the chance to treat someone be seized.

The very first thing to do is work out which of the patients are a biological match for the transplanted organ. If either of them isn’t, that ends the dispute immediately. Mechanical factors could also be considered - meaning whether the size and shape of the donor liver would suit each patient and whether the procedure would be substantially more difficult in either of them, for example if one of them had hemophilia.

In the UK, only around 1% of organ donors die in circumstances where their organs can be safely donated to another person.

There are then an enormous number of circumstantial factors that could then be assessed. For example, the father patient has a history of drinking, although the question does not say to excess. Might the teenage girl be more responsible with the liver and avoid heavy drinking? Demonstrate to the interviewer that you are aware that many of these social elements can be important in making the choice.

Perhaps the most important concept is that of Quality of Life (QoL). Which of the patients stands to gain the most with regards to long-term prognosis as a result of the transplant procedure? This is difficult to measure, but the Quality-adjusted Life Year is the most commonly used method. Essentially you’d wish to know which patient would live the largest number of years with the highest level of health - the girl has longer to potentially live, but would this necessarily be in the same health state as the father if something went awry during the operation?

Is it right that a heavy drinker should get a liver transplant over a non-drinker? These questions are very important for systems with constrained resources such as the NHS.

You may also consider the social impacts of your choice. The parents of the teenager are likely to suffer very badly emotionally if she were to die, due to her not having lived a full life, which would seem a great injustice. Conversely, the QoL for the two infant children would also likely be negatively affected by the lack of their father if he were to die.

Your interviewers will not expect you to choose ‘the right answer’ in these scenarios, as very often (if not always) the questions are designed such that one does not exist. Avoid jumping to a conclusion very quickly, as it’s all about how carefully you can assess the situation and consider as many factors as possible. Do choose an answer and provide solid reasoning to back it up, but always communicate that there are valid arguments on both sides.

Interview Question: Consequences of an Ageing Population

Medical advances inevitably result in citizens living longer lives, which we can all agree is basically a good thing. However, this results in a population that is not only larger overall, but also older on average. This change presents its own particular challenges for many aspects of society in the UK, including employment, economics and of course, healthcare. As of 2011, 16.4% of the population was aged 65+, but this value is increasing all the time. It is estimated that by 2039, 1 in 12 people will be older than 80!

Older patients have a much higher frequency of certain chronic conditions than average, such as heart disease and atrial fibrillation (irregular heartbeat). This will require more support staffing in these areas, which may divert funds away from other departments if the budget cannot be increased.

Another obvious factor is that of frailty - older individuals can typically not move around as easily, and may be at greater risk of damage from common injuries such as collisions and falls. They also are more likely to need longer periods in hospital or in care elsewhere, as well as provision of mobility aids (wheelchairs, scooters and the like) and in-home care or social workers.
 

Medical care is extending lifespans further and further, with ever-increasing costs

Furthermore, as older patients are more likely to suffer from multiple concurrent illnesses, this can often make their healthcare needs more complex, which in turn increases pressure on multiple NHS departments to meet with the patient and communicate between themselves. Additionally, this means longer stays in hospital which reduces the number of beds available for other patients, which is one of the most common causes of delays in treatment.

This all means that in a time of intense budget cuts and staff shortages, NHS services can become very stretched, particularly during the winter. This is true both of ambulance services and GP offices - three out of ten ambulance trusts in England declared a critical situation in the winter of 2014.

3 of 10 English ambulance trusts declared a critical situation in 2014.

Certain steps could be taken to mitigate the effects of the aging population, which mostly centre around lifestyle changes. The UK government published the public health ‘White Paper’ in 2004 which aimed to improve public awareness of these changes, which include healthy eating and physical exercise every day. Additionally smoking was banned in all workplaces in 2007.

These changes aim to improve the health of every member of society such that chronic conditions such as diabetes and heart disease are less prevalent, and prevent them from acting as such a large drain on NHS resources in order that better healthcare can be provided for everyone. This way the problems can be reduced in advance rather than than requiring very expensive treatment later on.

Interview Question: Sharing Exam Information

You are a second year medical student and have just finished your final exam of the term. On your way out of the venue, you hear several classmates talking and it becomes clear that they are writing down the questions and answers to give to the students taking the exam next year. What do you do?

This is a question that above all things tests integrity. There are many good responses that candidates could provide, but here are a few example talking points to make sure you’re covering a few bases in the interview.

Firstly, speaking to the friends in confidence first is always a good starting point. Their intentions seem to be good in helping their fellow medical students, but of course sharing the information with other students is cheating. Of course speaking pragmatically, they might feel like they were reducing the stress of younger students and therefore doing a positive thing.
 

