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MMI Questions: Scenario
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MMI Question #1
A 14-year-old patient requests birth control pills from you and asks that you not tell her parents. What would you do?
In this scenario, I am a physician with a 14-year-old patient who wants birth control pills and does not want me to tell this to her parents. As a physician, my main concern here is the wellbeing and safety of my patient, the 14-year-old. First, I must gather more information. I would ensure my patient and I are in a private area and she does not feel rushed. I should sit down and ask her why she is interested in birth control. I can also find out what she knows about birth control, and if she has taken birth control pills or used other contraceptive methods in the past. I should also ask if she has any other medical issues. Importantly, I need to sensitively ask if she is sexually active and to ensure she is not being forced or coerced into anything. Based on the information she gives me, we can plan together. She could simply be curious and not be sexually active right now, in which case I would give her resources (ex. websites, pamphlets) to find out more information.
If she is planning on being sexually active and is consenting to this activity, and I feel she understands the risks and benefits, I would go ahead and prescribe the birth control for her. My concern is my patient, and prescribing the pills is important for her safety; however, I would address that birth control pills do not prevent STIs and would give her the appropriate recommendations for preventing them. I would tell her that our conversations are confidential, and I would not share anything with her parents without her consent. Physicians must judge whether a patient is a mature minor and can consent to treatment without parental input. If I feel she is not able to consent as she does not understand the risks and benefits, I will let her know that I need to have a discussion with her and her parents present prior to prescribing the pills. If I feel that she is being abused or coerced into sexual activity, for example by a person over 18, I will need to report this to the appropriate authority. I would ensure to set a follow-up appointment with this patient prior to ending our visit.
To summarize, I would ensure my patient’s safety and find out more from her prior to planning with her input for further steps. Thank you and I am happy to address any follow-up questions if you have them.
MMI Question # 2
A member of your family decides to depend solely on alternative medicine for the treatment of his or her significant illness. What would you do?
In this scenario, I am a family member of an individual opting to pursue alternative treatments for their significant illness. My main concern here is the wellbeing and health of my relative. I must not jump to conclusions, and I will gather information first. I will have a private conversation with my relative. I will start by asking them an open-ended question: “How are you doing?” I can then ask them how they are coping with their illness. Then, I can ask what treatments they are pursuing. They may, in fact, be pursuing both traditional medical treatments with their physician and using alternative treatments as an adjunct with their doctor’s knowledge, in which case, I can offer my support and ensure I check in on them regularly.
They may, on the other hand, be pursuing only alternative treatments and not using any traditional allopathic treatments. In that case, they may simply not have discussed this with their physician; I can suggest that, since I care about them, I feel they should make a visit to their physician and let them know what treatments they are using. Alternative treatments could interact with traditional treatments, or may even be making their condition worse, so I would encourage them to disclose this information to their physician.
They may also not be trusting of allopathic medicine or physicians and be resistant to seeking out traditional, evidence-based treatments. I would want to listen to why they feel this way, and still offer my opinion that seeking out a physician’s opinion may be helpful to them, and I wish to ensure their future health and wellbeing. Perhaps they had a negative experience with a physician, and I can suggest seeking out another physician or going with them to the appointment if they are OK with that. However, there is a chance that they simply do not wish to pursue treatment with a physician. In that case, if they are competent to make their own decisions, I need to respect their autonomy to make their own medical decisions. I can keep checking in on them, however.
On the other hand, if I feel they are not competent to make medical decisions anymore due to cognitive impairment, I need to bring this up with the closest family member who could be their decision-maker; this is necessary to ensure their safety.
To summarize, I would focus on my relative’s well-being and safety, gather information, and respect their autonomy, while also relaying my concerns about their health to them.
MMI Question #3
If you have the choice of giving a transplant to a successful elderly member of the community and a 20-year-old drug addict – how do you choose?
In this situation, I am faced with the ethical dilemma of giving an organ transplant to a successful elderly member of the community or to a 20-year-old drug addict. First, I must remain non-judgmental and gather information. I must not jump to conclusions about age or the fact that one patient appears to have a dependence on drugs. First, I will ensure that both patients are indeed matches to receive this transplant. I need to find out about both patients’ conditions and what led them to requiring an organ transplant. I must also find out about the prognoses of both patients, post-transplant. Which patient is more likely to recover and gain the most from this transplant, including not just quantity but quality of life? Since organs are a very limited resource, I need more information first.
I also should not feel that only my opinion is important here. Healthcare is a team-based environment, and I will seek out others’ thoughts, including the patients’ physicians, nurses, other healthcare staff, and the hospital ethics or transplant board, which is often involved in finalizing these decisions.
If it turns out only one of the patients is a match for the transplant, then the team will go ahead with the transplant. For the patient who does not receive the transplant, the healthcare team will discuss this with the patient and their loved ones, and ensure they understand that not receiving the transplant right now does not mean that we are going to stop treatment or looking for ways to improve their condition, and that they are still on the transplant list. However, in the case where both patients are matches and can receive the transplant, I will consult with the other senior physicians and the hospital ethics or transplant board to assess which patient has the best chance of survival and quality of life after the transplants and decide on this basis. In either case, the decision will be made non-judgmentally and based on which patient will be able to have a strong recovery from this transplant.
Moving forward, I will ensure our hospital has a clear set of guidelines in place, so organs are allocated on a non-judgmental basis with clear policies in place. To summarize, I would gather information and ensure we have been non-judgmental in deciding which patient to provide the transplant to, and ensure guidelines are in place for future situations like this one. Thank you and I look forward to addressing any further questions you have.
MMI Question #4
An 18-year-old woman arrives in the emergency room with a profound nosebleed. You are the physician, and you have stopped the bleeding. She is now in a coma from blood loss and will die without a transfusion. A nurse finds a recent signed card from Jehovah's Witnesses Church in the patient's purse refusing blood transfusions under any circumstance. What would you do?
In this scenario, I am facing the ethical dilemma of whether or not I should override the recently signed card from Jehovah’s Witness Church found in the patient’s purse that indicates they do not want to get a blood transfusion in an attempt to save their lives. First, it’s important to act quickly and without judgment. The patient’s life is at risk, but I also must respect autonomy. I must recognize the significance of the patient’s religious belief that it is against God’s will to receive blood; betraying this commitment will lead to potential ostracization from their religious community. I also know that many people observe their faith differently, and pressed with an urgent medical matter, often go against this belief. This is why it’s important to investigate and not jump to conclusions.
If the girl’s family were present, I would consult them about the patient’s surmised choice not to accept the transfusion. I would explain clearly and calmly that if the patient doesn’t get the blood transfusion, they will die. An emergency room is also a highly collaborative environment, so I would consult with other physicians about the ramifications of the patient’s decision and confirm that respecting her autonomy is the correct ethical move. The bottom line is that the patient’s choice can reasonably be confirmed by the card, so there is no valid reason to go against their wishes.
If the information was lacking, for example, if I knew the patient was a Jehovah’s witness but didn’t have the card, or their parents weren’t present, then it would still be best to act in the patient’s interest and proceed with the transfusion. In either case, I would need to work with my colleagues and the hospital’s legal team to make sure the legal and ethical ramifications align with the pillars of medical ethics, which also entail nonmaleficence and justice. I think it would also be necessary to review the girl’s medical history to determine if she’s had a transfusion before.
Looking at the card’s date, if there is an indication that she did receive a transfusion or similar medical procedures after that consolidation date and also confirmed by the family that the patient is actually consenting, then the healthcare team will go ahead with the blood transfusion. If, the family are the ones objecting to the transfusion but it’s clear from research that the patient is actually consenting as evidenced by recent transfusion, then the team will explain to the patient’s family and respect the patient’s autonomy and go ahead with the blood transfusion.
However, if the card’s validity is established as confirmed by the family, then it’s important to respect the patient’s autonomy and religious beliefs and not transfuse. However, the healthcare team will research into other viable treatments options to ensure the patient has the best chance of survival.
In summary, because the girl is eighteen, an adult, and the card is valid, I believe it would be best to not transfuse, unless there is an indication from her medical history that she’s had a transfusion or similar medical procedure after the date that the card was signed.
MMI Question #5
Your mother calls you and asks you to help with a major family decision. Your maternal grandfather is 70 years old and has been diagnosed with a condition that will kill him some time in the next five years. He can have a procedure that will correct the disease and not leave him with any long-term problems, but the procedure has a 10% mortality rate. He wants to have the procedure, but your mother does not want him to. How would you help mediate this issue?
In this situation, I am being asked to mediate a disagreement between members of the family on whether my grandfather should agree to a procedure that will correct his disease. However, the procedure has a 10% mortality rate, but if he doesn’t agree to it, it will kill him at some point in the next five years. With my grandfather’s health and well-being being my primary concern, I will need to hear everyone’s side of the argument. We will need to resolve the disagreement by clarifying misinformation and by asking productive questions. I will start by asking my mother to explain her side of the argument so I can understand what she’s worried about. Then, I will ask my grandfather to explain why he wants to commit to the procedure. Even though his answer may seem obvious, it isn’t fair to assume; furthermore, communicating openly will facilitate understanding and openness to new perspectives.
After everyone has a chance to speak, if it turns out there was just miscommunication between my grandfather and my mother and in actuality, they are in agreement with his treatment plan, that is, going ahead with the procedure, I would initiative a family meeting to clear up any miscommunication and ensure my family provides the needed support for my grandfather as he undergoes this procedure.
If it turns out both my mother and grandfather are both aware of their differing stances on how to proceed with my grandfather’s diagnosis but hadn’t taken the time to understand each other’s perspective. I would again initiative a family meeting to sure everyone is able to articulate where they are coming from. Ultimately, I will ensure my mother understands it’s my grandfather’s decision and hopefully she’s understanding and is able to fully support my grandfather, and my grandfather is able to understand where my mother comes from.
If, however, even upon my grandfather openly communicating his choice and his reasons for wanting to go ahead with my procedure my mother is still adamant, I will emphasize that no matter what, the choice is ultimately my grandfather’s. As long as he understands the risks, he can give reasonable consent, and his final decision is informed, then he has the legal and moral right to the decision-making responsibility for his own treatment.
In summary, I start by asking everyone to state their opinion clearly, then I would steelman both sides of the argument; next, I would make sure the consequences of each option are understood by everyone. Finally, I would emphasize the importance of allowing my grandfather to make the final decision.
MMI Question #6
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?
It's crucial to approach this situation with sensitivity and empathy while respecting the autonomy and emotional well-being of the individuals involved. Additionally, it is important to acknowledge the emotional nature of the information and be empathetic about the potential impact it may have on Linda and her family.
