Difficult Medicine Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for a Medical Residency in Internal Medicine can require a breadth of knowledge and attributes. Here, we present 10 of the most difficult questions and answer suitable for candidates to Medical Residency in the US.  Further questions can be found in our Medical Residency Interview Question Bank

Drive & Values

Tell me something academic that you have participated in. Tell me about an academic achievement that stands out to you.

Something academic that I participated in is a national essay competition for a major popular scientific journal – my entry, on the relationship between art and patient experience in hospitals, was selected to be published by a panel made up of a mixture of research scientists and practising clinicians. The essay was an excellent chance to delve deeper into a subject of personal interest, and to express my findings through a more compelling prose than I have been able to use in journal articles that I’ve written before – as it was pitched very much as a read for the general public. I think it’s vital that we as doctors are able to explain things in a manner that interests and draws in laypeople. An academic achievement that stands out is getting an academic scholarship to my high school – without it, I likely wouldn’t have been able to attend. It made my parents incredibly proud, and though I was young at the time I understood its importance to my future.

What do you value in your own life?

I value my relationships, my ability to help others, and my fitness and ability to explore. I don’t find material possessions to be of particular importance – if I did I’d have chosen a different degree, or at least a different specialty to Psychiatry – but rather believe that so long as one is comfortable, other elements of one’s life become the main focus. For me, I have a wide circle of friends who I spend a significant amount of time with, many of whom are also medical students. I also enjoy spending time with my family, and my close family in particular I value immensely. I value my relationship with my girlfriend, who has been an immense support at the most challenging parts of medical school. I’m thankful that I can help others through my work, and find it to be very rewarding. Lastly, I value my physical health that allows me to take on challenges, and explore our country and the world. I’m of course overjoyed that I am able to follow a career in Medicine, and believe that my ability to do so is partially a result of those other factors that I value. 

What can you bring to this program?

I can bring a more mature and evolved version of who I have been at medical school. My high marks both in my degree and USMLE emphasise that I am highly driven, and understand what natural intelligence is not enough – we must work hard too, in order to succeed. My letters of recommendation illustrate that I am passionate about Medicine, empathetic towards patients, and eager to learn from senior physicians in order to drive better patient care, and in turn help the faculty that I am part of. I can bring a desire to take part in research, as well – I’ve been published in national journals, including the Journal of the American Psychiatric Association, and have been involved in research through both premed and medical school. I can bring empathy, resilience, and a keen analytical ability to bear on any challenge, great or small. I’m also keen to involve myself in the program outside of core work, and look forward to teaching medical students, and in time, residents.

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Broad Medical Knowledge

What are the dangers of an ageing population? Is ageing a disease?

There are dangers associated with an ageing population – an increasing burden on the healthcare system from people that are no longer working being the most obvious one. This burden stems from the increasing number of problems that one suffers as one ages – alongside typical comorbidities like diabetes and hypertension, we must also consider dementia, the impact of isolation on the elderly, etc. These are complex issues. Personally, I would choose to see an ageing population as a sign that we as a society have been able to keep our citizens alive – the question is, are they still healthy? We must therefore move toward looking at frailty as a measure of ageing rather than biological age, so that we can better treat those affected by pathologies, whilst ceasing to be ‘ageist’ and immediately view the elderly through a negative lens, which perhaps happens all-too frequently as it stands.

There has been a move recently towards treating ageing as a disease. Whilst traditionally viewed as a natural process, this does create confusion between ‘intrinsic aging processes’ and then processes that are viewed as pathological that stem from age. We must also consider that accelerated aging conditions like Hutchinson-Gilford Progeria Syndrome are seen as diseases. Overall, if we were to shift our attitude to aging from it being a natural process towards it being a disease state, then we would likely be able to better ‘treat’ it, and the many issues that aging leads to.

What is a clinical trial and why are they so important?

A clinical trial is a research study performed using real patients (eventually) in order to evaluate an intervention – be it medical or surgical. They allow researchers and clinicians to understand whether new treatments are safe and effective, and thus to balance the potential benefits of the treatment against its potential drawbacks. Crucially, they will allow one to compare a new treatment to the current standard, and see if it is more effective, or has fewer side effects. Clinical trials are vital to evidence-based Medicine.

Clinical trials are broken down into four phases. The first phase is testing on a small group of often healthy people (20 to 80) to judge safety and side effects. The second phase uses more people (100 to 300). This phase aims to assess efficacy rather than safety, and therefore relies on using patients who have the condition. Phase III gathers more information on both safety and effectiveness. The number of trial subjects can therefore be up to 3000 people, to allow a wider selection of the population to be assessed. Phase IV, the final phase, takes place after the drug is approved for use. It involves monitoring the drug across diverse populations over time.

