How to Prepare for Ethical Questions in a Medical School Interview

Why Ethical Questions?

Not knowing what kind of questions to expect is one of the biggest challenges when it comes to preparing for a medical school interview. There are some common medical school interview questions that are incorporated into most interviews, like tell me about yourself and why do you want to be a doctor, but what about all the other inquiries you should expect? There are a number of question types that are often used in interviews and ethical questions are perhaps one of the toughest categories you can face.

Why do interviewers ask ethical questions during a medical school interview? The interview landscape has drastically changed over the last couple of decades. Admissions committees what to assess your ability to think on your feet, your decision-making process, and your ethical values. Talking about your journey to medical school is one thing, but to be asked to talk about a moral dilemma in a mature and professional way is a totally different thing. Ethical questions allow interview committees to evaluate some of the most important qualities required for a good physician: communication skills, non-bias attitude, sound judgment, empathy, and more.

Today, ethical questions are incorporated by a variety of professional schools in their admissions processes. You can easily expect ethical questions if you are preparing for a nursing interview or physician assistant interview. You can expect ethical MMI questions, or during your CASPer test. This is why understanding what is expected of you and having a solid answer strategy is key. Proper interview prep for these types of questions can help you articulate your position and devise a solid decision-making plan that will impress your interviews, and later, help you as a practicing physician.

If you would like tips on preparing for your med school interview, check out this infographic:

Read on below to learn the best answer strategy for ethical medical school interview questions and our expert response to an ethical prompt.

How to Prepare for Ethical Questions: A Step-by-step Guide

The Fundamentals of Ethics Questions

First things first: it’s important to note that you are presented with ethical questions not to solve a world problem, but to demonstrate your decision-making process and the logic behind your decision. And here’s the first important rule of answering questions about ethical dilemmas: you must act. You cannot simply read or hear a prompt, decide it's too difficult, and say "I will delegate the decision to my manager/supervisor". This is not an acceptable answer. The interviewers expect you to come up with the best possible solution to a dilemma you are facing, even if there is no perfect way to solve the problem. They do not expect you to eradicate world hunger or cure cancer in 4 minutes that you have to answer the question, but your answer must demonstrate sound judgment and a mature attitude.

Introductions and Goodbyes

Before we get into the nitty-gritty of how to answer ethical questions specifically, let me remind you that how you set up the answer is just as important as its content. If your ethical question is asked during an MMI interview, do not forget to greet your interviewer(s) when you enter the room and ask for their name if they did not disclose it. Repeat their name(s) when you are leaving the station by thanking them for their time. These little details will help make a great first and last impression.

Now, let’s get into how you can answer ethical questions in a medical school interview setting.

Recap

Your answer must always start with a quick recap of your prompt. Whether you read it on a door before you enter an MMI station or whether you are given it verbally by your interviewers, a quick recap will show that you understand the situation you are in. Your recap must do the following:

A good recap will take 15-20 seconds and will incorporate all three elements seamlessly. Identifying your role should be your first step because it will allow you to gauge the parameters within which you can act. For example, if you are presented with an issue where you witness a customer yelling in a grocery store, your decision-making will be affected by whether you are another customer, a junior grocery clerk, or a manager of this store. By identifying your role, you will identify what kind of authority you have and what level of responsibility you have when dealing with this ethical dilemma.

In your recap, acknowledge all parties that are involved in the scenario/question – this will help you navigate your answer. Aim to restate only the facts that you are presented with. Do not make any rash judgments or assumptions about the parties involved. The prompt might purposefully lead you astray by including details of those involved that affect your judgment, but you must stick to the facts when you recap. Only facts should affect your decision-making.

And most importantly, your recap must identify the ethical issue that you have to address in your answer. Is it a conflict of interest? Is it an issue of professional boundaries, obligations, and ethics? Even if it seems common sense, do not assume that the interviewers know that you understand the ethical issue at the center of the scenario. Articulate it clearly in your recap! Identifying the central issue will guide you through your decision-making and keep you focused on what you must do to find the best possible solution.