Before, I proceed, I want to gather more information to know if Linda and her husband are aware of this non-paternity. For this, I will begin by holding a private conversation with Linda. I will first provide a simplified explanation of how inheritance works and the implication that the biological father of the affected child carries the mutation. Then, I will explain the results of the genetic analysis, emphasizing that neither Linda nor her husband carries the mutation responsible for their son's genetic defect. I will make sure to present the information in a neutral and non-judgmental manner. Finally, I will ask her if she and her husband are aware of this non-paternity.
After speaking with Linda, if it turns out that Linda and her husband are both aware of the non-paternity, I will schedule a follow-up appointment to address any questions or concerns they may have about the genetic condition. I will also offer genetic counseling to address the emotional and practical aspects of the situation.
If it turns out that Linda is aware however her husband does not know about the non-paternity, I will provide information on the option of discussing the results with Linda's husband, encouraging open communication between the couple. If Linda agrees to discuss it with her husband, we can also discuss the option of working with a multidisciplinary team including psychologists or social workers, which can enhance the support available to Linda and her family during this challenging time. If Linda does not agree to disclose the information to her husband, I would emphasize the ethical issues involved and why both parents must know this information so that they can together make a well-informed decision about their child.
However, in case Linda and her husband are both unaware of the non-paternity, and the genetic analysis has revealed unexpected information. Firstly, I will assure her that the information discussed is sensitive and will only be shared with the necessary medical team. I will tell her that I will be available for ongoing support and discussions as needed. I will encourage her to share the information with her husband by highlighting the importance of honesty and transparency in relationships. However, I will respect Linda's autonomy in deciding when and how to share this information with her husband. Finally, I will provide information about support groups as well as additional counseling services if needed.
In summary, disclosing sensitive information about non-paternity and potential misattributed parentage is a delicate matter that requires careful consideration of ethical principles and the well-being of the individuals involved.
MMI Question #7
A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anesthetize her and surgically repair the aneurysm. She survives and sues the hospital for millions of dollars. Do you believe that the physician's actions can be justified in any way? Is it ever right to take away someone's autonomy?
The main issue here is whether the patient was justified, legally speaking, in suing the hospital for ignoring her wish to forgo the surgery. The physicians believed that the patient was not in her correct state of mind, and therefore unable to make a reasonable decision. The patient, on the other hand, asserts that the actions of the physicians were not justified, given her verbal non-consent of the surgery. From her point of view, she believes that because she stated clearly that she did not want the surgery, her autonomy has been transgressed. From the physician’s perspective, time was of the essence; they had to make a quick decision and believing that the woman wasn’t in her correct state of mind, they decided that performing the surgery was the correct choice. Before proceeding, it is important to understand the facts of the case by thoroughly gathering information. I will speak with the physician in charge to understand the actions he took and why, and the procedures he followed. I will also request if available the case file to review the procedures taken. I will also request a private conversation with the patient to understand their perspective. To evaluate the justifiability of the physician’s actions, it’s imperative to consider if their decisions are ethically motivated.
If it turns out that the physicians’ actions were justified, as he took the necessary precautionary measures by discussing with the patient the need to perform the surgery, ways to minimize scarring and the patient actually consented upon further explanation from the physician. Then there wouldn’t be an issue, I would just suggest the physician have a discussion with the patient to clear any misunderstanding.
Ethically speaking, if the patient had limited mental acuity upon evaluation, and the physician assumed that the patient cannot make an informed decision then proceeded with the surgery in consultant with the patient’s family, that’s justifiable. According to the principle of medical consent, the patient must have the mental capacity to provide consent to give it. In an emergency like this, when there are indicators of a lack of ability to provide consent, the physicians made the correct choice with the deduced information they had. Physicians must be strong advocates for their patients to enable them to make informed decisions while keeping their best interest in mind. I would again suggest the physician have a discussion with the patient, so they understand the measures they took and why.
However, if the physician failed to follow due procedure, that is, getting official mental assessment, consulting the hospital ethics board and went ahead with the surgery despite the patient’s protests, then disciplinary action is merited specifically investigating the physician and the team involved. In addition to apologizing to the patient, I would suggest the hospital legal team look into measures to de-escalate the lawsuit by possibly inviting the patient to discuss the matter with an arbitrator.
In summary, it is important in such cases to assess the patient’s mental capabilities, their ability to understand their situation, and their decision-making skills before overriding their autonomy. It’s important to also explain to the patient that there are ways to minimize scarring and consult with their family before continuing with the procedure against the patient’s wishes.
MMI Question #8
You are a general practitioner, and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt, and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?
In this situation, the issue is that while it’s important to respect and understand different cultures, I also have a duty to identify when a child is being harmed and call protective services if necessary. I want to make sure I understand where the patient is coming from, so asking questions about “cao gio” will be important to ensure I don’t inadvertently disrespect the patient or discourage them from seeking medical help in the future. Therefore, I would first ask for clarification on what the practice of “coining” is so I understand its applications from the mother’s point of view. Cultural sensitivity is an important caveat, as I will need to avoid unfounded reports that defame a patient and their culture.
After addressing the woman’s cultural background, I would take a moment to discuss the evidence with another colleague and ask them to validate or invalidate my conjecture. After getting a second opinion that confirms my initial suspicion, I would continue my investigation. I noticed the patient feeling pain when I touched the bruises, so I would ask him how he’s feeling and assess his pain/discomfort levels. If the patient says that he is actually feeling better than he was before, then this might contradict the idea that he is being abused. I also understand that because the woman stated that the procedure was to improve circulation and healing, she had good intentions, so I need to acknowledge the evidence for both sides to assess the strength of each claim. I would begin to inspect how the child interacts with his mother. If he appears afraid of her or apprehensive, I will interpret this as evidence of abuse.
After gathering all this information, if my suspicions are unfounded and indeed the cao gio is helping the child recover and feel better as confirmed by the child, then I would respect the family’s practices although I would continue to monitor the child’s progress.
If it turns out although the mother had good intentions, the cao gio is negatively affecting the child’s health and worsening their symptoms. I would sensitively bring this to the mother’s attention and explain how the practice is negatively affecting her child. I believe that it’s best for physicians to stop cultural practice when it threatens the health and well-being of the patient. This would risk alienating members of certain cultural groups, but physicians have a duty to advocate for their patients and act in their best interest, which means in a situation like this, it is not my priority to avoid entirely incidental defamatory consequences.
However, if it becomes glaring that the practice is just a cover for ongoing abuse, as I have a legal and ethical duty to the child, I want to call child protective services immediately. I will be sure to inform the mother of my observations and actions to be taken. If a physician fails to report abuse or fails to make the right decision for the child’s well-being, they are subject to legal sanctions by their college.
To summarize, I would evaluate the relationship between the patient and her mother, ask the mother questions about the procedure and her culture, and assess the child’s mental and emotional state to corroborate my suspicion that he is being abused, judging by the bruises on his body. If my colleague’s assessment is similar, I would take actions to ensure the well being of the child.
MMI Question #9
A patient with Down Syndrome became pregnant. The patient does not want an abortion. Her mother and husband want the patient to have an abortion. What should a physician do in this situation?
In this situation, I must decide who I am going to prioritize: the patient who wants to keep their child, or the parents, who want their child to have an abortion. I will first need to learn about what the patient knows about pregnancy and motherhood to determine if she’s capable of making an informed decision, so I will ask her directly what she knows about those things. Then, to understand her parents’ side of the argument and remain impartial, I will ask her parents why they think she should get an abortion. My main priority in this situation is to make sure the patient is secure in her decision and that she understands the consequences pregnancy has on her short and long-term future, especially in terms of health. To get a better idea of where she stands, I will follow up with a question about what she plans to do when the baby is born.
After a thorough consultation with the patient, I will begin questioning the parents. I will start by asking them why they think their daughter shouldn’t go through with the pregnancy. I would want to follow up their response to this question with another about what they think will happen to the baby once their daughter gives birth. The goal here is to collect as much information as possible to ensure that the patient comprehends the gravity of the situation. After assessing the capacity of the patient and I can verify that she is correctly informed, understands her situation, and can make a reasonable judgement, then I will explain to the patient and her family that she has the right to make her own decision. If the parents continue to protest, I will explain that I’ve found no reason to disavow autonomy, but that I will continue to support the patient and answer any questions they may have.
In this situation, it’s important for a physician to advocate for the patient’s autonomy. Both involved parties may have reasonable sides to their argument, so my job is to facilitate a productive conversation and more importantly, that the patient can make a sound decision with the information provided. Even though the parents may feel that their daughter is making a mistake, I can make sure everyone can feel secure in the decision the patient makes by providing as much information as I can about pregnancy. The bottom line is that when patient autonomy is questioned, the physician needs to respect and defend it if necessary.
MMI Question #10
A 12-year-old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation?
In this scenario, the role I have as a physician is to decide whether I should listen to the parents and not disclose the prognosis to the patient, or to tell the truth. The first step I would take would be to collect information. It’s important to know all the variables and remain non-judgmental before making a final decision. Starting with the parents, I will ask them why they don’t want the patient to know about their prognosis. They might, for instance, think that hearing the prognosis will negatively influence their son’s psychological well-being, which they will want to preserve as much as possible in his final days. From the patient’s perspective, his main concern is to know the truth.
To advance this inquiry, I will need to assess the child’s maturity; in other words, I will have to be able to predict with reasonable accuracy how hearing the news will affect his psychological health. It isn’t fair to assume that the child is incapable of processing the news just because his parents are averse to the prospect of him knowing, or because he is young. To assess his maturity, I will ask him about how he’s feeling, and what he thinks of his condition. It will be important to understand what he already knows before I decide if I should reveal other critical details.
I have two available options: to go against the parent’s wishes and tell the kid, or to respect the parent’s wishes. If my assessment of the child’s maturity reveals that he can understand and appreciate his situation, then I would tell the child. It’s important to reveal the truth to the child in this case since this knowledge has health implications. While a physician should respect admonitions and the wishes of parents of children in a medical context, there are situations where siding with the child is obligatory, as their health is my primary concern.
If upon my assessment of the child’s maturity and ability to process his prognosis, the parents are still protesting, I will have a sit-down conversation with them to explain that it would be in the child’s best interest to let them know and how that would factor into their overall well-being. I would also connect them with social support and counselling to help process the psychological, emotional and practical aspects of the diagnosis.
However, if it becomes apparent from my findings that the parents were right and the child cannot psychologically or emotionally process his diagnosis, then I would respect their wishes in consultation with another senior physician. I would however suggest and connect them with social support and counselling who would help find other means to convey the diagnosis to their child in a way their son can understand and process.
