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Mastering an Ethics MMI Station: How To Approach It?

Published on
June 3, 2024

Three Steps to Mastering an Ethics MMI Station:

Ethics stations are the bread and butter of a medical MMI. After all, at its core the medical profession is about difficult decision making. Before we get into the details of what makes for an excellent medical candidate, the most important piece of advice is to remember that ethics stations should not be looked at as philosophical exercises. This is not an abstract situation – pragmatism and empathy are the names of the game.

As such, the very first step is to treat the case as if the stakes were real. Keeping this in mind, the interview becomes more focused on the just and fair treatment of all parties involved, rather than about assigning criticism.  

What Ethical Values Guide Medicine?

The first thing to remember is that doctors are inevitably in a position of power. This is because as a physician, you understand the hospital system and the biomedical science behind treatment much better than the patient. This additional insight means that there are certain values which doctors are expected to adhere to in their practice. The idea of medical values is deeply ingrained in clinical practice, and thousands of years old.

Examples of this include the Hippocratic Oath – a pledge medical practitioners often take prior to beginning their career. All this stresses the importance of understanding and expressing these ideas during your MMI medical interview

So, what exactly are the ethical values displayed by a good med interview candidate?

- Autonomy: a patient has the right to empowered decision making. Contemporary practice states that it is the doctor’s job to inform the patient of their circumstances, including their treatment options, and then allow the patient to make their own decision.

- Consent: a treatment or procedure cannot be administered to a patient unless they fully understand and agree to it. This concept is especially complicated when discussing language barriers or people with disabilities. A critically important element of modern medicine – especially in light of historical injustices.

- Confidentiality: simply speaking – all individuals are entitled to privacy. Specifically, this relates to disclosure of a patient’s personal hardships or medical conditions to anyone outside the doctor-patient relationship. The simple rule to follow here is this – unless the information given to you by the patient poses an immediate grave risk to themselves, or others (i.e. risk of homicide), it would be a violation of confidentiality to disseminate this information.

- Beneficence and Non-Maleficence: these two concepts, while similar, are very much distinct. Beneficence dictates that all actions undertaken by a physician should serve to improve the wellbeing of individuals being treated. Non-maleficence means abstaining from harm. The distinction exists in that logic such as “the needs of many outweighs the needs of the few” is unacceptable to clinical ethics, and probably has no place in your MMI.

What Does Justice Mean?

During your MMI ethics station, you will likely be presented with an ambiguous scenario. There will likely be multiple parties which are locked in a moral or ideological disagreement. Examples of this include the debate over the efficacy of alternative medicine, hospital working conditions, and disputes in research integrity. The situation may be described in a manner that urges you to jump to a conclusion – condoning one party in the dispute over the other. This is an incorrect approach! As is the case in the real world, the medical interviewer is looking for you to recognise that people do not fall into categories of ‘good’ and ‘evil’, ‘right’ and ‘wrong’. With very few exceptions, most individuals are a complicated mixture of circumstances and motivations. Therefore, in the context of an MMI, justice would begin with giving every participant in the scenario the benefit of the doubt.

Once you have set aside the tempting prejudices presented by the station, consider the following features of a ‘just’ resolution to any given:

- Fairness: does your solution offer all parties involved the opportunity to achieve a reasonable outcome? It is important to recognise that some people may find themselves disadvantaged circumstances and require assistance to achieve the same level of decision-making autonomy afforded to more advantaged individuals. Fairness also means that you stand-up against extreme and unacceptable behaviour. Violations of medical ethics principles such as confidentiality should be categorically highlighted as inappropriate.

- Legality: acting in a way that benefits and does not harm your patient does not excuse you from the law. Whenever proposing a solution, make sure that it is well within the boundaries of your defined role in the scenario. Do not hesitate to escalate to your superiors when you feel like the actions required are beyond your legally defined job-description.

How to be Fair and Equitable in MMI?

Fairness and equitability begins with an understanding that you almost never have the full set of information. This is certainly the case when considering the context and motivation that lead to characters in your MMI scenario making decisions. It goes without saying that it is not appropriate to clarify this context with your interviewer. Instead, a good candidate addresses the limitations of their understanding in their response. Open your discussion of the ethics case with a simple admission - “this is a complicated situation”. This also serves as a reminder to you, to illustrate the complexity that you are facing.

Follow this with a discussion of the situation from the perspectives of all parties involved – what are their motivations? Do these conflict with any of the aforementioned medical ethics? Are there any red flags? Now that you have fully analysed the station prompt, you are ready to propose an action plan. This is where you consider how you can create opportunity for all parties to legally achieve their goals.

This is the time for considering whether the case should be escalated to a higher authority – a supervisor or judge perhaps. Ultimately, it is the analytical, and unbiased logic which will score you the most points on an MMI ethics station. And of course, remember to be emotive and engaging in delivering your answer – communication is still one of the core underlying skills!