Public MMI questions

Critical thinking

A message that recently appeared on the Web warned readers of the dangers of aspartame as a cause of an epidemic of multiple sclerosis. The authors claimed that aspartame remains on the market because the food and drug industries have powerful lobbies in Congress. They quoted Dr. Russell Blaylock, who said. "The ingredients stimulate the neurons of the brain to death, causing brain damage of varying degrees." Critique this message, in terms of the strength of the arguments presented and their logical consistency. Your critique might include an indication of the issues that you would like to delve into further before assessing the validity of these claims.

Critical thinking

Imagine you are the principal of a full fee paying school. There has been an allegation by members of the public of an incident in a park in which at least two senior school students were seen verbally abusing a young person with intellectual impairment for the amusement of a group of other students. Two final year students are to attend a hearing with the principal to explain their actions in the incident. What are the issues the principal is likely to consider at the hearing?

Critical thinking

You are working on a group project with 5 other students. One of the students doesn‟t show up for meetings or if they do show up - they are late and leave early. They have put no effort into the group project but show up on the day of the presentation and try to take credit for the project. What do you do in this situation?

Critical thinking

Imagine you are the principal of a full fee paying school. There has been an allegation by members of the public of an incident in a park in which at least two senior students were seen verbally abusing a young person with intellectual impairment for the amusement of the group and other students. Two final year students are attending a hearing with you (their principal) to explain their actions in the incident. What are the issues that you (the principal) are likely to consider?

Discuss the pros and cons of legalizing marijuana on the Canadian Health Care system. How does this impact a physician‟s present ability to write out prescription for „medical marijuana'? Would legalization cost the health care system more or less after it was passed?

How does Canadian health care system compare to that of Britain‟s system?

A member of your family decides to depend solely on alternative medicine for treatment of his or her significant illness. What would you do?

A patient with Down's Syndrome became pregnant. The patient does not want an abortion. Her mother and husband want the patient to have an abortion. What should a physician do in this situation?

When is it appropriate to participate in assisted suicide of a patient? Why or why not?

A patient requests needles and syringes at his/her local pharmacy. They do not present with a prescription, and based on the records you can access, they are not receiving treatment for diabetes. Do you sell the syringes or not?

The story of Canadian Olympian and Paralympian Brian McKeever has touched many during the 2010 Winter Games in Vancouver. He was the first ever to qualify for both the Olympic Games and Paralympic games, but at the last minute, the Olympic skiing couch decided that Brian has a smaller chance in winning than his teammates, so he did not get to race. If you were Brian's friend, what would you do when he found out he couldn't race in the Olympic Games? You knew that his Paralympic games would take place 2 weeks after the Olympics.

Critical thinking

A friend has accessed your laptop and discovered your draft for an essay that is due by you both who are taking the same course. How do you handle this

A couple has decided to have a child through artificial insemination. They asked the physician for sex selection of the child. What should a physician advise in this situation?

If the Prime Minister of Canada were to ask your advice on one change that could be applied to the healthcare system in Canada that would improve it enormously and have the greatest positive effect, how would you answer?

A Vancouver bio-tech company was hired by the US Military to develop a cure for Ebola. They successfully developed a vaccine to treat the symptoms of the virus and lowered the mortality rate for infected patients. Discuss the implications of this on a global scale.

Critical thinking

A student is working in a clinic, where the office double book aboriginal patients. The student asks their reasoning and the receptionist replies that “These people never show up for their appointments.” How would you deal with this situation?

Critical thinking

You are a GP working in a community where the majority of patients have very little education and many are refugees from other nations. What challenges do you foresee

Critical thinking

You are spending your evening as a volunteer in the hospital. It is late and you see a number of staff duck into the supply closet with an empty bag and reappear in a few minutes with it appearing full. You have heard other staff members discussing that supplies are missing on a regular basis that cannot be accounted for. After observing the actions of the other staff members, what do you do?

Your best friend is an identical twin. The other twin has been sick with a variety of illnesses most of their lives. Several times, the other twin has been so ill that your best friend has supplied tissue (e.g., blood, bone marrow) sometimes to help their sibling stay alive. The other twin now needs a kidney transplant to stay alive. Their parents have assumed that your best friend will automatically donate the kidney as usual when tissue has been needed. However, your friend is now balking at this automatic assumption of donation and is considering saying „no‟. What would you say to your friend to convince him to donate the kidney?

Discuss health care issues that have been in the news in the last month.

You are sitting at a desk in front of the interviewer with a screen between you. You have a set of blocks in front of you and you have to set them up in a certain way. The interviewer knows the solution and you can't see them and can only ask them yes or no questions. Correctly assemble the blocks.

