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Medical schools across Canada continue to switch between in-person and online delivery of medical education. Discuss the impact of online medical education.
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Discuss your perspective on how social media is being used in the context of medicine.
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Medical students are involved with many extracurricular activities. Choose one and talk about it.
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Ethical decision making
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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?
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As a physician at a local hospital you notice that there is a man with an alcohol dependency who keeps on consuming the hand sanitizer offered at the hand sanitizer stands throughout the hospital. He is not a patient at the hospital at present but has been many times in the past. Consequently, there is often no hand sanitizer for public use. What do you do? Do you remove/change location of hand sanitizer stands? Do you approach him?
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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?
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A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent?
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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?
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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?
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A physician became sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician to become sexually involved?
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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?
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A 12-year old boy is diagnosed with a terminal illness (e.g., malignancy). He asked the doctor about his prognosis. His parents requested the doctor not to tell him the bad news. What should the doctor do in this situation?
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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?
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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?
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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?
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You are a genetic counsellor. One of your clients, Linda, had a boy with a genetic defect that may have a high recurrence risk, meaning her subsequent pregnancies has a high chance of being affected by the same defect. You offered genetic testing of Linda, her husband, and their son to find out more about their disease, to which everyone agreed. The result showed that neither Linda nor her husband carry the mutation, while the boy inherited the mutation on a paternal chromosome that did not come from Linda's husband. In other words, the boy's biological father is someone else, who is unaware that he carries the mutation. You suspect that Linda nor her husband are aware of this non-paternity. How would you disclose the results of this genetic analysis to Linda and her family? What principles and who do you have to take into consideration in this case?
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Your mother calls you and asks you to help with a major family decision. Your maternal grandfather is 70 years old and has been diagnosed with a condition that will kill him some time in the next five years. He can have a procedure that will correct the disease and not leave him with any long-term problems, but the procedure has a 10% mortality rate. He wants to have the procedure, but your mother does not want him to. How would you help mediate this issue?
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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?
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If you have the choice of giving a transplant to a successful elderly member of the community and a 20 year old drug addict – how do you choose?
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A member of your family decides to depend solely on alternative medicine for treatment of his or her significant illness. What would you do?
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A 14 year old patient requests birth control pills from you and asks that you not tell her parents. What would you do?
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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?
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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.)
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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.
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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?
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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?
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A man has been responsible for taking care of his wife who is in a vegetative state for 6 years after a car accident. She can breathe on her own but that is the extent of her abilities. He requests that her feeding tube be removed. What should you, as her physician do?
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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.
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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.
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Your friend tells you that a piece of expensive electronic equipment he had bought for $3000 just two weeks ago had stopped working. The store where he bought it had a 7-day return policy. Your friend goes to the store, buys a new piece of equipment and then returns the old damaged equipment in its place for a full refund. The store is owned by your uncle who is struggling to keep the business going. How would you deal with the situation?
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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?
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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?
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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?
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Your older sister tells you that she values her career and is reluctant to take time away to have a baby. Her husband agrees with her. They have arranged to conceive an embryo through in vitro fertilization. A company in India will implant the embryo in a surrogate mother from a nearby village who will be paid $5,000. Two weeks after the baby is born, the company will deliver the baby to your sister and her husband. Your mother is opposed to this arrangement whereas your father supports her decision. Your sister asks for your support. How would you respond to your sister?
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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?
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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?
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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?
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