Interviewees for 2011 entrance

Welcome! You will find that I’ve written a bit about the process, and if you pay attention to the posting dates, you will also find that I have not updated this blog in quite a while.

Truth is, I will not be able to continue actively helping applicants and interviewees prepare for the daunting grill of med school application. Which sucks, because I know how hard it is and how much of a difference a little help can make. (At least for me, being in med school is hard, but trying to get into med school was much harder.)

What I could recommend though, is a visit to www.premed101.com/forums/ (which I am sure 99% of you have been to). What many of you might not have done is joining the conversation in a constructive way. Don’t just freak out about minute details or stats – that will only stress everyone else out even more. Instead, help each other. Form practice groups. Answer some questions. Calm people down.

Yes, people on there are applicants and therefore competitors. But I think applying to med school is more like driving on the road. You don’t need to road-race everyone just because they are driving in the same direction. A little courtesy can not only help make the drive less stressful, it would probably help you get to where you want to be.

Feel free to use this blog as a forum too!

A few more thoughts for interviewees

Just held another interview practice for 2 interviewees tonight. This was the first session that I asked for a participation fee because I am starting to shift my private tutoring hours from HS students to premeds. With my previous experience with 18 participants, tonight's session was a lot easier to manage.

At the session, I collected some tips that I think would be useful for most interviewees, so I'll share them here:

1. Use the 2 minutes of reading the prompt to first identify the points you want to cover and formulate a strong opening statement. I find that many interviewees start their answer a bit shakily, only to gain confidence about 30 seconds into the answering period. If they had a simple, strong opening statement, I could follow their thoughts more easily and I generally ended up being more impressed than someone who gave basically the same answer but with a poor opening. Compare the following two openings:
   
   
   
   1. "I think the statement... I think there are a few things that one must consider in this situation... The statement asks about the issue of confidentiality, which I think is very important..."
   
   
   2. "In dealing with the issue of confidentiality, there are several conflicting interest involved. Foremost, the patients trust doctors with their private information... However, infectious diseases pose a threat to the public's interest... To resolve this conflict, I believe..."


2. Always introduce yourself! Depending on your comfort level, you could shake hands with the interviewer and give a big smile. For some people, that will do wonders to calm their nerves. For some, it's more straightforward to stick to business and go right into the question. But whatever your style, remember that a positive first impression wins you half the battle.


3. Demonstrate empathy whenever possible. I wrote briefly about the acting stations in this post, but I'd like to add a few basic skills of empathy so that people have a more concrete idea of what this means.
   
   
   
   1. If you can identify the emotion, identify it! If the person looks depressed, say something like: "you look like you are feeling depressed, would you like to talk about it?"
   
   
   2. Ask plenty of questions. "What's bothering you?" "Has this feeling affected your day-to-day functioning?"
   
   
   3. Appropriate physical contact is fine. Pads on the shoulder is a pretty direct way to show comradeship if done appropriately. Don't force it if you don't feel comfortable.
   
   
   4. Empathy doesn't have to be limited to acting stations! There are lots of situations where an understanding of people's emotions is crucial for a full appreciation of the situation. Ethical dilemma? What emotions could be present on either side of the table?

These tips are pretty general, but I think many people can benefit from them. Of course, a better way would be to practice with someone who can give you specific feedback.

Good luck, get some rest, and take care of yourself! You want to run at 100% capacity and only a good life style can help you do that.

"Doctor's note" scenario - discussion

Here's a reader's question regarding the practice prompt I posted: "Doctor's note".

I have a questions for you about our stations. For Station 3 about the child's note, I was just wondering whether I had gone off on a tangent ... I spent a lot of time explaining to the interviewer how I would: communicate with my son in order to understand why he was telling me he was sick; explain to him the value of the physicians note; and then, if after my discussion with him about responsibility, he still doesn't admit to the truth, I would suggest that we go to our family doctor to get one.

My station interviewer said that my response was mostly based on how I felt but didn't include any "logic" whereby logic would include things such as the impact of giving the fake note and the public's perception of this action by a physician.

