Which of the following scenarios would lead to a diagnosis of essential hypertension

Sitting the UCAT isn’t the end of your UCAT preparation. To gain admittance to most medical degrees, you’ll also need to attend a multiple mini interview and respond to some challenging questions and scenarios. In this article, we’re going to look at 6 common MMI scenarios and the sorts of challenging questions that may arise.

In this article, we’ll look at:

What’s an MMI?

The MMI is the interview format used by many universities as the final selection process for medical school admittance. The MMI is used for undergraduate and graduate programs. Both universities that do require or don’t require UCAT employ MMIs. An MMI is comprised of a series of interview stations (sometimes called panels). Each station will present you with a particular type of scenario or question.

You can find out more about the MMI, here.

In brief, the MMI has a series of stations that test different skillsets that schools want in medical school. Medical interviewers know that you’re not a medical expert (yet!), so you don’t need to know the specifics of medical procedures, treatments, or policies. however, they do want to have candidates who are aware of current affairs and popular debates.

Let’s look at some scenarios and what would qualify as an excellent or average response. For each type of station, we’ve provided you with two scenarios/questions so you can understand the sort of variety you may face. This will give you an indication of the sort of preparation you need.

1. MMI Interview Station: Ethical scenarios

The station for these MMI scenarios can either be a panel or a role-playing situation. In these questions, you are asked to contemplate an ethical situation and provide what you perceive to be the correct response or course of action.

Let’s look at a couple of scenarios and ways to approach them.

Scenario 1 – Cheating

You are sitting your final medical exam at university. Your cohort is fairly small – around 50 students – and while you aren’t friends with everybody, you are familiar with all the other students in the final year. In the examination room, before the exam commences and the papers are distributed, you are seated next to somebody unfamiliar who appears to be older than the rest of you. They are acting nervously and whenever you look at them, they turn their face away from you. You begin to suspect that they may be sitting the exam for somebody else. How do you handle the situation?

Average candidate responses,

• I would inform the invigilator and Dean about the student cheating.
• I would confront the “false” student before the exam and explain that they should not be facilitating academic dishonesty.

Excellent candidate responses,

• This situation raises a complicated situation that requires a calculated and ethical response. Academic dishonesty is never ethical and is a potential danger to future colleagues and patients.
• However, just because I don’t recognise the student sitting adjacent to me, does not mean they’re sitting the exam for another. The correct solution would be to raise the issue with invigilator once the exam has been completed. This is because:
  • Accusing the student in public or drawing attention to this during the exam would be inappropriate and cause the other student undue stress, especially if I’m incorrect and they’re innocent.
  • If there is time before the exam commences, I might introduce myself and ask who their lecturers were. If it became obvious they were engaged in academic fraud, I would then potentially raise it directly with the invigilator and definitely with the faculty dean’s office as soon as the exam was finished.

Scenario 2 – Unethical behaviour

You are a final year student on rotation in a suburban emergency department. You are shadowing a senior emergency doctor. A female patient in her 30s is admitted from triage complaining of sudden onset lower abdominal pain. After reading the patient notes, but prior to seeing the patient, the doctor describes her to you as “a frequent flyer” and implies that she’s drug-seeking. Upon visiting the patient, you note that the woman appears to be in significant pain. You become uncomfortable with the doctor’s cold and callous indifference to her. How do you respond to the situation?

Average candidate responses

• It appears the doctor is being judgemental and assessing the patient on past behaviour and not their symptoms.
• The doctor is being unethical and I would report them.

Excellent candidate responses

There are two sides to consider.

On the one hand:

• Stereotyping and pre-judging patients prior to seeing them could lead to slippery slope behaviour where patients suffering from symptoms similar to lifestyle-related health complaints such as liver, lung or weight issues are pigeon-holed inappropriately. There may be other underlying health complications that need addressing.
• Categorising patients as “frequent flyers,” “drug seekers,” or “hypochondriacs” is a dangerous behaviour that may lead to ignoring prominent signals and missing a serious diagnosis.
• Behaviour such as this might signal issues with the doctor’s professionalism and their authority to train future medical professionals.

