By: Ryan Kelly
Warning! Warning! There’s a dangerously adaptive, highly resistant viral outbreak in your vicinity. It’s up to you, and a small courageous team of healthcare professionals, to isolate and nullify the threat. You must act quickly before the virus spreads and infects the majority of the population.
What will be your first steps of action, before the well-being of humanity is compromised?
This “epidemic outbreak” scenario is a tricky prompt for MMI stations. There are many varieties, but they mostly sound like trailers for disaster movies. This MMI station makes you bust out your hypothetical hazmat suit to see whether you can handle the pressure.
To protect the artistry of admissions committees, we have chosen not to replicate the exact wording of any prompts; rather, we’ve “spiraled” the situation presented. We’ll convey the essence of the dilemmas to give you a chance to develop your own strategy for navigating tricky MMI stations.
An epidemic has broken out
A contagious, potentially life-threatening disease is spreading across the country. The overall survival rate is currently unknown. You are a healthcare administrator who is working to mitigate the threat, as your hospital floods with patients. What steps would you take? What factors would you consider?
During recent mock MMIs, I asked two different candidates to answer the “epidemic outbreak” prompt.
STUDENT A’s RESPONSE:
Based on the Ebola infections a few years ago, it’s clear that fear and misunderstanding can lead to high-risk behaviors, which in turn can give the virus more opportunities to spread. Even though I couldn’t go back in time and stop the onset of this outbreak, I could at least educate my community and the greater public about our current understanding of the virus, so that they could take appropriate measures to protect themselves and others.
I am not an expert in disease control, but I’m fairly certain that every state in the US has the authority to quarantine or isolate individuals during outbreaks of contagious diseases. I believe they also have the legal power to enforce those orders to citizens, but I imagine this is pretty uncommon in America. The CDC also has the power to quarantine, even when states are unwilling or unable to.
So, if I were a healthcare administrator, I would get in contact with my state officials or members of the CDC so that I could play my part in coordinating a proper response. If the situation called for a quarantine, I would organize my hospital staff so that we could isolate infected patients. I’d instruct my staff to sensitively explain the situation to patients and make them aware of their legal responsibility to remain in the hospital. From the patients’ perspective, these orders could seem like a threat to civil liberties, so we would need to ensure they are not abused.
If possible, I would reserve quarantine solely for individuals who have shown clear symptoms. Hopefully, we can eventually discharge them once they recover from the infection and are no longer contagious. Without showing any insensitivity, healthcare staff will want to limit their contact with those who have been exposed, at least until we can determine the true threat this disease poses to society.
Critique of STUDENT A’s answer:
This is overall a strong response. It’s fairly knowledgeable and carefully phrased, while also showing conscientiousness towards both the large-scale problem and individuals involved. I think it shows off Student A’s background in speech and debate.
In my previous article on MMI stations, I recommended a 5-step approach to tackling ethical dilemmas. Student A makes good use of many of these steps, albeit unknowingly.
1. Restate the prompt X
Student A didn’t bother with this step, but I don’t think it hurt the response too much, since the language and details of the prompt were pretty straightforward.
Not ideal, but a forgivable offense.
2. Present the competing ethical stakes ✓+
Student A makes a point to explain the necessary balance between compliance with the law and compassion towards the sick. Real doctors have to ride this line quite often, so it’s good to vocalize these conflicting obligations in your response.
3. Discuss what else you’d need to know to make your decision ✓-
Beyond confirming whether a quarantine is needed, Student A doesn’t explore too many questions surrounding the disease or situation. This seems contradictory with the response’s emphasis on educating the community. If educating others is the goal, wouldn’t you want to know as much as possible? Based on new potential information you discover, your approach could change, so take some time to discuss the different possible outcomes or factors.
4. Take your stance and explain your steps towards resolution ✓
It’s smart that Student A acknowledges the hypothetical role of a healthcare administrator without overstepping bounds or assuming too much power and responsibility. It’s clear how the situation would be handled, at least in the short-term. If Student A had more time, it might have been wise to consider long-term possibilities and implications.
