[MMI Prompt] Ex-convict

You are a major of a city, and a high profile rapist who finished his jail time is going to be released from prison next month. He is deemed to be of high risk to reoffend once he is free. The word is that he is considering relocating to somewhere near your city and possibly adopt a new identity.

There is tremendous public pressure to increase police surveillance on him, make his new identity public, or at least warn the public of his imminent release.

What would you do?

[MMI Prompt] Bullying

You are a third year medical student doing a clinical rotation in surgery. The surgeon you are working with is abusive towards everyone, constantly yelling at patients for disobeying his orders, criticizing nurses for failing to "do things my way in my OR", and having unreasonable expectations of you then calling you an idiot who shouldn't be in med school.

You feel offended, humiliated, and lost. What would you do? Your rotation is coming to an end and your evaluation is in one week.

[MMI prompt] ski trip

After a long school term, you are excited about the winter break. You planned ahead for a ski trip with some friends, and you booked a condo for 8 people who confirmed that they are coming with your own credit card. They agreed to pay you later.
At the last minute, however, one of your friends suddenly called you and said he couldn't make it. To make matters worse, he was one of the drivers. Now you are not only short on people paying rent, you have to figure out how to get another 4 people on the mountain possibly at a higher cost than agreed upon.
What are you going to do? What do you say to this friend?

[MMI prompt] Brian McKeever

The story of Canadian Olympian and Paralympian Brian McKeever has touch many during the 2010 Winter Games in Vancouver. He was the first ever to qualify for both the Olympic games and Paralympic games, but at the last minute, the Olympic skiing couch decided that Brian has a smaller chance in winning than his teammates, so he did not get to race.

If you were Brian's friend, what would you do when he found out he couldn't race in the Olympic games? You knew that his Paralympic games would take place 2 weeks after the Olympics.

[MMI prompt] Senior's driving right

Statistics have shown that 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's.

Do you think older drivers have to give up driving when they reach a certain age?

[MMI prompt] Doctor's note

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.

Some follow up questions:

1. What if Mark told you that he wasn't really sick, but he really really needed your note?


2. What if Mark was your son? What must you consider in this case?

5 principles of Canadian health care

I remember I used to be most intimidated by mmi questions related to Canadian health care... I just don't know much about it! I knew that there's this card that I need to bring to see a doctor, and if I tell my dentist that I am a university student with insurance through the school I can pay less money. Beyond that, I really had no clue.

That's why I'm so impressed by a participant at last night's practice mmi. He shared a way to systemically tackle questions related to Canadian health care. Namely, by addressing the "5 principles":

• public administration,


• comprehensiveness,


• universality,


• portability, and


• accessibility

To borrow the summary from the The New Press, they mean:

1. Public administration avoids the profiteering and thus the additional 20-30 percent overhead and profit associated with for-profit insurance companies. As with US Medicare the overhead for public health insurance is much less—4-5 percent.


2. Comprehensiveness means all necessary services are covered. Unless everything is covered, potential savings are lost if patients delay preventative care or necessary care as a result of financial concerns.


3. Universality means everyone is covered. Covering everyone allows allocation of resources based on need of the community rather than profitability. This kind of allocation of dollars allows for long range goals and planning improving the health of a neighborhood, a community, a city, a state, a nation.


4. Portability means you can take it with you. US citizens stay in unwanted jobs just to keep their health insurance. Reduced productivity of people who hate their jobs can stagnate an economy. Canadians are free to follow their dreams, because coverage is guaranteed.


5. Accessibility means freedom from economic, geographic and bureaucratic barriers to health care.

Try to apply these principles when answering this question:

"How would the 2010 Winter Olympics affect the health care of BC residents?"

[MMI prompt] Unprofessional colleague + tips for acting stations

I helped out at a practice interview session organized by a friend of mine tonight. It was a great success! I hope to replicate the organization and success with those of you who signed up in time, but we shall see how it turns out :)

I wrote this scenario for the acting station of tonight's practice:

You are a 3rd year medical student doing hospital rotations. A fellow medical student who is doing rounds with you often show up to these sessions tired, messy, hungover, or even drunk. One day you found him in the lunch room unaccompanied, so you decided to talk to him. Please enter the lunch room.

As we discussed earlier, the key to success for this type of stations is to go in with an open mind and let the troubled character in the situation tell his/her story first before you move onto. As I acted, I was looking for some "right questions" such as "I've noticed that you are often really tired, are you stressed?" or "is there a reason why you started drinking so heavily?" from the interviewees for me to go on to reveal the back story:

On the surface, he is a party-goer who risks patients' safety for his personal enjoyment/intoxication. When questioned, he initially provides irresponsible answers such as: "I just like to get drunk", "I like meeting girls at clubs and telling them I'm going to be a doctor", "I can perform in the hospital just fine even if I had a few drinks". And he can get defensive "what do you care?"

But upon persistent and nonjudgmental questioning (otherwise stay defensive till the end), he reveals that he is unsure of the career in medicine and doesn't want to quit but really isn't enjoying what he is doing. Lots of stress resulted from this internal conflict, which pushed him to escape by going to parties and forgetting about his worries. His grades, relationship with family and friends, and health are all suffering.

