Cambridge MEDICINE Virtual Mock Interview by Clare College, Cambridge

so hello molly and thank you very much for coming to your admission interview to claire college to the medical course um so i see from your application that you've done some work experience before deciding to do medicine could you tell me about that right so the majority of my work experience was volunteering in a care home so i went about fortnightly from maybe six seven months and before the covered outbreak um and like i started off just like just following someone around while they went around all the rooms and knocking to visit the residents um but when i sort of settled in more i spent a lot more time just sat in the common area like making us tea and stuff as well but just speaking to people whilst like whilst i was meant to be on my break i suppose um and just start listening to a lot of the patients um who had dementia especially um because they were really interesting they had a lot to say but i don't think any of the other people working there had the time to sit and listen whether you who you particularly remember so there was a um a pair of two women um and they always argued with each other but like you could tell they were really close friends i don't know if they knew each other before the care home or anything but they always reminded me of me and my friend the way we argue um and um they always used to judge the other residents um but i think they were really quite happy just the two of them um but between them they had some really interesting stories as well and you said that you were doing this at around the time of covert did kovid affect the care home while you were there so by the time that you know kobe was causing an issue in care homes it was very much a if you're not if your staff is not needed you're not allowed to come in um and obviously there was so much stress around the time that you know i didn't get any real communication during the first like few stages of the lockdown until afterwards where that a lot quite a lot of the patients had died i think at almost all the ones that i knew had died i've covered or they died whilst i hadn't been able to go in um but yeah it was really really quite hard not having any news for the first like fortnight or so and then just these gradual reports of you know outbreak in the care home and then just hearing which patients have died that day so a lot of what we do in medicine we have to deal with some very difficult issues where we care for patients and then we have to actually carry on caring for other patients how did you manage to deal with that very difficult challenge of you'd been talking with these people week week after weekend and then they passed away how did you manage that i think it was really hard because since like my grandma died when i was younger but like when i was too young to remember so i've not really experienced loss in that way before and i was really quite upset especially with the first ones but just like speaking to my parents who obviously have had more loss in their life than i have um just simply because they're older and they've got so much more life experience that was that was really you know that was a really great way to help um and then um my grandparents christians they've got lots of ideas about you know what happens after death and i think sort of their views on it really was sort of more uplifting than anything else um i'm not sure like how much of it i believe but it was just the thought that you know maybe they are somewhere better than they were like they're not struggling anymore did you see any examples of care of these elderly residents that you thought were particularly i think most of us like younger staff working there they always tried to like have time for a bit of a conversation a bit of a chat even when there was they were really no they weren't doing pleasant tasks they were you know changing that and i don't like diapers and stuff like they always were friendly and lovely to the residents and i think that was more important than any like medication they'd been give they were like distributing because just there lots of them didn't have any visitors and just the fact that someone wanted to talk to them you could visually like made them so much happier and when people were listening to them they found out what wasn't working for them and could change it and did you see anything that disturbed you that you thought actually this is an example of care that i'd be really happy with um there was one of the older people working in the care home so like not oh but they'd obviously been working there quite a while um they just they didn't really have they really didn't have time to like talk to patients and stuff but they were always short-ended with them um and obviously a lot of these patients you know had dementia and they they were they didn't purposely do stuff to get on their nut the woman's nerves but she always took it that way um and she just really wasn't good at communicating with the team either so like she was trying everything was trying to do it by herself but you know she didn't want to talk to paige she didn't want to talk and it was just she was really not very nice to be around and i can't imagine you know if that was the nurse you had when you were in a care home that just her mood would bring you down so much and then it had belittling you that would make me feel more miserable than anything else i think so what would you what would you take away from that about the way you would want to interact with people i think i would just always try to be positive and always like talk to a patient how i want to be talked to like not talking down to them not making them feel like their inconvenience no matter how stressful your day is you can always find a little way to you know make make a joke with a patient or you know smile at them it's that i think just stuff like that really little things like add up well thank you so much for talking about that experience that you had and it was clearly a very very tough experience in a very difficult time with a pandemic in a care home i'm just going to change gear a bit now and and we're going to sort of talk about some more um uh scientific if you like questions for the rest of the interview and i'm just going to um share my screen now and i'm just going to show you a few graphs and i'd just like you to talk about them and um these are questions where there isn't a sort of straightforward right or an answer so what i'd like