Medical Ethics is a guaranteed question at medical school interview whether for undergraduate or graduate applications. Not only is the ability to understand and apply the core ethical principles a pre-requisite for being a good doctor, but the style also lends itself well to scenario based questions or direct question so they’re easy for interviewers to conduct. While it might seem overwhelming, this is one of the stations where you can really stand out from the crowd by demonstrating not only knowledge but also understanding of the ethical principles and some key legislation regarding your duties as a medical student and as a doctor.

Like any interview station, the best way to get better at Ethical Scenarios is to practice! At Future Doc we offer 1-1 tutoring with medical students who can run-through interview topics with you. We also offer group teaching around medical ethics as a whole and run mock interviews with feedback and score sheets.

The ethical station tends to be one with a variety of scores, I’ve listed ideas that would be expected to be shown in a ‘good’ ‘bad’ and ‘average’ scored station:

The Bad Score

• Recognising an ethical problem in the scenario
• Not relating to the Four Pillars
• Making a snap decision
• Not talking about the duty of a doctor
• Not considering the patient’s perspective or safety

The Average Score

• Recognising the ethical problem in the scenario
• Relating it to the Four Pillars
• Giving some justification around what you believe the correct course of action is
• Considering either the role of the doctor or the patient’s perspective
• Limited knowledge of specific topics or legal issues (Jehovah’s Witness, DNACPR, Gillick Competence)

The Good Score

• Recognising the ethical problem in the scenario
• Relating it to the Four Pillars specifically instead of just listing them
• Justification around correct course of action with further planning (asking superior, following up with patient, checking guidelines)
• Detailed consideration of the role of the doctor
• Detailed consideration of the patient’s safety and perspective
• Ability to discuss ideas like capacity and consent
• Key legislation of Mental Capacity Act
• Knowledge of specific topics or legal issues / Knowledge of similar or alternative ethical cases in current affairs (Dr Bawa Garba, Archie Battersbee etc)
• Considering the impact of ethical decision making on wider society

When faced with an ethical scenario at interview it can feel overwhelming and scary but there is a system in place that will help you work through the scenario and you gather the information you need to tackle it. The key to surviving most ethical questions is to stick to this and remember to consider any specific examples or legal issues that might be relevant to the particular scenario you’ve been given.

The Four Pillars

The Four Pillars of Medical Ethics come from Beauchamp and Childress in 1979. They look at four areas that must be considered in ethical scenarios within the biomedical field. There are 4 pillars so it’s important to consider all 4 when discussing an ethical scenario. If you take out a pillar and don’t consider it, you might end up making a different decision so make sure to consider all 4!

1. Autonomy – the right for an individual to make his or her own choice
2. Beneficence – the principle of acting with the best interest of the other in mind
3. Non-maleficence – the principle that ‘above all do no harm’ as stated in the Hippocratic Oath
4. Justice – a concept that emphasise fairness and equality among individuals

These pillars can be used to work through an ethical scenario so that you consider it from as many angles as possible including yours, the patients, and societies as a whole. This can help you keep your thoughts and ideas organised and ability to talk about the pillars is something that will be on the examiner’s marksheet.

The 3 C’s

The next thing to consider in an ethical scenario are the 3 C’s. These are ideas that go slightly beyond the ethical principles and show a more detailed knowledge of understanding how decisions are made in a medical context. There is a lot of information available around these ideas but try to keep it simple.

• Consent – has the patient given consent for a procedure or medication to take place, for consent to be valid it must be given with capacity, has to be voluntary, has to be informed and has to be continuing
• Capacity – does the patient have capacity to make the decision, can they understand and weigh up the options or is there another factor that might stop them being able to do this (head injury, dementia, drug addiction etc)
• Confidentiality – everyone has the right to their personal and medical information being kept safe, is there a part of this ethical scenario that means disclosing information to someone who isn’t the patient, without the patients permission

Specific Ideas and Examples

While it’s impossible to list every idea and example relating to medical ethics, there are some key topics that might be useful to read up on in order to really elevate your answer into the ‘amazing’ category at interview.

• Legal Ideas – capacity and consent fall into this, other things to have a brief look at are the Mental Capacity Act, Mental Health Act, Implied Consent and the Hippocratic Oath
• Hot Topics – these are commonly discussed or referenced in interviews even outside of ethical stations, things like Gillick Competence, Brexit, COVID vaccines, DNACPR and End of Life Support. Future Doc runs regular teaching sessions which cover Hot Topics in detail and demonstrate structures for tackling these questions at interview.

To get the most out of an ethical interview station, make sure to identify the ethical dilemma or dilemmas first of all and get that clear in your mind. Then you can work through the 4 Pillars to provide structure to your thinking and answer. Then you can consider the 3 C’s and comment about whether the person or people in the scenario have capacity, consent and whether or not this is confidential. Then finish off by linking it either to a legal idea such as the Mental Capacity Act, or a Hot Topic that is relevant such as COVID vaccines. There is a scenario below which demonstrates the type of things to say in an ethical scenario.

Scenario Example

A 15-year-old boy attends the GP asking for the COVID vaccine, his mother has previously refused the vaccination for him, but he has done some research and he wants to have it. What ethical principles do you need to consider here?

A Good Answer would say things like…

“As with any patient, I would need to consider the four pillars to give myself a structure to think about the ethical variables in this scenario”

“Because this is a child, I would then need to consider Gillick competence and have a discussion with my patient as to whether I believed they qualify”

“I might consider broaching a three-way conversation with the patient and his mum, if that was what he wanted”

Instead of things like…

“I don’t think I can treat him without his mum’s permission”

“It’s not contraception so I’m not sure”

“I suppose he can have it if he wants it”

“He should be vaccinated, so I would give him the vaccine”

At the time of writing this article I am a final year graduate entry medical student and just last week I had to give a presentation on medical ethics as a core component of my GP placement block. This demonstrates the fact that medical ethics isn’t something that ‘goes away’ but it’s re-visited and built upon as you go through medical school and further training as a doctor. Aside from doing well at interview, your real goal should be to understand and apply principles to keep you and your patients safe in the future.

If you want help getting into your dream university then also be sure to check out our Elite Coaching Programme. As part of this programme, you will get in-depth help with the entire application process from whatever stage you join at till you get into the medical school of your choice. This is done through 1-on-1 mentoring and the founder of the course, Dr Ashley Hilton is always available for any questions. You can find out more about the Elite Programme here.

Written by Charlie Bailie