Some people started on the wrong foot and began to lecture too early ("You shouldn't be drinking so much, it's bad for the patients"), but most people were able to suspend their judgment and focus on helping the colleague. Some did better and invited him to share the reasons behind his drinking problems. This requires some empathy skills (watching out for the colleagues' posture, emotions, key words like "drinking takes my worries away"), and some listening skills.

Some things that were well-done by the participants tonight, in point form:

• suggested career counselling. Never offer advise that you are not trained to give like "maybe you should drop out of med school"


• encouraged colleague to reflect on what brought him into medicine in the first place,


• listed motivations to get help with drinking problems, such as a better controlled life-style, patients' safety, and the public impression of the medical profession,


• opening with "do you have a minute? I have something I'd like to talk to you about",

Some things I would suggest to everyone facing questions like this:

• ask lots of questions, don't rush to provide answers before you get the complete picture;


• referral when appropriate;


• relax!


• some lecturing is called for in this situation.

Even the best participants tonight could do better with the last point: there is a hard message that you should give your colleague -- drinking is not acceptable when you are acting as a health professional in a hospital. The key is to build understanding and trust with the colleague first before you deliver this message, through listening, empathy, and the above-mentioned good stuff.

Once you've shown that you understand your colleague and is interested in helping him with his concerns, you can say something like this:

"As your colleague, I have to tell you that you really need to address the drinking issue. This is for your own benefit as well as everyone around you, because this will help you find a lifestyle that you can enjoy and help your patients receive the care that they need."

[MMI prompt] Public health

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?

[MMI prompt] Acting stations

A special type of MMI stations is acting. I personally like this type of stations because I think they are fun and creatively challenging. However, these are also the hardest to practice; you really do need actors to act out the scenarios, otherwise you can only imagine what happens and how you will respond.

A very important thing to note is that the prompt may not give you all the information on the scenario. Here's an example:

Your friend Jason hasn't come to class for a few days. Being a hardworking premed 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.

Enter the room and talk to Jason.

And in the room, you may find Jason all depressed, drunk, and if you ask the right questions, he may tell you that he is suicidal.

Unlike the "dilemma-type" questions, which is designed to reveal your problem solving and reasoning skills, the acting stations are here to test your ability to respond to physical and verbal queues, to communicate under stressful situations, etc. Namely, your empathy skills.

And the best way to practice, is to find a few friends or family, and try out a few different scenarios. Or better yet, watch out for real situations in which your friends or family need a listening ear. For those of you who volunteer at a counselling service, or stay up late into the night with a friend who just broke up, grab your chance to shine. :)

[MMI prompt] Non-paternity

You are a genetic counselor.  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 carry 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 Linda nor her husband are 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?

[MMI prompt] Health care

In a particular socialist society, the health care system is set up as follows: the public shares the cost of health care, and everyone who needs it enters a line-up. Because the public funding is limited, the health care system does not operate to its full capacity (in other words, some doctors want to work more hours but can't get paid for extra hours), and the line up for health care is long.

It has been proposed that in order to reduce the burden on health care, we allow some patients to pay for their medical services and receive them faster. It is argued that the rest of the public will not have to wait any longer, because the doctors and surgeons have unused hours, and the private funding goes to pay for these hours instead of jumping the public line.

Discuss the pros and cons of the introduction of this two-tier system (ie. coexisting public and private funding sources for health care).

[MMI prompt] Doctor's obligation

You are an ER resident who specializes in trauma. One day, a martial arts sportsman is sent to your ER with an apparently throat injury. His coach said he was hit by the opponent in the throat during the semi-finals match. You are aware that in this type of martial arts, attacking unprotected areas of the head such as the throat is ground for disqualification.

Your attending physician (your boss in the hospital) told you that the opponent of the injured player is your countryman, whereas the injured player is a foreign contender of the champion title that your country values highly. He wants you to "examine the injury carefully" right after he remarks how important the match is for the country.

How would you handle this situation?

[MMI prompt] time management

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, Mark, 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 Mark.

[MMI prompt] driving a friend

Prelude

I'm sure if you have googled "practice mmi" or anything to that effect, you would have come across a very good set of 10 practice questions, with a variety of categories. If you haven't already, practice with these first. This set of questions are prepared by people who created the whole MMI business, and few things other than doing a real MMI can give you a better pictures than this.

Having said that, it'll be quite easy to finish all of these questions and still feel under-prepared. That's why I'll post some questions that I've come up with (in no shape or form are these from my real MMI for obvious reasons), as something you could think about as you prepare.

Driving a friend

You have been in a new relationship for 5 months, and you just got into medical school. As the saying goes, many relationships are ended in med school because of the stress, and lack of time, and the excitement of meeting hundreds of new, young,  intelligent soon-to-be doctors. You suspect that your partner is slightly worried about your attending medical school.

One evening, you have to attend a social event that your partner cannot go to. One of your colleagues from out of province asks you for a ride to the party, as he/she does not know how to get there. You feel slightly uncomfortable but at the same time obligated to help as a local and a friend.

How would you approach this situation?