Multiple Mini Interview (MMI) Questions & Answers
Advice & Insight From MMI Interview Specialists
MMI Scenario 1
You are a second year medical student preparing for your end of year examinations. One week before your examinations, you have a Molecules, Cells and Diseases (MCD) coursework due. One of your friends has just emailed you a selection of coursework, completed by students in prior years for the same project. Explain your actions in this scenario.
This appears to be a relatively straightforward case, with almost all candidates recognising that it would be inappropriate to utilise the coursework provided, however there is a stark difference between the approach taken by those passing and those excelling in this station:
Average Candidate Response:
- I would not use the coursework provided as this would be cheating, and I may be reprimanded for this.
- I would also tell me friend that they should not be sharing coursework.
Excellent Candidate Response:
- This case raises a number of issues in relation to my actions, my friend’s actions as well as those who have completed the coursework in prior years.
- My first priority would be to arrange a discussion with my friend at the earliest convenience. Whilst I would acknowledge that his intentions were likely good in ‘sharing’ this work, I would explain that this is not appropriate for a number of reasons. These reasons include:
- Sharing of coursework undermines the whole assessment process, and may affect our ability to become suitable medical professionals.
- By sharing coursework, it is possible that a number of our friends would produce similar work, which would likely result in disciplinary action.
- If my friend understood that their actions were inappropriate, I would leave them to take corrective measures, however if they defended their actions, I would consider discussing my concerns with other friends involved as well as my educational supervisor.
- Additionally, I would want to establish if the coursework had been distributed with the permission of those in older years, as any plagiarism accusations would likely involve disciplinary action towards them as well. If they were not aware that their coursework had been widely shared, I would inform them of this, and advise that in future they do not disclose their coursework to anyone.
MMI Scenario 2
Review the graph enclosed and explain your findings:
Content modified from www.diabetesdaily.com
Average Candidate Response
- This graph shows that diabetic individuals have higher blood sugars than non-diabetic individuals at baseline and after meals.
Excellent candidates will use the ‘BlackStone Tutors Six Point Approach for MMI Data Analysis’
- Data Title (if present)
- ‘x’ axis and ‘y’ axis
- Graphical/tabular progression shown
- Physiological correlation (How can this pattern be explained biologically?)
- Anomolies/additional information of note
- Critical analysis of data/data source
‘This is a graph comparing mealtime blood sugars in a diabetic and non-diabetic individual. On the ‘x’ axis is the time in hours with blood sugars represented on the ‘y’ axis. The time ‘0’ is likely to signify the commencement of mealtime. The graph shows that at baseline, diabetic individuals, represented by the red line have higher blood sugars than non-diabetic individuals, who are represented by the blue line. Additionally, in response to food, diabetic individuals demonstrate a greater rise in blood sugar compared to non-diabetic individuals with peaks of 215 and 140 respectively. Thereafter the normalisation of blood sugars in non-diabetic individuals takes a maximum of two hours to return to baseline, compared to almost six hours in diabetic individuals.
The higher baseline blood sugar and slower return to normal levels in diabetics can be explained by an absolute deficiency of insulin in Type 1 Diabetics and a relative insensitivity to insulin in Type 2 Diabetics. With insulin’s important role in lowering blood sugars through transport of sugars into storage organs and conversion of glucose to glycogen, an absolute or relative lack of insulin will result in generally higher blood sugars.
There are no anomalies demonstrated, and the data is from a reputable source (Diabetes Daily), however it would be beneficial to note the units used to measure blood sugars on the ‘y’ axis.’
MMI Scenario 3
You are a medical student in a GP surgery, shadowing one of the GP partners, who is also your supervisor. Your next patient is Mrs Collins, a 30 year old secretary who your supervisor states is a ‘typical hypochondriac…always coming in with new concerns, with no real medical problems’. Your GP supervisor advises you that placebo medications (sugar pills) are the best treatment for these patients, and ‘always do the trick’.
Outline the main issues raised.
Average Candidate Response
- It appears that the GP is being judgemental and not taking the patient’s symptoms seriously
- This case raises ethical issues, and it could be argued that the GP is acting unethically
There are two sides to consider:
- By effectively deceiving patients and giving them placebo medications rather than actual medications, you are undermining patient autonomy
- Slippery slope argument: If this doctor is prepared to deceive this ‘category’ of patients, they are likely to feel comfortable acting similarly towards other patients for example ‘self-inflicted conditions’ (eg. Smokers/alcoholics/sporting injuries).
- Attempting to categorise patients (eg. ‘hypochondriacs’) may lead to missing more serious diagnosis, as you will consistently ignore potentially sinister red flag symptoms.
- Another issue raised is whether this doctor be allowed to practice medicine, let alone train future medical professionals.
On the other hand, it may be argued:
- Placebo medications (Sugar pills) are likely to have less side effects than prescribing stronger alternative medications which are unlikely to be required, if there is no underlying medical condition.
- With patients often reporting some benefit from the placebo medications, you are fulfilling your duty of beneficence as a doctor.
- This GP is effectively managing the patient with limited resources, hence not placing additional strain on the resource-stricken National Health Service
MMI Scenario 4
You are asked to assist the nursing staff in giving medication to a patient weighing 70kg. The recommended medication dose is 1mg/kg. A syringe is prepared containing 280mg in 2ml. What volume of the solution in the syringe do you need to administer?
70kg = 70mg
(70mg = total dose of medical that needs to be given)
70/280 = 0.25
(ie. 25% of the 2ml syringe needs to be administered)
0.25 x 2 = 0.5ml
MMI Scenario 5
You are a third year medical student on a medical rotation, Your consultant requests your advice on deciding whether to utilise a liver transplant for a 65 year old retired solicitor or a 20 year old Hepatitis B positive intravenous drug user. How would you decide who to give the transplant to?
Average Candidate Response:
- I would give the liver to the 20 year old patient, as they are younger and likely to live longer.
- I would give the liver to the 65 year old patient as the younger patient’s liver failure is self-inflicted. Thus, even if they are given the transplant, they may continue to use intravenous drugs and require further transplants in the future.
- In deciding who to give the organ to, I would consider a range of mechanical, biological and circumstantial factors.
- It is important to identify if either, neither or both the patients are a biological match for the donor organ. Whilst my personal opinions may be inclined one way, it is more important to ascertain which patient is the better biological match.
- Circumstantial factors should also be considered; for example if the 65 year old gentleman previously had received two liver transplants, and continued to pursue non-favourable lifestyle choices (eg. Excess alcohol), I would be more inclined to allocate the organ to the alternative recipient. Despite this, it is important to recognise that lifestyle choices are not the only cause for needing a transplant, and whilst the 20 year old may be an intravenous drug user, they may have contracted Hepatitis at birth rather than as a result of their intravenous drug use.
- I would also consider mechanical factors although these are arguably less important. For example, placing the liver of a 20 stone donor would be more appropriate in a large recipient rather than a slim-build young adult.
- Finally, it would be important to compare prognosis for each of the individuals if they were to receive the transplant. Simplistically, this could be through comparing additional life expectancy following transplant, although using measures such as QALY (Quality Adjusted Life Years) would help to assess not only the number of additional years, but also the potential improvement in quality of life.
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