How to answer Medical Ethics interview questions

2017-12-14 · Long video (solo, talking head or whiteboard) · Ali, Charlotte, Molly Hunt, a guest · recording, 26:21 · watch on YouTube

Topic: Medicine and his doctor years · mode: Explanation and tutorial · tags: Aimed at students

Ali, a final-year Cambridge medical student, opens a series on medical ethics interview questions: with his friends Charlotte and Molly he applies the four principles of medical ethics to a bariatric-surgery scenario from his Imperial interview, adds opportunity cost, QALYs and practical thinking as ways to stand out, and explains that the four principles distil virtue ethics, deontology and utilitarianism.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Ali introduces the medical ethics mini series and his friends Charlotte and Molly

★★ Ali says every medicine applicant with an interview will recite the four principles of medical ethics, so to stand out you should give more than just the four principles. — 00:00:00 · Four principles of medical ethics, Medicine interview
★★★ Ali says the four principles of medical ethics are the structure he, his friends and everyone else would recommend for answering a medical ethics scenario. — 00:00:29 · Four principles of medical ethics, Medical ethics
★ Ali says Charlotte and Molly have medical ethics as a specialist subject, having taken it as one of their papers in their third year at Cambridge. — 00:00:58 · Charlotte, Molly Hunt, Medical ethics
★★ Ali says the medical ethics scenario in this video is exactly the one he was given in his Imperial interview. — 00:00:58 · Imperial College London

00:01:52 — Charlotte and Molly introduce themselves

★★ In the interview scenario, a surgeon must decide whether to offer bariatric (weight-loss) surgery to a woman with a BMI of 45, and the interviewer asks for the ethical issues. (hypothetical) — 00:02:26

00:02:34 — The scenario: should a surgeon offer bariatric surgery to a woman with a BMI of 45?

★★ a guest: The four principles of medical ethics are beneficence (helping patients), non-maleficence (doing no harm), justice (allocating treatments fairly) and autonomy (patients make their own decisions), a good start to any ethical scenario. — 00:03:24 · Four principles of medical ethics

00:03:32 — The four principles of medical ethics

★★★ Ali says everyone knows the four principles and that they must apply them, so what distinguishes candidates is what they say while applying them and showing personality: talk engagingly and smile occasionally. — 00:04:23 · Four principles of medical ethics, Medicine interview
★★ Ali says saying the usual points in a nice way, giving examples or showing real insight into medicine is what sets an applicant apart in an ethics question. — 00:05:04 · Medicine interview
★★ Charlotte would approach the bariatric-surgery case by taking each of the four principles in turn and addressing it with the case at hand. — 00:05:04 · Four principles of medical ethics

00:05:24 — Charlotte applies the four principles to the case

★★ Charlotte: Under beneficence, Charlotte says the woman is at significant risk of heart attacks, strokes and diabetes, so offering her the surgery would improve her health and long-term outcomes. — 00:05:39
★★ Charlotte: Under non-maleficence, Charlotte says doctors want to minimise the woman's risk of complications of being overweight, such as stroke, diabetes and hypertension. — 00:06:01
★★ Charlotte: Under autonomy, Charlotte says that if the woman is over 18 and has the mental capacity to decide, she has a right to choose her own treatment. — 00:06:01
★★ Charlotte: Under justice, Charlotte says bariatric surgery is expensive: it needs experienced surgeons, nurses and theatre staff, a hospital admission and nursing care, plus its opportunity cost. — 00:06:45
★★ Charlotte says justice is about deciding the best use of resources, because the NHS has finite resources and cannot give everyone everything. — 00:07:14 · NHS

00:07:46 — Justice, the key issue in this case, and opportunity cost

★★ Charlotte asks how else the cost of the bariatric surgery could be used: if it cost £20,000, the same money might start a smoking cessation service reaching 200 people. (hypothetical) — 00:07:57
★★ Charlotte says the NHS is founded on the principle of discriminating only on the basis of clinical need. — 00:08:27 · NHS
★★ Charlotte says the aim is to discuss the case with the interviewer and show that you appreciate the complexities of allocating resources. — 00:08:27
★★★ Ali says opportunity cost can always be mentioned under justice: even when asked to choose between two transplant patients, consider what the money could do if neither got it. — 00:09:05 · Four principles of medical ethics

00:09:48 — Molly on non-maleficence: the harm the surgery itself can cause

★★ Molly Hunt: Under non-maleficence, Molly says the surgery itself could harm the woman: every treatment has side effects, complications or risks, which doctors must grapple with. — 00:10:04 · Molly Hunt
★★ Molly Hunt: Molly says that when deciding what is in a patient's best interests you must weigh the harm a treatment could cause, not just the harm of not treating. — 00:10:33 · Molly Hunt
★★ Ali says it is useful to mention in an ethics answer that any operation inherently causes harm, which shows interviewers insight into medicine. — 00:10:33
★★ Ali says quality-adjusted life years (QALYs) can be brought into the justice part of an answer, since they are the measure by which most things are allocated, at least in the UK. — 00:11:01

00:11:11 — Quality-adjusted life years and how they relate to justice

★★ Charlotte explains QALYs: the years of life an intervention adds, weighted by their quality on a scale of zero to one, where one is a year in perfect health. — 00:11:59
★★ Charlotte says NICE suggests that an intervention costing less than about £30,000 per QALY is probably cost-effective and can probably be offered on the NHS. — 00:12:55 · NHS
★★ Charlotte says a cholesterol tablet is very cheap per QALY, while very specific immunotherapies for rare cancers are very expensive per QALY, so resources must be balanced. — 00:12:55

