The Guide

2. Option I don’t agree with 
a) Why someone might side with this argument 
b) Why I am not going to side with this argument 

3. Option I agree with 
a) Why someone might not choose this option 
b) Why I chose this option 

4. Outcome of decision – this is usually a compromise

 

Moral & Ethical Judgement – Questions

1. Transgender women can take medication to reduce their testosterone levels when competing in the Olympics. What is your opinion on this? Should transgender people be allowed to compete in the gender category in which they identify? Should a separate category be made for transgender people?
2. Describe a time where you witnessed someone do something unethical or immoral. What did you do and what would you do differently if you could do it again?  
3. Decision making for water fluoridation has recently shifted from the  local council to the DHB. There is some opposition from the public. What do you think about this?  
4. You are the owner of a pharmacy. You notice that one of your customers keeps coming to your pharmacy for anti-constipation pills (laxatives). You know that these pills can cause harmful effects if abused as ‘slimming aids’. What would you say to the customer? 
5. You are a GP and a friend (with a medical condition) wants a prescription medication, because she knows that the medication works and is too busy to see her own doctor. What do you do? 
6. What are the PROs and CONs of placebo treatments? Would you ever prescribe them?
7. You catch your friend cheating during one of the pre-med exams.  What do you do? 

NZ Health Issues 

It is quite common to be given a health issue and be asked what you  would do to change it if you were a person in power. For this purpose, it is good  to be well informed on the health issues in NZ.

For answering any questions regarding NZ health issues it is important to  consider the underlying issue. People do not choose to be unhealthy, there  is always a reason. These might include poverty, discrimination and racism,  colonisation or poor education. A good answer includes recognition of these  underlying causes. 

Rural health 

People living in rural-regional areas are usually overrepresented in health issues  due to relatively few doctors in rural areas (reducing availability) and increased difficulty of access to health care (distance to hospitals/health facilities). Rural communities have fewer educational opportunities which add to the increased representation in health issues. Overall, rural communities also have different attitudes to receiving healthcare due to stigma. For example, men are seen as very masculine, tough and hardworking and do not like to be seen as ‘needing help’. 

Binge drinking 

Binge drinking is the act of drinking heavily over a short period of time. It is unfortunately quite common in NZ culture. Consuming large amounts of alcohol has negative effects on all body systems including brain damage, increased blood pressure, increased risk of cancer and others. An important consideration is that people from different cultures  and backgrounds drink for different reasons and will therefore require different strategies.

Rheumatic Fever 

Rheumatic fever is a disease caused by complications of a sore throat. When a person has a sore throat due to a streptococcus infection and it is not treated  properly, the body develops an immune reaction and accidentally attacks the  heart valves. Many people living in poverty don’t seek treatment for reasons such as low accessibility to health care, lack of education, financial barriers and lack of culturally sensitive care. It is commonly associated with poverty as infection is facilitated by overcrowding, poor housing quality and reduced likelihood of visiting a GP. 

Mental Health

A mental health issue is anything affecting mood, thinking and behaviour. This includes, but is not limited to, clinical depression, anxiety disorder and bipolar disorder. New Zealand youth (particularly males) have a high rate of mental health disorders when compared internationally. This is thought to be reflected in the country’s high rate of youth suicide (again, particularly in males). An important consideration is why this gender disparity exists, for example, there are strongly rooted social expectations for a male to be strong and a provider meaning vulnerability has been historically frowned upon. There is also a large difference in suicide rates between Pakeha when compared to Maori and Pacifica.

COVID-19

The topic that has ultimately dominated the last two years, this is a subject where opinions and approaches may differ. It is important to consider all sides when tackling questions related to COVID-19; from lockdowns, to vaccination rollout, COVID is extremely broad in the potential for questions. Important areas of discussion are: lockdown (agree/disagree, where, when, how and why?), vaccination (agree/disagree, who first? where first?), border control (open/close?).