On the other hand,

• The doctor may have had a past encounter or encounters with this patient.
• The doctor may be frustrated and concerned about the unnecessary load the patient may be placing on the department, hospital, and health system overall.

Consequently, I would ask the doctor why they have made this judgement and what the medical reasoning was behind their actions. Then I would be in a better position to consider my course of action prior to acting.

2. MMI Interview Station: Critical thinking scenarios

These scenarios present you with situations where you need to think critically about a problem. These might involve comprehension and the parsing of information. You may be presented with challenging, esoteric, or quirky questions that don’t have a clear answer. Often, how you propose to solve these is more important than a correct or specific answer.

Scenario 1 – Critically engaging with information

On social media, a close family member shares a documentary on the 2020 Coronavirus Pandemic. The documentary asserts that any vaccination program for COVID-19 is dangerous and individuals should refuse the vaccine when the government begins its mass-vaccination program. The documentary includes the following assertion:

Vaccinations are inherently harmful. Vaccines are made of egg protein, polysorbate 80, and dihydrogen monoxide. Giving children vaccines can lead to them developing autism and other illnesses. It has been clinically demonstrated that the dihydrogen monoxide in vaccines reacts inside the body causing congenital defects in growing bodies. Vaccines are only legal because of the immense wealth and influence of the pharmaceutical lobby. Knowing the harm you are doing to your child vaccinating them will you still do it? I wouldn’t!

Evaluate this statement. What would you say to your family member?
In your response, critique the validity of the arguments and their logical construction. Your response should include consideration of the scientific, logical, and rhetorical structure of the argument.

Average candidate responses

• You’re wrong. Vaccines are safe.
• The statement makes broad statements that aren’t scientifically correct.
• Anti-vaccine hysteria endangers the lives of more vulnerable members in society.

Excellent candidate responses

• Making blanket statements concerning the documentary will likely not convince my family member. Instead, I would point out that this documentary has factual and logical errors and relies on rhetorical manipulations to elicit fear and concern in an audience:
  • The connection between autism and vaccines has been widely discredited and its early advocates have been deregistered.
  • The facts stated are either false, illogical, or misrepresented –
    • Egg protein is widely used in several medications and is commonly consumed without complication.
    • Dihydrogen monoxide (H2O) is an unfamiliar term for water. As the documentary asserts that dihydrogen monoxide causes congenital defects, it shows that it contains factual errors.
  • The final statement “Knowing the harm you are doing to your child vaccinating them will you still do it? I wouldn’t!” employs dramatic pathos and provocative rhetorical questioning to instil fear and concern in the viewer.

Scenario 2 – Thinking outside the box

You sit at the station and the interviewer asks you:

How would you count all the flags in Australia?

Describe your method.

Average candidate response

• I would count all the flags in Australia.
• I would survey the whole country and find out who has flags.
• I would use a service such as Google Earth to count the number of flags.

Excellent Response

This question seeks to see how you would approach an unusual question and problem solve. There are no correct responses to this question, are but there are more accurate or innovative solutions that would impress the panel:

• I would survey a suburb and see how many flags were flown by residents, businesses, and council/government agencies. I would divide this number by the population of the suburb and use this to calculate a ratio of flags to people and extrapolate this for the rest of the country.
• I would use a phone survey across the country and ask if owners or occupiers of residential buildings had flags flying. I would audit a sample of businesses with the same question. I would use the percentage of this to extrapolate for the total population of Australia.
• I would do an internet search to estimate how many flag suppliers are in Australia, and perhaps contact one or two pretending I was going to place a large order to try and estimate their stock levels. The question didn’t specify that the flags have to be flying.

3. MMI Interview Station: Data and calculation scenario

The questions at this station are designed to test your ability to quickly complete maths and data assessments. You might be given dosage scenarios, datasets to analyse, or graphs and charts to read.

