Preparing for Your Med School Interview: An Intro to Medical Ethics
Written by Luca Voli
Edited by Gabby Coleman
Perhaps the most exciting yet nerve-racking part of the medical school application process is the interview — particularly for those schools which utilize the multiple mini-interview (MMI) format. An MMI typically consists of 6 to 10 stations which each present a different personal question or ethical scenario. The goal is to create an equitable and holistic assessment of individual character and empathy by having a different interviewer assess applicants at each station [1]. Applicants are expected to offer a thoughtful, well-organized, and multidimensional response. To best prepare, it is thus vital to research and familiarize yourself with various ethical topics in medicine.
Clinical Ethics
One common scenario in an MMI involves the concepts of informed consent and surrogate decision-making. Imagine a patient has suffered severe trauma and requires surgery. The most apparent course of action is to explain the surgery to the patient and obtain their consent. But this is not sufficient: to obtain informed consent, you must also detail any alternative forms of treatment and the risks and benefits of each [2]. Moreover, you need to be sure the patient understood your explanation. To flesh out your answer, you can say that you would allow the patient to ask follow-up questions, closely involve the patient’s family if the patient approves, or speak with the patient through a medical interpreter if there is a language barrier. Be sure to closely analyze the information provided in the scenario and incorporate such specific points into your response — this can help demonstrate your line of thinking!
Now imagine the patient’s trauma had rendered her unconscious for an indefinite period. How can you obtain informed consent in this case? If the situation is an emergency, you can act on implied consent. Otherwise, you must communicate with a surrogate decision-maker, i.e., an individual (usually a parent, spouse, or adult child) who is legally authorized to offer informed consent on behalf of an incapacitated patient. The surrogate consents to whatever the patient would most likely desire, a principle called substituted judgment; if they are unaware of the patient’s desire, they decide based on the patient’s best interest. If the patient is a minor, consent is deferred to the parents, who cannot deny treatment for the patient if it would significantly harm their health. Depending on local jurisdiction, minors of a certain age and maturity may even be able to consent to their own treatment in cases involving sexual or mental health [2].
Organ Transplantation
Another frequently asked scenario in MMIs is the ethics of organ transplantation. This is a divisive issue in medicine because organ demand far exceeds supply, which leads to debate on how best to allocate organs to recipients in need. According to the United States Health Resources and Services Administration, an ideal allocation policy balances utility, justice, and respect for persons.
Utility refers to maximizing good and minimizing harm, i.e., ensuring that a living donor will remain in good health and that organs go to those who will receive the most benefit [3]. Renowned bioethicist Arthur Caplan suggests a “survival matching” system in which candidates with the highest chances of post-transplant survival and the most gain in quality life years should receive transplants first, followed by those within 10 to 15 years of age of these candidates [4]. For example, a young adult with end-stage renal disease would be more likely to survive for many years to come due to a kidney transplant compared to an elderly person with several co-morbidities. This does not, however, mean that age alone should determine transplant priority.
Justice refers to the fair distribution of benefits and the equitable evaluation of candidates on an individual basis [3]. In the case of the young versus elderly patient with end-stage renal disease, the urgency with which the transplant is needed and the amount of time each has been on the waiting list are important factors to weigh. Additionally, consistently choosing to give an organ to a young patient over an elderly one creates an unjust bias in the allocation system.
Lastly, respect for persons refers to transparency about transplantation procedures and honoring the autonomy of every patient involved [3]. Typically, a donor’s decision to gift an organ to a specific person takes precedence, but even here considerations of utility and justice apply. A donor should not, for instance, specify a social group to donate his organ to, as this would be a violation of justice. Ultimately, what matters in an interview is considering all three of these principles collectively and how they interact in the given scenario.
Conclusion
This only scratches the surface of ethical topics that could come up in a medical school interview. The key to success is not to memorize one answer or formula: rather, do your research on the latest in medical ethics, then practice how you might apply this knowledge to various scenarios and build a meaningful response. Other topics worth exploring include COVID-19, AIDS, the opioid epidemic, difficult patient encounters, and end-of-life care. Hopefully, you will remember this article when it comes time for you or someone you know to prepare for interviews — good luck everyone!
Luca Voli ’27 is a student in the College of Arts and Sciences. Luca can be reached at gev29@cornell.edu.