So, I was hoping to get your thoughts.  When I first read this question, I think I took it quite literally as in explain how I would deal with this (communication-wise) but it seems that it could also be a question about ethics (would you or would you not give the note and why or why not). Did I miss the point here? And if I did, do you have any suggestions on how I could read these prompts so that I will not miss the boat again? :P

And here's my reply:

It seems like you answered this question quite well until you said you would get a fake note for your son, and your interviewer was quite right to point out the ethical considerations in this situation. Besides honesty and professional integrity being very important for a physician, the public's trust in the profession being jeopardized, getting a fake note for your son is almost certainly detrimental to his character in the long run.

You didn't go off topic if you tackled this scenario as a communication challenge, but like in any other scenarios, ethical considerations must be addressed whenever warranted. The same goes to acting stations, stations that ask about your personal experience, stations about health care... almost any question asks you, explicitly or implicitly, to evaluate right and wrong.

So my answer to you would be: in the 2 minutes that you have to prepare your thoughts, brainstorm all the things you must consider -- who's interest is involved? What ethical aspects are at play? How are you going to deliver your message? Why may someone disagree with you?

I hope this would help :)

[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] 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. :)

[Interview] 5 days till the Big Day

I went to the Wine and Cheese social event organized by the Med Undergrad Society last weekend, and it was really a wonderful night (for various reasons :P). Social-wise, I got to know more med students and reconfirmed my finding that these people are the coolest kids in town. They are so dynamic, so unique, and all so enthusiastic about what they do... I want to be a part of this family.

A few interviewee friends of mine were there too, and one of them were quite nervous about her upcoming interview. She has it at the same timeslot as me.

I, on the other hand, was totally chilled. I could think of a few reasons for this too:

1. I've approached this application as a test run -- just to test the water and see how things work. My real med school application effort will come next year.

2. I'm never the type that gets nervous about exams and interviews; I was talking to another friend the other day, and I figured that my mentality is "do all I can do and see what happens".

3. My mind is just too damn occupied right now to worry about med interview. Is there anything more important than an imminent interview? *Surprised* Yes, yes there is.

Anyway, what have I done in the last little while and what will I do in the next 5 days, in terms of med school interview?

Last week, a friend of mine and I each organized a mock interview, hers at her apartment, and mine at some classrooms on campus. Counting the other practices, I've had 4 runs in total, and really, I think that's enough. If you haven't tried reading the question prompts and answering under time pressure, I strongly recommend you do so. Don't do it by yourself; best to find current med students or friends who are interviewing, but if that's not available, find other friends and family. Just ask them to sit there, keep time, and listen to you talk for 7 minutes.

I'm also reading some books on medical ethics, and I will probably read up on the rural medical issues. The book I am reading is called "Doing Right", by Philip C. Hebert.

Here I'd like to stress how previliged and thankful I feel about having an awesome supporting team of around 10 interviewing students. There is very little sense of competition among our group; we genuinely want each other to do well, giving the best feedback and suggestions we can give to each other. Also, I couldn't find that Doing Right book in bookstores and ordering it would take a month, so I sent out an email to this group for help. Within 24 hours, 3 people replied offering to lend me the book.

Anyway, in the next little while I'm just going to take it slow. Read the stuff I plan to read, do the school work I need to do, and on that fateful Sunday morning sleep in until 10am if I can, get a nice big brunch, take a walk around, shower, change, and drop the bomb.

[Interview] Mock MMI: tips I learned, and why I LOVE MED STUDENTS

Tonight, I met some 1st and 2nd year med students at 6:45, who organized a mock interview with 10 stations for 14 of us. It's now 11:30, and I just got back, being dropped off by a super awesome interviewer who stayed and talked to the very last anxious interviewee.

I'm so thrilled by this process and how much I learned, that I'm now typing this up fast -- still in my suit because I don't have time to take it off.

So, firstly, these are what I learned:

1. Avoid the law. Some situations are complicated with legal consequences, such as when your patient died, but the reviewing committee wants to see your empathetic response. How you feel for the patients, how you express your sincerity, how you approach the situation with warmth and honesty. Screw the hospital protocols; be the genuine, caring person that you are.

2. A big part about being a doctor is educating the patients. When the patients or your friends have some stuff that needs education, take that opportunity and tell them the correct information. Don't assume they are joking when they think STD stands for standard deviation.

3. Explore both sides of the argument when two conflicting sides exist. Even when you are clearly in favor of one side, if there is a dilemma, there has to be a strong argument for the other side as well. Explore that side of the situation and explain why you disagree with it.