00:13:44 — Think about practicalities, not just abstract ethics

★★★ Ali says few candidates think practically about an ethics scenario, so saying what you would actually do as a doctor in that situation earns extra marks. — 00:13:54
★★ Molly Hunt: Molly says that beyond the broad ethical issues you should think practically about how you would handle the case as a doctor, such as sitting down with the patient to discuss risks and benefits. — 00:14:24 · Molly Hunt
★★ Molly Hunt: Molly says that if the bariatric surgery is a risk-benefit decision, it ultimately lies in the patient's hands, with the doctor's guidance on both risks and benefits. — 00:14:53 · Molly Hunt

00:15:23 — Interim summary

00:15:45 — Where the four principles come from: Beauchamp and Childress, and getting off the fence

★★ Ali says understanding where the four principles come from is useful, giving more understanding of where they fit in the wider medical ethics debate. — 00:15:51 · Four principles of medical ethics, Medical ethics
★★ Ali says the older philosophical frameworks of ethics conflict with each other and are about decisions in life generally, while medicine wants one standardised framework. — 00:17:17
★★ Ali says Beauchamp and Childress wrote a treatise on medical ethics proposing the four principles as a distillation of the other schools of thought. — 00:17:57 · Four principles of medical ethics
★★ Ali says the four principles of medical ethics have been criticised but are still a pretty good method for answering ethical scenarios. — 00:17:57 · Four principles of medical ethics
★★★ Ali says knowing the schools of thought behind the four principles helps you get off the fence when torn between two options in an ethics question and pressed for an answer. — 00:18:27 · Deontology
★★ Ali says that in his Imperial interview he was asked to make a yes-or-no decision and based it on a utilitarian approach. — 00:19:11 · Imperial College London
★★ Ali says the bare minimum is applying the four principles of medical ethics; knowing the schools of thought is not required but improves your answers. — 00:19:41 · Four principles of medical ethics

00:19:58 — Virtue ethics, deontology and utilitarianism

★★ a guest: Virtue ethics, pioneered by Aristotle, says to think about what you are rather than what you do: doing what a virtuous person would do is right. — 00:20:10
★★ a guest: Virtue ethics can be a circular argument, since someone might think a virtuous person endorses slavery or harming others. — 00:20:39
★★ a guest: Deontology, led by Immanuel Kant, holds that acts are right or wrong in themselves whatever their outcome; killing another person is always wrong, however many it might save. — 00:21:09 · Deontology
★★ a guest: In Kant's deontology an act is right only if it could apply universally: if breaking promises could not be universally right, you should not do it. — 00:22:00 · Deontology
★★ a guest: Utilitarianism, the main form of consequentialism, comes from Bentham, Sidgwick and Mill in the 18th and 19th centuries: happiness is good and suffering is bad. — 00:22:29 · Consequentialism
★★ a guest: In utilitarianism the right action causes the greatest happiness for the greatest number, decided by a cost-benefit analysis of its pros and cons. — 00:22:58
★★ a guest: In practice it is more useful medically to think about how Beauchamp and Childress distilled the schools of thought into the four principles and how to apply them. — 00:23:28 · Four principles of medical ethics

00:24:04 — Summary, more videos to come, and closing remarks from Charlotte and Molly

★★ Ali says many more videos are coming over the next few weeks about other parts of medical ethics. — 00:24:45 · Medical ethics · first in: 2017-10-01, Applying to Medicine at Oxford or Cambridge - Questions to ask yourself, open days, stereotypes
★★ a guest: Interviews may ask about more specific topics, such as termination of pregnancy, euthanasia, consent and confidentiality, each with its own issues, which later videos will cover. — 00:25:14 · Medical ethics
★★ a guest: Knowing past laws and what doctors have done before is useful not only for interviews but for clinical practice, as it explains how medicine is practised today. — 00:25:44

Threads in this video

kept · Ali promises more videos on the BMAT, interviews and personal statements (2017) — Ali starts a mini series on medical ethics for medicine interviews, opening with how to answer an ethical scenario using the four principles. (00:00:00)
progress update · Ali promises more videos on the BMAT, interviews and personal statements (2017) — Ali says many more videos are coming over the next few weeks about other parts of medical ethics. (00:24:45)
first on record · How do you answer medical ethics questions in interviews? — Ali says the four principles of medical ethics are the structure he, his friends and everyone else would recommend for answering a medical ethics scenario. (00:00:29)
refine · How do you answer medical ethics questions in interviews? — Ali says everyone knows the four principles and that they must apply them, so what distinguishes candidates is what they say while applying them and showing personality: talk engagingly and smile occasionally. (00:04:23)

Where the stories that moved here went next

Ali promises more videos on the BMAT, interviews and personal statements (2017) — kept

Mentioned

Central: Four principles of medical ethics · Medical ethics · Medicine interview

Also: People: Aristotle · Charlotte · Henry Sidgwick · Immanuel Kant · James Childress · Jeremy Bentham · John Stuart Mill · Molly Hunt · Tom Beauchamp

Organizations: Emmanuel College · Imperial College London · NHS · NICE · University of Cambridge

Concepts: Consequentialism · Deontology · Opportunity cost · Quality-adjusted life year · Utilitarianism · Virtue ethics

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