Many fire-related tragedies in Canada have been the result of children playing with fire. Discuss the roles and responsibilities of parents, lighter companies and society with respect to this issue.

A physician went to vacation for 2 weeks. He did not find another physician to cover him. One of his patients with hypertension developed severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial hemorrhage. Is the physician responsible for this patient?

An actor plays the role of your elderly neighbor. You have just accidentally run over your neighbor's cat whilst reversing your car. You have 5 minutes to break the bad news to her.

Is it ethical for doctors to strike? If so, under what conditions?

An athlete who is training for the Olympics admits that he is using anabolic steroids and asks you to monitor his liver function. He would prefer to be under your care, as you are his family physician and you know his history. However, he states that if you do not agree, he will go to a walk-in clinic. Discuss the ethical issues in this case.

You witness two girls hitting a homeless woman and taking items that belong to her. The victim has only a bleeding nose. You approach her after the incident and she tells you she is fine, this has happened before by the same girls and it is no big deal. How do you deal with it?

Critical thinking

A high school student has to choose between two colleges. The student had several friends who were similar to himself in values and abilities at each school. All of his friends at school A liked it on both educational and social grounds; all of them at school B had deep reservations on both grounds. The student visited both schools for a day and his impressions were the reverse; he enjoyed school B, but had reservations about school A. Dr. James Wanstedt provided a testimonial that school B provides a superior education. Furthermore, the registrar at school B has just released a report claiming that the employment rate for graduates of school B is 93%, 10 percent higher than it was 10 years ago. Finally, an unbiased consumer advocate reports that 98% of the alumni association have indicated that they were happy or very happy with the education they received at school B. Which school should the student choose? Discuss the student's decision with the examiner.

Critical thinking

The City of Vancouver has taken great measures to increase accessibility to alternative forms of transportation (Canada Line, Hornby and Dunsmuir Bike Lanes, Proposed Evergreen Line, and Burrard Street Bridge closures). Discuss the impacts (both positive and negative) of these decisions?

Critical thinking

You are a resident working in a team of several others for on call shifts. You and your partner just had a new baby. Would you re-adjust the call schedule? How? What problems do you foresee and how would you approach the problems?

A general principal in the pharmaceutical industry is that a drug is not real unless it has been tested in English speaking countries. A real drug is one that actually works and can be an economically viable product. Do you think this general principal is valid and/or acceptable? Discuss this question with the interviewer.

In your opinion, what is a primary flaw in the health care system? How would you address it?

You are a family physician. One of your patients, Mark, did not attend one of his classes and missed an important exam. He told you that his teacher would like a doctor's note explaining his absence from class; otherwise, he will receive zero, and all hell will break loose. He wants to you write a note for him, indicating that he was not feeling well enough to write the exam. Not able to find any physical symptoms, explain how you would deal with this. Enter the room and talk to Mark.

Without using your hands, explain how to tie shoe laces.

As medicine advances with technology, what are the pros and cons? Discuss your experience with use of technology.

Critical thinking

Data has shown that doctors who smoke are less likely to make good role models for patients. Should doctors be allowed to smoke? Do doctors need to be role models?

How would you advise patients who are interested in visiting an acupuncturist or a chiropractor?

Your best friend tells you he is a compulsive gambler. He has lost all his money and he asks you for a loan in order to buy food, to pay back his loan sharks and then use the rest to try to win it all back. Discuss the broad implications of gambling on society.

Dr. Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr. Cheung doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches and muscle aches, because he believes that it will do no harm, but will give them reassurance. Consider the ethical problems that Dr. Cheung's behaviour might pose. Discuss these issues with the interviewer.

Your 5 year old nephew asks you, "Why is the sky blue?” How would you answer him using a series of simple scientific experiments?

Critical thinking

You are given a list of items that you would want to take in your suitcase for a two-week holiday. You are told that you can only pack half of the items available.

The Canadian Pediatric Association has recommended that circumcisions "not be routinely performed". They base this recommendation on their determination that "the benefits have not been shown to clearly outweigh the risks and costs". Doctors have no obligation to refer for, or provide, a circumcision, but many do, even when they are not clearly not medically necessary. Ontario Health Insurance Plan (OHIP) no longer pays for unnecessary circumcisions. Consider the ethical problems that exist in this case. Discuss these issues with the Interviewer.

It has been argued that wait times for organ transplants can be significantly sped up through surgeries and donations from other countries. You are a physician working with a patient who you noticed had recently gone to the Mexico to receive a liver transplant. What are the ethical issues involved?

You and your best friend try out for the varsity track team. You just find out you got in, but your friend was rejected for the 3rd time. Enter the room.