NZ Health Issues – Questions

1. What is your opinion on the implementation of pepi pods?
2. What do you think about the retirement age being raised?
3. Think about a problem where the old solution didn’t work and you  came up with a new one. What did you change and why? 
4. Children are coming to schools hungry in the morning. You are the minister and have to come up with a proposal for a solution.
5. You are presented with a list of NZ’s ranking in a number of factors for the Social Progress  Index, e.g. housing, suicide, greenhouse emissions, obesity. NZ  ranked quite low on most of these factors. Should we be satisfied?
6. Binge drinking is a big issue in NZ. How would you manage this?
7. Discuss alcohol advertising in sport. What is your opinion on it? 
8. What changes would you make to the MBChB/BOptom/BPharm entry criteria? 
9. What would you say to people who believe that it is the parent’s  responsibility to ensure children do not get sick?
10. What is your opinion on the lockdown approach to COVID-19 in NZ? 
11. Should the vaccination for COVID-19 be compulsory?
12. Suicides in NZ are predominantly male, why do you think this is the case? How can these rates be lowered? 
13. Describe challenges faced by people living in rural areas. How do you  think they affect health outcomes? What strategies could  be put in place to mitigate these challenges?

Problem Solving Framework 

Underlying issue

Recognise why the issue is so prevalent in the specific population and apply the framework to the underlying cause in addition to the downstream effects.

For example: poverty, poor access in rural areas

See – The educational initiative

These strategies allow widespread acknowledgment of the problem and the fact that it needs to be addressed.

For example: posters, ads on TV/radio, petitions

Act – The policy initiative

These strategies facilitate changes on a political level and enable a system for the change they are supporting.

For example: phase out of plastic bags, replaced with reusable bags in shops

Change – The prevention initiative

These strategies enable people to make personal change. The ideal  change is that the  people themselves  fight against the  issue. This is usually the most  difficult part.

Example: Binge drinking

Underlying issue: Issues of poverty, liquor outlets targeting low SES areas.

See: Advertisements on TV/FB/Radio targeting those who engage in binge drinking activities, showing consequences, bringing attention to perception of a ‘normal’ amount of alcohol versus medically recommended limits.

Act: Alter laws for the way liquor is sold e.g. out of view in supermarkets, not targeting low SES areas. Provide counselling for those addicted to alcohol.

Change: Teach children and young adults about the adverse effects of alcohol on the body and the consequences of intoxication. Provide appealing alternatives to alcoholic drinks i.e. cocktails.

Problem Solving Framework – Questions

1. Discuss a health issue you would prioritise if you were the Minister of Health, and what strategies you would use.
2. Medical professionals have a terrible record of washing their hands. Please describe some initiatives you would put in place to improve this.

Ethnicity 

Medical professionals in NZ work with a multicultural population and therefore must be competent in interacting with patients from diverse cultural backgrounds. Patients’ cultures affect how they understand health, illness, how they access healthcare services and how they respond to health interventions. The purpose of cultural competence is to improve the quality of healthcare services and outcomes for patients.

Your goal in this section is to demonstrate an understanding of the following  topics and WHY they are all important. It is likely they will not be mentioned  specifically but you are expected to bring them up yourself. Knowing about  these topics and being able to explain their purpose and history is a good way to  show your cultural competence.

• The Treaty of Waitangi and its relevance to NZ today 
• The impact of colonisation on Māori 
• The MAPAS scheme 
• Māori and Pasifika health outcomes and interventions

The treaty of Waitangi – Te Tiriti o Waitangi

	English version	Te Reo Māori version
1	Sovereignty	Kawanatanga
2	Forests, Fisheries etc	Tino Rangatiratanga, Taonga
3	Māori treated as British

Translations:

• Sovereignty = supreme power or authority 
• Kawanatanga = Governorship 
• Tino Rangatiratanga = absolute sovereignty 
• Taonga = treasure 

The articles

Article 1

From the British point of view, the Treaty gave Britain sovereignty over NZ and the right to govern the country. The Māori believed they gave the British the right of governance without giving up their authority over their own affairs.

Article 2

From the British point of view, this article gave chiefs full exclusive possession of their lands, forests and fisheries. This implied physical property, however the Te Reo Māori version states Taonga = “precious things”.

Article 3

This article states that the Māori will receive “all the rights and  privileges of British subjects”.Inequitable health outcomes therefore are in direct contravention of the treaty, as these exist due to racist systems that deprive Māori of the equal treatment they were promised. Article 3 can be used to guide future health policies and decisions – will they  disadvantage Māori, or will they help restore Māori rights?

