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How to ace policy type interview questions such as: "What is the greatest challenge facing the health care system?"

Questions that ask you to address substantive matters of policy or practice in medicine afford you an opportunity to exercise your 'big picture' analytic skills while also showcasing your prior experience in the health system, from volunteering to work to research.

In Sherwin B. Nuland's Doctors: The Biography of Medicine, he describes the most essential criteria for answering a technical question in the life sciences: clear, concise, complete, correct and consecutive. I would like to posit that while these criteria don't make for the most interesting answers, they make for very doctor-like answers. These criteria will make you look prepared and systematic. Use them.

What is the policy type interview question "what is the greatest challenge facing the health care system" actually asking?

This question is asking you to communicate competently around a major issue that poses risk in your health care system. The goal is not to pick the correct issue, there is no correct single issue, but you should know something about three or four 'pillar issues'. Pillar issues include: health human resources, integrating technology into health systems, patient confidentiality, access to primary care, health equity, appropriate use of emergency medical services, cost containment, managing inefficiencies, adequate provision of mental health services, antibiotic stewardship and the social determinants of health.

What should you know about each of these? Enough to articulate a few sides of the issue, future directions, core ethical tensions implicit in the issue and relevant legislation and policy. You should also have your own position, rooted in reasoned deliberation and evidence. The best way to start your answer is with a story from your lived experience. If you've been an ER patient care volunteer, then you should talk about how insufficient access to primary care after hours in Canada leads to inappropriate use of ER services during evenings and weekends. This is a significant inefficiency that you could discuss using a particular story of a patient you met or saw. Please ensure that you always respect patient confidentiality. Talk about how the ethical tension of the issue played out for that patient, or their family.

How should you talk about your accomplishments while also answering this question?

In addition to using real narratives from patient stories you've witnessed through research or volunteer work, you can lend credence to your perspective on the most important issue by talking about relevant experiences. For example, if you volunteered in a food bank, you can discuss food security as a threat to reducing the burden of cardiovascular disease and obesity in your area. If you did research on lung cancer or chronic obstructive pulmonary disease (COPD), you can talk about smoking as a core driver of morbidity and health care expenditures. If you're from a rural area, you can talk about differential access to specialized care for people in rural and remote settings. Your objective should be to connect the story of the most important issue to the reason you want to become a doctor and why you would be an excellent doctor. As we have discussed on this blog, knowing why you want to be a doctor is among the most significant hurdles in the application cycle. I don't mean that you should have a vague notion in your mind about why you want to be in medicine, I mean you should have a cohesive and compelling written paragraph about why you want to be a doctor and it should ring remarkably true for you.

Where do I learn about core issues facing the health system in Canada & the United States?

First off, you should get to know the Canadian and/or American Health Acts. This is the core legislation enshrining the principles of health care systems in the US and Canada. Second, you should understand how hospital and physician services are paid for and regulated in your jurisdiction. Check out your state/provincial sites.  Also consider combing your local and national papers in the months before your interview so that you can absorb a variety of voices on important matters. Of course, if you've got time in your schedule, it makes sense to take a health policy or health studies course. Learning the language from someone with an advanced degree in the topic can make understanding the vast challenges facing doctors and the health care system more straightforward. It is your responsibility to develop a point of view on the system you aim to work in and you do patients a great service by becoming a reasoned advocate.

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About the author:

Dr. Ashley Faye White is currently a rural medicine resident at McMaster University and a senior admissions expert at BeMo. She has an M.D. from McMaster medical school and has navigated her way into med school as a non-traditional applicant.

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