In summary, I would assess the child’s capacity by asking questions about what he knows about his health, probe the parents for information on why they think he shouldn’t be told, and then based on this information, make a decision about revealing the prognosis.
MMI Question #11
A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation?
A physician should understand this situation from the couple’s point of view. They should remain impartial and compassionate conduits of information and support. I don’t, for example, know their lifestyle, and it’s not fair to assume what their reasons are for asking for sex selection. Wanting a specific sex for their child is a personal choice that the physician needs to respect and understand from a psychological and physical health point of view. It stands to reason that if the couple desires a specific sex for their child, then this will probably help them develop as a family if this desire is respected.
I think that it’s also important for the physician to understand any cultural reasons for wanting sex selection. If the physician were to impetuously judge or behave in a way that discourages the couple, then this might alienate them from seeking medical help in the future. The physician should ask the couple questions about their motivations in a neutral and positive tone to avoid making them feel like their desire is invalid or unimportant. The reason why being non-judgemental is so crucial is because I know that, for instance, there are examples of asymmetric male and female genetic histories among some specific groups. Furthermore, if this is the case for the couple, it would be important for me to know as the physician so I can apply this provision to future patients.
There are some who might think that sex selection for non-health related reasons is unethical. If the physician discovers that the couple has health-related reasons for wanting sex selection, I think it’s fair to side with the couple, as some conditions are more severely expressed in one gender. Also, some couples might have a history of losing a child of a particular sex, so it would be important to be sensitive to this situation if that is the case, even though it’s not a strictly health-related contingency. Finally, it’s important to discuss methods of sex selection, as the couple will need to know what each option entails to make a confident choice. In a country where sex selection is not prohibited for non-health related reasons, respecting the couple’s right to choose under reasonable circumstances should be the physician’s primary objective.
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MMI Question #12
A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?
Engaging in a sexual relationship with a current patient as a physician is widely considered unethical in the medical profession. Several key factors underline the concerns associated with such relationships. First and foremost, the power imbalance between a physician and a patient creates a situation in which obtaining informed and voluntary consent for such a relationship is extremely challenging. Patients often place a great deal of trust and vulnerability in their healthcare providers, making it difficult for them to consent to any non-professional relationship in an objective manner. Professional boundaries are intentionally established in the physician-patient relationship to safeguard patients from actions that could potentially harm their well-being. When a sexual relationship enters the equation, these boundaries are breached, and the physician's ability to provide objective and unbiased healthcare is compromised. Furthermore, the American Medical Association (AMA) Code of Medical Ethics explicitly prohibits sexual relationships between physicians and current patients. Violating this code can result in severe consequences, including disciplinary actions, the loss of medical licensure, and significant damage to the physician's professional reputation. I would approach the situation in a non-judgmental manner and gather all the facts before proceeding. I would have a private conversation with both the physician and patient separately to understand if it’s true, who initiated it and if it’s consensual. I would also consult with other physicians in the hospital to ascertain if they have made any observations about the physician and their physician-patient relationships and their history working with patients. If it all turns out to be a false rumor, and indeed there is no inappropriate relationship between the physician and the patient as confirmed by both the physician and the patient as well other senior staff, then I would take no further action as no ethical boundaries were crossed, although I would inform the physician of the rumor so it can be addressed. If it turns out the physician is sexually involved with a current patient who initiated or consented to the contact but is taking measures to terminate the physician-patient relationship and redirect the patient to another physician. This includes directing the patient to another qualified healthcare provider to ensure the patient continues to receive appropriate medical care. I would still discuss with them how unethical their actions were for getting involved with the patient in the first place and suggest they self-report to the ethics board of the hospital and the actions they are taking to remedy it now and in the future. However, if both parties are absolutely unwilling to desist from this relationship and the physician is unwilling to terminate the physician-patient relationship. I would immediately report this as their actions breaches AMA’s Code of Medical Ethics. It's important to note that even in cases involving former patients, the AMA regards sexual relationships as unethical if the physician exploits or uses their previous professional relationship in any way. This underscores the profession's commitment to maintaining the highest ethical standards and prioritizing patient well-being above all else.
MMI Question #13
A physician went on vacation for 2 weeks. He did not find another physician to cover him. One of his patients with hypertension developed severe headaches. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial hemorrhage. Is the physician responsible for this patient?
In this situation, the well-being of the patient is the main priority as their health is on the line. The physician is another consideration as it needs to be ascertained if they took the necessary measures to ensure proper patient follow-up and care prior to their time-off. First, it’s important to remain non-judgmental and gather information first. In this situation, the physician’s role in this patient’s sudden collapse can heavily depend on some key factors that will need more clarification before a final judgment can be made. It is important to investigate and determine whether the physician met the standard of care expected in their field, and whether their actions (or lack thereof in this case) were negligent. In addition to speaking to the physician privately, a careful review of medical documentation, such as the patient's records will be conducted to confirm whether any necessary instructions were provided to the patient before the physician went on vacation. Additionally, the patient’s role in the situation cannot be overlooked.
If the patient was informed of the risks of waiting for their physician to return and the physician made the necessary arrangements with the patient consenting for another physician to oversee their case, yet knowingly chose not to seek alternative medical care, the patient’s informed decision making must also be taken into consideration as the physician was not negligent.
On the other hand, if the patient did not thoroughly grasp the risks of waiting and therefore felt it was not necessary to follow up with the other physician, then the physician’s approach need to be examined as their actions contributed to the patient’s current condition.
However, if the physician understanding the patient’s condition did not make the recommendation or the necessary arrangements for them to see another physician and it’s established that the delay in medical care directly contributed to the patient’s condition and severity, then the physician was negligent, and the necessary disciplinary action need to be enforced. It’s also important to investigate and address the shortfalls in the hospital patient management system to ensure physicians have clear plans in place for their active patients before any time-off.
In summary, these factors will be vital for determining the responsibility of the physician. If the answer is still not clear-cut after these considerations, seeking expert opinions from legal professionals may become necessary.
MMI Question #14
A 40-year-old schizophrenic patient needs hernia repair. The surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent?
Schizophrenia is a complex mental health condition that may affect a patient's capacity to provide informed consent. While a diagnosis of schizophrenia does not automatically negate a patient's ability to make medical decisions, it raises important considerations and necessitates safeguards to ensure the protection of the patient’s best interests and well-being. Informed consent is rooted in the ethical principle of respecting patient autonomy. In this context, it is important to determine the patient’s ability to understand not only the procedure, but also its risks, benefits, and alternatives. However, with a schizophrenic patient, capacity assessment comes to play as well, and it is also necessary to psychiatrically evaluate the patient’s ability to not just comprehend and retain information, but also decide and communicate on a decision. To enhance the patient's ability to make an informed decision, healthcare providers can consider various strategies. These may include using enhanced informed consent materials, such as computerized presentations, tailored to the patient's cognitive abilities. However, it's important to recognize that each patient's capacity may vary, and a one-size-fits-all approach may not be appropriate, If upon evaluating the patient’s ability to not just comprehend and retain information but also consent, it becomes clear the patient can indeed give informed consent, then this should be done and respected. If it becomes apparent that the patient does not have the capacity to provide informed consent, but the patient is under full guardianship where proxy consent is appropriate and has been used for past procedures, then this can be used, where a legal guardian or family member makes decisions on behalf of the patient. However, it should be used cautiously, considering the patient's best interests and preferences. However, if proxy consent is inappropriate or cannot be used then another approach would be to involve a second physician in the decision-making process, separate from the patient's primary physician. This can mitigate potential conflicts of interest and ensure that the decision is made with the patient's well-being in mind.
MMI Question #15
A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient’s condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence?
This scenario involves complex ethical and legal issues regarding liability. The patient’s well-being is the main priority especially ensuring the actions of the physician where in their best interest. The physician is a secondary concern as they may be ethically and legally liable depending on their actions. The first thing to consider is that in most parts of United States and Canada (and in other countries around the world such as Australia), varying degrees of legal protection is offered to the physician in the form of a “Good Samaritan Law’, which states that a person rendering emergency care to a person at the scene of an accident is not liable for any injuries or death of that person. This is to encourage bystanders to help others in distress without fear of being sued for damages. However, the extent of protection may vary by state and province, so it is important to gather key details missing from this event before an informed decision can be made. This would entail speaking privately with the physician in a non-confrontational manner to understands his actions, what measures he took to ensure the victim received the necessary help and if and when he reached out for help, like calling emergency services. Another factor to consider is the diagnosis of quadriplegia, to ascertain if the actions of the physician exacerbated or caused it. If possible and if the victim is conscious, it’s important to get their side of what occurred and if consent was sort. Whether or not the physician is liable can depend on whether they adhered to the standard of care expected in such situations. If the physician's actions were consistent with what a reasonable and prudent person with their medical training would do in an emergency, and there are no causal links can be found between the physician’s actions and the quadriplegia, this would weigh in their favor. If that’s not the case, where although physician's actions were consistent and reasonable, with the victim consenting, their actions can be linked to the patient’s condition, the quadriplegia, then necessary disciplinary action needs to be enforced as the physician is liable although they had good intentions. However, if the patient was conscious and capable of understanding the situation and the physician failed to explain their actions and obtained verbal consent and call emergency services promptly, which then worsened the patient’s condition, then this would affect physician’s position in the matter, as they would be liable in this case. In summary, depending on the actions of the physician, especially in relation to the health and wellbeing of patient (victim) they may be liable but this needs to be investigated non-judgmentally in light of the legal and ethical implications.
MMI Question #16
As a physician at a local hospital, you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitizer offered at the hand sanitizer stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitizer for public use. What do you do? Do you remove/change the location of the hand sanitizer stands? Do you approach him?
My primary and most immediate concern is regarding the individual’s health. I must promptly check for signs of alcohol poisoning and prioritize medical treatment immediately if required. If this isn’t necessary, my concern is still regarding the patient’s health. I must ensure that I respect the individual’s right to medical confidentiality, and approach the individual privately with empathy and concern, expressing my intention to help rather than to judge, by saying something like, “I’ve noticed you’ve been using the hand sanitizer frequently. I’m concerned about your health, and I’d like to help if I can. Can we talk about what’s going on?” If the individual is willing to engage in conversation, I can offer information about available resources for alcohol dependency treatment and provide pamphlets or contact information for addiction support services. If the individual is open to receiving help, I can then involve a hospital social worker or counselor who can conduct a more in-depth assessment and provide guidance on available treatment options and ensure appropriate follow-up and coordination with addiction treatment services, while staying supportive throughout the process. If the individual is not willing to engage in conversation or not cooperative, it is still important to maintain a patient-centered approach. It’s important to respect the individual’s autonomy and choice in seeking help, but I would still provide the information they need, so they may decide to seek help on their own later. In the meantime, I will continue to monitor and document the individual’s behavior to ensure they do not pose a threat to themselves or others. It would also be prudent to incorporate these events in our training program for the employees of the hospital to prevent such future occurrences from happening.