For Māori, historical decisions such as the signing of the treaty of Waitangi  and the subsequent land confiscation have had a significant impact on present  health patterns. Such effects arise directly through factors such as narrowing  the Māori economic base and reducing Māori political influence.  

These structural factors have important flow-on effects. Sufficient purchasing  power to feel secure and included in society is central to the health of individuals in  any community. Individuals and households need sufficient disposable income  to afford stable, adequate housing, educational opportunities and effective,  available and acceptable health care. Having financial security is one of the  factors that makes it easier to feel secure psychologically. Adults with partners  or confidantes tend to be buffered from outside socioeconomic pressures, but  most people still need wider social support to prosper. Affirmation of identity  – whether it be ethnic identity or sexual orientation – is also closely related to  health. Those who are financially secure, psychologically confident and socially  supported are also more likely to look forward to the future and to want to adopt  and maintain health-related behaviours that yield long-term health benefits.  Those who are not financially or psychologically secure, or who live in deprived  neighbourhoods, are more likely to undertake self-destructive behaviours that  threaten their health, such as smoking, eating high-fat diets and being less  physically active. 

(updated version?)Vision 20:20 is an initiative that aims to improve Māori and Pacific health  outcomes by increasing the number of Māori and Pacific health professionals  to 10% of the health workforce by the year 2020. In the 2013 census, 15% of  the population identified as Māori and 7% identified as Pasifika. In 2008, 3%  of doctors were Māori and 2% were Pasifika. This scheme initiative consists of  MAPAS, Certificate in Health Sciences and the Māori recruitment programme.  The purpose of these schemes is to create a supportive environment for Māori  and Pasifika students in health careers. Be careful to not assume that this is  because they ‘need help’. It is simply because social and political processes  have caused Māori to be disadvantaged in the health sector.

Research shows that numerous disparities exist between Māori and non Māori. Avoidable death rates are almost double for Māori than for other New  Zealanders, and Māori die, on average, 8–10 years earlier. Māori have a higher  rate of disability, illness and serious injury. Māori have reduced access to  medical care and rehabilitation services. 

Studies demonstrate that some doctors treat Māori differently from non Māori, most often due to cultural misunderstanding and unconscious bias. For  example, two percent of Māori diagnosed with clinical depression were offered  pharmaceutical intervention compared with 45 percent of non-Māori patients  with the same diagnosis. 

Māori culture emphasises familial and community ties, and a world view that  acknowledges the wisdom of the past as well as connections to the present,  through historic places, ancestors, and the physical world. Doctors should  keep this in mind to help understand the behaviours of many Māori patients. 

Ethnicity – Questions

1. What do you think of the Te Reo Māori language week? 
2. The University is giving preferential entry to health students who are  willing to work in rural areas for two years after they graduate. This  is to try and get more people to work in the rural areas. What do you think?
3. How would you make Māori and Pasifika (alternate question: LGBT, women, minorities) students feel more comfortable  at university?
4. In Māori culture, as part of the Pōwhiri, only men can sit in the front  2 rows. Discuss whether this should be considered sexist, and whether it is compatible with “modern” values. 
5. Why does the University provide programmes such as RRAS  and MAPAS? Do you agree with these programmes? Do you think  these programmes are effective? How could they be improved?
6. The Maihi Karauna (The Crown’s strategy to revitalise Māori Language) set the goal of one million New Zealanders having the ability to speak basic Te Reo Māori by 2023. Is this a realistic goal?
7. Should Te Reo Māori be compulsory in primary schools? 
8. Māori are disproportionately affected in health outcomes compared to non-Māori. For example, Māori men mortality rates for lung cancer are nearly 3 times those of non-Māori men. Please explain this trend.
9. Your patient, who has cancer, wants to try traditional Māori medicine.  How do you respond?

Professionalism and Experience

‘Mental bank’

Personal questions are difficult – talking yourself up without coming across as arrogant is  not easy! These are questions like “talk about a time you made an  important decision” or “tell me why you would make a good doctor”. The best way to prepare for these questions is to have a mental ‘bank’ of experiences  and qualities you can use to answer questions, so write a list of experiences you can refer to for common questions. Personal experience questions may come up in one way or another (e.g. as a follow up) and having a scenario ready in your head saves time. This is different to memorising  an answer, you are simply preparing the scenario you want to use.  

