Prompt: "You are the only ER doctor on duty and are responsible for all decision making during this shift. This night you have two patients rushed into the ER who desperately require a kidney transplant. One patient is an 80 year old university professor who is suffering from acute kidney failure related to his age; the other patient is a 20 year old university student who has been brought in for yet another episode of kidney problems related to excessive drinking of alcohol at a school party. There is only one kidney available that matches both patients. Who do you give the kidney to?"
Sample Answer: "Well in this situation as the ER physician, I understand that I have to make a very difficult decision. Of course, I am sympathetic and appreciate that both individuals are suffering immensely with pain as a result of their conditions. However, my decision-making will solely be guided by my expertise, clinical experience, and the scientific literature, and not by the personal backgrounds of the patients. Furthermore, the decision as to who receives the kidney will ultimately be based on which of the two gentlemen will benefit most from this transplant, and will have a better chance of receiving the kidney and surviving the post surgical complications. Immediately, if possible, I would place both of the gentlemen on dialysis in order to buy some time so that I can assess the situation further and gather more information.
Since in this case there’s only one kidney available that matches both patients, then the decision is tougher and will require further investigation. I can at this point review both patients records, take a detailed history, send for appropriate tests, perhaps consult with other colleagues and specialists in the field, and more importantly examine the current literature on the effects and outcomes of kidney transplants on 80 year old males with acute renal failure vs. those in a 20 year old, for example. Once I have gathered all of the evidence, and objectively analyzed all of the risks and benefits associated with the transplant for both patients, I would then provide the kidney to the individual who, from a scientific and clinical point of view will have a better chance of receiving the kidney and surviving the post surgical complications. If that is the young student then he will be the candidate. If it turns out that the older gentleman will have better outcomes, then the kidney will be given to him. Whoever does not receive the kidney, will continue to be monitored by us and maintained in a stable condition until the next available kidney for transplantation."
So, the above would be considered a strong and appropriate response. As you can see, the answer was nicely organized, coherent, concise, and more importantly, was delivered in a systematic manner. As discussed in our earlier strategy, in answering this question, we remained objective and non-judgmental, and did not allow the personal attributes of the patients interfere with our decision-making.
I found it strange that they didn't consider the student's drinking issue, doesn't that make the likelihood of a positive outcome lower?
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Do you agree with this sample MMI question and answer?
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