MMI Question #17
An 18-year-old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation?
In this situation, the 18-year-old man poses a significant danger to both himself and the people around him. Bacterial meningitis is a serious infection that can cause death, and people who recover can have permanent disabilities. The physician’s primary concern will be the health and safety of this individual and anyone who may encounter him. The physician should first attempt to educate the man and have a candid and empathetic conversation with him, explaining the seriousness of the infection, its potential complications, and the importance of immediate treatment. It’s important for him to understand the potential risks. If he understands and comes back to the hospital for treatment, the college administration and campus police would still have to be notified, so that they can take appropriate measures to mitigate the risk of an outbreak. If the patient continues to refuse treatment, patient autonomy must be respected. The physician must document the patient’s refusal and his reasons for doing so and notify the college immediately. While the patient has refused treatment, the physician can still offer supportive measures to manage symptoms and alleviate discomfort. This may include pain relief, fluids to prevent dehydration, and close monitoring of his condition. In some areas, if there is a high risk of harm to others, there may be legal mechanisms for overriding the patient's refusal of treatment in the form of involuntary treatment. However, this should be a last resort and is highly dependent on local laws and regulations.
MMI Question #18
There is an outbreak of an incredibly contagious life-threatening disease. The disease is spreading across the country at a rapid rate and the survival rate is less than 50%. You are a senior health care administrator, and when the vaccine is developed, you have priority to receive the drug. Do you take the vaccine yourself or give it to another person? Why or why not?
The decision about whether to take the vaccine for a life-threatening disease myself or to give it to another person is a deeply ethical and moral one. On one hand, taking the vaccine may enable me to continue fulfilling my vital role as a health care administrator. If my health deteriorates, it may hinder my ability to effectively manage the crisis and provide leadership. Furthermore, public trust is crucial during a health crisis, and if a healthcare administrator is seen taking the vaccine, the event can serve as a strong endorsement for its efficacy, which would potentially encourage others to get vaccinated. On the other hand, considerations of equity must also be weighed. It’s essential to assess whether there are individuals such as frontline workers or vulnerable populations who may need the vaccine more urgently. Ultimately, I would opt to publicly take the vaccination only if ample doses are available to meet the urgent needs of those who need it most. Alternatively, if there are capable individuals who can assume the leadership role in my absence, and I do not face heightened vulnerability, I would abstain from self-prioritization.
MMI Question #19
You are a health researcher at an academic institution. You have been asked to work on a top-secret vaccine that would treat biomedical weapons or other communicable diseases. Before your breakthrough, you are instructed by the government to stop all research and turn over all materials and copies of your work to be destroyed. You know you are very close to finding a cure. What do you do?
The most pressing issue here is my dilemma between my ethical and legal responsibilities. On one hand, I have an ethical responsibility to develop these treatments that may save lives. On the other hand, I am obligated to follow government orders, and failing to comply may lead to severe repercussions such as imprisonment and a compromise of national security if the research falls into the wrong hands. With these in mind, I would need to gather more information from government officials. My first concern is to verify whether this directive originated from the legitimate government or possibly from an unauthorized source (like a spy). Ensuring the authenticity of the orders is crucial before making any decisions. If it was indeed a government order, I would respectfully seek to understand their reasoning for halting the research and explore the possibility of addressing their concerns while still pursuing the potential vaccine. Collaboration and negotiation may lead to a compromise that satisfies both my ethical and legal obligations. If my research indeed holds the promise of saving lives and protecting public health, I will emphasize this point during discussions with government authorities. Highlighting the potential benefits to society could influence their decision. However, in the worst case, I may discover that the government's decision poses a significant threat to public health or safety. In such cases, I would consult with legal experts and consider appropriate channels for raising concerns while minimizing personal risk.
MMI Question #20
A patient requests needles and syringes at his/her local pharmacy. They do not present with a prescription and based on the records you can access, they are not receiving treatment for diabetes. Do you sell the syringes or not?
In this scenario, the patient’s health is my main concern, and it’s important to respect their autonomy and confidentiality. I would first non-judgmentally engage in a conversation with the patient to understand their intent. If they are seeking needles and syringes for a legitimate medical purpose unrelated to diabetes, such as administering medication or managing another medical condition, it may be appropriate to sell them after verifying their needs using any other forms of documentation the patient may have. If the patient’s intent is related to drug addiction and/or other non-medical purposes, I would instead prioritize patient education. I would offer them information on local resources, clinics, or harm reduction programs that can provide additional support and services to individuals facing addition challenges. If the patient remains committed to their request without a legitimate medical reason, I will exercise my discretion. If local regulations allow it and prioritize public health, it may be pertinent to provide these clean needles for the patient, which could reduce the spread of diseases like HIV and hepatitis C. In any case, I will keep clear and accurate records of the transaction, including the patient's identification, the quantity and type of needles and syringes provided, and the date of the sale. This documentation may be necessary for legal and ethical reasons. Furthermore, if this was a prominent issue in my area, I would also consider advocating for addiction treatment and education.
MMI Question #21
Dr. Blair recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Blair 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. Blair’s behavior might pose. Discuss.
MMI Question #22
You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell the patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?
MMI Question #23
As a physiotherapist, you are referred a 16-year-old for treatment of severe burns that limit function on the patient's arms and hands. Upon examination, you notice other burn marks and unexplained bruises on the patient. After working with the patient for a few weeks, you ask about the other marks on the patient's body. The patient admits to being abused by their parents but begs you not to tell anyone. What do you do?
MMI Question #24
As an occupational therapist, you work with clients of all ages. One of your younger clients begins searching you on the Internet and contacts you through social media sites. In this age, it is common for people to have many various personal and professional web profiles through sites like Facebook, LinkedIn, Twitter, Instagram, etc. What measures would you take if this happened? What would you do if the client would not stop?
MMI Question #25
You are an occupational therapist that works with a population with complex psychiatric histories. One of your older clients has been recently diagnosed with neurodegenerative disease, and she has schizophrenia. There is a history of the client’s children neglecting her needs and taking advantage of the client financially. Nevertheless, the client has a relationship with her family and they want to be named the primary decision maker for the client. How do you work with the client and her family knowing the past history of neglect and the present needs of your client?
MMI Question #26
Your neighbor has a five-year-old child who has many decayed teeth. The mother asks you for advice because she knows you volunteer for a dental professional and her child is in pain. The mother needs a dentist who will accept monthly payment for treatment. You provide her with different options and coach her on how to seek dental care for a child. One week later you see the mother and ask if she was able to acquire care for the child. She says no. What do you do?
MMI Question #27
You are working alone in a convenience store as a cashier late at night. An older man comes in and buys a coffee. He is staggering, seems disoriented, and you smell alcohol on his breath. On the way out, he bumps into a shelf and knocks some cereal boxes off. He tries to put the boxes back, but cannot manage this task. What actions might you take in this situation? Provide reasons for your responses.
MMI Question #28
You are on holiday at a Mexican beach resort with some friends who are staying one floor down from you. In the middle of the night, a large earthquake takes place, and the building you are in is severely damaged. You have injured your leg, suspect it might be fractured, and you hear someone yelling for help nearby. What would you do?
MMI Question #29
You are a specialist who has just received lab results with regard to one of your patients. The results indicate that your patient, a single mother of two young boys, has been diagnosed with terminal cancer and that she will only have 4-6 months to live. There are not many treatment options aside from a few experimental procedures that are still under study. There are some alternative treatments available in Europe; however, they have not been validated by scientific studies in North America. What would you say to your patient once they are in the office? If an alternative treatment, without scientific evidence for its efficacy, existed for a terminal illness would you recommend it to a patient?
MMI Question #30
You are the father of a 12-year-old boy. Your son’s friend, who is also your neighbor, is playing with your son in the backyard. As you approach them to ask them about lunch, you notice some severe bruises on the friend’s arm and upper neck. You are worried about these obvious signs and decide to approach your neighbor (the young boy’s father). How would you approach this situation? What would you say to the father of the young boy? What are some potential concerns that you may have?
MMI Question #31
You enter the cafeteria at work. You sit down to eat with a group of male colleagues who are having a conversation about a female colleague of yours. The comments they make are not very professional and can be deemed rude and offensive. You feel very uncomfortable. What do you do? What do you say to your male colleagues? If this became a regular occurrence, even after you speak to your colleagues, what other steps would you take to resolve the situation?
MMI Question #32
Every week, your classmates gather at the local coffee house to review the lessons from that week. In the last month, everyone has been working on a major paper on Roman history, which accounts for 40% of the course grade. One of your classmates has copies of two of the papers that last years’ students wrote for the same course. Your classmate has e-mailed copies of the paper to you and the other people in the group. What would you do in this situation and explain why? Discuss what values and choices are relevant in this situation? What are the implications if you decide to read the paper from last year?
MMI Question #33
You are the emergency doctor on duty when two patients are rushed in within 7 seconds of each other and both desperately need a heart transplant. You only have one donor organ available. And both patients are a match, and both are equally medically fit for the operation. One patient is a 35-year-old single dad with 3 children, while the other is a 35-year-old single male, who’s an Olympic Gold medalist. Who would you give the heart to and why?
MMI Question #34
You are a research supervisor, and you notice that one of your graduate students has been sleeping in the lounge area within the research facility because your student is a recent international student she cannot afford to rent a place of her own with her student stipend. You are aware that the facilities' safety policies prohibit overnight stays. How do you approach the student about this?
MMI Question #35
You are the executive director of a law firm. You find out that your articling student has accidentally destroyed an important piece of evidence that would have cleared a wrongfully accused person. If you reveal this to the authorities, your student will not only lose her job but will face jail time for destroying court evidence. What will you do in this situation? What if you had information that the accused person is indeed guilty of other unrelated but more serious crimes for which you do not have any evidence that would hold up in the court?
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MMI Question #36
A friend of yours has a cat named Jingles. One day your friend calls you and tells you that Jingles is very ill and in need of a vet. Unfortunately, Jingles does not have insurance, and the cost of seeing a vet will be around $1500, which your friend has to pay out of pocket. She cannot afford the cost and asking you for help. What would you do and say in this situation?
MMI Question #37
A 15-year-old patient requests medical marijuana from you and asks that you not tell her parents. What would you do?
MMI Question #38
You are a surgeon, and you find out that your next patient, who needs a heart transplant, has been convicted of child abuse. What will you do in this situation?