Focus on the Decision-Making Process Rather Than the Decision Itself

As we already mentioned, the ethical issues you are presented with during an interview cannot be solved in 5 minutes. And typically, there is no universal right answer to these questions. But there are wrong answers and wrong approaches to solving these dilemmas. So, do not focus on proving the perfect solution – rather, focus on the process of making your decision. Outlining the steps that you are going to make to solve a problem is much more important than giving the perfect answer. What does this mean?

After your recap, start by clearly stating that you are not going to make any judgments or assumptions about the situation. For example, if we continue with the example of a loud grocery store customer where you are simply a fellow customer, you can say “I will stay calm and not get upset about the customer’s behavior. I do not know whether they are upset about a personal issue, or whether they have health issues that affect their actions”.

Next, clearly state the steps you will take to mitigate the problem. Start by gathering information. This is always a good step for demonstrating that you want to make a non-bias decision. Say your steps out loud. For example, to continue with the example of the grocery store customer, you can say “I will gather more information to assess whether the customer is yelling at someone or whether they are simply raising their voice when they speak. I will gather more information to understand how I can help the customer and other customers in the store.” This shows that you are taking action to solve the problem, gathering more information to make a sound decision, and it also shows that you are empathetic to this person. You do not react poorly to their emotional state or reject their outburst without figuring out what is bothering them. The gathering of information is a very important part of your answer. This is why you must clearly articulate every step you would take. Do not assume that the interviewers can read your mind or understand your decision process. Voice every step you are taking.

Very importantly, do not let the prompt sway your decision-making. Oftentimes, the prompts are designed in a way that triggers your prejudices or assumptions. Focus on facts only by filtering any qualifiers that should not affect your decision. This is very difficult to do! Only practice with ethical questions and personal feedback of a professional can train you to sift through unnecessary misleading details of ethical questions.

Conclusion

Your answer should end with a statement of clear action. Even if it does not solve every issue in the question and appease everyone involved 100%, based on the information you are presented with and what you gather, you must make the best possible decision for the scenario you are facing. Use the if/then formula to articulate your conclusion. For example, continuing with the example of a grocery store where you are just another customer, you can say “After gathering information and talking to other customers in the store, if I find that the customer is suffering from a health issue that triggered an outburst of anger aimed at nobody and I see that no harm has been done to other customers and myself, then I will continue my grocery trip unperturbed.”

Importantly, if possible, your answer should also include action for the future that would help address the issue and appease all parties involved in the scenario. For example, with the case of the grocery store, you can say that you would educate yourself on mental health issues and promote others to do the same. This shows long-term thinking that will truly impress the interviewers.

This video covers Ethical Questions in Multiple Mini Interviews and offers tips to answer questions:

Sample Prompt, Expert Response, and Analysis

Now, let’s go over a sample prompt, expert answer, and professional analysis of an ethical question that will help you cement the steps we outlined in the section above.

Prompt

You are the only ER doctor on duty, and you are responsible for all the decision-making during this shift. This night, you have two patients rushed into the ER who both desperately require a kidney transplant. One of the patients is an 80-year-old university professor suffering from acute kidney failure related to his age. The other patient is a 20-year-old university student who has been brought to the ER several times previously. Here he is again with another episode of kidney problem related to excessive drinking of alcohol at school parties. There is only one kidney available that matches both patients. Who do you give the kidney to?

Expert Answer:

“I am dealing with a pretty significant ethical dilemma. While I am the only physician in the emergency room in charge of making decisions, two patients with severe kidney complications come in. One elderly man with acute renal failure and one young university student. Both of these individuals require transplants, but there is only one kidney available that matches both.

I am in a very difficult position. The central issue here is to make sure that this kidney goes to whoever has the best chance of accepting it successfully. I am sympathetic to both of my patients and what they are going through, whether it's a renal failure or kidney complications, both are extremely painful. However, I need to make sure that whatever decision I make is based on scientific evidence, current literature, my own expertise, and my clinical experiences.

The personal backgrounds of each of these candidates are irrelevant. What matters most and what my decision will be based on is who will benefit the most from the transplant and who has the best chance of surviving the surgery, surviving the post-surgical complications that might arise, and who is least likely to reject the transplant.

The first thing I need to do is to get these patients stabilized and buy myself some time. I am going to put both of them on dialyzes and monitor them closely. This will give me time to gather more information from relevant resources and brush up on some literature, if necessary. I may also consult with some of my colleagues. And if it has not been done already, I would make sure the patients’ families are contacted.

