How to answer Medical Ethics interview questions

hey guys welcome back to the channel if you new here my name is Ali I'm a final year medical student at Cambridge University and this is a new mini series where we're going to be talking about medical ethics and how to answer medical ethical scenarios that you might get in your medicine interviews we're gonna be going a little bit beyond what you need to know for your medicine interviews but to be honest every single person applying for medicine and getting a medicine interview is just going to be reading off the four principles of medical ethics so if we want to stand out in our interviews ideally we want to be giving a little bit more than just the four principles so that's what this series is aimed at having said that this video is all about the four principles of medical ethics which is the structure that me and all of my friends and literally everyone would recommend for how to answer a medical ethical scenario two things firstly if you look in the video description below you'll find timestamps to every single thing that's mentioned in this video so if you already know what the four principles are and you don't want to be told again you can just skip that and move on to the next section where we apply them to a real-life scenario secondly this video and the rest of the videos in the series are going to be featuring two of my very good friends charlotte and molly they're both amazing at interviews they're both amazing at talking to patients and they also have this medical ethics e stuff as kind of a specialist subject because they did it as one of their papers in their third year so they're both very kindly agreed to sit in front of the camera and discuss some of these ethical scenarios these ethical issues with you so hopefully you can learn from that and yeah very grateful to them for taking part so let's get the show on the road firstly i'm gonna let shoulder and molly introduce themselves and then we're gonna introduce a medical ethical interview question ii kind of scenario which is actually exactly what I got in my Imperial interview so hopefully they don't use it anymore because I'll have just given the game away but to be honest it's a fairly standard scenario and it's exactly the sort of thing that a lot of medical schools use in their interviews so we'll be introducing the scenario and then we'll be explaining how you might go about answering it and as I said every single thing is down below time stamps so if you want to skip some of the video don't feel like you have to watch it all in one go or like all at the same time or whatever anyway sure and while you're gonna introduce themselves coming up I'm Shirley I'm a final year medic man your college and I'm Molly I'm another final year at Emmanuel College - so both of us for our surgery report - at Cambridge we did history and philosophy of science so we did papers in ethics and law so it's of an interest of our space yeah and we've also next week we've got our final exams and part of those exams is about ethics and law so it's good revision for us to to have a discussion and to think through some of these topics with you okay so that's introduction sorted now we're going to introduce the scenario which as I said is the one that I got asked in my Imperial interview and quite closely mirrors the sort of ethical scenarios that other medical schools might give you in your interview so have a listen and see what you can come up with so we want you to imagine that you're in an interview now and your interviews give you this scenario so you're your doctor you're a surgeon in the hospital and a lady comes to you and she has a BMI of 45 which is puts her in the morbidly obese category and you have to decide whether you're going to offer her bariatric surgery so weight-loss surgery and the interview says to you can you talk me through the ethical implications and the ethical issues in this case what would you what would you do what would you say do your interviews right so that's the scenario that we're going to be dealing with in this video I'd recommend you pausing the video and think about how you might answer it because now we've got Shauna and Molly discussing how they would approach it firstly they're gonna introduce the four principles of medical ethics and then they're going to apply the four principles to this scenario and that's a structure that we would all suggest you use when answering these sorts of ethical questions one of the ways that you can always if you're struggling in an ethical situation when you get one of those questions is take a moment and one of the principles that all of ethics is so founded on in medicine is the four principles so there's beneficence which is generally a doctor should be trying to help patients and there's non-maleficence so wanting to make sure that doctors are not making not doing any harm to someone and there's justice so making sure that we allocate treatments fairly and then autonomy that patients are people in their own right and they should be allowed to make their own decisions and so that's a really good way of starting to go about any ethical scenario like this okay so that was the four principles of medical ethics that's autonomy beneficence non-maleficence and justice and like I said at the start of the video literally every single person applying to medicine and getting an interview will know these four principles off by heart and we'll be reeling them off so it's pretty much bare minimum knowledge for medicine interviews but you know this video is just an introduction so now Charla