Recently, the Prime Minister of Canada suggested the idea of deterrent fees (a small charge, say $10, which everyone who initiates a visit to a health professional would have to pay at the first contact) as a way to control health care costs. The assumption is that this will deter people from visiting their doctor for unnecessary reasons. Consider the broad implications of this policy for health and health care costs.

You are a 1st year med student and you are in the room with a small group of students, a doctor and a young female patient. The doctor tells the patient to remove her shirt to do a breast exam. The patient is visibly uncomfortable but does what she is told. The physician then performs the exam and tells you to do it as well. Discuss your reaction to this situation. An elderly woman has been admitted to emergency room with asthma/difficulty breathing. She refuses to allow a medical student to treat her. Discuss the ethical issues in this case and possible safeguards to protect patient and students/physicians.

A 17-year old boy lives independently. He is married and has one child. He wants to participate in a medical research study. Does he need his parents‟ permission?

Statistics have shown that effects of advanced age such as changes in vision and response time may adversely affect elderly drivers' ability to drive safely. As a matter of fact, many doctors discuss the issue of stopping driving with their older patients as a precaution for the safety of theirs as well as the public's. Do you think older drivers have to give up driving when they reach a certain age?

John X is a convicted pedophile and repeat offender. He is about to be released from prison after serving 7 years of his 10-year sentence. He will be in close contact with his parole officer and he will be monitored on a daily basis. Should the community be aware of John X's history? You are in charge of deciding whether or not to warn the community about John X. What issues/factors would you consider in making your decision?

Critical thinking

Some people think that the new or younger generation of physicians are not as hard-working (i.e., wanting to leave right at 5:00 p.m., not wanting to put in as long of a work week) as previous generations. How do you feel about this perception?

The parking garage at your place of work has assigned parking spots. On leaving your spot, you are observed by the parking attendant as you back into a neighbouring car, a BMW, knocking out its left front headlight and denting the left front fender. The garage attendant gives you the name and office number of the owner of the neighbouring car, telling you that he is calling ahead to the car owner, Tim. The garage owner tells you that Tim is expecting your visit. You enter Tim‟s office.

Tasers are under greater public scrutiny. What are the medical, public health, public policy, legal and practical issues involved? What is your position as regards the use of tasers by public officials and in the private sector?

You have two patients who need an organ transplant and one organ available. One is a 20 year old drug addict and the other is a 70 year old prominent member of the community. Who do you give the transplant to and why? What information will you use to make your decision?

Two patients need a liver transplant, but there is only one liver available at the time. Tell the interviewer how you would decide between a 64 year old politician who happens to be an alcoholic or, a 26 year old mother of three who is on welfare.

Preferential Admission (Knowledge of the Heath Care System): Due to the shortage of physicians in rural communities such as those in Northern Ontario, it has been suggested that medical programmes preferentially admit students who are willing to commit to a 2 or 3 year tenure in an under-serviced area upon graduation. Consider the broad implications of this policy for health and health care costs. For example, do you think the approach will be effective?

Mrs. Jones has signed a donor card indicating that she is willing to donate her body to science without notifying her husband and son. She gets into an accident and it is determined that she is brain dead. The family doctor, who is on call that afternoon, reviews the chart and determines that she would be perfect for medical students to practice the removal of organs for transplantation purposes. The doctor then talks to the family to discuss the procedure and to confirm their consent. They both oppose the procedure and refuse to allow their doctor to move forward. The doctor points out that Mrs. Jones could be helping hundreds of people by educating the medical students and that technically consent has already been provided. The husband understands how beneficial the educational experience is but is too emotional to allow them to continue. The son, a medical student, refuses because he knows the bodies are not treated with dignity. If you were the doctor, how would you proceed? Why?

You are part of a committee to decide where the money for health care in our province is spent. It is your turn to inform the committee of your opinion on what you think is the single most important area requiring funding.

Critical thinking

One of the key competencies for medical practice outlined by the Royal College of Physicians and Surgeons of Canada is the need to develop and maintain self-assessment skills. Describe the strategies you employ when assessing your ability.

What is the difference between HMOs and PPOs?

Discuss one of these health care issues: human genome project, AIDS, abortion, the right to die, the cost of health care, and genetic engineering.

A patient has just been diagnosed with cancer. The patient takes the news very badly and is concerned with pain and the immediate treatment. You know that is it extremely likely that the patient will die within 9 months regardless of course of treatment. What do you tell the patient, what are your ethical obligations, your legal obligations?