Exams are there for a reason, and in medicine they're important for patient safety

However, it interferes with the examination process which is not only dishonest, but medical exams are intended to prepare doctors for practice and exposure to the public. Cheating might leave gaps in crucial areas of knowledge which the exams were supposed to identify. Furthermore, if a large number of students gets all the answers right in the next year, then disciplinary action could be taken against your friends if the academic staff found out what had happened.

The next step might be to establish whether this type of information has been distributed amongst students before, for example to your friends by older students. If this is a problem affecting a large number of people, it warrants further investigation by academic staff.

In terms of resolving the situation, it would be ideal to recommend that your friends do not go ahead with sharing the exam information and give them the chance to do so. If that doesn’t seem likely, at that point it would be worth discussing in private with your tutor before taking further action.

Fairly obviously, don’t agree with the friends and don’t offer to help them.

Interview Question: Lost Blood Sample

Imagine that you’re a medical student on placement or junior doctor on a hospital ward. A patient’s blood sample has gone missing, and you need to explain to them that another one needs to be taken.

It doesn’t have to be blood - it could be stool, urine or some other bodily substance of your choice. This is a common type of question, which combines a number of issues. The best way to approach these scenarios is to consider what the patient might see from their point of view when faced with this scenario.

Firstly, the concept of their privacy. Blood bottles can feature a patient’s first name and surname, their ward, their date of birth and more besides. At the very least, this information is now in the open, and potentially visible to anybody else on the ward, including other medical staff, patients and even visitors. Because this information is supposed to remain entirely confidential, the patient might think that a breach of trust has occurred.

Secondly, having a blood sample taken is not a comfortable procedure at the best of times for many people, particularly if multiple attempts were needed. Because of a hospital mistake, they have to undergo this pain again.

Blood sample being taken (Image: US Navy)

The last talking point you could consider is that of delayed test results. Because the first sample has been lost, another must be taken which involves coordinating the required staff (a doctor, nurse or phlebotomist) and sending the collected sample for testing once again. This by necessity results in the tests taking longer to come back, which may cause additional stress in patients anxious about their condition.

The key thing to remember when approaching communication, as with all answers in these scenarios, is to be completely honest. Absolutely do not use euphemisms such as ‘a small mishap’, and remember to be polite when delivering the news. You should listen very carefully to any concerns the patient has, and do your best to explain that you empathise with them.

Some stock phrases you might use for inspiration:

“Mr Johnson, I’m very sorry but there has been a mistake and your blood sample has been lost in the hospital. We need to take another from you, and I apologise that you have to go through that again during a time that must be stressful for you. We will do our very best to maintain your privacy and will get the results to you as quickly as we can.”

“I’m very sorry Mrs Lindham, we don’t know the whereabouts of the blood sample that was taken from you yesterday. In order to get your results back to you quickly we need to take another one. I completely understand if this frustrates you and I’m deeply sorry for what has happened, but we want to do the best we can for you moving forward. Please let me know if you have any concerns.”

Simply put, own the mistake, be courteous and deliver the news in as straightforward a manner as you can. The patient has every right to be irritated or upset, so hear them out and make sure they know that you have taken their views on board. They must be absolutely clear on what exactly has happened, why it has happened, and what the next steps are.

Interview Preparation: Four Pillars of Medical Ethics

Medical ethics refers to a series of principles that when considered together aim to ensure that everyone receives the same standard of healthcare and serve to guide doctors in approaching the care of their patients. While healthcare professionals must use them each and every day in carrying out their roles, they can also be examined more closely when conflicts arise to work out exactly how they should be resolved. Such cases are known as ethical dilemmas.

These ideas are loosely defined in four key values, known as the four pillars of medical ethics. In no particular order, they are Autonomy, Beneficence, Non-maleficence and Justice. This article will address each of these ideas in turn and elaborate on their meaning and consequences for the practice of medicine, which you’ll want to be aware of before your medical school interview. We’ll explore them more individually in future articles but for now here’s a primer.
 

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The Hippocratic Oath, dating back to the 5th century BCE, outlines many principles of medical ethics which are still used today

The first, autonomy, is recognition that the patient has ultimate control over whether they receive the treatment or not - medical practitioners may not force treatment upon them under normal circumstances. The exception to this is when patients cannot be deemed able to reasonably make decisions for themselves, for example when detained under the Mental Capacity Act.

