What do you do when you are in an interview and you are presented with a life-or-death scenario?
Today I want to walk you through one of the most difficult kinds of scenarios that you
can face in the MMI, in an interview traditional or panel or any other variety, or even in CASPer.
So before I get started, hi my name is Dr. Sarah Kleeb and I'm an admissions expert
at BeMo Academic Consulting. So I'm going to provide you with a really tough prompt that
will give you an idea of the situation we have to deal with. First I'll give you a sort of overview
of some of our strategies for addressing this kind of scenario and the station in general as
if this were at MMI, then I'll give you will run down through how you might put together an answer
that takes into consideration a variety of things, some provided in the prompt some not, an answer
that pushes back against the prompt a little bit, it demonstrates our ability to isolate what is
the most central concern and put together a mature responsible professional answer in a situation
where you need to you know sort of act quickly. So first that little overview of our general
strategy again assuming this is an MMI although this would work in any kind of interview scenario,
you're going to enter the room, you're going to make your first best impression by offering a
warm and assertive greeting, providing your name, getting the name of the interviewer if possible
so that you can extend that professional courtesy to them, and at that point begin your answer. Now
the first thing that we want to do is offer a recap of the prompt to ensure that we're on the
same page as the interviewer. After that we're going to identify what type of question we're
dealing with, the central issue that needs to be considered, check our assumption or any assumptions
that might be present in the prompt itself, note any involved parties and how they might be affected
by our decision and then outline some options for moving forward. So here's the difficult prompt that
we're dealing with and I'm just going to read this so forgive me for that. You are the only
ER doctor on duty and you're responsible for all decision-making during this shift. This night you
have two patients rushed into the ER who both desperately require a kidney transplant. One of
these patients is 80 years old, he's a university professor suffering from acute kidney failure
related to his age. The other patient is a 20 year old university student who has been brought in to
the ER several times previously and here he is again with another episode of kidney problems
related to excessive drinking of alcohol at school parties. There's only one kidney available that
matches both patients who do you give the kidney to. So this is really difficult alright this is a
scenario in which there is a lot at stake, there are some serious ethical questions to take into
consideration, and a lot of us without preparation would look at a question like this and probably be
in shock and don't really know how to move forward from there, especially if you haven't read up on
professional ethics in the area. So that's a quick aside to make sure that whatever a professional
area you are intending to go in to ensure that you're familiar with the professional ethics in
that field obviously this particular scenario is most immediately relevant to med students, pre-med
students, residency students, things like that. However this kind of scenario can absolutely come
up in other disciplines simply to see what your decision-making process looks like, but in general
as long as you have a good general idea of those professional ethics you'll have some foundation to
build on in putting together a response. So again after I've read the prompt on the door to the room
if this was an MMI, I'm going to enter with and the buzzer goes off, I'm going to give my warm and
assertive greeting, exchange names, provide a recap to ensure that we're on the same page, and a recap
that also sort of acts as almost the introduction to your answer as if this were a short essay that
you were verbalizing, you always want to give a short intro and then setting up the answer. So
for my recap, I would start off by simply saying you know in the prompt that I have been given I
am dealing with a pretty significant ethical dilemma. As the only physician on duty in the
emergency room I'm in charge of making decisions and two patients with severe kidney complications
have come in. One elderly man with acute renal failure and one young university student. Both of
these individuals require transplants but there is only one kidney available. That matches both.