is going to be talking about how she might apply these four principles to the question and that's really what distinguishes candidates because everyone is going to know the four principles and everyone is going to know they have to apply them to the question so really it's all about what you can say while applying them and kind of showing the interviewers a a little bit of personality you know talking and engaging kind of fashion make sure you smile occasionally that sort of thing and secondly the kind of stuff you say even though everyone will be saying roughly the same thing if you can say it in like a nice way or you can give give give some examples or you can show a real insight into medicine then that's what's gonna set you apart from the crowd but yeah here's Charlotte talking about how she might apply these four principles to the ethical scenario at hand here we go I think what we what we'd say how we'd approach is to take each of those principles in turn and try and address it with the with the case at hand so in this case if we if we think firstly about beneficence so doing good a lady who's got such a high BMI is a significant risk of lots of health problems things like heart attacks and strokes diabetes and so in order to do good offering her this surgery is going to improve her health and improve long-term outcomes so so we will be doing good by offering her this surgery [Music] in terms of doing no harm it's kind of the same we we don't want this lady to to develop nasty complications of being overweight so again things like stroke diabetes hypertension and so we want to minimize the the risk that she's going to be exposed to if we then think about autonomy if we presume that this lady is is she's over 18 she's got the mental capacity to decide then she's got a right to to decide for herself what treatment she wants and if if she wants to have that intervention we as doctors need to need to yeah really respect that and to take that into account when we're making a clinical decision and the justice thing is is all about how we allocate our resources so bariatric surgery is is expensive it takes it takes experienced surgeons and nurses and theater staff there's the time the person will have to be admitted in hospital and all of the nursing care that goes with that and then there's also the opportunity cost of what else could we do with that money that we're going to use for this procedure we could we could do other surgeries other interventions we could offer other people drugs and so it's about how how we decide what's the best use of our or resources because the NHS is is it's got finite resources it's we're not able to give everyone everything and so in this scenario we take each one in turn and discuss that three so I think justice is probably the one that stands out most to me and so we'd have to consider if it's going to take X amount of money to give this lady her bariatric surgery how else could we use that and how many other people might that benefit so if we said it was going to cost twenty thousand pounds for example if we had that pot of money and we could we could start a smoking secession service that would impact 200 people should we should we allocate the resources differently because of the number of people who'd benefit and the NHS is founded on that principle of that we should discriminate only on the basis of clinical need and that can be really tricky in situations like this because we have a patient sat in front of us who who has a healthcare need she needs to lose weight in order to to not have really negative outcomes but we also have a huge number of other people who who need interventions and it's it's about how we how we can discuss that with an interviewer and show that we appreciate the complexities of allocating healthcare resources right so that was Charlotte talking about how she might apply the four principles to this ethical scenario and she also made that really good point about opportunity cost I think opportunity cost is always something you can mention when talking about the justice component of the four principles because opportunity cost is one of those things it's like what else could we be doing with this money instead of just what what you're being asked so if your scenario asks you to choose between two different patients for a transplant or something like that still consider opportunity cost to think about what if we didn't give the the transplant to any of them what could we use that money for instead I think that's quite a nice little argument we get extra marks for it when mentioning it in our ethics and law papers and I think if you were to mention it in your interviews as part of justice that would score you some good brownie points with your interviewers now we're gonna hear from Molly who's gonna be expanding on this point just a little bit here we go Union things I might think about in this scenario on the basis of those four principles again and definitely beneficence we've got to balance how much good we could do to this lady so if we give her the surgery could we be avoiding all of these future complications the one thing that I think stands out to me is that actually in Nam it's also the fact that we could cause harm by giving her the surgery and so as a doctor one of the main things you have to realize is that every treatment you give has side effects or has complications or has risks and that's something you're really going to have to grapple with as a doctor in the future and you have to decide whether that beneficence outweighs the non-maleficence and so I think that's an