The University of British Columbia UBC Medicine Interview Questions

Motivation and Insight into Medicine – These stations explore your knowledge and interest in the issues that are facing medicine. While applicants are not expected to have an in-depth knowledge of the inner workings of the healthcare system, a basic level of awareness of how the Canadian system differs from other countries such as the UK, USA, Australia and New Zealand is recommended. Issues with extensive media coverage at the time of your interview are also likely to be a point of discussion. Topics that may arise include:
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• The City of Vancouver has taken great measures to increase accessibility to alternative forms of transportation (Canada Line, Hornby and Dunsmuir Bike Lanes, Proposed Evergreen Line, and Burrard Street Bridge closures). Discuss the impacts (both positive and negative) of these decisions?
• If the Prime Minister of Canada were to ask your advice on one change that could be applied to the healthcare system in Canada that would improve it enormously and have the greatest positive effect, how would you answer?
• The man who lives next door to you often rides his bicycle in the company of his two young children but without a helmet. In fact, on several occasions, you have seen him riding with his helmet hanging by its straps from the handlebars. His young children sometimes wear a helmet, sometimes not. If the man fell off his bicycle and hurt his head in a way that would have been prevented if he had worn a helmet, would it be reasonable to ask him to contribute towards the treatment costs for his injury?
• Due to a shortage of physicians in rural and Northern communities in BC, some policy-makers have suggested that medical programs preferentially admit students who are willing to commit to a two or three-year tenure in rural areas after graduation. Consider the broad implications of this policy for health care and the costs associated. Will this policy be effective?
• Recently, certain hospitals in the Vancouver Area have been charging patients $29/day for their hospital fee on top of the fees charged to MSP. What are the implications of this policy? Discuss both positive and negative impacts with the interviewer.
• Do you think general practitioners have an obligation to report their patients’ health status to a public health agency if their patients have active infectious diseases?
• Statistics have shown that the effects of advanced age such as changes in vision and response time may adversely affect elderly drivers’ ability to drive safely. As a matter of fact, many doctors discuss the issue of stopping driving with their older patients as a precaution for the safety of theirs as well as the public. Do you think older drivers have to give up driving when they reach a certain age?
• In recent years, there has been an increase in popularity of full-contact sports, such as Ultimate Fighting Championship (UFC) and boxing. Should doctors have a role in regulating such sports?
• Do you think medicine should be more about changing behaviour to prevent disease or treating existing disease?
• Discuss the pros and cons of legalizing marijuana on the Canadian Health Care system. How does this impact a physician’s present ability to write out a prescription for ‘medical marijuana’? Would legalization cost the health care system more or less after it was passed?
• Imagine your friend’s father is 70 years old and has lived in Vancouver his whole life. He is taken to the emergency department at the Vancouver General Hospital. He has had good health until now and this is the first time he has been to the hospital of any kind since he was 20 years old. What changes in the healthcare system and environment in the hospital do you think he would notice?
• Discuss any topical health care issue that is unique to the Pacific Northwest region?
• Discuss one of these health care issues: human genome project, AIDS, abortion, the right to die, the cost of health care, and genetic engineering
• How does the Canadian health care system compare to that of Britain’s system?
• Recently, the Prime Minister of Canada suggested the idea of deterrent fees (a small charge, say $10, which everyone who initiates a visit to a health professional would have to pay at the first contact) as a way to control health care costs. The assumption is that this will deter people from visiting their doctor for unnecessary reasons. Consider the broad implications of this policy for health and health care costs
• What is your opinion about stem cell research using fetal tissue?
• How would you advise patients who are interested in visiting an acupuncturist or a chiropractor?
• When is it appropriate to participate in the assisted suicide of a patient? Why or why not?
• A Kootenay town runs a health-collective that provides various alternative and traditional forms of medicine. The physicians there encourage parents of small children not to vaccinate their children. Discuss the positive and negative impacts of this opinion.
• In June 2011, the Vancouver Canucks lost the Stanley Cup and riots broke out in Downtown Vancouver. Discuss the impact on the community and the range of health care professionals at St. Paul’s Hospital.
• “Liberation Therapy” (LT), a vascular operation developed to potentially cure multiple sclerosis (MS) in certain patients, has recently come under very serious criticism – delaying its widespread use. Among other experimental flaws, critics cite a small sample size in the original evidence used to support LT. As a healthcare policymaker, your job is to weigh the pros and cons of approving novel drugs and therapies. Please discuss the issues you would consider during an approval process for LT.
• In June 2011, the infamous Vancouver riots took place after their hockey team lost in the Stanley Cup Finals. Stores were ransacked and cars were burned. Hundreds of people were injured and sent to overcrowded hospitals. As the police chief in Vancouver, what measures or policies would you put in place to make sure this does not happen again? 

