How to Approach the Multiple Mini Interview (MMI): Ethical Station

“You colleague Dr Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr Cheung doesn’t believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches and muscle aches, because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr Cheung’s behaviour might pose, and what your responsibility is here. Discuss these issues with the interviewer.”

Every medical school applicant should expect to answer at least one ethical question during their medical interviews. As future physicians, an encounter such as above is quite likely and hence the committee likes to know if the applicant is able to reason through the various ethical principles and arrive at a definitive course of action.

It is quite important to familiarize yourself with the four pillars of medical ethics: autonomy, beneficence, non-maleficence and justice. Although taking an ethical course during your degree can be helpful, it is not an absolute requirement. Surfing through the web for the principles should be the least you can do, and if you are keen on mastering ethics then I highly recommend Doing Right by Philip Hebert (try finding it at a local library or on Kijiji).

Let’s see how we can simplify answering ethical questions into a three-step approach.

1. Summarize the Ethical Principles

Once you have read the question, it can be helpful to organize yourself by highlighting the ethical principles at play. For example, in the question above, one can argue that autonomy, beneficence and non-maleficence are valid ethical principles in question. These principles can be explicitly stated during the introduction.

This allows the interviewee to organize their thoughts and structure their response. Furthermore, it allows the interviewer to recognize that the applicant is aware of the important ethical principles that are applicable to the case, and makes it easier for them to follow the response.

2. Expand on the Principles

Now that you have stated the principles, it is time to expand on them. For example: what exactly does autonomy mean, and why is it being challenged in the scenario with Dr. Cheung? It can also be helpful to describe the impact of being unethical on all parties involved.

For example, if patient autonomy is not respected, the physician could be abusing their power and could be liable for legal repercussions if such practices are exposed. This could impact the public perception of physicians in a negative manner and thus hurt the public image of the profession. From the patients perspective, its possible that the advised medication could do more damage than good. Non-specific symptoms could be early indications of something more severe, and by not extensively evaluating their symptoms the physician may cause more suffering to their patients.

3. Present an Actionable Plan

Although ethical stations may seem like hypothetical situations, such things do happen in real life as discussed earlier, and require an actionable approach. Many interviewees will discuss the principles but fail to present their next steps. However, we also need to keep in mind that applicants don’t possess adequate knowledge to make decisions at this point but rather should focus on simply discussing different options and what their implications are.

For example, as a colleague, you could do multiple things including: ignore the situation, discuss his practices with Dr. Cheung and your perspective on why it is unethical, or report Dr. Cheung to the medical board without discussing with him. I would like to reiterate that you don’t want to fall into the trap of making a decision, but rather discussing the pros and cons of different options. This shows the committee that you possess an ability to think critically, and that is all they can expect at this level.

 

Sim Singh Photo

Simranjeet (Sim) Singh is a second-year medical student at the University of Saskatchewan. He completed the International Baccalaureate (IB) Diploma in High School and won the 2015 Schulich Leader Scholarship. His academic interests include research in Stroke Management and Medical Education.

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