you to do is just share your thoughts and if you can just sort of think out loud um and and just describe what you're thinking about that would be really helpful because we just really want to get a sense of you know how you think uh rather than there's a sort of set right or wrong answer for any of these questions so just share your thoughts and and think out loud and then um we'll we'll sort of have a conversation about about what i'm going to show you okay so let's see if we can share this okay so can you see a graph in front of you molly it sort of turned into a it's cropped itself a bit and i can only see b yet why access okay should we try i'm just gonna try swapping the display and see that you can see that that's very good okay so can you see can you see the whole graph now yes so all i'd like you to do is just describe the graph that you can see and tell me about it so i can tell by the labels that it's looking at the percentage of patients alive after the time of diagnosis with 100 patients being alive at the time being diagnosed um and then over time the lying shows that more and more patients are no longer alive so by the time it gets to about maybe just over two and a half three years um almost all the patients are all zero percent of the patient's still alive um and about fifty percent are still alive maybe just over just under two of the years years after diagnosis okay so i'll tell you that this is this is we don't need to know about what the disease is but this is this is all these patients were diagnosed um at the start of the graph so they've all been this is this is that they would die it's the time after diagnosis and um it's all of them were diagnosed with the same disease so you're quite right about that would you like to speculate anything about what sort of disease this is about the type of illness this is um i think the fact that you know it's such a cool it's it's so many years short like it's only a couple years when most all patients diagnosed at the start are no longer alive it's going to be aggressive and maybe even terminal um because it's only there's no information about sort of treatment i'm not 100 sure you know what type of disease it could be but um i would say it's probably something that's like less well understood um okay well we don't we we'll just hold that thought so so it's clear that this is a very serious illness and i think your description of the graph was very accurate so let's say that this this line is showing us the black treatment of this illness and now i'm going to show you another treatment of this illness and this is the same illness but now the patients are being given a treatment we'll call the yellow treatment so would you like to compare with me the yellow treatment with the black treatment and tell me what you think of it so starting at the time of diagnosis there's still 100 people alive as you you'd hope before you start administering treatment um and then by the time you're getting about 57 patients alive you are quite a lot further in this quite a bit longer after diagnosis um almost about the same time as when 100 of the patients have died with the black treatment and then the likes of longest like time after diagnosis before everyone's died is um i'd say probably about over four and a half years which is significantly more than it was with the black treatment so you talked about the if you had to come up with one number that would would come up would summarize the difference what what sort of what sort of number might you use um i probably wouldn't want to use um sort of the time when zero patients were alive because i feel like that's the max moment of life expectancy for diet time after diagnosis with this disease so i'd probably stick to maybe something around 50 of the patients live because that'll have less of like outliers um so i'd go that with the black treatment it was probably maybe maybe two and with the yellow treatment it's probably closer to three which isn't as much the difference when you compared to when you look at zero percent okay i think that's a very reasonable way way to put it okay so so just very briefly which which would you prefer to have if you had this illness the yellow one okay that wasn't hard okay right now let's look at another treatment and this is the red treatment now would you like to describe to me let's focus on comparing the yellow treatment because we said that was the best better of the two that we've looked at so far let's compare the red treatment and the yellow treatment and tell me what you think of those so whereas the yellow treatment um there's not much uh dropping percent of patients alive in the first maybe year or so it drops really rapidly we've read to almost about 50 within i'd probably say about the first year um but then after that it the graph changes um and that even as time progresses after the dying maybe a year after diagnosis the rate at which the percentage of patients alive is dropping is a lot slower than it is on the yellow graph so much so that even after five years diagnosis there's um probably around 30 35 percent of patients still alive compared to zero with the yellow treatment so we talked about using this kind of 50 alive number as a way to compare treatments now if you applied that to the red treatment how does that stack up it was not very good at all because it's only reflective of like a year or like within the short term span of the treatment um whereas this one changes a lot after the first time like the prognosis changes a lot after you they survived a year of treatment so so you know if you had to just tell me what the 50 survival is then comparing the the red and the yellow treatment just to yeah so if i'd say 50 survival and then ride would be maybe maybe a year maybe a year and a couple of months right call it a year yeah well yeah and then with yellow i'll probably say about three years okay so so on that measure we're going to throw the red treatment out aren't we because it's clearly terrible if we just look at that number what would you say the outlook for the red treatment is beyond five years i think it's a lot better than the yellow one because there's a significant percentage of patients still alive after five years of diagnosis and there's obviously still a few percentage drops but the gradient's a lot less steep um compared to the yellow one where after the 50 measure it continues to um drop quite rapidly but not rapidly but as rapidly as it is in the first place so that yeah if do you think do