January 25, 2020
Multiple Mini Interview (MMI)
Biomedical ethics stations do not have to be scary if you know some basic ethics concepts. Understanding the following 5 principles and 2 models will help you to succeed in your medical school interviews and to make ethical decisions as a doctor.
“Everyone has a duty to advance the good of others if it is possible to do so without undue risk to oneself.”1 This is what doctors aim to do – provide beneficial treatment to help each individual. It is important to note what counts as “advancing the good of an individual” is always relative to that individual’s values, not the treating physician’s.
Following beneficence, the principle of non-maleficence states everyone has a duty to prevent harm to others. Often this is abbreviated to: Do no harm. Again, what counts as harm is subjective and relative to the values of the recipient, not those of the health care professionals.
Justice and Equality
These ethical principles state persons who have similar circumstances and conditions should be treated alike. Equality may not necessarily mean two people should be treated exactly the same – it means people should be treated equitably, taking into account ethically relevant differences. In healthcare, these concepts are often applied to scarce resource distribution.
“All persons are autonomous beings worthy of respect, and as such have a fundamental right to self-determination that is limited only by unjust infringement on the rights of others.” 1
In a healthcare sense, autonomy means all competent patients are self-determining decision-makers. Accordingly, they have the right to accept or decline any health care intervention. This concept is absent in paternalistic health care models, which will be discussed next.
In a paternalistic health care system, expertise confers authority, meaning doctors have ultimate power to make all treatment decisions for patients. While these decisions are made in the best interest of the patient, this model violates autonomy and ignores the requirement for informed consent. The paternalistic model was prevalent historically and is still used in some countries; It is not how modern medicine is practiced in North America.
Fiduciary is Latin for trust. In the fiduciary model, the physician and patient trust each other and the autonomy of patients is balanced against the expertise of physicians.1 What this means is this model respects the physician-patient power differential yet allows the patient’s values to direct any health care intervention. This model is the contemporary standard for ethical health care.
Once you have an understanding of these principles, it is essential to practice applying them to practice scenarios. Note I purposefully directed you to understand these 7 terms instead of just know them. It is less important to use these actual terms in your answers than to properly apply their concepts to the station’s prompt.
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1Kluge, Eike-Henner W. 2013. Ethics in Health Care: A Canadian Focus. Ed. 1. Pearson, Toronto.
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