 
Ethical Scenarios – These stations often do not have a clear right or wrong answer. Instead, they expect you to be able to demonstrate that you can explore the multiple sides to the issue and confidently justify your stance. Ensure that you have a good understanding of Ethical Scenarios: Two Sorts, Two Sides prior to your interviews. Ethical dilemmas may include:

• A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?
• A member of your family decides to depend solely on alternative medicine for the treatment of his or her significant illness. What would you do?
• If you have the choice of giving a transplant to a successful elderly member of the community and a 20-year-old drug addict – how do you choose?
• An eighteen-year-old female arrives in the emergency room with a profound nosebleed. You are the physician, and you have stopped the bleeding. She is now in a coma from blood loss and will die without a transfusion. A nurse finds a recently signed card from Jehovah’s Witnesses Church in the patient’s purse refusing blood transfusions under any circumstance. What would you do?
• The Canadian Paediatric Association has recommended that circumcisions ‘not be routinely performed’.  They base this recommendation on their determination that ‘the benefits have not been shown to clearly outweigh the risks and costs’. Doctors have no obligation to refer for, or provide, a circumcision, but many do, even when they are clearly not medically necessary. BC Medicare no longer pays for unnecessary circumcisions.
• Consider the ethical problems that exist in this case. Discuss these issues with the interviewer.
• A Vancouver biotech company was hired by the US Military to develop a cure for Ebola. They successfully developed a vaccine to treat the symptoms of the virus and lowered the mortality rate for infected patients. Discuss the implications of this on a global scale.
• 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?
• You are a genetic counsellor. One of your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carries the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda’s husband. In other words, the boy’s biological father is someone else, who is unaware that he carries the mutation. You suspect that neither Linda nor her husband is aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family? What principles and who do you have to take into consideration in this case?
• A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence; the surgeons decide to perform the procedure without consent. They anaesthetize her and surgically repair the aneurysm. She survives and sues the hospital for millions of dollars. Do you believe that the physician’s actions can be justified in any way? Is it ever right to take away someone’s autonomy?
• You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy’s torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as “Cao Gio,” which is also known as “coining.” The procedure involves rubbing warm oils or gels on a person’s skin with a coin or other flat metal object. The mother explains that Cao Gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy’s back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?
• A patient with Down’s syndrome became pregnant. The patient does not want an abortion. Her mother and husband want the patient to have an abortion. What should a physician do in this situation?
• A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation?
• A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation?
• A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?
• A 17-year old boy lives independently. He is married and has one child. He wants to participate in a medical research study. Does he need his parents’ permission?
• A physician went on vacation for two weeks. He did not find another physician to cover him. One of his patients with hypertension developed a severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have an intracranial haemorrhage. Is the physician responsible for this patient?
• A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent?
• A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient’s condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence?
• As a physician at a local hospital, you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitizer offered at the hand sanitizer stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitizer for public use. What do you do? Do you remove/change the location of hand sanitizer stands? Do you approach him?
• An 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation?
• Is it ethical for doctors to strike? If so, under what conditions?
• There is an outbreak of an incredibly contagious life-threatening disease. The disease is spreading across the country at a rapid rate and the survival rate is less than 50%. You are a senior health care administrator, and when the vaccine is developed, you have priority to receive the drug. Do you take the vaccine yourself or give it to another person? Why or why not?
• You are a health researcher at an academic institution. You have been asked to work on a top-secret vaccine that would treat biomedical weapons or other communicable diseases. Before your breakthrough, you are instructed by the government to stop all research and turn over all materials and copies of your work to be destroyed. You know you are very close to finding a cure. What do you do?
• A patient requests needles and syringes at his/her local pharmacy. They do not present with a prescription and based on the records you can access, they are not receiving treatment for diabetes. Do you sell the syringes or not?
• Dr Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr Blair 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 Blair’s behaviour might pose. 
• Additional MMI Ethical Scenarios with Model Answers can be found in the MMI Question Bank.

Role Play Stations – This may involve interactions with a trained actor, or medical school student as well as an observer. Role-play scenarios often test a number of different attributes at once, for example, communication skills, empathy and ethical principles. For effective ways to navigate this type of station review BlackStone Tutors “6 Stages of MMI Role Play”. Examples of these scenarios include: 
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• You are a family physician. One of your patients, Mark, did not attend one of his classes and missed an important exam. He told you that his teacher would like a doctor’s note explaining his absence from class; otherwise, he will receive zero, and all hell will break loose. He wants to you write a note for him, indicating that he was not feeling well enough to write the exam. Not able to find any physical symptoms, explain how you would deal with this.
• You are a 3rd-year medical student doing hospital rotations. A fellow medical student who is doing rounds with you often shows up to these sessions tired, messy, hungover, or even drunk. One day you found him in the lunchroom unaccompanied, so you decided to talk to him. Please enter the lunch room.
• Your friend Jason hasn’t come to class for a few days. Being a hardworking pre-med student, he very seldom skips classes. You know that he is applying to medical school in the past several weeks. You called his house and he said you can visit him. You decided to pay him a visit after your classes.
• You are a cardiologist at a local hospital, who just finished a shift and has a tight run to your daughter’s high school graduation ceremony. As you headed off to the door, Jennifer, a patient who knew you well, saw you from the waiting room and grabbed your attention. “Doctor! I have a bad chest pain. Please stay for a bit. I’ll feel much better if you were here.” Enter the waiting room and talk to Jennifer.
• You are a current undergraduate student. During the week of graduation, you attend a number of parties around the Lower Mainland with your best friend, Kelly. The last party is held at a campground in Squamish. The morning after the party, you receive a call from Kelly. She asks that you come over and talk. Kelly reveals that she left early and drove home despite drinking that night.
• You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell the patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?
• Your 5-year-old nephew asks you, “Why is the sky blue?” How would you answer him using a series of simple scientific experiments?
• Your company needs both you and a co-worker (Sara, a colleague from another branch of the company, who is gripped by fear of flying since one of her friends narrowly escaped being at the World Trade Centre when it was destroyed) to attend a critical business meeting in San Diego. You have just arrived to drive Sara to the airport. Sara is in the room. 
• Additional Role Play & Communication Stations with model answers can be found in the MMI Question Bank