Scenario 1 – Calculating dosages

At this station, you are presented with a card containing calculation questions:

Question 1: 

You are asked by a specialist to assist a nurse giving a patient weighing 75 kg a 0.75 mg/kg IV injection of Mirclcur. The nurse has prepared a syringe containing 100 mg of the drug in 2 mL of saline. What volume of the solution in the syringe needs to be administered?

Question 2:

You are asked to give a patient 3 mL of the new flu treatment, Hard-n-Up, which is a 2% solution of the drug. How many milligrams of the drug are you administering?

Worked solutions to the questions

Let’s look at the correct solutions to these problems.

Solution 1:

The patient weighs 75 \text{ kg} and you need to administer 0.75 \text{ mg/kg}. Therefore, you must give 56.25 \text{ mg}.

The syringe contains 100 \text{ mg} in 2 \text{ mL}.

Use an equation where the volume of solution is denoted by x:

Rearrange the equation to find x:

Response: The nurse and I need to administer 1.125 \text{ mL} of the syringe volume.

Solution 2:

2\% means that there are 2 \text{ g} in every 100 \text{ mL} of solution.
Therefore there are 2000 \text{ mg} in 100 \text{ mL}
Therefore there are 20 \text{ mg} in each 1 \text{ mL}

Therefore there are 3 \times 20 = 60 \text{ mg} in 3 \text{ mL}

Response: I will have administered 60 \text{ mg} of the drug to the sick patient.

Common mistakes from candidates include:

• Confusing units
• Not being consistent with cross-unit calculations
• Not double-checking calculations to ensure you aren’t out by a factor 10.

Scenario 2 – Reading charts

You are given the following graph:

Review this graph and explain your findings.

Average responses from candidates,

• Will try and pass off as knowing what the bacteria is, even if they don’t. You wouldn’t be required to know what Treponema pallidum is.
• Make assertions that go beyond the scope of the data in the graph without attempting to substantiate it from the data.
• Try to see trends where there are no trends supported by the data.
• Try to infer causal relationships between variables, where the data only indicates correlation (if at all).

Excellent responses from candidates,

• Use the data to extrapolate a series of statements about the effectiveness of the various antibiotics.
• Develop an argument about the change in resistance of Treponema pallidum to the various antibiotics shown, based upon the trends illustrated in the graph.
• Focus only on the data provided.
• Ground any hypotheses about why the resistance might be increasing with data from graph.
• Acknowledge uncertainty and assumptions being made, and further information required.

An excellent response might be,

This is a graph comparing the efficacy of antibiotics in treating Treponema pallidum. On the x-axis is time, illustrating fluctuations in the effectiveness of the various antibiotics. The y-axis shows the percentage of antibiotic resistance acquired by Treponema pallidum.

The graph shows that over time some antibiotics have become less effective in treating Treponema palladum. The graph shows that antibiotic resistance to penicillin has become most significant, increasing 15% over a 10 year period. Resistance to Macrolides have seen around a 5% increase, mostly after 2015. Cefixime has consistently had the lowest incidence of antibiotic resistance, only fluctuating by around 1%. The efficacy of the antibiotics fluoroquinolone and tetracyclines have fluctuated somewhat over time but have remained relatively similar in the long run. Quinolones have become slightly less effective by about 1-2%, though the graph may only be showing fluctuations.

The graph does not provide enough information to show a cause for this resistance. However, because penicillin resistance has increased by over 15% over the 10 year period, we might deduce that it is the most commonly used, leading to overuse or improper use of this common antibiotic, which in turn leads to increased resistance. Macrolides resistance has increased by about 5% since 2015, which may also correspond to increased use since that time. The other antibiotics only have variations under 3-4%, suggesting that these antibiotics are less widespread, either due to cost or availability or how regularly they are prescribed in relation to this bacterium. It would be interesting to compare this graph to the number of prescriptions of these antibiotics over time in relation to this bacterium and also to consider the situation under which they are prescribed (e.g. first course of action by GP vs last course of action restricted to hospital treatment). 

