[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."