5. Explain ethical, legal, professional restrictions you'd need to uphold ✓+
Student A shows reasonable knowledge about the CDC and the laws surrounding disease outbreaks. Overall the response illustrates Student A as a future doctor who can remain poised, uphold fairness, and fulfill necessary duties.
STUDENT B’s RESPONSE:
This is an urgent and challenging situation for many reasons. Patients and their families will likely be desperate for immediate answers, and the news media will likely throw blame towards healthcare professionals no matter how hard and fast we work. This can add a lot of pressure when we’re also trying to gather clues surrounding the outbreak and piece them together. If we’re wrong, more people die, but we also run the risk of implicating the wrong microbe or disease transmission.
It’s possible that this suspicious outbreak is just many different illnesses being confused for the same thing, or maybe even errors from a lab. So there are many questions that I would ask and hopefully find answers for. What are the signs and symptoms? Are the cases linked to a common source or agent? Can we confirm how many cases there are?
Likely, there would be efforts to isolate the infected citizens and establish a system for gathering data about the disease, so that we could better respond over time. On a broad scale, the nation would be following the scientific method to investigate possible causes. Hopefully, we could use information about those who are ill and close observations to determine a hypothesis. For example, I know that epidemiologists used dead crows as a link in the West Nile Virus outbreak in NYC.
Hopefully there’s a relatively easy fix, but it may require outreach and educational measures over the long-term to encourage behavioral changes, similar to promoting condoms and needle exchanges to prevent disease transmission.
Critique of STUDENT B’s answer:
Another fairly well-informed response, given by a student who is halfway through a Master’s in Public Health. I think Student B’s background accounts for certain parts of the response, like the media attention surrounding the disease or the clues used in the West Nile outbreak.
1. Restate the prompt X
Same critique as Student A.
2. Present the competing ethical stakes ✓-
This step seems a little scrambled in Student B’s response. A lot of factors are thrown in at once--anxious patients, criticism from the media, avoiding costly mistakes--and they all steer towards the potential negative aspects of the situation.
Medical schools ask this prompt to see how you’ll respond to a crisis, so it’s smart to lay out a series of priorities and focus on positive goals, like a successful quarantine or keeping infected patients alive. Jumping to conclusions about media scrutiny makes Student B’s priorities seem a bit warped.
3. Discuss what else you’d need to know to make your decision ✓
I appreciate Student B’s questions about the nature of the disease, but in theory, they could have been easily answered with one phone call to the CDC. Student B’s response seems to assume that it’s a new virus, with no established case history, documentation, or protocol for response. That might be true, but it’s smart to appeal to a higher authority in your response before taking action. Then you can use if/then conditional statements in your response based on the hypothetical information you learn from the CDC or the government.
4. Take your stance and explain your steps towards resolution ✓-
There are solid insights provided in Student B’s methodical approach, but at times it sounds more like the work of an epidemiologist than a healthcare administrator. A somewhat opposite problem to Student A, but this is more problematic. This could come across as a bit hasty, or worse, unprofessional. It’s best to stick to your role and prioritize the patients and staff under your current jurisdiction.
5. Explain ethical, legal, professional restrictions you'd need to uphold ✓-
Student B shows decent knowledge about potential responses to outbreaks. However, the response makes a a few jumps in the logical process and oversteps important parameters.
What have we learned?
Always consider why a prompt is being asked (in this case: knowledge of disease control, response to stress and pressure, professional limitations)
Know your role and let it guide the scope of your response
Prioritize and stay positive
Appeal to a higher authority when possible
When taking your stance, use if/then conditional statements to explain how you’d react to new information you might discover
Do your research (this CDC link is a good start)
Think you can handle the pressure?
You’ve probably seen one of the many movies about deadly disease outbreaks. Now it’s time to live them out. What do you think? Could an outbreak happen in your area? If you were in charge of solving the problem, would you be up to the task?
We hope our tips and feedback will help you form your own approach to this dramatic, stress-inducing prompt. Best of luck!