4. MMI Interview Station: Teamwork

These scenarios test your ability to function as part of a team. The medical profession only functions effectively when it is a collegial, professional, and supportive environment. Common MMI scenarios assessing teamwork can ask you to work with others or reflect on past teamwork experiences.

Scenario 1 – Giving instructions

You arrive at a station and on the table are the following:

• A children’s skateboard
• A sheet of wrapping paper
• Clear tape
• A ribbon

You are instructed by the panellist to tell them how to wrap the skateboard. They will only do exactly as you instruct. How do you proceed?

The differences between average and excellent responses

This sort of scenario is assessing your ability to:

• Critical think.
• Plan ahead.
• Give clear instructions.

Medicine is a field where processes and planning are essential for patient and workplace safety.

This task requires you to visualize the object and then think about the problems you would face wrapping the object. You then need to consider the problems you may encounter explaining the process to somebody sitting in front of you.

Excellent responders will:

• Plan out the entirety of the task –
  • The orientation and placement of the board on the wrapping paper.
  • The turns required, from the panellist’s perspective, to appropriately cover the object.
  • How to explain the operation of scissors safely and effectively.
  • How to tie a ribbon.
• Assess potential problems and failure points. Communicate these to the panellist before and during the process:
  • For example, “Wrapping the skateboard wheels down on the paper is likely to cause a tear in the paper and make the process unstable. This may be avoided by beginning with the flat side down.”
• Explain the task systematically before instructing the panellist to undertake the task.
• Remain calm, polite, and clear as the process is completed. It is essential you don’t lose your cool, even if the panellist makes an error (unintentional or intentional)
• Don’t be upset if the wrapping looks terrible or is ripped. How you cope with stress and failure is integral to the test.

Scenario 2 – Succeeding and failing together

You arrive at the station and are asked,

Describe an example of when you worked in a team and you failed.

Average responses from candidates,

• Don’t explain the scenario, the team, or the goal clearly and effectively
• Are too self-deprecating. You must be reflective and not self-flagellating
• Place blame and single out others. While you need to be able to identify failings in what the team did, you must be clear about the failure of the team as a collective.

Excellent responses from candidates,

1. Clearly explain the scenario:
   • What was the team?
   • What task was being attempted?
   • How was failure and success defined in this case?
2. Explain how the team failed. Identify what lead to the team’s failure.
3. Explain exactly what your role was in the team. Reflect on what you did well and be honest about your contribution to the failure of the endeavour.
4. Describe what processes and behaviours you would change and outline what suggestions you would make were you to face the same task again.
5. Try and analogise the lessons from this task for a challenge you feel you might face in a medical career.

5. MMI Interview Station – Role-Playing Communication Scenarios

Role-playing communication stations are common MMI scenarios for a variety of topics and situations. However, while the situations and topics may vary, the focus is on how you communicate and engage with others. Key to these scenarios is your control of body language and use of empathy and EQ (emotional intelligence).

Scenario 1 – Breaking Bad News

You enter the interview space and are handed a card by an actor and their colleague that presents you with the following scenario:

You and a friend are staying at her parents’ house while they are on holiday. Your friend is working overnight on rotation the night before the parents return. Your friend asks you to move their parent’s Mercedes, which had been parked in the driveway, back into the garage before they arrive home. While parking the vehicle in the garage you scrape the side of it along the garage entrance. You’ve been thinking about how to discuss the incident with the parents. The parents return home from their holiday and enter the house. Discuss the damage to their vehicle.

The actors will play the role of the parents. How do you proceed?