You are a second year student shadowing a doctor in the O.R. Once the patient, an obese female has been given general anesthetic and the procedure is under way the doctors start to make comments about her weight and call her names that you find inappropriate but most of all unprofessional. Do you talk to the doctor about his comments or do you keep your comments to yourself? Why?

You tell a mother her two year old child has leukemia, but she refuses chemo but insists upon seeing her family physician who is a naturopath. What do you tell her, how do you handle this so that you may continue to have some influence as regards the treatment of her child? (The child‟s life is in the balance as the naturopath will be unable to save the child‟s life and you have an obligation to your patient, the child, who cannot make an informed decision. In paediatrics, its beneficence and “the rule of rescue” that takes precedence.)

Discuss the social, legal, medical implications of a needle-exchange program with the interviewer. (Consider a needle exchange program to be a free service in which screens for STIs are provided, along with immunizations, physician referrals, and exchanging used needles for new ones). Follow up question: What are some viable alternatives?

Your best friend and partner are undergoing in vitro fertilization to have a baby. The technique allows for the selection of certain characteristics for the child by identifying them in the embryo before implantation. Your friend asks for advice on the characteristics they should select. How would you respond to your friend?

When you enter the room there will be a blank sheet of paper in front of you. On the other side of the room there is another candidate who will provide you with instructions regarding how to turn this page into an origami (paper folding) project. Do not look at the other candidate until told that you can do so. You have 5 minutes to complete the project after which you will be given 3 minutes to discuss with your colleague any difficulties that arise during your communication.

You are on duty in the ER when an unconscious three–year-old girl is brought in. It‟s clear that she needs an immediate blood transfusion to survive, but her Jehovah‟s Witness parents are adamantly against it. What would you do and why?

Your friend is of Chinese descent and fluent in Mandarin. You both want to get into medicine. She registers for Mandarin 101, a course in Chinese language for beginners. The course coordinator asks that students who can already speak just a little bit of Mandarin should leave because this is a course for beginners. Your friend remains but makes a sufficient number of deliberate mistakes in the classroom discussions, in the required homework and in the examinations that she will not be detected and yet still receive an excellent grade. What would you do in this situation?

Critical thinking

You are a first year medical student who is doing above average in some subjects, and below average on others. What would you do in this situation? What resources would you access?

You are working in a clinic for street youth. A 16 year old girl comes in seeking sleeping pills that you do not think is appropriate for her. She says she will see another doctor if you do not prescribe them. What would you do?

There are two people in the next room that are in a conflict. Mediate the discussion and find a way to resolve the situation.

Critical thinking

At the beginning of your last year of undergraduate studies, the Dean of your Faculty has offered to all of you the opportunity to swallow a „red‟ pill. If swallowed, this pill would increase enormously your ability to „absorb‟ all the educational material being presented to you in all your courses. In fact, this pill would basically guarantee that you would receive an A+ in all your future courses with a significantly reduced workload. Would you take the red pill?

Critical thinking

You discover that your boyfriend has a substance abuse problem. His conduct has never been influenced by this since you have been together. How do you handle this?

In June 2011, the Vancouver Canucks lost the Stanley Cup and riots broke out in Downtown Vancouver. Discuss the impact on the community and the range of health care professionals at St. Paul‟s Hospital.

What is your opinion about stem cell research using fetal tissue?

You learn from your best friend that she was involved in a hit and run accident one night when she had too much to drink and had hit a person crossing the street. She feels badly about this incident. What do you do if anything?

You are a young, single doctor working in a small town of 1500. You meet an attractive male/female at the bar that you are interested in. What problems do you foresee?

You are a physician who has finished his or her day and decide it's appropriate to leave on time for the first time in months. You have promised to meet your family for dinner. You suddenly receive a phone call from Mrs. Black, a 87 year old patient in a nursing home long time, who wishes that you attend to her long-standing condition. She has been patient of yours for 15 years and refuses to see another doctor. What issues are involved? How would you approach this situation?

You are an emergency room physician at a local hospital. A patient comes in requesting painkillers for his back. Upon reviewing his file, you realize that he frequently comes to the hospital requesting painkillers and he has already capped his prescription for the month. Upon examination, you notice no new injuries to indicate an increase in painkillers. You politely tell patient that you will not increase his dosage or re-fill out another prescription for him. He tells you that he will go and inject himself with heroin right now if he does not get the painkillers. What do you say next? What do you do?

In recent years, there has been an increase in popularity of full contact sports, such as Ultimate Fighting Championship (UFC) and boxing. Should doctors have a role in regulating such sports?