MMI Question #39
You are an ER doctor, and your patient needs several expensive medical scans. Your patient does not want to get these scans because they do not have insurance to help offset the costs. What will you do in this situation?
MMI Question #40
Your patient, Sally, had a stroke and is now on life-support. Your patient’s best friend has been at her side for the past several days at the hospital and shares with you that it is Sally’s wish not to be kept alive by machines. Sally does not have a living will, or a written Do Not Resuscitate (DNR) order, but the friend is insistent. Please discuss how you will approach this situation with the interviewer.
MMI Question #41
You are a physician, and you have been treating a patient in the hospital for several days. You learn that the patient’s family has been complaining to your supervisor that they do not like your bedside manner, and they would like a different doctor. How would you handle this situation?
MMI Question #42
Your estranged cousin, who you have heard from your parents had fallen into “a bad crowd” ran away from home recently. This cousin contacts you, asking for money. What do you do?
MMI Question #43
One of your classmates has been posting to social media that they feel alone and misunderstood. Their most recent post shows them in hunting gear in front of a carcass, in which they say “Finally in control of my life again - I feel so alive!” What do you make of this situation, and what do you do, if anything?
MMI Question #44
You are a doctor working ER intake during a particularly busy shift. A man in very ragged clothing enters, smelling strongly of alcohol. He claims that his pain medication has run out and presents an empty pill bottle with the label scratched off. What do you do?
MMI Question #45
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. What would you do? Your rotation is coming to an end and your evaluation is in one week?
Check out a realistic MMI mock interview led by one of our admissions experts:
MMI Question #46
An 80-year-old terminally ill man calls you up to tell you that he is going to take a lethal dose of painkillers. He has called you to tell you that you have been a great doctor and many thanks. How do you handle the situation?
MMI Question #47
What would you do if you were seeing a patient in the emergency room and he or she wants to leave against medical advice?
MMI Question #48
How would you react if a colleague wanted you to keep a medical error they made a secret from a patient?
MMI Question #49
You have two patients who have been admitted after a serious accident. Both require immediate attention in order to survive. One patient is 20 years old; the other is 60 years old. Which life would you save?
MMI Question #50
A 14-year-old gay and promiscuous male comes to you to be treated for an STD. During the conversation, he mentions that he has been tested for HIV several times and would like to be tested again to see if he is still uninfected. What would you do?
MMI Question #51
During a routine physical examination of a 10-year-old girl, you discover unmistakable evidence that she has been physically and sexually abused over a period of time. Both her parents are in the waiting room. What would you do?
MMI Question #52
How would you express your concern for a child who needs an amputation?
MMI Question #53
How would you tell a patient just diagnosed with cancer that he has only a few weeks to live?
MMI Question #54
Your best friend's 16-year-old daughter is adamant about getting a tattoo next week which is causing a lot of friction in her household. What advice would you give?
MMI Question #55
You are the shift supervisor at a fast-food restaurant. The owner of the franchise has called you over. He is very upset, as he has received three complaints in the last 30 minutes about the meat in the hamburgers being poorly cooked. There are two people (one male, one female, both 15 years old) who have been cooking the meat for the hamburgers for the past two hours. The culprit is the owner’s daughter. How would you handle this situation?
MMI Question #56
A friend of yours has hit her three-year-old after the child has had a temper tantrum. She becomes very emotionally distraught after doing so and swears it has never happened before. How do you respond to the situation?
MMI Question #57
A surgeon sees a patient who had a heart problem due to heavy drug abuse. He treats her and she comes back one week later with the same problem. He suspects she is abusing drugs again. Halfway through the treatment, she says she has to leave because of personal problems. The surgeon says, “If she comes back, I will not treat her.” What issues do you see with this situation?
MMI Question #58
Your best friend and partner are undergoing in vitro fertilization to have a baby. The technique allows for the selection of certain characteristics for the child by identifying them in the embryo before implantation. Your friend asks for advice on the characteristics they should select. How would you respond to your friend?
MMI Question #59
You are working with a man in a nursing home with a dementing illness who was asking to be vaccinated for the flu llike the rest of his peers. He’d been deemed incompetent and his wife, who is his executive decision-maker, tells us he does not want him to be vaccinated as she feels vaccinations are dangerous. Working with the geriatrician, what would you do?
MMI Question #60
You have just started working in a clinic where the office staff double-books aboriginal patients. You ask about their reasoning and the receptionist replies “These people never show up for their appointments.” How would you deal with this situation?
MMI Question #61
Your best friend has been skipping class or arriving to class late for the past two weeks and often smells of alcohol. You just ran into him on campus, what do you do?
MMI Question #62
The apartment next door is for rent. The previous tenants were nothing but trouble and have been evicted. Your landlord tells you about a new tenant he has found with more promising credentials. As he tells you about him, you realize that he is one of the drug addicts who was in treatment at a halfway house you volunteer at. You know that this person has a history of relapsing and may not have been completely honest on the application form. Do you warn your landlord about the person's history, or do you keep your knowledge confidential?
MMI Question #63
A YouTube video of a group of junior high-school boys verbally abusing bus monitor Karen Klein went viral in July. The abuse included taunts, profanity, physical ridicule, and even threats to Karen’s person and home, ultimately resulting in her breaking down and crying. The video prompted an investigation on the part of school officials and local police. The boys were suspended from school and given 50 hours of community service. Klein stated that she would not press charges, partly because of the flood of criticism aimed at the boys. Do you believe the boys’ punishments were just, or what could have been done differently?
This is one of the toughest MMI question categories, which stumps students and makes them panic. But in the wise words of our expert Dr. Jaime Cazes, MD and a graduate of the University of Toronto Faculty of Medicine:
"Probably the worst thing you can do is begin speaking without thinking. It is perfectly OK to take a moment to collect your thoughts and think about your answer thoroughly before beginning your response. Luckily, the MMI gives you the chance to reflect on the question and plan your answer - use it!" - Dr. Jaime Cazes, MD, University of Toronto Faculty of Medicine
This is all to say that the responses we give you below reflect the kind of answers you can start delivering if you have the right MMI practice and prep plan. Believe us when we say that our students, after working with us, are able to deliver answers of this quality and even better within the given MMI timeframe. All you need is proper prep, and you will be able to tackle any MMI question with ease.
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MMI Questions: Policy
MMI Question #64
Your local Paediatric Association has recommended that circumcisions 'not be routinely performed'. They base this recommendation on their determination that 'the benefits have not been shown to clearly outweigh the risks and costs'. Doctors have no obligation to refer for, or provide, a circumcision, but many do, even when they are clearly not medically necessary. BC Medicare no longer pays for unnecessary circumcisions. Consider the ethical problems that exist in this case. Discuss these issues with the interviewer.
Circumcision is a contentious topic in pediatric health because the procedure has lifelong consequences for the patient receiving it, and parents must act as the substitute decision-makers for their children attempting to act in their best interest. “Best interest”, in this case, can have a variety of religious or ethnic connotations. I understand that in most jurisdictions, the authority that parents have is limited to situations that are medically necessary. This is a large portion of the dispute in which parents defer medical necessity for religious or cultural reasons. The crux of this ethical dilemma, then, is that there are situations where parents might request a circumcision for reasons that are nebulous in relation to what’s established as a medical necessity.
In response to this recommendation by the Paediatric Association, I think it’s important to make decisions on a case-by-case basis. The relevant literature is not conclusive on this topic, but there are many clues that support this approach. There are, for instance, certain advantages to be gained from this procedure for newborns, such as a decreased risk of contracting a sexually transmitted disease. Furthermore, medical necessity is not a settled dispute, so I think it’s unfair to impose a universal rule. There are cases, where it would be important to allow the patient to make their own choices when they are old enough to consent to the procedure. Of course, there are still complications that can arise in patients who choose circumcision in adolescence or adulthood, so elucidating the benefits and potential risks will need to be reviewed independently.
As a physician, it’s our job to provide the most unbiased and up-to-date information available at the time to respect the patient’s autonomy and best interests. Especially because these situations are not definite in my estimation, working together with the families of the child and other physicians will be an important part of deciding whether circumcision is a medical necessity, or whether breaching this rule is worth the potential risks. I would also say that it will be important to provide a list of pros and cons for the parent to consider. Educating them with resources that they can access on their own, and that I can provide for them in my office will facilitate a productive dialogue that will help them make a better decision.
MMI Question #65
A biotech company was hired by the Military to develop a cure for Ebola. They successfully developed a vaccine to treat the symptoms of the virus and lowered the mortality rate for infected patients. Discuss the implications of this on a global scale.
In the event that an Ebola cure is developed in the form of a vaccine, there are a number of implications this would have on the world in terms of health and policy. I think one of the first concerns we would need to establish would be which strain of Ebola the vaccine is designed for, as there are two types: the Zaire ebolavirus and the Sudan ebolavirus; the latter of which has no proven vaccines. If a vaccine was developed for both of these strains, the next concern would be at what rate can these be produced and distributed. If there is a shortage of vaccines, for example, then it would be important to prioritize countries with the highest rates of infection. Ideally, we would have a vaccine that protects against many filoviruses, which would be somewhat of an elixir against a family of viruses that disproportionately affect certain regions. For the countries chosen as the targets of the first vaccine rollout, physicians and vaccine technologists will need to work together with politicians and leaders to ensure people understand how the vaccines work, how they can access them, and what it does for the health of the community. Transparency is the precondition for trust, which is a factor directly correlated with how effectively the vaccine will protect the population. Misunderstanding and fear can give the infection an opportunity to spread, which can exacerbate worst-case scenarios.
The first step I would take as a healthcare administrator in my jurisdiction would be to contact state officials to discuss and coordinate a response to infection and develop a vaccine rollout plan. In a hospital setting, it would be important to give priority access to more at-risk members, such as children. If isolation or quarantine were necessary, I would communicate this with my hospital staff and tell them to explain to isolate infected patients according to procedure. I would emphasize that it is their legal responsibility to remain in the hospital to avoid infecting others. Explaining this in a calm and sensitive manner should help placate some patients who are confused or reluctant to trust our judgement. It’s also important to note that the Center for Disease Control and Prevention has the authority to quarantine, even when states are unwilling. Their contribution to disseminating relevant information such as transmission methods.
The vaccine rollout plan should progress from vulnerable persons to adults and adolescents, eventually reaching a state where scientific uncertainties can be monitored and investigated as needed. Health care staff would need to limit contact with infected patients, so the proper equipment would need to be worn and replaced regularly to keep the vaccine rollout plan moving swiftly through our designated priority groups until the infection rate is sufficiently lowered and eventually near or at zero.
MMI Question #66
Is it ethical for doctors to strike? If so, under what conditions?
