Sample MMI Station: Contemporary Issue

The Multiple Mini Interview (MMI) for medical admission is difficult, but with practice you can hone your interviewing skills and become more capable at answering common scenarios. In this post I’ll be breaking down a common medical interview scenario, one in which the interviewer gives you a prompt about a contemporary issue affecting society (typically related to health or ethics) and asks you to discuss it.

The Scenario

Vaccinations are an important way to build individuals’ immunity, and are indispensable in keeping our communities safe from disease. It is ideal for all children to get immunized at the appropriate age to prevent contraction of preventable diseases. However, there are some that oppose vaccination. They argue the harms of vaccinations outweigh their benefits, and that vaccination programs result in a lack of freedom of choice in how their children should be raised. Their claims often have no scientific basis and create unnecessary fear in society. You are on the advisory board of the Government, looking to create legal change to improve vaccination rates in society.

The Questions

Some individuals believe compulsory vaccination restricts their freedom of choice in raising their children, and that vaccinations will do their children more harm than good (for instance, that vaccines will cause autism). If the advisory board decided against instituting compulsory vaccination laws, what else could you do to persuade such individuals to vaccinate their children?

Current laws make vaccination a legal requirement, such that child and youth welfare payments will only be made to children who are up to date with their vaccinations. Do you agree? Do you believe this will increase vaccination rates in our country?

Should parents who choose not to vaccinate their children be punished by the law?

What do you think is the best way to raise awareness and increase vaccination rates?

There are various ‘anti-vaccination’ groups that publicly promote the ‘dangers’ of vaccines. Should the government intervene to curb their activities?

Question One

In questions like this, it is important to remain focused on the specific question you have been given in the MMI. Having read an extensive prompt about vaccination, it is easy to inadvertently go off on a tangent and fail to address the MMI question substantively. The best way around this is to craft a clear opening statement that addresses the terms of the MMI question and will act as a foundation for the points of your response. For instance:

It is definitely true that some people have unfounded beliefs about vaccines, such as the idea that they cause autism, and I think that there are a number of policy options that the advisory board can institute in order to increase vaccination rates among this group. Firstly…

Using the key terms of the question shows the interviewer that you have understood it, and also prepares you for giving the points of your response. That said, be careful not to recite parts of the MMI question at length. The interviewer can only mark you on novel analysis that you offer, so keep your opening short and to the point, especially given the time constraints of the interview. In my example, I only spend a single sentence on the introduction before moving on to my first point.

This MMI question asks you what you would do to persuade those against vaccination to vaccinate their children. Numerous policy options are available. To deliver a strong response, you will need to not only offer a range of potential policies, but also provide analysis on why you believe the specific policies you are proposing are likely to be effective. This will likely also require some analysis of the people the question is asking about, as the design of your policies will change depending on the target demographic:

Many people with anti-vaccination views have low levels of health literacy. So, one policy I think could be effective would be a public health campaign targeting expectant mothers. This could include gentle positive messaging about the health benefits of vaccination and the high levels of safety testing that all vaccinations administered go through. I think that it’s important to note that people against vaccination aren’t malicious, they just want what’s best for their children. Health education that stresses the importance of vaccination to protect against various diseases could help them to better understand why they should vaccinate their children. Another policy I think could be effective is…

Question Two

The second MMI question is in fact two yes/no questions. You will have to give clear answers to both questions in order to deliver an effective response. Your answer can come in your introduction or in your conclusion, and can be more nuanced than a simple yes or no, but in MMI questions like this you do have to be clear about what you believe and avoid sitting on the fence:

I believe that the current policy, under which payments are only made to vaccinated families, is a positive policy that is likely to increase vaccination rates. Firstly…

In a MMI question like this, there are various upsides and downsides to the stated approach. On the upside, you could talk about the fact that welfare is likely to act as a carrot for the vaccine-hesitant, especially since those against vaccination are disproportionately of a low socioeconomic status. On the downside, you could discuss the fact that depriving these families of benefit payments is likely to further reduce their health status, and that this policy does not address the underlying issue (considered in question 1) of low levels of health literacy.

Question Three

This MMI question is a broader ethical question that provides a lot of room for discussion. Like in question 2, you will need to give a clear statement as to what you believe at some point during your response.

In support of punishing those against vaccination, you could discuss:

• The selfish nature of anti-vaccination, insofar as it decreases health outcomes not only for those who choose not to vaccinate, but also for other individuals in society such as the immunocompromised through the reduction in herd immunity
• The dangers of allowing medical misinformation to spread, something which could lead to a reduction in society’s trust of the medical system more broadly and hence reduced health outcomes

In opposition to punishing these individuals, you could discuss:

• The importance of bodily autonomy and consent in healthcare (autonomy is one of the four pillars of medical ethics), and the consequent ethical issues associated with mandating or forbidding certain medical treatments
• The potential social upheaval that could be caused by forcing treatments on individuals against their will, which could damage trust in the health system
• The fact that this policy does not address the poor health literacy which undergirds anti-vaccination attitudes

While good responses must come to a clear conclusion, you can discuss both sides to demonstrate your breadth of knowledge. You can rebut opposing points, showing why you believe what you believe despite the presence of some valid points on the opposing side.

Question Four

This MMI question is quite similar to question 1. To avoid repeating yourself, it will be worthwhile to take stock of where the questions differ (this question does not specifically ask about those opposed to vaccination) and target those points specifically. As opposed to question 1, you could talk about more general public health schemes such as TV adverts. Like in question 1, make sure to justify your proposed policy with suggestions as to why it will be effective:

One group that might be potentially under-targeted by vaccination messaging is that of young people, who might have less knowledge of the importance of vaccines and might not be exposed to traditional public health campaigns. I could consider an advertising campaign on platforms like TikTok in hopes of reaching youth…

Question Five

As with question 3, you will have to demonstrate a good level of insight into the pros and cons of this approach. Your answer need not be a simple yes or no, but it must be clear.

Some points in favour of suppressing these groups include:

• For the last century, medical consensus has been overwhelmingly in support of vaccination programs; allowing such groups to spread misleading propaganda is irresponsible and results in reduced health outcomes
• Failing to restrict these groups goes some way towards legitimating their beliefs, when their beliefs are in fact conspiratorial and have no basis in science

Some points against suppressing these groups include:

• While these groups may be harmful, the harms to civil liberties would be even greater were we to place policy restrictions on their speech
• The creation of chilling effects via the restriction of such groups could suppress oversight of medical practice, which is essential to preserve an equitable and functional medical system

Conclusion

Current affairs questions like this one, on topics such as COVID-19, vaccinations, road safety, education, and the carceral system, are common. Some prior knowledge of these topics from following the news can be quite helpful in synthesising an effective response. My main piece of advice is to present a good balance of varied points and explanatory detail to demonstrate your depth of understanding. I hope this post has helped you better understand this type of MMI question!

Written by Callum, an experienced MedEntry interview tutor

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