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Sample Difficult MMI Question + Expert Analysis & Response:

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Sample MMI Question + Expert Response (video transcript below): 

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

So, once you have read the prompt on the door and entered the interview room and have said your hellos and sat down, it is always a good idea to give a quick recap or summary of what you have read outside the door to the interviewer in order to get them on the same page. This also serves as an introduction and helps you to set up the remainder of your answer.

Here is an example of a recap:

"From what I have read on the door, I understand that I am the only ER physician on duty and in charge of making decisions. Two patients are brought in suffering from kidney pathologies. One is an 80-year-old gentleman with acute kidney failure, which seems to be age related, and the other gentleman is a young university student who has made repeated visits to the ER for kidney issues. His condition seems to be related to alcohol consumption. They both require a transplant but we only have one kidney. And I am asked what I would do in this situation. "

This would be considered a good recap of the prompt. It is factually accurate, it is concise, creatively organized and to the point. Once you have given your recap, then you will go ahead and deliver your answer using our BeMo strategy, which was discussed earlier.

Here is our response:

"Well in this situation as the ER physician, I understand that I have to make a very difficult decision. Of course, I am sympathetic and appreciate that both individuals are suffering immensely with pain as a result of their conditions. However, my decision-making will solely be guided by my expertise, clinical experience, and the scientific literature, and not by the personal backgrounds of the patients. Furthermore, the decision as to who receives the kidney will ultimately be based on which of the two gentlemen will benefit most from this transplant, and will have a better chance of receiving the kidney and surviving the post surgical complications. Immediately, if possible, I would place both of the gentlemen on dialysis in order to buy some time so that I can assess the situation further and gather more information.

Since in this case there’s only one kidney available that matches both patients, then the decision is tougher and will require further investigation. I can at this point review both patients records, take a detailed history, send for appropriate tests, perhaps consult with other colleagues and specialists in the field, and more importantly examine the current literature on the effects and outcomes of kidney transplants on 80 year old males with acute renal failure vs. those in a 20 year old, for example. Once I have gathered all of the evidence, and objectively analyzed all of the risks and benefits associated with the transplant for both patients, I would then provide the kidney to the individual who, from a scientific and clinical point of view will have a better chance of receiving the kidney and surviving the post surgical complications. If that is the young student then he will be the candidate. If it turns out that the older gentleman will have better outcomes, then the kidney will be given to him. Whoever does not receive the kidney, will continue to be monitored by us and maintained in a stable condition until the next available kidney for transplantation."

So, the above would be considered a strong and appropriate response. As you can see, the answer was nicely organized, coherent, concise, and more importantly, was delivered in a systematic manner. As discussed in our earlier strategy, in answering this question, we remained objective and non-judgmental, and did not allow the personal attributes of the patients interfere with our decision-making. We also recognized that further investigation was required and thus we addressed those issues in our answer. Once we had gathered all of the facts, then we came up with practical solutions that we could draw upon to solve this difficult situation. We chose the most rational, objective, and scientifically sound option, which was in the best interest of the patients and caused the least amount of harm to those involved.

Now, keep in mind that sometimes once you have delivered your response, the interviewer may ask the following question: “Let’s assume that you do not have any time to do any further tests, nor do you have access to any dialysis machines, and the only information you have are those provided to you in the prompt. You must make a decision now. What will you do? Who will you give the kidney to?”

Here is the BeMo response…

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