MMI Question #67
What is your opinion about stem cell research using fetal tissue?
MMI Question #68
How would you advise patients who are interested in visiting an acupuncturist or a chiropractor?
MMI Question #69
When is it appropriate to participate in the assisted suicide of a patient? Why or why not?
MMI Question #70
A Kootenay town runs a health-collective that provides various alternative and traditional forms of medicine. The physicians there encourage parents of small children not to vaccinate their children. Discuss the positive and negative impacts of this opinion.
MMI Question #71
“Liberation Therapy” (LT), a vascular operation developed to potentially cure multiple sclerosis (MS) in certain patients, has recently come under very serious criticism – delaying its widespread use. Among other experimental flaws, critics cite a small sample size in the original evidence used to support LT. As a healthcare policy maker, your job is to weigh the pros and cons in approving novel drugs and therapies. Please discuss the issues you would consider during an approval process for LT.
MMI Question #72
The nursing workload is a significant problem that needs to be addressed. Often nurses find they do not have adequate time to complete the tasks that are required of them in the time given each shift. How does this impact patient care? What are the implications for the nurses and the work culture and environment? What are the potential policy changes that can help alleviate some of this workload pressure?
MMI Question #73
In 2007 the Journal of Dental Education surveyed over 1000 dental students and found that 74.7% admitted to some form of cheating during their undergraduate career. The university has asked you to be part of a student focus group to determine how to reduce the incidence of cheating. You are well aware of this behavior as you have observed the reusing of old assignments on many occasions. What suggestions would you make to help reduce the incidence of cheating and improve the academic integrity of students?
MMI Question #74
Universities are commonly faced with the complicated task of balancing the educational needs of their students and the cost required to provide learning resources to a large number of individuals. As a result of this tension, there has been much debate regarding the optimal size of classes. One side argues that smaller classes provide a more educationally effective setting for students, while others argue that it makes no difference, so larger classes should be used to minimize the number of instructors required. Discuss your opinion on this issue with the examiner.
MMI Question #75
In 2007, the American Family Physician Journal published an article exploring the issue of physicians as role models, using a scenario in which an obese physician is offering nutrition and exercise counseling to his obese patient. According to the author’s research, patients have more confidence in health-counseling advice from non-obese versus obese physicians, and physicians with poor personal lifestyle habits are less likely to counsel patients about a healthy lifestyle. Based on these research findings do physicians have a responsibility to act as healthy role models to their patients? Please elaborate.
MMI Question #76
A proposed bill would require all individuals to vote in federal elections or face a $100 fine. What do you think about this bill?
MMI Question #77
You are the director of a financially struggling hospital. You have been unable to generate enough revenue to implement some very important initiatives at the hospital and are at risk of inevitable service cuts if more funding is not secured immediately. The only secure source of funds that is being offered is by a cigarette company. They are willing to provide your hospital with all the resources required in exchange for advertisement at your facility. What will you and should you do as the hospital director?
MMI Question #78
Some medical schools have a preference for selecting medical candidates from certain geographical locations. What are your views about such selection policies? Please discuss your answer with the interviewer inside the room.
MMI Question #79
You are a PhD student and your supervisor, Prof. Harry, has recently published the results of his publicly funded research project with the intention to commercialize his discovery. What are your views about university professors that use public funding to create for-profit solo ventures?
MMI Question #80
It is well known that big pharmaceutical companies along with their expansive lobby have a huge influence on the medical profession and its education. In your opinion what are the positives and negatives of having the pharmaceutical companies play a role, if any, within medical educational institutions? If you do not think that pharmaceutical companies should have any role within medical schools, what steps would you take to remove big interest groups such as Big Pharma out of the education system if given the opportunity?
MMI Question #81
As a healthcare policy maker, your job is to weigh the pros and cons of approving a new policy that would require companies to give employees paid parental leave. Please discuss the issues you would consider during the approval process.
MMI Question #82
In Sweden, daycare is tax-subsidized making public daycare available and affordable for all. No matter how many children you have, no matter how many hours they spend in daycare, and no matter what your income is, you never pay more than a fixed amount. Discuss your view on this policy with the interviewer.
MMI Question #83
The American Medical Association (AMA) describes medically futile treatments as those having “no reasonable chance of benefiting the patient.” Even when it is clear that continued medical interventions for a dying patient will be futile, it is not easy to stop a determined family from insisting that care for a patient be continued. In some states, futility laws authorize doctors to overrule the patient's family. Do you believe that a physician should have the authority to overrule a family’s wishes if treatment is medically futile? Discuss your opinion with the interviewer.
MMI Question #84
Doctors are encouraged to report elderly patients who might have impaired vision, as they could be a danger to other drivers and themselves. However, reporting this information can be seen as a breach of patient confidentiality. What is your view on this matter?
MMI Question #85
What is your stance on universal basic income?
MMI Question #86
Statistics have shown that the effects of advanced age such as changes in vision and response time may adversely affect elderly drivers' ability to drive safely. 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 Question #87
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 Question #88
The government wants to track citizens across the country in order to maintain public safety in the face of a pandemic. How would you advise the government to do this?
MMI Question #89
Which country has the best system of medicine? Why?
Want to learn more about MMI policy questions?
MMI Question #90
How would you fix the growing homeless problem?
MMI Question #91
How would you treat a patient who wants to die?
MMI Question #92
What are the strengths and weaknesses of the Canada/US health care system?
MMI Question #93
What role do social determinants of health play in the practice of medicine?
MMI Question #94
What is your opinion about what we can do about the high cost of healthcare?
MMI Question #95
Do physicians have the right to deny care to patients on Medicaid?
MMI Question #96
What do you think should be done to control health care costs in this country?
MMI Question #97
What are your views on alternative medicine?
MMI Question #98
What are your views on mandatory vaccinations within the public school systems?
MMI Question #99
What are the top three issues currently facing the U.S. health care system?
MMI Question #100
In June 2011, the Vancouver Canucks lost the Stanley Cup and riots broke out in Downtown Vancouver. Discuss the impact on the community and the range of health care professionals at St. Paul’s Hospital.
MMI Question #101
What is the difference between HMOs and PPOs?
MMI Question #102
A message that recently appeared on the Web warned readers of the dangers of aspartame (artificial sweetener – Nutrasweet, Equal) as a cause of an epidemic of multiple sclerosis (a progressive chronic disease of the nervous system) and systemic lupus (a multisystem auto-immune disease). The biological explanation provided was that, at body temperature, aspartame releases wood alcohol (methanol), which turns into formic acid, which is in the same class of drugs as cyanide and arsenic. Formic acid, they argued, causes metabolic acidosis. Clinically, aspartame poisoning was argued to be a cause of joint pain, numbness, cramps, vertigo, headaches, depression, anxiety, slurred speech, and blurred vision. The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress. They quoted Dr. Russell Blaylock, who said, “The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees." Critique this message, in terms of the strength of the arguments presented and their logical consistency. Your critique might include an indication of the issues that you would like to delve into further before assessing the validity of these claims.
MMI Question #103
In healthcare professions like dental care, you will be required to establish good working relationships with people from all walks of life. Talk about what you think will be your strengths and challenges in establishing these relationships with your future clients. Will you have more success or challenges in relation to:
- Young versus old clients
- Clients from different cultures
- Clients at different levels of health
MMI Question #104
With increasing concerns about climate change, there is a growing demand for healthcare facilities to adopt sustainable practices. As the director of a large hospital, what policies or strategies would you implement to reduce the hospital’s environmental footprint while ensuring patient care remains unaffected?
MMI Question #105
A 17-year-old boy lives independently. He is married and has one child. He wants to participate in a medical research study. Does he need his parents’ permission?
MMI Question #106
The City of Vancouver has taken great measures to increase access to alternative forms of transportation (Canada Line, Hornby, and Dunsmuir Bike Lanes, Proposed Evergreen Line, and Burrard Street Bridge closures). Discuss the impacts (both positive and negative) of these decisions?
MMI Question #107
If the Prime Minister/President were to ask your advice on one change that could be applied to the healthcare system that would improve it enormously and have the greatest positive effect, how would you answer?
MMI Question #108
The man who lives next door to you often rides his bicycle in the company of his two young children but without a helmet. In fact, on several occasions, you have seen him riding with his helmet hanging by its straps from the handlebars. His young children sometimes wear a helmet, sometimes not. If the man fell off his bicycle and hurt his head in a way that would have been prevented if he had worn a helmet, would it be reasonable to ask him to contribute towards the treatment costs for his injury?
MMI Question #109
Due to a shortage of physicians in rural communities, some policy-makers have suggested that medical programs preferentially admit students who are willing to commit to a 2 or 3-year tenure in rural areas after graduation. Consider the broad implications of this policy for health care and the costs associated. Will this policy be effective?
MMI Question #110
Recently, certain hospitals have been charging patients $29/day for their hospital fee on top of the fees charged to MSP. What are the implications of this policy? Discuss both positive and negative impacts with the interviewer.
MMI Question #111
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 Question #112
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 Question #113
In recent years, there has been an increase in the popularity of full-contact sports, such as Ultimate Fighting Championship (UFC) and boxing. Should doctors have a role in regulating such sports?
MMI Question #114
Do you think medicine should be more about changing behavior to prevent disease or treating existing disease?
MMI Question #115
Discuss the pros and cons of legalizing marijuana. How does this impact a physician’s present ability to write out a prescription for ‘medical marijuana’? Would legalization cost the health care system more or less after it was passed?
MMI Question #116
Imagine your friend’s father is 70 years old and has lived in major North American City his whole life. He is taken to the emergency department at the local General Hospital. He has had good health until now and this is the first time he has been to a hospital of any kind since he was 20 years old. What changes in the healthcare system and environment in the hospital do you think he would notice?
MMI Question #117
Discuss any topical health care issue that is unique to the region for Med School you are applying to?
MMI Question #118
Discuss one of these health care issues: human genome project, AIDS, abortion, the right to die, the cost of health care, and genetic engineering
MMI Question #119
How does the Canadian health care system compare to that of Britain’s system vs. the American system?
MMI Question #120
What is the difference between Medicare and Medicaid?
MMI Question #121
Recently, the Prime Minister suggested the idea of deterrent fees (a small charge, say $10, which everyone who initiates a visit to a health professional would have to pay at the first contact) as a way to control health care costs. The assumption is that this will deter people from visiting their doctor for unnecessary reasons. Consider the broad implications of this policy for health and health care costs.
MMI Question #122
In recent years, the spread of misinformation on social media platforms has significantly influenced public health decisions, contributing to vaccine hesitancy and resistance to public health measures. As a health policy advisor, what strategies or policies would you recommend to address the spread of health-related misinformation and ensure the public is better informed?