important thing to draw in this scenario because you've got to make sure that when discussing things with a patient and when deciding what's in their best interests you take into account the harm you could cause by doing any treatment and not just the harm that will happen if you don't give them the treatment okay so that was an interesting point to make about non-maleficence anytime we do an operation to someone we are inherently causing harm to them and that's against something useful to mention because it if you if you can appreciate that actually surgery is complicated and has complications and you know potentially causes harm that's another kind of brownie point for insight into medicine that they're looking for in your interviews now we're going to hear Sharla talking about another sort of semi advanced topic which is qualies quality adjusted life years and that's another thing you can bring into the Justus thing because that's the measure by which most things are allocated in the UK at least here is Charlotte talking about qualies I think all of this it can feel like it's quite nebulous it's quite qualitative you know it's all about how people are feeling and and it can be difficult to quantify in in in numbers and figures and the attempt that we make in in the NHS to try and navigate what is a minefield is to use these things called quality adjusted life years so qualies and what we do we for every intervention for every drug we have for every treatment we're going to offer we we think about how many years of life they are going to add on to a person so how much long we'd expect that person to live if they are given the interval and then we weight that based on how good the quality of that time will be so it's on a scale of naught to 1 so 1 would be a year in perfect health and we wait the year and we think about things like are they free from pain are they free from psychological distress how well can they go about performing their activities of daily life things like getting up getting washed getting dressed and so every intervention that we have will be given this rating and that in some part goes goes to help us decide what where should we put our resources and the National Institute of Clinical Excellence has some recommendations for us and nice suggests that if one quality adjusted life year costs less than about 30,000 pounds it's probably cost-effective and we can probably offer that on the NHS anything more than that and things become a little bit more tricky so interventions like giving someone a cholesterol tablet are really cheap per quali it's really excellent value for money whereas treatments like very specific immunotherapies for very rare types of cancer they're really expensive per quali and so we have to we have to balance our resources and and qualities are a way of helping to think about justice and resource allocation okay so that's our brief discussion about qualies you can look it up I've got a link in the description to the Wikipedia article if you want to read more about it now Molly is going to make a really good point and that's about thinking practically what you might do if you were a doctor actually faced with that ethical scenario and again I think this is a good one to listen to carefully because if you if you can mention this in your interview that again will also score you lots of brownie points because so few candidates are going to be thinking practically about the scenario they're going to be thinking in an abstract way they're gonna be applying awful principles but if you can say that actually if I were a doctor in this circumstance what I would do is probably then again that's that's more brownie points that's more kind of big tix in the little sheet but they're going to mark you within your interviews probably so here's morning talking about that I think also when you're faced with one of these questions it's it's worth not just thinking about these broad ethical issues but also thinking practically about how you would have to go about it as a doctor because it's all very well saying I think about beneficence non-maleficence autonomy and justice and go through all of them but actually at some point you have to say in reality what I'm gonna have to do is sit down with this patient and speak with her about what the pros and cons what the risks are what the benefits of the surgery could be and it's gonna be her autonomy in the end unless you really think you could be causing serious harm and you you really don't want to recommend this surgery and if it is that risk benefit decision then ultimately that will end up lying in the patients hands with your guidance making sure that you inform her of both the risks and benefits and let her then decide what she thinks is is worthwhile for her okay so that's the end of this first section of the video we've talked about an introduction to the four principles of medical ethics autonomy beneficence normal Ephesus justice and Shara and Molly have talked about how they might apply these to the ethical scenario and you've also heard a little bit about Polly's a little bit about opportunity cost a little bit about practically speaking what a doctor would do in the circumstances all of which are things that are gonna score you brownie points with your interviewers we could end the video here but I don't like the idea of just kind of saying to you guys that just apply the four principles and you'll be fine because I think it's important to know where the four principles come from and when I was applying to medicine and I was changed some my friends about this and we