At this point you’re concerned with establishing whether you have explained all the treatment options the patient has available to them, the patient understands their choices and that they are capable of making that decision. Lastly, whatever actions need to be taken in order to deliver that treatment can only be taken if the patient has provided their informed consent - moving ahead without this consent is treated as battery, or unlawful personal violence.

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Beneficence refers to the idea of having the best outcome for the patient in mind at all times, particularly when all the options available (of which there may be many) have been considered. It is the duty of medical practitioners to identify which treatment would give the best outcome and to communicate that to the patient.

Do bear in mind that this could be more complicated than it sounds, as the patient will have their own views about the treatments beyond medical statistics. There might be elements to their lives that make some methods incompatible with their situation, for example. It’s all about identifying that best outcome and discussing it with the patient.

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Non-maleficence is taken together with beneficence, and is essentially a concise version of the Hippocratic Oath: Do No Harm. I highly recommend that anyone interested reads the memoir of neurosurgeon Mr Henry Marsh, who applies this principle very frequently throughout the book. The risks of an intervention should always be weighed up against the outcome of doing nothing at all.

Of course harm can come by neglect, which is where the latter case comes in. A holistic assessment of the situation is therefore necessary, to identify all possible sources of risk, be it the competence and experience of the medical practitioner, the circumstances of the patient beyond the hospital and of course any basal risks that are inherent of the treatment itself.
 

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The last of the four pillars and perhaps the most complex is Justice, which concerns identifying whether or not an action is fair in society and within the realms of the law. As one might imagine, this is no easy feat because of the nuances and subjectivity associated with the idea of fairness.

Say you were faced with two patients who desperately needed liver transplants and would surely die without them. You have access to one liver, compatible with both patients but you may only choose one. The first patient is a middle-aged male with two young children and a morphine addiction, while the second is a sixteen year old female. In this case, do you choose the option which gives one patient more years of life, or that might result in fewer for the other but provide the two children with a more stable environment?

This is an extreme example but reflect on the point made - responsibility lies in very large part with the doctor and you must be able to live with the consequences of your choices. The four pillars serve as a way to inform these choices and ensure the best outcomes for your patients.

Interview Question: Challenges of Being A Doctor

This is part of my series on medical school interviews. Be sure to check out the rest of the articles on the website to make sure you’re properly prepared when interview day comes around so you can perform at your very best and nail that medical school offer! As with all articles in this series, the following is intended as a rough guide containing talking points and elements to consider, rather than content to be repeated as-is in your interview.

This could be phrased in a variety of different ways, but essentially you’re thinking about the negative aspects of being a doctor, of which there are many. Be aware of a variety of them, but there will be a couple that might particularly concern you, which would be good candidates to think and talk about should you be asked.
 

Medicine is often dramatised, leaving out many of the challenges of the profession (Image: Scrubs, Disney-ABC)

First and foremost is quite simply the inordinate amount of time to be spent working and studying. Doctors work up to 100 hours a week in some cases, depending on the particular speciality and stage of training, which might be maintained for years. Regardless of whether or not you personally can tolerate that idea, think that you’ll more than likely have others dependent on you before you get anywhere near consultant status, be it friends, partners or maybe even children. Medicine, despite recent efforts to limit working hours does not inherently offer a good work-life balance, beyond a few specialities, or at least certainly not as well as many other noble professions do.

Building on this point is the idea of responsibility. Beyond the friends and family we just considered, doctors have ultimate responsibility to their patients. While all of us have the idea of a patient crying with happiness after you’ve cured their malady to get them home in time for Christmas (or any other seasonal holiday of your choice), imagine a different scenario. You made the wrong call on a diagnosis, or got the dosage wrong which has resulted in the death of a child. You have to go out and explain to the parents exactly what happened, and that burden is yours to bear. Of course everyone makes mistakes, but when doctors do the results can have catastrophic outcomes for their patients, so they need to be able to manage this.

"Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures"
-René Leriche, 'La philosophie de la chirurgie', 1951

Of course, not every medical disaster that occurs will be your fault, but you’ve still got to be able to deliver bad news in the general case, which often results in the so-called ‘detachment’ of doctors by necessity. Imagine you’ve delivered a woman’s baby, only to have to tell her that it needs emergency surgery immediately or has been born with a birth defect she wasn’t expecting. An incredibly joyous situation has immediately turned into something potentially quite different.

Doctors often work very long hours which can challenge their personal lives (Image: hiroo yamagata on Flickr, CC BY-SA 2.0

Thirdly, the roles of doctors in the UK have become increasingly intertwined with those of the administrative staff around them. You do not simply have free reign to operate as and when you like, you are at the mercy of the resources of your NHS Trust and you might not always be able to give the best care you want to.