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MMI Questions: Personal
MMI Question #123
What experiences have you had (and what insights have you gained from these experiences) that lead you to believe you would be a good physician? Discuss this question with the interviewer
MMI Question #124
Robert Collier stated: "Success is the sum of small efforts, repeated day in and day out." Consider the quote you have just read. What does this quote mean to you in terms of how you live your life and how you will pursue your career?
MMI Question #125
Regardless of what we do in life, there will be times when we will come into disagreement with an authority figure or a superior. Describe a time when you came into conflict with an authority figure and how you dealt with it.
MMI Question #126
What is your favorite quote? Discuss the quote and what it means to you with the interviewer inside the room.
MMI Question #127
What do you do for hobbies and in your spare time?
MMI Question #128
MMI Question #129
Suppose you are given the chance to write your past self a letter. What would you tell yourself?
MMI Question #130
Describe a time when you decided to go against the guidance of a superior (eg: parent, teacher) What was the situation, and why did you make the choice that you did?
MMI Question #131
Tell me about your greatest regret. What was it, and what would you do differently?
MMI Question #132
What are your thoughts on the steadily increasing rates of obesity? Mention any policies that you may be aware of, and/or discuss potential ones that you can think of.
MMI Question #133
If you could instantly learn any skill to have proficiency as if you’ve had 5,000 hours of practice, what would it be and why?
MMI Question #134
What is the most important quality for a physician to have?
MMI Question #135
If you didn’t pursue medicine, what would you do?
MMI Question #136
What does ‘integrity’ mean to you?
MMI Question #137
What is the most negative thing about practicing medicine?
MMI Question #138
Tell me about a time you demonstrated adaptability.
MMI Question #139
What is the most important issue in healthcare to you right now?
MMI Question #140
Tell me about a time when you had to deal with conflict.
MMI Question #141
What kind of medicine would you like to practice?
MMI Question #142
Where do you see yourself in 10 years?
MMI Question #143
Describe how you achieve a good work-life balance; what steps do you take during stressful times?
MMI Question #144
How could you affect the health care system?
MMI Question #145
If you were to do anything differently in your preparation for medical school, what would that be?
MMI Question #146
Where do you plan to practice?
MMI Question #147
Describe an experience you have had in which you were misjudged. What were your responses?
MMI Question #148
Would you get out of your car to help a victim after observing an accident?
MMI Question #149
What causes your greatest frustrations in life?
MMI Question #150
Describe the most unusual event in your life.
MMI Question #151
Convince me that you can handle the workload in medical school.
MMI Question #152
Why do you want to be a doctor? What will be your specialty?
MMI Question #153
What are three characteristics you think a good doctor should possess?
MMI Question #154
Who is your role model?
MMI Question #155
Let us say that you are rejected for admission into all medical schools to which you have applied. What would be your second career option?
MMI Question #156
What do you believe your greatest challenge will be if you are accepted into this program?
MMI Question #157
Burnout is a very real possibility in the medical field. What strategies do you use to deal with your stress effectively and prevent this from happening?
MMI Question #158
How would your professors describe you?
MMI Question #159
When was the last time you showed sensitivity to the needs of others?
MMI Question #160
It has been said that the average intern has killed 1.5 patients. Would you be able to live with yourself and how would you handle this?
MMI Question #161
We use a PBL (problem-based learning) approach here. Describe to me how you have achieved independent learning goals in the past?
MMI Question #162
What is the most important responsibility a doctor has?
MMI Question #163
What makes you mad?
MMI Question #164
What is the last book you read?
MMI Question #165
How do you imagine the balance of research and clinical work in your future?
MMI Question #166
How would your friends describe you?
MMI Question #167
What do you do for fun?
MMI Question #168
What was the most stressful situation you ever faced? How did you handle it?
MMI Question #169
If you are not accepted, what will you do?
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MMI Questions: Acting Stations
MMI Question #170
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 you to 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. Enter the room and talk to Mark.
MMI Question #171
You are a 3rd-year medical student doing hospital rotations. A fellow medical student who is doing rounds with you often shows up to these sessions tired, messy, hungover, or even drunk. One day you found him in the lunchroom unaccompanied, so you decided to talk to him. Please enter the lunchroom.
MMI Question #172
Your friend Jason hasn't come to class for a few days. Being a hardworking pre-med 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 could visit him. You decided to pay him a visit after your classes. Enter the room and talk to Jason.
MMI Question #173
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, Jennifer, a patient who knew you well, saw you from the waiting room and grabbed your attention. "Doctor! I have bad chest pain. Please stay for a bit. I'll feel much better if you were here." Enter the waiting room and talk to Jennifer.
MMI Question #174
You are a current undergraduate student. During the week of graduation, you attend a number of parties around the Lower Mainland with your best friend, Kelly. The last party is held at a campground in Squamish. The morning after the party, you receive a call from Kelly. She asks that you come over and talk. Kelly reveals that she left early and drove home despite drinking that night. Enter the room and talk to Kelly.
MMI Question #175
Your company needs both you and a co-worker (Sara, a colleague from another branch of the company, who is gripped by fear of flying since one of her friends narrowly escaped being at the World Trade Centre when it was destroyed) to attend a critical business meeting in San Diego. You have just arrived to drive Sara to the airport. Sara is in the room.
MMI Question #176
The parking garage at your place of work has assigned parking spots. On leaving your spot, you are observed by the garage attendant as you back into a neighboring car, a BMW, knocking out its left front headlight and denting the left front fender. The garage attendant gives you the name and office number of the owner of the neighboring car, telling you that he is calling ahead to the car owner, Tim. The garage attendant tells you that Tim is expecting your visit. Enter Tim’s office.
MMI Question #177
Your best friend, Jennifer, calls you to tell you that she has been rejected for the 3rd time from all medical schools that she had applied to during the previous application cycle. She invites you over to her house to have a chat about her future plans. Go inside the room and speak with Jennifer.
MMI Question #178
You are the team leader of a group assignment and two of your group mates inform you that one of the group members, Tim, has a very strong body odor and they are unwilling to take part in any further group meetings until Tim addresses this issue and takes care of his personal hygiene. Tim is waiting inside the room, go inside and discuss this issue with him.
MMI Question #179
You are the Dean of Admissions at a very competitive medical school. One day as you are leaving your office at the end of the day, you are approached by the mother of a student who was recently rejected from your school. The mother explains that her son has a 4.0 GPA, scored 98th percentile on the MCAT, and has numerous awards and many relevant accomplishments. She wants answers right now and she demands to see every applicant’s file. Go inside the room and talk to the parent.
MMI Question #180
You are a cardiologist at a local hospital, who just finished a shift and has a tight run to your son's high school graduation ceremony. As you headed off to the door, Jason, a patient who knew you well, saw you from the waiting room and grabbed your attention. "Doctor! I have bad chest pain. Please stay for a bit. I'll feel much better if you were here." Enter the waiting room and talk to Jason.
MMI Question #181
Acting Station: You are a teacher, and your student has cheated on his/her final exam. If he/she fails this exam he/she fails the class. Go into the room and confront him/her.
For the actor: You need to graduate so that you can get a better job for your family. Your father is an alcoholic and has left the family without any income. You are working two jobs and going to school and the only way you could pass this final exam was to cheat. You did not want to, but you did it because you felt you had no other option.
MMI Question #182
Acting Station: You are a gas station attendant, and someone asks to use the bathroom key. You suspect they might be up to something. Go into the room and talk to them
For the actor: You are addicted to heroin, and you are in the process of shooting up, be aggressive.
MMI Question #183
Acting Station: You are an attending, and you notice that a medical student has been having some trouble keeping up with their classmates on rounds. Today you asked them if they did a physical exam on one of the patients they were assigned and they said they did. You get the feeling that they did not actually do the work.
For the actor: You are an entitled medical student, you feel like this is below you. You hate coming in and doing rounds, your grades are good, but you don’t really enjoy touching or talking to patients. You did not do a physical exam, but you need to keep lying and try to talk your way out of it.
MMI Question #184
Acting Station: You are an employee at a retail store. A customer comes in and wants to return something that has clearly been well used. You aren’t even clear if that is something they bought at this store. Go into the room and talk to them.
For the actor: You are in need of money, you have lost your job, and you are a single parent with two kids at home. Money has gotten very tight, so you are trying to return something to a big box store. It has been used and you don’t have the original box, but you remember it was kind of expensive when you got it. That money sure could help make ends meet for your family this week.
MMI Question #185
Acting Station: You are a third-year medical student, and you have a patient who is a three-pack a day smoker. They do not believe smoking is bad for them. Your attending has given you the task of convincing them to cut back to only two packs a day. Go into the room and talk with them.
For the actor: You do not believe that smoking is bad for you. No amount of evidence can change your mind. You like to smoke, and you firmly believe that the media wants you to stop, but that there is no real science on it. You refuse to listen to reason. You are almost to the point where you also believe that the Earth could be flat as well.
Want to see how other students overcome the MMI hurdle? Check this out:
MMI Questions: Quirky
MMI Question #186
Your 5-year-old nephew asks you, "Why is the sky blue?” How would you answer him using a series of simple scientific experiments?
MMI Question #187
"Education is the kindling of a flame, not the filling of a vessel." - Socrates. What does this quote mean to you? Go inside the room and discuss your thoughts with the interviewer.
MMI Question #188
Please describe the object presented to you to the interviewer. The interviewer has never seen the image. Note you are only allowed to use your words to describe the image. (The image could be any abstract image that you may have never seen before)
MMI Question #189
If you could have any superpower, what would it be and why?
MMI Question #190
“The first task of the doctor is political: the struggle against disease must begin with a war against bad government. Man will be totally and definitively cured only if he is first liberated...” What are your thoughts about this quote by Michel Foucault?
MMI Question #191
Lord Byron stated, “always laugh when you can, it is cheap medicine.” What does this quote mean to you in terms of how you will pursue your career in medicine?
MMI Question #192
Hippocrates stated, “Let food be thy medicine and medicine be thy food.” Discuss what this quote means to you with the interviewer.
MMI Question #193
If you had to either fight 100 duck-sized horses or 1 horse-sized duck, which would you choose and why?
MMI Question #194
What is your favorite movie?
MMI Question #195
What is the best state of matter solid, liquid, or gas?
MMI Question #196
What genre of music is the best?
MMI Question #197
What is the one thing you would do if you were president?
MMI Question #198
What is the difference between sympathy and empathy?
MMI Question #199
You are granted any three wishes by a genie. What would your wishes be?
MMI Questions: Writing Station
MMI Question #200
In a class of 78 students, 41 are taking French, 22 are taking German. Of the students taking French or German, 9 are taking both courses. How many students are not enrolled in either course?