What has to change from foetus to baby with regards to blood circulation?

The foetus depends on the mother – nutrition and oxygen are transferred through the placenta. Blood therefore bypasses the lungs by means of a shunt. It flows to the inferior vena cava and then into the right atrium of the heart, where it is shunted to the left atrium. Oxygenated blood therefore moves into the left ventricle, where it is pumped around the body. Returning blood enters the right atrium, then moves into the right ventricle – where it bypasses the lungs and is instead shunted to the placenta – allowing the mother’s circulatory system to deal with waste products and CO2.

At birth, the shunts (the ductus arteriosus and foramen ovale) both close. The baby’s circulation now functions like that of an adult.

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How would you go about making the decision on whether or not to discontinue life support for a brain-dead patient?

The core issue here is lack of patient consent – without knowing what the patient would want, or have wanted, the decision falls to relatives and the doctor’s clinical judgement. Clinical guidance documents in general assert the importance of the doctor’s judgement when withholding futile treatment. However, in practice the consent of the patient’s relatives or proxies is normally ethically required.

Therefore, when considering whether to withdraw life support, one should carefully weigh the potential benefits of continuing treatment, vs the futility of continuing it. In this instance, with a braindead patient, recovery is impossible. Continued treatment is futile. However, a discussion needs to be had with the relatives, to ensure their understanding of the position is clear and complete.

I would like to highlight that I’m taking ‘braindead’ to mean brain stem death in this answer. Recovery from brain stem death is impossible, and as such a doctor can terminate life support without recourse to courts if necessary. Persistent vegetative state could often be labelled as ‘brain dead’ in the media.

Your mother calls you and asks you to help with a major family decision. Your maternal grandfather is 70 years old and has been diagnosed with a condition that will kill him sometime in the next five years. He can have a procedure that will correct the disease and not leave him with any long-term problems, but the procedure has a 10% mortality rate. He wants to have the procedure, but your mother does not want him to. How would you help mediate this issue?

Firstly, one should listen to both sides independently. Either party may have strong reasons for their opinion, and it may be that they haven’t shared this reason in their discussions with each other yet.

Next, one should gently probe the level of understanding both parties have of the procedure. Has your grandfather fully considered the mortality risk? Are there other potential risks from such a procedure, and has he considered these too? One would assume he has been deemed competent to be allowed the procedure, but make sure to consider his competence as well.

On the other side, has your mother considered your grandfather’s current quality of life? For him to make the decision to undergo this procedure, with associated risk, he is likely suffering at the moment. Equally, his life expectancy has been dramatically shortened – but with the procedure he will likely have a chance to live out a full old-age.

Ultimately, this is a question of autonomy. Your role is to check understanding, ensure that both parties are well-informed, and to hopefully promote an agreement over what route to take; but in the end it is your grandfather’s decision as the patient. Both you and your mother must respect the decision he makes.

What would you do if a woman with two children came to you and asked for a tubal ligation; she requests that you do not inform her husband.

Assuming you have no moral objection to the treatment itself, and the patient has capacity to consent to treatment, then there is no reason not to follow her instructions. However, it is surely worth exploring why she doesn’t want to inform her husband of this serious decision. It might also be worth exploring alternatives, like the contraceptive implant or a contraceptive pill, to see if these could solve the issue without rendering her permanently infertile.

You’d also have to inform the patient that you won’t be able to lie to her husband, although you can choose to withhold information. Therefore if her husband asks if she’s healthy and unable to have children, your response would be that you’re unable to discuss that without permission.

This is a seemingly complex situation, but in reality the answer is fairly simple. The patient’s right to privacy comes first here.


A member of your family decides to depend solely on alternative medicine for the treatment of his or her significant illness. What action would you take, if any?

Your main concern must be your relative’s health. First of all, begin a dialogue to better understand their position and their motivations. We don’t know to what extent they have discussed traditional medical therapies with their doctor, and why they currently aren’t pursuing them.

One should suggest that they speak to their doctor about the alternative treatments they are using, as these could interact with traditional medicine if they are to take it.

When trying to understand why they are not using traditional medicine, gently probe the reasons – it may be a distrust of evidence-based medicine. If this is the case, you should respectfully offer your opinion, adding that you are only doing so as you really believe it to be in their best interest. Perhaps seeing a different doctor would be helpful to them – they may have a poor relationship with their current doctor. Clearly, a doctor who has an open mind and is willing to listen to their beliefs is needed.

The core pillar here is autonomy – a patient has the right to refuse treatment. As such, if someone has turned down medical treatment, and they are competent to do so, it is their decision.

To summarise, in a situation like this one should ensure the patient has as much information as possible to make an informed decision – as you care about their wellbeing – have a respectful conversation exploring their motivations, and ultimately respect their autonomy.

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