Average responses from candidates,

• Begin by jumping directly into the question.
• Are too curt, distant, or impolite. You’re being assessed on how you communicate and engage with others.
• Avoid responsibility. Don’t blame it on an unfamiliar car, your friend palming the task on to you, or a mechanical fault like a sensitive accelerator. You need to demonstrate your ability to take ownership of mistakes.
• Don’t blame it on stupidity or carelessness. You were driving the car, it is your fault.
• Fail to show empathy or understate matters with euphemisms – “a small scratch” or “a bit of ding.”
• Become defensive if one or both parents become upset or angry.

Excellent responses from candidates,

• Will carefully explain and reframe the situation.
• Explain with clarity exactly what has happened, even though the parents may be angry, they will appreciate your honesty and forthrightness.
• Take care to make it clear that you are contrite but don’t go out of your way to offer solutions. Instead, ask them what solution they would appreciate and work forward from there.
• Pay attention to your eye contact and body language.
  • Be assertive and attentive
  • Make eye contact
  • Don’t be laid back
  • Don’t shout or raise your voice if they raise theirs

Scenario 2 – Dealing with conflict

You enter the interview space and are presented a card by a female actor with the following scenario on it:

You are a 3rd-year medical student shadowing a senior oncologist. You have an elderly patient that has stage 4 cancer and a terminal diagnosis. Without treatment, they will most likely die within weeks, perhaps days. The patient has declined further treatment and asked for palliative care. During a consultation with the family discussing the palliative process, your consultant is called to an emergency. You are left alone with the patient’s daughter. She immediately starts pressuring you to continue her father’s treatment because she disagrees with her father’s decision to discontinue care and doesn’t feel that the consultant agreeing with the patient’s demand is the correct approach.

How do you respond?

During the role-playing scene, the woman becomes increasingly upset and angry.

Average responses from candidates,

• Jump straight into the scenario with solutions for the issue.
• Fail to explore further details of what the patient’s daughter would like to occur.
• Make statements or promises that extend beyond your role and position in the hospital.

Excellent responses from candidates,

• Will focus on the fact that the issue at hand is not the father’s illness, the treatment, or diagnosis, but the daughter’s feelings.
• Be aware that the woman is coping with grief. It is important that you manage this empathetically but professionally.
• Will enquire, empathetically, about why the woman feels that way. Finding out more information from the actor will help you produce more effective interpersonal responses.
• Ask questions of the woman to understand what outcome she wishes for and why.
• Reframe the question for themselves so that they can better understand the situation and courses of action.
• Explain professionally why, as a student, they are not able to make decisions regarding patient care.
• Explain that healthcare decisions for patients are patient-centred. To continue treatment would be unethical as it goes against the wishes of the patient – a core value for the Australian healthcare system.
• Walk through the various situations and their ramifications with the patient’s daughter. For example:
  1. Agree to try and convince the specialist to keep the patient in against his wishes. The patient or daughter’s position may change in a few days, but the patient will face increasing pain and discomfort due to treatment. This could lead to family disputes between father and daughter at a time where he desires palliative care and a peaceful end of life scenario. This is moving beyond your role in the hospital.
  2. Explain that the father’s decision is final and that it would be unethical to keep the father in longer. This honour’s the patient’s care and wishes but will not appease the daughter.
  3. Explain that you are a medical student and that this is beyond your remit as an intern. This extricates you from the problem but doesn’t resolve the issue.
  4. In light of your limited authority, offer to discuss the situation and suggest facilitating a meeting between her, the specialist, and her father. Additionally, offer to involve a social worker or palliative care specialist to provide information about palliation and hospice care.
• Assertively and compassionately argue for the most preferable response (for example, number 4 would be the most ethical).
• Be conscious that your primary duty lies to the patient and their wishes, not the daughter regardless of how much she argues.
• Remain calm and empathetic at all times.

6. MMI Interview Station – Policy Scenarios

These common MMI scenarios are often based around “hot” or current topics in public health. It is worth your while doing some research around these policy issues and formulating some nuanced and detailed responses ahead of time.

