Advice & Insight From Interview Specialists
You are a renal transplant specialist working in a hospital. A kidney becomes available for transplant, and there are 2 patients who require a transplant. The first is a 60 –year-old woman, who has developed renal failure as part of an autoimmune disease. The second is a 24-year-old man who has developed renal failure due to substance misuse.
To ensure the decision was made fairly, many factors have to be considered. Firstly, I would estimate the increase in quality of life for both patients, and then compare them. I would try to calculate the QALYs to give a realistic estimate of the benefits of the transplant for each patient. I would also assess the potential compliance of each patient – to ensure that the future lifestyle is compatible with the transplant. Someone who is likely to abuse substances and use/continue to use drugs is unlikely to “look after” the new kidney as well as be take the necessary immunosuppressant medication.
From a biological perspective, considering the tissue matching of the organ is important; if the organ is not HLA compatible, the recipient will likely reject the transplanted organ. Finally, mechanical factors may also need to be considered with the organ needing to be appropriately sized for the patients abdominal cavity and capacity.
What have you learnt from your work experience?
From my work experience, I recognised the importance of effective communication both within the MDT and between doctors and patents. I think that being able to adapt how you communicate, depending on the situation and to whom is very much an art form, for example, it can be difficult to obtain a full history from a patient but this is vital information as 80% of diagnosis are made from history taking.
My work experience also emphasised the importance of teamwork in the medical profession, as doctors work alongside a number of healthcare professionals who have very useful input especially at multidisciplinary meetings. There were also a number of challenges faced by doctors, primarily a consequence of limited resources resulting in a lack of bed space, long waiting lists, some treatments not licensed by NICE on the NHS.
Finally, I learnt how medicine can be considered an art as much as it can a science. Although the reasons for diagnosis primarily have a scientific background, the method with which patients are dealt with is very much an art.
As a group, discuss whether there should be global coordination and consensus on organ donation rather than country specific policies?
How to succeed in the teamwork station
Advantages of a global organ donation policy
Disadvantages of a global organ donation policy
Name two medical conditions which have decreased in prevalence over the last 50-100 years?
Public health campaigns and medical research have allowed great progress to be made with reducing the prevalence of certain diseases. In 1988, the largest health initiative in history was begun to eradicate polio in the Global Polio Eradication Initiative. It was greatly successful, and led to a tremendous decrease in polio prevalence across the world, particularly in Asia. Smallpox is another disease whose prevalence has been decreased so much that it was declared eradicated. In 1980, an immunisation campaign led by the World Health Organisation saw an aggressive approach to eradicating this viral disease, and ultimately was successful.
If you could be any medical instrument, which would you be?
I would consider myself like a stethoscope, because I believe that it is very important to listen to what each patient has to say, not only in making an accurate diagnosis, but also in ensuring that the investigation and management plan is properly understood. Also, many stethoscopes have two sides depending on the required purpose, similarly I believe that I can adapt my approach depending on the requirement, whether it be taking a history or breaking bad news.
You are required to give a patient 1.2g of a new chemotherapy agent Co-Algonate. This comes as a 10% (w/v) solution in bags containing 500ml. What volume of the 500ml bag would you need to give?
1% = 1g in 100ml
10% = 10g in 100ml
10g = 100ml
1.2g = 12ml
(The size of the bag in this case is irrelevant information)
Why did we ask you to complete this calculation task?
Mathematic calculations are essential in medical practice with everything from calculating drug dosages to a patient’s BMI. Additionally, when calculating drug dosages, small calculating errors can have significant negative medical consequences ranging from excess side effects and complaints to significant morbidity and possible mortality.
Additionally, safe prescribing and calculations is the responsibility of all MDT professionals ranging from doctors and nurses to pharmacists and even medical students who may be present in an observatory capacity, but should still be qualified to highlight any medication errors observed.
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