Disclaimer: Please note that our sample MMI responses are for guidance only, and alternative responses can be developed using our recommended strategies. Some of the questions are from BeMo’s database of questions and some are from official universities and colleges that administer the MMI as part of their admissions process. I provide the list of all outside sources at the end of the blog. Please note that BeMo does not endorse nor affiliate with any of the mentioned universities and colleges. Each respective source is the copyright owner and the material is shared here under the fair use clause of Copyright Act.
Here's some tips for MMI writing stations:
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Why Is Practicing with MMI Questions Important?
I want to stress that for most students the MMI is by far the most difficult obstacle in the admissions process, no matter which profession they are pursuing. If you are struggling with this interview format, please do not feel alone. Hundreds of our students express great frustration and panic when it comes to these types of interviews. Our student Tanish shares her experience:
"I got waitlisted the first time I applied, as the program is very competitive. I had good stats and MCAT score, but my interview skills needed to be strengthened."
And Tanish is really not alone in this. The pressure students feel when it comes to performing well in an MMI is enormous. Sometimes, your whole future depends on how well your do in your MMI. Take the example of Megana Varma, our student who needed to outperform her competition in the interview at all costs to have a chance of getting accepted:
"My MCAT score and GPA were not as competitive as I needed them to be, so the interview was really important for me to practice and get right!"
You as a premed can probably sympathize with this do or die attitude. The interview is your last chance to make the right impression. In some schools, your MMI performance outweighs all other application components put together. This is a lot of pressure! Luckily, there are ways you can prepare and ensure that your ace your interview. Even in cases when you have very limited time to prepare, if you have the right approach, you can still ace the interview. Take the example of our student Johnathan Hawn, who got accepted after he received a last-minute interview invite!
"[Initially] I felt disappointed [because I did] not even receive an interview. I was interviewed super late. Getting in last minute was a miracle, honestly."
So, make sure to keep up with your MMI prep! This is what these MMI questions are for! As you could see in this article, I guide you through different MMI question types, share some of the toughest MMI questions so you can practice, and provide your with sample responses that my colleagues and I prepared to demonstrate the logic of how you can and should approach these difficult questions.
100 More MMI Questions
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100 More MMI Sample Questions to practice with!
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BeMo MMI Prep Reviews
Want our help with your MMI prep? First check out some BeMo reviews from our happy students:
"Helen Martin was by far the most helpful advisor I have had! She took the time to give me detailed feedback, but what I really appreciated is that she made sure to emphasize what I had done well so I knew what to do again. She also gave me specific examples of what I could have included to make my answers better. Also, she recommended some additional reading that would help prepare me for my mock MMI. Thanks so much Helen!!" - BeMo student.
"I just had my second MMI mock session with Liz, and I couldn’t be happier! She is an incredible interviewer who creates such a positive and encouraging atmosphere during and after the session. Her feedback is detailed and insightful, and she shares so much valuable knowledge!" - Melika, BeMo student.
"Dr. Daniel Medina-Luna helped me prepare for my medical school interview by giving me a mock interview with an MMI portion and a traditional interview segment. Dr. Medina-Luna asked me a variety of prompts and answered all of my questions so that I would be ready for anything that I might be asked." - Brian, BeMo student.
"Margaret Wang was amazing for the MMI/interview prep session. She did a wonderful job coordinating oral and written sample questions followed by really insightful feedback for how to improve for the future. I also really liked the way she provided instructions at the beginning, as well as a great timer for managing the different questions. Thank you!" - BeMo student.
"I just had a Hybrid/MMI prep session with Ariel Peckel and everything went great. As an interviewer, he was serious and professional, which truly helped me practice in a stressful condition and simulate a difficult interview encounter. As an advisor, his feedback was really thorough and he analyzed each part of my answer and gave me very good insights. I look forward to working with him again in the future, as he's an exceptional advisor." - Gabriel Schostack, BeMo student.
"Nasem is an excellent MMI tutor at BEMO. He prepared individualized MMI questions to guide my practice for the specific schools I am interviewing at. He then provided detailed feedback to improve my time management, structure, and delivery. Can't recommend him enough!" - BeMo student.
"BeMo MMI prep,Review for Dr. Haitham Shoman. Very good recap session was very helpful in identifying what I should work on in the future." - BeMo student.
"I sincerely appreciate my sessions with Dr. Simon Marmura Brown, and for the MMI interview preparation, it was no different! He is always so kind and attentive to details regarding what I say specifically as it pertains to pointing out my strengths, and areas of improvement. The way he provides his feedback is very motivating! He helped me through both oral and typed questions, including personal, policy and situational questions. Thank you!" - BeMo student.
"My evaluator, Joe, was very thorough and compassionate on how I could improve in my MMI preparation and was very thorough in the ways I could do so. This is my first MMI and Joe gave me the confidence I need to succeed." - Javier Russo, BeMo student.
"Great and caring advisor! I especially appreciated that Carley really listened to my ideas, and took the time to help me develop them, as well as sharing her own suggestions on how to improve." - Ludovica Daffini, BeMo student
"Noah Heichel was an amazing consultant. He provided detailed feedback for my MMI session and even helped brainstorm ideas based off of my experiences. He noticed how stressed I was and went over time to give me some great, calming advice. I really appreciated his insightful feedback!" - TW, BeMo student.
"Samira Lavei provided excellent MMI tips especially regarding the acting stations." - Muhammad Shahzad, BeMo student.
"Dr. Grimaldi did a terrific job in preparing and solidifying what I've learned. She helped me calm my nerves and orient my thoughts into more cohesive answers and ones where I feel more confident in. She was awesome with feedback and let me know honestly in areas I needed help with." - Alec, BeMo student.
"Nasem was fantastic! He had lots of helpful MMI advice and also some personalized advice about particular schools in general. Highly recommend" - BeMo student.
"Dr Christine Gerson helped me excel at my MMI skills!" - Evan, BeMo student.
"Thank you Sofia for all your feedback during our session. Sofia was able to provide me with some awesome tips to strengthen my responses. Sofia made me feel confident going into my interview and I appreciated the take home suggestions to continue practicing." - BeMo student.
"Dr. Daniel was very helpful with my MMI prep!" - Evan, BeMo student.
"Kelly was extremely thorough in her feedback and was happy to review all my questions regarding the format. She took the time to give me very question-specific tips for the different types of questions so when I encounter them, I am equipped to answer them to the best of my abilities." - Hassan, BeMo student.
"Rhoda always cuts to the chase! She gives your her 100% attention and has noted my progress over multiple sessions. I feel fortunate to have received her feedback." - BeMo student.
"Dr. Martin Poirier was beyond helpful with MMI/Interview prep. He provided detailed examples of ways I can improve my answers, and was thorough and uplifting through all my questions! I could not recommend him more for interview prep." - BeMo student.
"Mehdi Khalfallah served as an excellent and insightful instructor. This sessions as allowed to feel much more confident, whilst also giving a proper indication as to what I should be working on next. There is no doubt in my mind that today served a crucial part in my preparation for my upcoming interviews." - BeMo student.
1. What are MMI questions and why are they used in medical school interviews?
MMI (Multiple Mini Interview) questions are designed to assess non-academic qualities like communication, ethical reasoning, and problem-solving. Medical schools use the MMI format to evaluate candidates in real-world scenarios, ensuring they possess the interpersonal skills needed to be successful physicians.
2. How long does an MMI interview last, and how many stations are there?
The multiple mini interview is sometimes compared with speed dating; test-takers address a prompt or question at a station and when a buzzer rings, they have to move to the next station. Here’s a breakdown of what to expect:
- 1.5-2 minutes to read a question or scenario (the prompt) outside the room.
- Enter the room and discuss the prompt with an evaluator for 4-8 minutes.
- Timing varies by school.
- After the buzzer rings, move to the next station.
- Students typically rotate through 6-12 stations during the interview.
- Some stations involve interacting with actors playing specific roles.
- Others may require teaching a task or collaborating with other students to solve a problem.
3. Will I be asked any questions in the interview room?
Over the course of your entire MMI, it's likely that you will encounter some MMI follow up questions. An evaluator may ask a question or two after you've finished your discussion of the prompt. These questions are often designed to catch you off guard, explore a problem or issue further, test the consistency of your argument, or examine your personal opinion or experience relating to a topic. Not all stations will ask you a follow-up question, but it's a good idea to be prepared for any questions should they be asked.
4. Will I have a copy of the MMI question prompt inside the interview room, or do I have to memorize it?
This totally depends on the school; however, it is most common to have the prompt available inside the interview room. If this information hasn't been provided in your interview materials, you'll want to contact the school to find out if this is the case. In addition, you can also ask about the duration of each station and whether or not you’re allowed a pen and paper to take notes.
5. What should I do if the interviewer has no follow-up MMI questions?
Do not feel the need to keep talking or offer up small talk of any kind. MMI interviewers are often instructed to not interact much with students, so they may not say anything. Simply sit quietly and wait for your interview to be over. You must get comfortable sitting silently. If your interviewer takes the lead in asking small talk questions, go ahead and interact with them, but allow them to take the lead.
6. What is the best way to prepare for MMI interviews?
Practice with realistic MMI scenarios, focus on structuring your responses clearly, and get feedback from peers or mentors. Mock interviews, time management drills, and understanding common question types will help build confidence.
7. What are common mistakes to avoid in MMI interviews?
Avoid rambling, failing to answer the question directly, and not considering multiple perspectives. Poor time management and lack of eye contact can also hurt your performance. Stay calm, think critically, and communicate clearly.
8. Can I practice MMI questions by myself, or do I need a partner?
You can practice alone by recording your responses and timing yourself, but working with a partner or coach provides valuable feedback. Practicing out loud helps improve fluency and confidence in real interview settings. The best way to practice for MMIs is using realistic, mock interviews!
9. What should I wear to an MMI interview?
Dress professionally in business formal attire—a suit or blazer with dress pants/skirt and minimal accessories. Choose neutral colors and ensure your outfit is comfortable for movement between stations.
10. Do all medical schools use MMI interviews?
No, but many do. Schools in Canada, the UK, Australia, and the U.S. commonly use MMIs, while others still use traditional panel interviews. Always check the specific requirements of the schools you're applying to.
To your success,
Your friends at BeMo
BeMo Academic Consulting
Sources: UBC Center for Student Involvement and Careers, University of Alberta – School of Dentistry, University of Victoria – Co-operative Education Program and Career Services, Tuft University - An Admissions OSCE: the multiple mini-interview, University of Calgary, Wilfred Laurier University, Harvard University, Missouri State University, Central Michigan University, University of Ottawa