So note here I have identified my role, right knowing and clearly stating what your role is
in each scenario will allow you to think of what kinds of options are available to you, different
roles will have different options available to them. I've focused on objective facts. I haven't
offered any speculation about particularly the young student you know we know that his kidney
issues are likely to do with alcohol consumption, there are other explanations sure he's been here
several times according to the prompt for that drinking related kidney complication, there could
be something else going on here and we also don't really want that to shade our answer and I'll get
to that in a minute. I've identified the central issue which is the fact that there are two people
and only one kidney and that introduction was concise, it was well-organized and it was to
the point. This is something that usually only takes about 15-20 seconds to do, you are under
a time crunch when you're dealing with MMI, but it really helps set things up helps the interviewer
see where you're coming from and make sure that you've isolated that critical central point. So
after giving that I would begin going on with my answer. So I would want to acknowledge that
this is an incredibly difficult position that I am in. I want to have a sympathetic approach
to both patients and appreciate that both of them are in pain and suffering a lot. So that's
simply how I would start, I'll give you sort of my ideal answer here. So in this scenario according to
the recap that I've just given I'm in a very difficult position. The central issue here is
the fact that we need to ensure that this kidney goes to whomever has the best chance of accepting
it successfully. I am sympathetic to both patients and what they're going through a renal failure or
kidney complications are extremely painful and I really appreciate the suffering that both of
them are going through. However I need to make sure that whatever decision I make is based on
my own expertise, my clinical experiences, and the scientific literature and evidence. To be
completely honest the personal backgrounds of each of these candidates is irrelevant. What
matters most and what my decision needs to be based on is who is going to most benefit from
this transplant and who has a better chance of surviving the surgery, surviving the post
surgical complications that might arise, and who is least likely to reject the transplant. So the first
that I need to do is try to get these patients stabilized and buy myself some time. So I'm going
to put them both on dialysis and have them put under constant monitoring so that I can gather
some resources, some information, brush up on the most recent literature if necessary, maybe
even consult with some of my colleagues, and if it hasn't been done already I'm going to ensure that
someone contacts the families of both individuals. Again with only one kidney between the two this
is a really tough decision so I'm going to want to review the medical records of each of these
patients, I'm going to need to take a detailed history, find out what if any medications they're
currently on, what other conditions they may have, anything else that would contribute to my larger
process of decision making. I'm going to send for some tests and some labs to make sure that
I have verified all of their health information and don't see anything that really stands out
as potential for rejection. And again I'm going to review that current literature on the effects and
the outcomes of transplants on an 80 year old male with acute renal failure and a 20 year old
male. I'm going to make sure that I do this as objectively as possible, analyzing the risks and
benefits in each patient and then based on what I've learned on the information that I've gathered,
I'm going to perform the transplant on whomever will have a better chance from a scientific and
a clinical point of view. Whoever receives the kidney is going to ultimately be educated on
any potential complications that might arise and any lifestyle changes that may be necessary to
maximize the benefits. And that applies in both cases again regardless of their background there
are always potential complications, there are very often lifestyle changes that need to be made and
so whatever is contextually appropriate to each individual, that's the information that they will
get .And importantly whoever does not receive the kidney at this time will remain on dialysis under
monitoring until another kidney becomes available. So that is a strong, mature, and appropriate response.
It was organized in a clear way, we walked through the logic that was necessary to follow to come
to our decision, it was coherent, it was concise, and most importantly it was delivered in a very
systematic manner, step by step. Here are the steps, here are the chronological steps that
I'm going to take, here's why I'm taking those steps, here's what I'm taking into consideration,
and here's what needs to be set aside in terms of the prompt right not all of the information
that they gave us was actually directly relevant to the decision that needed to be made. Again if
the kidney goes to the young man who tends to drink he's going to have to be educated about how
to better take care of himself to ensure that he's able to you know maintain his health with
this kidney transplant. So my answer was objective and non-judgmental, this is absolutely critical in
these kinds of scenarios and I didn't allow those personal attributes of either patient to interfere
with my decision-making there. I acknowledge that further investigation was required, again that's
really important it may seem obvious that you would do things like get a full medical history,
look over their charts, or send for labs and things like that but if you don't articulate those things,
then the interviewer has no idea that they have actually crossed your mind. You need to be
really careful to give the interviewer access to all the things that are going on in here, you
can't take anything for granted or assume that they will assume that you know these things. If
you don't tell them they have no way of knowing. Then so after I identified the fact that there
was information missing I demonstrated some of the outlets that I would utilize for gathering
that information and then came up with a practical solution and I chose the most rational, objective,
and scientifically sound option which was in the best interest of the patients and which caused
the least amount of harm to those involved. This is not an ideal situation. You're not going to get an
ideal answer all right somebody's going to get a kidney and somebody isn't in this case. But what we
can do is ensure that we demonstrate how we would make the best choice given what is available to
us and then importantly at the end we followed up to say you know whoever doesn't get it they're not
just going to be you know abandoned, we're going to keep them on dialysis, we're going to keep them on
monitoring, we're going to help keep them alive and as healthy as possible until another transplant
opportunity arises. So we've planned for the future. Both in the case of the next medical intervention
necessary for whoever doesn't get the kidney, and we plan for the future for whomever does
receive that kidney by ensuring that we discussed how we're going to educate that person on any
potential complications and lifestyle changes that they might need to incorporate. So overall
this is one way that you can approach these kinds of really difficult scenarios, a lot of ethical
scenarios or ethical dilemmas aren't going to be life-or-death situations but even for the ones
that are, you can still often work through them in a very logical systematic manner, plodding
step by step, buying yourself a little bit of time and really demonstrating that you can approach
a genuine crisis with a cool objective and clear and concise answer. So I hope that you enjoyed this
and that you found it helpful .iI you did please do go ahead and like it, share it with a friend
who might find it useful or benefit from it, and feel free to comment with any questions you might
have. If you'd like us to help you out with your own preparations, please do click the link that
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us. We'll set you up with one of our admissions experts to answer any questions you might have
and get you started on your preparations. We have all sorts of different programs to suit
your needs and we are happy to work with you to determine which plan is going to support
you most effectively. Thank you so very much your time, take care, and I'll see you next time!