we we didn't really know where they came from we just kind of thought Oh medical ethics yeah four principles are done but as we were going through our clinical ethics and law course we realized that actually these four principles came about for a very good reason and I think understanding where they come from is kind of useful because it just it just gives you a little bit more understanding and more of an overview of where they slot into this whole medical ethics debate basically what we're trying to work out is what is the right thing to do under morally uncertain circumstances you know if if you have got a patient and you if you do have to decide between two transplants if you do have to decide whether to give this surgery to this patient or to that patient if you have to decide whether to operate without consent if you have to decide so how do we work out what to do in a given situation we could do what the philosopher is back in the day used to do and follow particular schools of thought so some of the main ones might be don't ology virtue ethics utilitarianism consequentialism that sort of thing and these were all like frameworks that were invented by various different philosophers and they gave us a nice framework for making moral decisions how to weigh up one decision from another and work out which one is the morally right thing to do now back in the day these frameworks were what doctors used to use to work out whether you know were to work out what to do in in an ethical dilemma so if they were deciding between two patients to do a treatment on they might call upon utilitarianism or they might use virtue ethics to decide whether to operate without consent something like that the problem was that firstly these various frameworks they're all well and good but eh they're quite conflicting in that you know feature that makes different decisions and kind of in medicine you want a more standardized framework so medical professionals everywhere can use the same framework ideally so firstly they were quite conflicting in that they said different things and secondly they were quite generalized like there are more about how to make decisions in life generally as opposed to specifically to medicine so what happened was that these two blokes I think Oh blokes Beach him and Childress they put together this treatise about medical ethics and they came up with these four principles autonomy beneficence normal Ephesus and justice and what they said was that these four principles are a distillation of all of the other schools of thought so taking the bits that are common to each of these schools of thought and applying them specifically to a medical sphere and these four principles have been criticised but to be honest there's still a pretty good method for answering ethical scenarios I think it's useful to know that they come from a distillation of these other schools of thought like some of you guys might have heard of utilitarianism or console which is a more Aristotle or whatever but you know just think of him as a distillation of all of these various various ethical principles so what's gonna happen now is that Molly and Charlotte are gonna briefly explain the three main schools of thought very briefly a virtue ethics deontology and utilitarianism i think it's really useful to know about these schools of thought because firstly it helps you understand where the four principles comes from which is good for increasing understanding generally but secondly knowing about these schools of thought helps you kind of get off the fence like if you're a torn between one scenario and another scenario in an ethical question then it's all it's all well and good it's kind of reading off the four principles and kind of explaining the arguments but what if they press you for an answer what if they say yeah so which patient would you give the drug to and it's not enough - it's gonna be on the fence so that's what happened in my Imperial interview they asked me to make a decision yes or no and I called upon utilitarianism I said well I think a utilitarian approach would work for this and that would favor double-dot and with this is what we do in in quite a lot of our medical medical ethics and law exam papers as well you get extra marks for coming to a decision based on one of these frameworks so I think if you know about them okay it's it's not required knowledge really the only bare minimum is just applying the full principles of medical ethics but I think if you do know about these schools of thought and it just expands your ability to give a better answer in ethical scenarios so yeah that's that's me done let's now hear from Charlotte and Molly who'll be explaining these three schools of thought and I will say some final words at the end so and there's various different schools of thought about how what is morally right and what's morally wrong and and it's useful to just give you an overview of some of those things so we'll just do the real basics of a few schools of thought and so the first one is the school of virtue ethics so this was pioneered by Aristotle in his day and he talked about the first stop law and this is pioneered by Aristotle in his day he talked about the fact that you should think about not what you do but what you are and that if you are doing what you think a virtuous person would do then you're doing the right thing so as you can see this is this can be quite a search circular argument in the end and because you might think that a virtuous person is someone who endorses slavery or someone who endorses harming other people for what they