you think you might have cured some people um i think you might have killed some but it's hard to tell on the basis that the line is still um it's still sloped downwards it's still negative gradient and it might just be that it's just really prolong some people's lifespan and if now i haven't told you anything about the disease or the drugs or whatever but if you have to speculate what do you think the side effects or the quality of life would be for patients on these two treatments um i think with the red the fact that it drops so quickly in the start that it might be some of the side effects of the treatment before it starts having an effect so it could be like really it could interfere with like the medication and you know cause lots of problems um compared to the yellow which i assume wouldn't have as many side effects because well it might obviously might have side effects they might not be as much an impact on health but i think that the quality of health after the 50 mark would be a lot better in red than it is in yellow especially because yellows keep keeps dropping the curve so that you know people are still dying whereas red there's um not many as many people dying i would i would i would agree with that i mean i haven't we don't know do we i haven't told you okay so this is going to be now the last one what do you think of that so um i'm not sure what you know it means by the fact it stops does that mean that's the end of the day it's a brand new treatment and we've only got okay years of data i think that it's optimistic the fact that at the same point that yellow was 50 and red although it's you know stabilizing a bit so there's not many there's not very many deaths per year so like um it's still got a lot more percent of patients life but i think it's really important that we see out the five years or so and even longer to compare it to red because it could drop rapidly from the third year mark yeah okay so we we don't really know do we okay all right so we've talked through these four different treatments now let's imagine that you're in your clinic and you're seeing a patient who has this disease and your patient is a 30 year old woman with three young children and she has this disease which is clearly a very horrible disease and she says doctor can you explain to me which of these treatments i should have talk me through the you know talk me through these treatment options she says i want to make a decision i want you to advise me so could you sort of role prep play you know she's not applying for medicine at claire college um she's not got lots of very high-flying school exams she's not interested in 50 some gradients and rates she just wants you to talk through the different treatments so perhaps if you sort of talk through the yellow treatment the red treatment and the pink treatment to her could you explain to her in a simple language what what you know about those treatments okay so i'd probably say you know to start um the yellow treatment um i think it like the maximum sort of life expectancy we're looking at with that would be about five years but um it does could drop quite rapidly from about the first year mark and whereas with the red treatment um the time after diagnosis that we might expect to see um a life expectancy you know we don't we're not 100 sure because it just improves um the time after diagnosis so the life expectancy so much however with that one there is the risk but within the first year the risk of dying on this treatment is really high so much so that around 50 of patients dying i don't really want to be fit to look after my young children which treatment should i choose i think um with the yellow treatment you're more likely to have um at least two or three years where you are quite wild you're quite fit and quite healthy whereas with the red treatment you might struggle a bit with the first year or so but after that you know your life expectancy which is really quite high and you should be really really quite well to see your kids grow up i've heard about this new purple treatment on the internet doctor can you tell me about that okay so the purple treatment is looking really good at the moment um we're only a couple years in to start introducing it so we really don't know where it's gonna go even now about the three-year mark um 80-95 patients are still alive it is we're looking pretty good but my concern with that one is that we don't know where it's going to go from there um we don't know if that four years all of a sudden it drops off and no patients survive that so i'm really quite cautious about putting you on that one um until we maybe see what's what is actually happening with that one but doctor i really care about being able to look after my children now which one should i go for um i think obviously the purple one looking really good and if you look at the sort of the first year or so it's really quite similar to the yellow treatment um so i think that might be the best option and then i guess within um maybe a year or two years or so we might have much better idea of what the outcome is with the purple treatment and we can talk about maybe change into it or if there's any other alternatives okay i'll i'll spare you i'll spare you the rest molly but you can see how how you can how it's quite challenging actually to explain to somebody when you don't have all the information now let's switch it back to um an 85 year old man with no dependence with the same disease what would you advise him to do i'd probably spend more time focusing on quality of life rather than life expectancy so i'd probably say that with the red one um your quality of life within the sort of first year or so although it might improve um it's going to have really struggled with side effects and symptoms in that time and there's quite a high risk of dying within that year when but if you look at the yellow treatment yes within sort of five years most almost over all the patients who've had the yellow treatment have died but within those first sort of two three years not very only a small proportion have and so that gives me hope that within that time you'll have much better quality of life well thank you very much molly that's a really good um answer to those questions um and thank you very much for coming to see us um and uh yes i hope you enjoy your second interview at claire

Channel: Clare Schools

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Id: -CKuyDA8qSc

Length: 23min 21sec (1401 seconds)

Published: Thu Dec 02 2021