I will review the medical records of each of these patients and take a detailed history. I need to find out if they are on any medications and whether they have any other conditions and any other information that would affect my decision-making. I will send for some tests and lab work to verify their health information.  

My analysis will be as objective as possible, analyzing risks and benefits for both patients. And then, based on what I learned, I will perform the transplant on whoever has the best chance of accepting the transplant from a scientific and clinical point of view. Whoever receives the kidney will be eventually educated on any potential complications that might arise and any lifestyle changes that might be necessary.

Importantly, whoever does not receive the kidney will remain under dialysis, under monitoring until another kidney becomes available."

Expert Analysis

As you can see, the answer starts with a quick recap of the prompt. This is especially important for MMI stations, but even if you have a traditional or a panel interview, a 10-20 second recap of your prompt is a good idea. This will allow you to re-state important points of your scenario, identify your role and demonstrate to the admissions committee that you understand the central issue of the situation.

In our expert response, note that the speaker clearly identifies their role. Being able to identify your role in a given scenario allows you to reflect on what options are available to you and what you can do to address a situation since different roles give you different options. For example, if you are not the physician in charge, your actions might be different. This is why identifying your role at the beginning of the answer is very important.

Another vital component of the recap in our case is that the speaker focuses only on objective facts. They do not add any personal speculations or judgments. No moral claims are made regarding the patients. Notice that the speaker does not mention the reasons as to why the patients are in the ER or speculate as to why both are experiencing kidney issues – the patients’ lifestyles are not mentioned at all.

And most importantly, the speaker clearly identified the ethical dilemma of this question. Who gets the kidney? How do you come to this decision?

The answer clearly states the central issue of this scenario: they must decide who has the best chance of accepting the transplant and surviving the surgery. The speaker emphasizes that only this should lead their decision, not any other circumstantial qualifiers like age or lifestyle. The decision must be made based on scientific evidence and clinical expertise. The patient’s history is irrelevant. While the decision is pragmatic, the speaker adds a human touch by emphasizing that they are empathetic to the patients’ pain.

The speaker creates a logical, step-by-step guide that outlines what they will do to make sure the best decision is made. They will stabilize the patient, gather all the available relevant information, and make the decision based on these results. The prompt intentionally leads us astray by providing qualifiers such as the patient’s age and addictions. When you initially look at the prompt, you might be tempted to make judgments such as “he is too old” or “he has bad habits” and focus your answer on these details. But remember, any ethical question must be approached with a rational and non-judgmental attitude.

The answer is concise and clear, providing us insights into the logic behind the decision. Note that the speaker articulates even the most seemingly insignificant details like looking at the patients’ history, consulting with colleagues, and gathering all the relevant information about the patients’ health. You might think that the interviewers will simply assume that you will do all these things, but this is not the case. You must articulate everything you will do, including things you consider commonsensical. So, when you answer, make sure to outline every step of your decision-making process.

Once the speaker reaches a decision, they conclude with a look to the future – whoever does not receive the kidney at this moment will remain on dialysis and will be monitored until another kidney becomes available.

Ethical questions can come up in any interview format. Check out what kind of interviews you may be facing:

Conclusion

At the core of ethical questions is the desire to see what kind of logic and actions you will take in a difficult situation. Becoming a physician means taking on responsibility for your patients and those in your care. You must demonstrate that you understand the gravity of ethical situations and know how to address such issues with a calm and sound decision-making process.

This kind of attitude is not easily developed. In fact, sound decision-making comes with lots of years of experience. If you are a traditional premed student or even a non-traditional medical school applicant, you might not have enough experience to craft a well-articulated decision under pressure. This is why practice is important.

Practicing alone with sample ethical questions is a good start, but it’s better to get feedback from a professional who can help you work on your answers during a mock medical school interview. The problem of ethical questions is that there is no cookie-cutter temple for answers. Each student’s decision-making process is different and it’s important to hear whether yours is sensible. This is why a medical school advisor or med school interview prep services can help you assess whether you are ready for these types of questions. Consider reaching out to medical school admissions consulting to evaluate your answer approach and help you work on delivering concise and impressive answers.

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