One thing that medical schools often like to test in an interview is your knowledge of medical ethics and your ability to talk your way through an ethical scenario.
Medical schools might test this by giving you a scenario to prepare beforehand, but often they will just give you an ethical question or scenario on the spot. Ethical scenarios are not designed to be easy, so there is unlikely to be an ‘obvious’ answer. This type of question is not designed to get you to give the ‘right’ answer straight away, rather to see how you can reason through a difficult scenario and weigh up different factors.
Here is some guidance for answering an unseen ethical question in an interview or MMI.
1. Read the scenario carefully and formulate a plan
Especially with a medical ethics scenario question, the interviewers don’t expect you to and don’t want you to jump straight into an answer. Take your time to read/ listen to the medical ethics scenario question and process it. It is really important that you have all the key information in your head before you begin to answer. Try to have a non-specific plan of how to structure an ethical scenario answer prepared before your interview. That way you can try to map the details of the scenario onto the scaffold you have already established.
2. Talk through the four pillars of medical ethics in relation to the scenario
Here is a quick summary of the four pillars of medical ethics, you may wish to read more in depth about these and their implications in certain scenarios.
Autonomy – The patient has the right to make their own decisions about their life and treatment, even if this goes against medical advice.
Beneficence – Maximising the benefits of medical care for a patient. This is the idea that doctors should ‘do good’.
Non-maleficence – To ‘do no harm’. This is all about minimising the harm that the treatment might do to a patient.
Justice – Considering the wider impact on society. This is about the fair distribution of benefits, costs, and risks.
These are the key to debating your medical ethics scenario question well. You may wish to talk about other issues that you can’t encompass whilst talking through these pillars, and you should do so afterwards.
Some other important issues you should be aware of when answering medical ethics scenario questions are:
Consent – The patient making the decision must be informed, i.e. given all of the relevant information about what the treatment involves, make a voluntary decision and have the capacity to do so.
Capacity – Is the patient able to make their own decision? All adults (aged 16 and over) are presumed to have capacity unless shown otherwise. Some examples of cases where adult patients do not have capacity are if they have severe learning disabilities, or are intoxicated by alcohol.
Confidentiality – No patient information may be disclosed without the patient’s consent. This is both an ethical and legal duty, however there are instances, for example disclosures required by law, where a healthcare professional may be required to break confidentiality.
3. Summarise the main issues
At this point, having reasoned through all of the issues in the scenario, summarise what you believe are the main points. There will probably be no more than two to three key arguments based on the scenario. It is important to keep this bit concise; they don’t want to hear you repeating what you have just said.
You have hopefully shown your logical reasoning skills whilst answering this question so demonstrate you can prioritise and summarise the most important parts. In an MMI station, bear in mind the time restriction so keep this bit brief to ensure you have enough time to round off your answer.
4. Give your final answer
Ethical scenarios most often don’t have a right answer. However, the interviewers may push you for what you would do. In these situations you can’t sit on the fence, you have to come down on one side or another. Give your final answer with a short reason. Even if you feel really unsure, you don’t want to show the interviewer that you are indecisive, as a key quality of a doctor is one who can make decisions based on the evidence available to them.
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The best way to gain good ethical reasoning skills is to practise how you might approach answering any medical ethics scenario questions. The more scenarios and questions you practise before your interview, the better placed you will be in the real one. It takes practise to be able to formulate a well structured and balanced answer to a scenario you have not seen before.
Ethical scenarios are tricky, especially as an MMI station. There is never a right answer and it is important to show you have a good grasp of the main medical ethical concepts. If you reason through your answer following these steps you will do well on an ethical question!