Some areas you may consider looking into are:

• Healthcare funding and privatisation
• Access costs
• System strain
• The challenges of providing healthcare for an ageing population
• Antibiotic overuse
• Public funding of dental care
• Scheduling of medications
• Vaccination policies

While you are not expected to be an expert, you are expected to be aware of the issues and able to form a succinct, reasoned, and logically structured response.

Generally, you will have a couple of minutes (2-3) to prepare before entering the station.

Scenario 1 – Limiting Access

Before entering the station, your are presented with a card containing the following information:

As emergency departments experience a significant increase in patients attending in winter, the NSW State Government outlines a plan for deterrent fees for visiting Emergency Departments. The proposed fee is not significant – only $10 – and would only be payable on the first contact for that particular visit. This initiative is driven by the idea that the fee will deter people from visiting Emergency Departments and overrunning them for simple complaints like common colds, the flu, and mild stomach upsets.

Discuss the implications of this policy for public health, health care costs, and the ideals underpinning NSW Health, Australian health policy, and Medicare more broadly.

Average candidate responses,

• Jump right in and answer the question without reframing it and inquiring after more information.
• Make simple statements in favour of or against the statement.
• Do not weigh the different sides of the debate.
• Do not consider the different policy issues involved in the question – the short term financial savings and burden on the system contrasted against the long term ramifications of more significant care for patients who defer visiting a doctor.

Excellent candidate responses,

• Will reframe the question, framing the issue from different positions. For example:
  • Providing the upfront fee will limit patients with light or non-life-threatening ailments to visit their local GP.
  • The barrier of an upfront fee will lead to patients who can’t afford it (pensioners, the unemployed, the chronically ill) deferring care when they should obtain it.
• Provide a comprehensive discussion of the issue from both positions.
• On one hand, the upfront fee will limit healthcare costs for emergency departments:
  • Allowing for funds to be reallocated to other parts of the health care system.
  • Creates space in the system to offer better patient care.
  • Pushes the healthcare system to function more efficiently by redistributing the burden of care more evenly across General Practices.
  • This policy would garner support amongst those that feel healthcare is a private burden and issue, not a public one.
• On the other hand, the upfront fee raises important ethical and financial ramifications to the system:
  • The fee raises a barrier of entry to the healthcare system.
  • Many GPs either do not bulk bill or require a co-payment, limiting access.
  • While this policy will limit the number of presentations at emergency, patients from lower socio-economic or financially precarious backgrounds – such as pensioners, people with chronic health conditions, and those with mental health issues – will defer attending for care.
  • Patients deferring care may lead to cost savings in the short or even medium-term, but in the long term patients who have deferred initially will present with more significant issues that require greater and more complex care. It is a well-studied fact that preventative care and intervention produces more significant cost savings in the long-term as well as better healthcare outcomes.
  • The short term reduction in presentations might limit the strain on emergency departments, but in the long term will see an increase of patients requiring care in other departments of the hospital requiring more resources and funding.
  • This policy would also garner much opposition from those who believe that healthcare is a public issue that can provide social and economic benefits to society if universal access is maintained.
• Understand and discuss that this is a complicated and, often fraught, area of policy decision making. A well-considered response will reframe the question, outline the different sides to the debate and provide a solution backed by reasoning considering the values of the public health system.
• Be sure to answer the question as a whole – apart from the cost and work load, the ideals underpinning Australian health care policy and Medicare must be addressed.

Scenario 2 – The state of healthcare

Outside of the interview space, you are presented with the following statement:

In your opinion, what is the largest challenge that the Australian Medicare System/United Kingdom’s NHS  faces today? You must discuss this issue for 6 minutes.

You are given 2-minutes to prepare before entering the interview space.

The challenges involved in this type of question

Unlike other policy questions, such as scenario 1, this is a very broad question. This question invites you to focus on a single issue and explore it in detail. This is the sort of question you can prepare for.

Doing some research around current healthcare topics worldwide and within Australia/the United Kingdom will provide you with information to prepare or pre-plan responses to this type of question.

