How to answer “Describe an ethical dilemma you faced” in a medical school interview

A strong answer to "describe an ethical dilemma you faced" in a medical school interview tells a real story in which two duties you owed to somebody pulled in opposite directions, and shows how you decided between them. Both choices had a cost, so the reasoning carries the answer.

What the interviewer is assessing

• Ethical reasoning
• Self-reflection and growth

An ethical dilemma is a conflict between two defensible obligations, in which acting on one means failing the other. A temptation to do what you knew was wrong is a different thing, and interviewers notice when an applicant presents a temptation as a dilemma. Medical schools ask this question because clinical practice is full of real dilemmas: a patient's confidentiality against another person's safety, honesty against kindness, loyalty to a colleague against duty to a patient. They want to see how you reason when neither option is clean.

The interviewer listens for whether you recognized the conflict at the time, whose interests you considered, which principles you weighed, whom you consulted, what you decided and whether you can look back on it critically. In a panel interview, the follow-ups test the decision from the losing side. In an MMI, the question often sits in a personal station, sometimes paired with a hypothetical scenario on a similar theme.

How to structure your answer

1. Describe the situation in two or three sentences, and name the two obligations that conflicted.
2. Say who had a stake in the outcome, including people who weren't in the room.
3. Explain how you reasoned: the considerations on each side, and which ones weighed most.
4. Say whom you consulted, or whom you wish you had, and what you decided.
5. Describe what happened as a result, including for the person or group that lost out.
6. Close with what you'd do differently now, and how you'd handle a similar conflict involving a patient.

Pick a situation from a job, a volunteer role, a team, a lab or a friendship. A confidence a friend asked you to keep that put them at risk is one kind, and a teammate's shortcut that would cost them if you reported it is another. Be honest if you now think you chose wrongly, because a well-reasoned regret says more than a tidy victory. The clock gives you three minutes, so tell the story in forty-five seconds and spend the rest on the reasoning.

Common mistakes

• Presenting a temptation to cheat or lie as a dilemma tells the interviewer you were drawn to a clearly wrong act, and the answer ends the moment you say you resisted.
• Choosing a situation you only watched leaves you with no decision of your own to defend.
• Jumping from the situation to the decision, with no account of how you weighed it, hides the reasoning the question is assessing.
• Casting yourself as the person who did the obvious right thing suggests you never saw the cost to the other side.
• Choosing a dilemma in which you covered for a serious breach, such as a friend's academic dishonesty, raises a professionalism concern that no reasoning repairs.

Follow-up questions to prepare for

• Would you make the same decision today?
• What did the person who lost out think of your decision?
• Who could you have consulted, and why didn't you?
• How would the same dilemma look if the person involved had been a patient?
• Which ethical principles were in conflict, in your own words?