Anecdotes

Using anecdotes in your answers will make you memorable, add  authenticity to your answer and they are easy to refer to. Speak positively about your experiences and never attack anyone in your answer as it will reflect negatively on you. When asked for personal experiences of scenarios, speak about the lessons you learnt, what you would do differently and how it has benefited you as a person to have gone through that. 

Teamwork

Teamwork will always be an important part of medicine. You will be working  with many health professionals and in order to work effectively and efficiently  with them, you must be a good team member. After all, you are all there to  benefit the patient and they have the right to a good health team.

A good team member is willing to listen, to contribute and is respectful of  others. They accept the team leader and their decision and when they think  their actions are questionable, they bring up their concerns in a respectful  manner. 

A good team leader is open to discussion and must be a good communicator,  is able to recognise the potential in team members, makes difficult decisions  and is approachable and respectable. They must also recognise  when they are in over their head and someone else may do a better job. 

When answering these questions and picking qualities and  experiences to fill your ‘bank’, keep in mind what qualities the program you are applying for is looking for. Does what you are saying align with what they want? Here is the list from the MBChB interview page:

• Fluency in oral English

• Excellent communication skills

• Resilience and adaptability in responding to challenges

• Commitment to self-reflection and life-long learning

• Ability to lead and contribute positively within groups

• Well-rounded abilities and interests across a variety of areas

• Awareness of the nature of the health profession

• A strong commitment to the study and practice of health care

• Empathy, sensitivity, and enthusiasm for people and their well-being

• Social responsibility including an awareness of prevailing community needs and global health issues

• Commitment to supporting safe, inclusive, and equitable access to health care for all people in Aotearoa, New Zealand, including:
  • Māori as tangata whenua of Aotearoa
  • Pacific communities
  • LGBTQITakatāpui+ communities
  • Those living with disabilities
  • Refugees
  • Those living in material hardship/poverty
  • Multifaceted communities and cultures
  • Others experiencing inequities in society and health*

Professionalism and Experience – Questions

1. A patient has sent you an unprofessional email. How do you manage  this situation? Would you include anyone else from the practise? 
2. Talk about an event that has majorly affected your outlook on life. On reflection, do you think there is anything you would have done  differently? What core values did this event form or change? 
3. What does it mean to be a good team member? What makes a good team leader?
4. Describe a time you were team leader and had to resolve a  conflict. 
5. What is one of your extra-curricular activities, and how would this  help/hinder you in a medical career? 
6. Describe a time you were incorrectly judged or wrongly accused.
7. What is something that you are not happy with about yourself?
8. How are you creative? 
9. Describe a time you felt you had been judged unfairly or critically.  How did you respond?
10. Who is someone you look up to and why? Given you  idolise this person, what have you done to live up to their example?
11. Describe a time when you had to apologise to someone. How did  your apology change your relationship with them? 
12. What do you prefer: working in a team or working alone? 
13. Give an example of a stressful situation you have found yourself in and what are some methods you used to overcome it? 

Practical Interview Advice 

Dress to impress

If you look smart, you’ll feel smart. Generally, a job interview calls for you to wear professional, or business attire. Examples include a button down shirt, a suit jacket and pants with a shirt and tie, a blouse and dress pants, a skirt or a dress. Make sure you are comfortable in what you are wearing to avoid distracting yourself during the interview.

Posture

Stand tall, sit upright and remember your posture. How you stand and sit and appear  physically will determine how you come across. People who slump appear less confident and less enthusiastic. Keep eye-contact and remember to smile. Be careful not to fidget.

Get motivated

Listening to inspirational speakers beforehand can help get you into a confident and positive mindset. A good place to start is a TED talk by  Amy Cudy – Your body language may shape who you are. 

Good impressions

It is a good idea to offer a handshake to the interviewers, smile and say “Hello, nice to meet you”. When leaving the station, thank them for their time.

Speech

Pace is very important. Don’t speak too fast or too slow and try not to stutter. Avoid slang and filler words like ‘um’, ‘like’, ‘cool’ and don’t swear.

Speaking like a doctor 

When answering a question involving patients, remember that patients have a  right to be treated with respect, a right to having their privacy respected and a right to services which take into account their values and beliefs.