However, just having a lot of general knowledge about the issues is not enough to produce a good response.

Candidates will also need to demonstrate an ability to weigh both sides of an issue and develop a logical and clear response about their chosen topic.

Candidates will also need to be confident public speakers able speak off the cuff. While the sample question is broad, the potential question could focus on particular healthcare system issues, the Australian NDIS or the UK patient pathway and districting regulations for GP access.

Average candidate responses,

• Offer a simple response that illustrates little awareness of public health issues.
• Fail to think about the different policy issues raised by the question. For example,
  • The complications involved in State vs Federal healthcare policy and funding in Australia.
  • Any potential political difficulty in discussing public healthcare costs where Medicare/NHS and healthcare access are involved.
  • The strong and varied different public opinions towards public health and Medicare/NHS for all.
• Pretend to be a complete expert and that you have all the correct information
• Present a convoluted, contradictory, or inchoate response.

Excellent candidate responses,

• Will focus on a single concern or issue.
• Present an argument that considers all sides of an issue – positive and negative.
• Consider the different facets of public health policy consideration:
  • Patient outcomes
  • Healthcare coverage
  • System ramifications
  • Economic issues
  • Wider public health outcomes
  • Political concerns that may be involved in your topic (e.g., vaccines, antibiotics access, women’s reproductive health access).
• Be willing to explain your ignorance and lack of knowledge of some areas that might be up for discussion. You are not expected to be a public health expert.
• Include counterpoints to your arguments. Don’t be afraid to play devil’s advocate.
• Offer a well structured, researched, and signposted response that considers the pros and cons for each point of discussion.

Short, sample response

Let’s look at what responses may include.

For our topic, we will consider the ageing population (a topic pertinent to the Australian, New Zealand, and UK healthcare systems) and its ramifications for healthcare. Arguably, an ageing population requiring access to a public health system includes the following concerns:

• Cost of providing care – staffing, medication, hospital services.
• Provision of aged care specific treatment and facilities.
• Increased lifespan and improved care can mean more people requiring more care for longer.
• Balancing preventative, palliative, and reactionary care with health budgets and system resources.
• Staffing shortages and systemic care issues in health care systems.
• Tele-health and online healthcare offer opportunities for improved care (but there are barriers to access).
• Care for the elderly, if not managed correctly, can be significantly more expensive than care for those in society who are younger.

When presenting and structuring a response, be aware of potential counterpoints.

Consider employing a rhetorical structure like:

1. Introduction: Present the problem
2. Expand: Explain some of the issues involved in the issue
3. Focus: Pick one of the issues and expand on it
4. Solution: Outline a potential solution and how it might work
5. Counterpoint: Explain or list the complications arising from or inhibiting the solution. Offer a resolution if and where applicable.
6. Focus: Pick one of the issues and expand on it
7. Solution: Outline a potential solution and how it might work
8. Counterpoint: Explain or list the complications arising from or inhibiting the solution. Offer a resolution if and where applicable.
9. Focus: Pick one of the issues and expand on it
10. Solution: Outline a potential solution and how it might work
11. Counterpoint: Explain or list the complications arising from or inhibiting the solution. Offer a resolution if and where applicable.
12. Summarise: Summarise your argument
13. Conclude: Finish by presenting your position on the topic.

A sample response, then, might look like:

To my mind, the most significant concern facing healthcare today is the increasing ageing population. An ageing population poses a number of important issues to our healthcare system. An ageing population requires greater healthcare resources – and specialist resources at that – leading to an increase in costs. Ageing populations can increase the strain across the breadth of a healthcare system. As patients age, they increasingly face more chronic non-communicable diseases related to greater longevity and lifestyle choices. Consequently, we face a decision to restructure national healthcare away from a treatment model to a preventative care model.