perceived to be the right way of doing things so it can lend itself down depending on what you think a virtuous person is so another way of saying things about it is deontological choice you have to say this word is another way of saying de ontology I can say that way the only color to categorical imperative so another school of thought is that of the ontology and in this one our headline man is Immanuel Kant he thought that actually acts in themselves are either morally right or morally wrong so you can no matter what the outcome of an act some things are always going to be wrong and so he would say that killing another person is always wrong no matter how many people you might save no matter what the consequences are of that action and and another thing that he says is that a law if you can apply it universally so if you can say that everyone in the world if they acted in that way it would be better then that's fine but if you couldn't apply that action to the whole world so for instance he talks about breaking promises and if you couldn't say that breaking promises would be universally the right thing to do then you shouldn't do it so in the the last big kind of school of thought to cover is is consequentialism which does what it says on the tin it thinks about consequences of actions and utilitarianism is is the it's the most important type of consequentialism that we we need to address so there were these guys in the 18th and 19th century Bentham centric Stuart Mill and they they they said at the fundamental level happiness is good suffering is bad and so the right thing to do is the action that will cause the greatest happiness for the greatest number of people the overarching the overarching decision should be a cost-benefit analysis so think about think about the pros and the cons of the action and if they're if the pros outweigh the cons then that's ok so that's the that's the school of consequentialism utilitarianism maximizing happiness for the greatest number of people it's useful to have that grounding I think of knowing where all of these school of thoughts have come from and the various different moral values that you might decide to base answers on and to base your thoughts on but actually in practical terms it's really helpful as from a medical point of view to think more about what bow shop is at Beecham was it beach from a practical point of view it's actually more useful medically to think about what Beecham and Childress did when they distilled all of these down into the four principles that we've talked about earlier and how you can apply them to medical practice okay so that brings us to the end of the video that was Charlotte and Molly discussing these three schools of thought and those are the ones that were distilled down into the four principles of medical ethics which is how we recommend you should answer medical ethical scenarios so what we discussed we've talked about the four principles we've given you an introduction to what they mean we've applied them to this specific medical scenario about do we give gastric bypass surgery to this fat person we've talked a little bit about opportunity cost we've talked a lot about Qualys and we've also talked about practically speaking what a doctor might do if faced with an ethical scenario and I think those are things that might actually give you brownie points when you're when you're doing your interviews finally we entered with a discussion about these three schools of thought just to kind of expand our minds a little bit so thank you very much for watching this was just an introduction but we've got loads more videos coming out over the next few weeks about other parts of medical ethics and yeah I'll leave it there please like comment subscribe and I'll leave you with Charlotte and Molly who will be saying some closing remarks and thanking you and saying goodbye so here are Charlotte and Molly I'll see you in the next video saying that's the general framework that we would we would advise you you kind of use in your ethical scenario questions think about the full principles think about autonomy and justice and beneficence and non-maleficence and and structure your answer around that but there are of course some other more specific topics that you might get asked about things like termination of pregnancy euthanasia consent confidentiality they all have their own issues specific issues to them and we're going to talk through some of those using it in other videos we'll go through in some more detail more than you need to know but we think that if you have a good idea of these things that it's not only really useful for your interviews but also going into clinical practice you need to understand what's happened in the past what laws have been made what doctors have previously done and how that's informed how we practice today so thanks very much for watching and we hope that's been useful to talk about how to go about answering an ethical question and we look forward to seeing you in the next few videos [Laughter]

Channel: Ali Abdaal

Views: 182,374

Keywords: medical ethics, medicine ethics, medicine interview ethics, ethics, medicine interview questions, medicine interview, medicine interview preparation, how to prepare for medicine interviews, medical school interviews, interview prep, medicine interview prep, med school interview, med school interviews, medical school interview, medical school interview prep, tips for medicine interview, medicine interview tips, interview tips, medicine tips

Id: 4QtYOmblLOY

Length: 26min 21sec (1581 seconds)

Published: Thu Dec 14 2017