MMI integrity questions on honesty and disclosing mistakes

Physicians make mistakes, and the profession's standard is to tell the patient, which is why MMI integrity questions hand you an error that only you know about. The scenarios in this topic put the mistake in a spreadsheet, a score sheet, a grade or a reference call, and in each one silence would be easy, defensible to yourself and wrong.

What these questions test

Raters score honesty under cost. Several errors in this topic favor you, such as a grading error in your favor that keeps your scholarship, and the rater wants to see whether you'd act the same way if the error went against you. They also score open disclosure, which in medicine means telling the person affected what happened, what it means for them, what's being done about it and that you're sorry.

The role-play scores how you deliver a truth, and the rater listens for the difference between tact and deception.

How to approach them

1. Say who is owed the truth and what they'd want to know. A manager hiring a former camp counselor asked whether he ever left children unsupervised, and 40 families in a league you keep the books for paid $60 too much. Each has a fact they'd act on if they had it.
2. Treat an omission that misleads as a lie. Correcting only the grades an outdated answer key pushed up, or giving a reference for a former counselor without the month he was always late, leaves the listener with a false picture you built on purpose.
3. Check your own stake and name it. When the error favors you, say what the correction costs you and that you'd accept the cost. When it favors a friend, such as a league president who'd rather not announce your error, say what you owe him and why it isn't silence.
4. Disclose in order: the person affected first, then the facts, what it means for them, what you're doing to fix it and a plain apology. Don't minimize, and don't blame a spreadsheet formula or an outdated answer key.
5. In a role-play, start with what's true and useful, be specific, and leave room for the person to ask. A kindness that becomes a lie about a friend's novel costs her the agents' rejections and your credibility with her.
6. Expect the MMI follow-up to add a reason for silence, such as a friend who'd rather not announce the error or a game result already signed as final, and say why that doesn't move the duty. On a panel, the personal story is the proof, so pick a real mistake, say what you did about it and say what it changed in how you work.

Common mistakes

• Accepting the quiet fix a league president or a professor proposes shows the rater you'll defer to authority over honesty.
• Deciding the truth would hurt too much, and withholding it to protect someone, takes a decision that belongs to them.
• Confessing at length, instead of giving the facts and what you've changed, makes the conversation about your guilt rather than the person affected.
• Choosing a mistake with no cost, or one that belonged to someone else, tells the panel you weren't looking.