As our population ages and the elderly become a greater percentage of those in the system, conditions such as hypertension, cardiovascular illnesses, diabetes, arthritis, and cancer become more prevalent. An increase in patients presenting into the health system is going to increase the end to end burden on public health. More elderly patients will present to emergency and need varying degrees of care throughout the system from specialist treatments such as those provided by orthopaedic specialists and oncologists through to rehabilitation specialists and hospice care. This rising burden on the system presents a substantial increase in future funding for healthcare. As a consequence, the government will need to find a means to increase the budget for the public health system, especially for rural and regional healthcare districts.

There are some ways in which we can proactively engage with this issue to spread costs. A long term policy might be to introduce a system akin to superannuation where individuals pay into a care fund throughout their working lives. Contributions to this fund would be compulsory but limited to a small amount and perhaps proportionally matched by the government. This would face some challenges from some quarters by those opposed to forcing contributions from individuals as government overreach and essentially as increased taxation. Similarly, there will be those who argue that healthcare provision is purely the responsibility of government and it is inequitable to transfer this to the public. Having said that, while it might be difficult to pass in the short-term, and it won’t reduce the short-term costs of providing public health care, it provides an equitable and sustainable model for high-quality public care. This will potentially allow us to continue sustaining the NHS/Medicare indefinitely.

Another avenue for accommodating an ageing population is offering wide-spread telehealth. The recent international crisis has seen advances in the technology and public pick-up of such technologies. in addition, policymakers have begun to include telehealth as a model for some care. By expanding access to telehealth and allowing patients with a wide array of issues to utilise it, we can alleviate the burden on GP practices, Emergency Departments, and hospitals. However, there will be some barriers to entry for such programs. For example, patient access to the required technology and the knowledge and practice of using it might be difficult to establish. While there are some technologically savvy elderly people in the community, there are also those who don’t utilise technology or own PCs. This inherently limits the short term success of such programs. Although, a grant scheme or the government provision of equipment might still prove more cost-effective than face-to-face consultations.

Surely, the best long term solution and, in my opinion, the most effective, would be to restructure health care in this nation to a preventative model rather than our current treatment-focused model. A preventative medicine model, by introducing preventative medicine across the system – with better education around healthy living and more resources to enable those who require treatment to seek it before their conditions worsen and become more expensive – we could head off significant public health cost increases before they hit. There would be a reluctance to move towards such a model, those opposed to public health and those who are fiscally conservative will likely be quite vocal in opposition. However, treating chronic diseases such as diabetes, high blood pressure, or arthritis before they become chronic reduces the costs for specialists and infrastructure, especially the bricks and motor resources like hospitals, elderly care facilities, and hospices. Such an approach would have long-term savings and potentially increase the age that workers would leave the workforce (although that is a different and equally fraught issue in and of itself).

Ultimately, the ageing population presents a pressing and complex policy issue. It is multifaceted and threatens us with increased health costs, a substantial hit on already strained national budgets. Approaches such as increased access to telehealth and a contribution system to fund future costs are plausible solutions. In addition, I strongly believe that restructuring our healthcare system to focus on preventative medicine offers the best long-term outcomes and care. Such an approach is directly in line with our national values which are focused on public health, well-being, and the public good, values I look forward to upholding and furthering in my career in medicine.

(Please note, the above response isn’t the public health or political perspective of UCAT Masterclass on public health policy. In addition, the above statement is not reflective of a total solution to what is a complex and nuanced debate.)

Final thoughts on MMI preparation

The MMI is set up with a variety of different challenges to assess different aspects of your character and skill set. If you don’t perform well on one station, that’s not the end of days. You have other stations that you can perform well on!

After looking at these common MMI scenarios, you’ve hopefully realised that the MMI requires the same sort of careful preparation and practice as your UCAT.

Make sure you set aside time for research and practice in your study timetable.

You don’t want to attend an MMI unprepared as it could undo all your hard work throughout the previous years.

Want to make sure you ace your UCAT and guarantee an MMI?

Register now for the free, UCAT Mock Exam Day to see how you rank against your peers.