How To Answer Scenario Questions (ethics, empathy, confidentiality, consent):Dental/Medical MMI tips

You will find lots of material on how to talk about certain scenarios on the Internet. However, what you may struggle to find key principles that you can include in a variety of answers. Most of what's on the Internet are examples of scenarios and model answers to those but I didn't find them very helpful. It's very likely that you won't be asked the exact same questions you found the Internet and so it's important that you have some rules or principles for answering any ethics questions.

I actually read about this in a really good book 'Make It Stick' which is about learning new content but is also backed up by scientific research. Basically, it distinguishes between 2 types of learning- rule learners vs example learners. And the idea is that example learners memorise examples, rather than the underlying principles behind problems while rule learners learn the 'rules' and principles which then can be applied to later, unseen problems. I found a lack of the 'rules' to answering ethical scenarios so here are my rules and principles. Although, I think a good strategy would be to look at lots of different examples and abstract key principles from them- which is basically what I have done and am writing about.

You may also struggle to find scenarios that are dentistry specific. In this post you will find me echoing a lot of the 'standard' advice on how to answer these scenarios but also useful ideas and principles which can be applied to a wide variety of scenarios.

The Traditional Advice That I Found Actually Useful

Pillars of ethics

• So this is pretty standard. Justice, autonomy, beneficence and non maleficence. Learn what they mean and crucially how to pronounce them.

Structure

• Always start of outlining the problems/ dilemmas posed by the scenario then go on to address them in turn.

• If there are two sides or perspectives to the scenario, argue for both sides. There really isn't a need to pick a side or say what you would definitely do in a situation. Talk about different courses of action and justify why might someone carry them out.

• If you have time, summarise what you have said and maybe explain which arguments you find most compelling and which side you're leaning towards.

Rules And Principles For Talking About Most Scenarios

Consent

• Apparently interviewers like to ask about consent. However, I haven't ever been asked explicitly about it. Nevertheless, I feel like consent is a pretty easy thing to work into certain answers which will show the interviewer that you have a good understanding of it (even though they didn't ask you explicitly about it).

• Scenarios where you could work consent into your answer include:

• Anything to do with children

• Eg what would you do if a child needed their teeth extracted but their parents refuse

• You should assess whether they can consent to their treatment and override their parents' decision.

• Anything to do mentally ill people

• Similar to talking about children

• Scenarios when dealing with people who don't speak English

• Make sure they consent/ can consent

• And make sure consent is valid

Before performing any kind of treatment

• Obtain valid consent

• Valid consent is even important in emergency scenarios

• However, there are caveats, see below.

Organ donations

• Obtain consent from families

• Even if people who die have organ donation cards, the family can till refuse consent.

So what is valid consent?

• Valid consent has 3 main criteria

• It must be:

• Voluntary

• Ie not consenting under pressure

• Informed

• Ie the patient is given enough information, both pros and cons of a treatment

• Ask the question 'what would a reasonable patient want to know'

• Competent

• This is key in giving valid consent- being able to work this into an answer will be pretty impressive

• If a patient is not competent enough to give consent, then the consent is not valid

• Criteria for competence; the patient must be able to

• Understand the information

• Retain the information

• Weigh up the information

• And repeat back the information

• All adults are assumed to be competent unless proven otherwise

• This is especially relevant when dealing with children

• There is something called Gillick competence where people who are 16 or 17 are treated as an adult but they cannot refuse treatment if a parent or guardian gives consent to the treatment.

• On the other hand, people below 16 are assessed for Gillick competence. This assesses whether they match the criteria for competence and if they do, they are treated like they are 16 or 17.

What if patients do not have the capacity to consent but urgently need treatment?

Advance directive

• This is something written by a patient about what they would consent or not consent for in the future

• Do not resuscitates are examples of this

Lasting Powers of Attorney

• Where someone is nominated to consent for the patient and to act in their best interests

If patients do not have this, dentists/doctors should act in the patient's best interest.

• Usually this is multidisciplinary

• Dentists/doctors talk to friends and family about religious beliefs, preferences etc.

• NB patients can withdraw their consent at any time, refuse treatment or ask for it ot be stopped after it has started (GDC).

GDC

I did a post on GDC guidelines a while back (find that here) where I stated the 9 principles and underlined any useful/important points. Most scenario questions are based along these principles so learning them would be very useful. And as a dentist you are expected to adhere to these principles so you might as well learn them now.

Good things to learn include:

You are expected to make 'reasonable adjustments' for any disabilities

• Ie if you are a small practice you may not have to buy a bariatric chair since it may not be 'reasonable'

You may need to balance patients' oral health needs with their desired outcomes

• 'If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits and likely outcomes to help them to make a decision.'

Patient interests will be put before financial gain and business needs

Your duty to raise concerns overrides any personal and professional loyalties or concerns you might have

• Ie always report colleagues for malpractice

Read my previous post going a bit deeper into the principles.

Equality Act

• This can be brought up when talking about people who may be 'disadvantaged' in some way.

Topics interviewers love bringing up includes:

• Patients who may be too heavy for the dental chair

• Patients who can't afford treatment

• Lifestyle choices around smoking, drinking and taking drugs

Basically, the idea is to not discriminate or change how you approach the situation based on their lifestyle choices or situation and once again you are expected to make 'reasonable adjustments' to accommodate your patients.

It's good just to bring up the Act so that the interviewers know that you know about it.

Moral Stances

• You can bring these up to show that you can acknowledge differing points of view.

Consequentialism

• Basically how moral something is is based on what the consequences will be

• For example if stealing some bread involves saving someone from hunger, this could be seen as morally good since the consequence is 'good.'

Deontology

• The idea that things are always right or wrong, regardless of the consequences

• For example, stealing is always wrong

Talking to Patients

• There are certain things you should remember when you are talking to patients.

• It sounds obvious but state that you should be empathetic, patient, sensitive etc

• Always introduce yourself

• Obtain consent

• Ask if they have any questions/concerns/expectations at the end

• Ask if there is anything else you can do for them

• Thank them for their time

• When talking to relatives of patients, it's important they you confirm that they are actually their relative.