October 5, 2015

Part 3: How to Prepare for the Ethical Discussion Scenarios of the MMI

Alison Herr

In case you missed it, we already covered the overview of the MMI as well as which schools use this format.  Today, I want to talk to you about strategies you can use in the ethical discussion scenarios.


Scenario to be discussed with evaluator: In 2007, the American Family Physician Journal published an article exploring the issue of physicians as role models, using a scenario in which an obese physician is offering nutrition advice to his obese patient. According to the author’s research, patients have more confidence in the health counseling advice from non-obese versus obese physicians, and physicians with poor personal lifestyle habits are likely to counsel patients about a healthy lifestyle.
Based on these research findings, do physicians have a responsibility to act as healthy role models to the patients? Please elaborate.

Before you read how we would coach you to handle this situation, take a few seconds to state - in your own words - the gist of the argument for and against this question.

  1. Why do physicians have a responsibility to act as healthy role models?
  2. Why do physicians not necessarily have to be role models?

If you can answer both questions well, that’s enough for you to get started.


  1. Take your time when reading the notecard outside the room that tells you what the situation is going to be.  You will be given about two minutes, but you can take longer.  If the school allows you to carry a pen and paper, use them to take notes!
  2. This may sound silly, but act as though you are a doctor entering an exam room.  Knock on the door and introduce yourself, just like a doctor would.
  3. Summarize your understanding of the research.  This gives you a chance to get comfortable and make sure you articulate the issue at hand.  If you misunderstood the scenario, the evaluator can steer you the right way.
  4. Explore both sides of this argument:
  5. A physician does have a responsibility to act as a role model.
  6. A physician is just human, and can still be an effective doctor even if he is not perfect.
  7. Offer multiple solutions.  While it is easy to see why a healthy role model would be easy to make an argument for, it is your job to explore both sides.  Be creative.  “An obese physician can relate to the struggles of an obese patient, if he is willing to be vulnerable and honest.  This could be more meaningful than a thin doctor who has never had to struggle.”
  8. Ask questions and use the evaluator’s follow-up questions to guide you.  “Would it be appropriate for a doctor to share their own struggles with weight and exercise?”
  9. The evaluator is likely to ask standardized probing questions:
  10. Is a physician who does not follow a healthy lifestyle employing a double standard when they are providing lifestyle-counseling?  Explain.
  11. Do you think there is a difference between an unhealthy lifestyle that manifest themselves more visibly than other (ex. obesity vs. smoking)? Explain.
  12. What determines whether or not another person is a role model?  Who decides and why?
  13. What are the limits to this responsibility?
  14. Do you have any additional comments before we end this discussion?
  15. Relate the scenario to something you have gone through or medicine in general.  “I try to have a goal of staying healthy, but I know as a young doctor that I will be sleep deprived.  This doesn’t mean that I won’t counsel my patients to get proper sleep.” “One of my favorite doctors growing up was Dr. Smith who struggled with his weight.  He helped me understand that doctors are real people.”
  16. Last but not least, have fun!  This station is a challenge, and it’s similar to the kinds of ethical challenges you will face as a doctor.  Try to enjoy the process (to the extent you can) of preparing for your future career!  


Try the following scenario on for size:

Also read:

Part I: How to Prepare for the MMI

Part 2: Which Schools Use the MMI?

Part 4: How to Prepare for the Acting Scenarios of the MMI

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