4. Explain the thinking process; for questions that clearly does not have a right answer, the answer is not what's important, how you reach your answers is. Explain what's going through your mind, what values are being weighed on.

5. Explore all relevent areas of the question prompt. When the prompt asks for "what are the issues involved", think about who's involved, who's feelings are affected, what are the consequences of your decisions.

6. When the interviewer asks "do you have anything to add", don't take that as an invitation to babble on. If you reached your optimal, stay there and don't distract the interviewer with repetition.

7. Talk in an appropriate tone for the station. Some stations are more creative and fun, while some are more serious and heavy.

8. When a procedure fails, be mindful of the well being of the entire team: the nurses, the anaesthetist, everyone involved.

9. Read up on the Canadian Medical Association Journal for information on rural doctor shortage: rural doctors are actually getting paid more, but still there is a serious shortage, so the financial incentive is obviously not effective on its own.

10. When wearing a suit jacket, the last button should be undone.

[Interview] Practice MMI: Placebo Effects

Placebo (Ethical Decision Making)

Dr Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr Cheung 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 Cheung's behaviour might pose. Discuss these issues with the interviewer.

* * * 

Outline: 

- ethics in informing the patient

- placebo effect as reassurance is trickery and undermines physician-patient trust

- using useless drugs may make the patients feel treated, and they do not have to follow other measures to improve their non-specific symptoms

* * *

Response:

Although the goal of doctors is to improve the well-being of the patients, physically, mentally, and emotionally, I believe that using placebo effects to trick patients into a false sense of safety and reassurance is unethical. It may be true that placebo effects sometimes are real; the mechanism of psychology affecting physiology is poorly understood, but not unheard of. And sometimes the patients may even demand the drugs that they believe are useful.

Despite that, I will explain two reasons why using placebo effect may be unethical, and propose a better approach to dealing with these patients.

First, using the psychological effect of placebo to sooth the patients is at best a well-intended lie. It puts the patient's trust for this doctor and even the entire medical system at jeopardy, since the patient may find out that the drug he or she was prescribed has no effect to improve his or her conditions. 

Second, even if the patient does not find out the ineffectiveness of the prescribed drug, providing him or her with this false sense of security may undermine other efforts to improve his or her health. For example, if the patient is reassured by the placebo for fatigue, he or she might ignore the suggestion to quit smoking, which may actually be the root cause of his or her fatigue.

In the situation when the cause of the patients' symptoms are ambiguous, the physician should be honest and open about the ineffectiveness of placebo, and suggest treatments that are actually beneficial for the health of the patients. These may not even need to be pharmaceutical; for non-specific symptoms that do not have medical treatments for, suggestions for a healthy life style such as regular exercise, a balanced diet, and adequate rest would be more beneficial for the patients.

[Interview] Rules of the Game: Multiple Mini Interviews

I think by now we all know what MMI is, if not, it's a lot like this:

Basically, this is like speed dating but with very serious dates who grade you not on your looks but on your character. (Hm... my own metaphor intrigues me... which type of dates would I prefer?)

The above is the official description. But like everything else med school-related, there are abundent myths surrounding the details of this interview process. Here is a list of them and what I gathered:

Myth: the interviewers are not allowed to respond to you in any way, including nodding. They are not allowed to say a word, so basically you are talking to a video camera with a human face.

What I gathered: the interviewers are not allowed to talk to you about anything unrelated to the question. But they can ask you things related to it, so to probe your thoughts and keep the conversation going. I think it's true that they are not allowed to nod though, so it would be kinda weird.

Myth: it's better to keep talking, because otherwise the room will fall silent and awkward.

What I gathered: if you run out of things to say, the room will fall silent and awkward. I have a friend who stopped talking and stared at the floor with the interviewer for 2 minutes until the time is up (the interviewer was not allowed to keep talking or write down notes in the presence of the interviewee, so he had nothing to do either). But I think that's better than rumbling on with the same thing over and over again and muddle your arguments.

Myth: there is nothing you can do to prepare for the MMI becaues you will never know what the questions are.

What I gathered: the skills to read the question under pressure, synthesize a well structured oral response in your head, and articulating your thoughts precisely and concisely may be much more demanding than you thought. It is actually quite easy to stare at the question prompt and waste your 2 minutes, and be completely confused and nervous in front of the interviewer.

My solution: practice with mock MMI's.