Similarly, to the chagrin of NHS staff everywhere the amount of paperwork, dictation and bureaucracy has exponentially increased. Doctors spend hours dealing with emails, trying to find spare beds and chasing bloods, X-rays and the like rather than spending time with their patients and they would no doubt much rather be doing.

Personally speaking the challenge that most worries me is that work-life split. I wish to have a family of my own one day, which is of course possible and perfectly feasible knowing the enormous number of medics that have achieved that successfully. My personality tends to lead me towards whatever the most difficult of a set of outcomes is merely for the challenge and stimulation (and therefore very intensive fields), which is something I will personally need to work towards if I am ever to have a properly fulfilling career in medicine.

Interview Question: Why Do You Want to be a Doctor?

This is part of my series on medical school interviews. Be sure to check out the rest of the articles on the website to make sure you’re properly prepared when interview day comes around so you can perform at your very best and nail that medical school offer! As with all articles in this series, the following is intended as a rough guide containing talking points and elements to consider, rather than content to be repeated as-is in your interview.

Odd though it may seem, this is a question that can catch medical applicants completely off guard during interviews, and many will unravel extremely quickly. Instinctively 99% of students will simply say ‘I want to help people’, which an admissions tutor can then redirect in any number of ways and doesn’t suggest that much thought has gone into the application, which it most certainly should have done if you’re seriously thinking about committing to a life in medicine.

Try to think what is it about medicine in particular that attracts you?

For example they could very quickly just say ‘then become a paramedic or a nurse. They help people’. When you think about it, an enormous number of occupations involve helping society in one way or another.

What you need to do is convey a sense of purpose and confidence, that gives the impression you have a solid reason you feel that specifically medicine above all else is the correct choice for you as a person. What is it SPECIFICALLY about the art of medicine that attracts you, and why do you think you’d be good at it?

For example, doctors routinely have to combine information from many sources (patient histories, blood samples, physical examinations etc) in order to solve problems and work out the diagnosis. If you enjoy science as well as problem solving, that would be good to mention. Better still, if you could provide an example from your own studies that combines these two aspects, that will sound much more convincing.

"When you think about it, an enormous number of occupations involve helping society in one way or another"

In terms of addressing the idea of why other healthcare roles might be unsuitable for you, doctors are ultimately in control of the care that a patient receives, and wield the most administrative power in doing so. While nurses and auxiliary care staff deliver treatment, the doctors decide what form it should take. If you feel that you want more of a say in this first stage of care then you’d be good for medicine, but be sure to make the point that this places a very large responsibility on you and you alone, which you must bear should anything go wrong following your decision.

Of course if you’re a graduate entrant to medicine (like myself) then you may well have worked in a clinical setting before. This might also of course be true if you did some volunteering in a hospital setting as a younger applicant. In this case try to reflect on the working environment - doctors can often be team leaders and you could talk about having led teams yourself.

Doctors are responsible for the treatment patients receive, but crucially also any mistakes

Equally if you’ve had some experience in your own life, which could be seeing relatives treated in hospitals or having witnessed an accident with doctors present and seen them take control of the situation and reassure everyone, they can be good to talk about. My own answer is along these lines, which you can read more about in another article to come.

You might reflect on that most sacred of bonds, the doctor-patient relationship. While this has been restricted somewhat in recent years by reductions on consultation times, as a doctor your responsibility is not to your NHS trust or to your hospital’s clinical targets, but to your patients. It is an immense privilege that doctors are afforded, and if you can recognise how important that is and why you think you should be trusted with it, that would go a long way.

"as a doctor your responsibility is not to your NHS trust or to your hospital’s clinical targets, but to your patients"

Finally, I think a great but simple thing would be being able to come home at the end of every day and knowing you made a difference to somebody’s life. Be careful with this, because it won’t always be positive, and an interviewer could then follow you up on it. That is the great curse of the medical profession, particularly in dangerous fields like neurosurgery where mishaps are relatively more common and the actions of doctors can have very long lasting, debilitating results for their patients.

With this question, perhaps more so than any other you’d be asked in a medical school interview you MUST be honest. Absolutely do not try to fluff up your answer by giving false narratives or regurgitating buzzwords. Take a breath before you speak, look your interviewer in the eye and tell them plainly and simply why you want to be a doctor. This is a question all about self-reflection, there are no extraneous factors at play. Tell the truth, and it’s smooth sailing from there.