A woman enters the emergency room with stomach pain. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm. The physicians inform her that the only way to fix the problem is surgically, and that the chances of survival are about 50/50. They also inform her that time is of the essence, and that should the aneurysm burst, she would be dead in a few short minutes. The woman is an exotic dancer; she worries that the surgery will leave a scar that will negatively affect her work; therefore, she refuses any surgical treatment. Even after much pressuring from the physicians, she adamantly refuses surgery. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. They anaesthetize her and surgically repair the aneurysm. She survives, and sues the hospital for millions of dollars. Do you believe that the physician's actions can be justified in any way? Is it ever right to take away someone's autonomy?

Due to a shortage of physicians in rural and Northern communities in BC, some policy-makers have suggested that medical programs preferentially admit students who are willing to commit to a 2 or 3 year tenure in rural areas after graduation. Consider the broad implications of this policy for health care and the costs associated. Will this policy be effective?

Critical thinking

The man who lives next door to you often rides his bicycle in the company of his two young children but without a helmet. In fact, on several occasions you have seen him riding with his helmet hanging by its straps from the handlebars. His young children sometimes wear a helmet, sometimes not. If the man fell off his bicycle and hurt his head in a way that would have been prevented if he had worn a helmet, would it be reasonable to ask him to contribute towards the treatment cost for his injury?

There is an outbreak of an incredibly contagious life-threatening disease. The disease is spreading across the country at a rapid rate and the survival rate is less than 50%. You are a senior health care administrator, and when the vaccine is developed, you have priority to receive the drug. Do you take the vaccine yourself or give it to another person? Why or why not?

You are a general practitioner and a mother comes into your office with her child who is complaining of flu-like symptoms. Upon entering the room, you ask the boy to remove his shirt and you notice a pattern of bruises on the boy's torso. You ask the mother where the bruises came from, and she tells you that they are from a procedure she performed on him known as "cao gio," which is also known as "coining." The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. The mother explains that cao gio is used to raise out bad blood, and improve circulation and healing. When you touch the boy's back with your stethoscope, he winces in pain from the bruises. You debate whether or not you should call Child Protective Services and report the mother. When should a physician step in to stop a cultural practice? Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine?

Do you think general practitioners have an obligation to report their patients' health status to a public health agency, if their patients have active infectious diseases?

An eighteen year-old female arrives in the emergency room with a profound nose bleed. You are the physician, and you have stopped the bleeding. She is now in a coma from blood loss and will die without a transfusion. A nurse finds a recent signed card from Jehovah's Witnesses Church in the patient's purse refusing blood transfusions under any circumstance. What would you do?

If the Prime Minister of Canada were to ask your advice on one change that could be applied to the healthcare system in Canada that would improve it enormously and have the greatest positive effect, what would it be?

You have a meeting set up with Frankie. He is the son of a family friend who moved to Thunder Bay about 20 years ago and so you have never met him. He has come down from Thunder Bay to look over "southern universities". He urgently needs some information on schools as he will have to make some serious decisions soon. He is happy to get this meeting as he realizes how tight your schedule is. In fact your next meeting is in 8 minutes. Frankie is in the room.

A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patient‟s condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence?

Should there be legislation stating that a physician must report a gunshot wound of their patients to police? Discuss.

Deterrent Fees (Knowledge of the Health Care System) Recently, the Prime Minister of Canada raised the issue of deterrent fees (a small charge, say $10, which everyone who initiates a visit to a health professional would have to pay at the first contact) as a way to control health care costs. The assumption is that this will deter people from visiting their doctor for unnecessary reasons. Consider the broad implication of this policy for health and health care costs. For example, do you think this approach will save health care costs? At what expense? Discuss this issue with the interviewer.

What do you see as being the biggest issues/problems in health care now and in the future. What do you think are possible solutions to these issues?

A 14 year old patient requests birth control pills from you and asks that you not tell her parents. What would you do?

What is the difference between Medicare and Medicaid?

Critical thinking

It has been suggested that in order to promote healthy lifestyles, medical schools preferentially admit students who do not smoke. Do you think this approach will be effective? Discuss the implications with respect to health and health care costs.

Critical thinking

You are presented with a list of 15 individuals, including details of their age, sex and occupation. You are being told that a nuclear attack is imminent and you are only allowed to save 5 of them from destruction. Which ones and why?

A 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation?

Critical thinking

The daughter of the interviewer is 16 years old. She is adamant that she have a tattoo next week. The interviewer is against letting her daughter have a tattoo and this is causing much friction in the household. What advice would you give the interviewer?

Recently, certain hospitals in the Vancouver Area have been charging patients $29/day for their hospital fee on top of the fees charged to MSP. What are the implications of this policy? Discuss both positive and negative impacts with the interviewer.

130 practice questions for 2022

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