In dentistry MMI type of interviews which many dental admission departments use, you will be presented to discuss and elaborate on at least one station with an ethical dilemma. Dentistry schools are testing your knowledge of ethics within dental care and also your communication skills in the MMI interview. Usually, there will not be an actual correct or incorrect choice but it’s your reasoning and articulation that you will be assessed on during the interview for dentistry. In other words, are you presenting initially a balanced argument for each side, and do you know the salient features of the ethical dilemma?
Dentistry Ethical Scenario Examples
Here is a common ethical scenario you can be asked to discuss.
This has been lifted from an interview conducted in 2020 by Leeds School of Dentistry to a candidate. The ethical question was presented as: “Who should receive out of two eligible patients the dental implant treatment and why?”
A 53-year-old woman who is a 20-a-day smoker and a 25-year-old pregnant lady both have missing teeth and a treatment option is that both could benefit from having dental implants, but there is only one set of dental implants within funding for the department.
With all ethical MMI questions at the dental interview, it is always extremely vital that you consider both sides here and take some time to formulate your answer appropriately as it conveys to the interviewer how you are really thinking about the scenario. As always, take a few seconds to pause and then delve right into your response.
In this case, there are plus points for each patient but also unfavourable factors as well to get across before you give your overall opinion as to which of the two patients you are putting across to have dental implants. From the outset, you must state that the NHS was made to give quality care to everyone regardless of age, gender, religion or creed and so even if the woman is a lifelong smoker it is unfair to treat the pregnant patient in preference over her. Perhaps also mention and define what dental implants are and the other option alternatives to missing teeth for patients.
However, it is likely that a lot of time, motivation, dental visits and resources will have to be invested into this patient in order for her to stop or cut down as dental implants have a higher chance of failure if you are a smoker but not an outright contraindication which theoretically could have been avoided if she did not smoke 20 a day. Once dental implants are placed in an ex-smoker, there is always a significant risk that the patient may start smoking again and statistics show this.
When she starts smoking again, this could jeopardise the implant longevity. Even so and with all this in mind, we should not approach this by pointing the blame at the smoker for needing implants in the first place through tooth loss and she should also receive adequate care.
You can shoehorn the GDC’s Principle of “putting patients’ interests first” and this means not embarking on a treatment unsuited to a particular patient even if the patient is asking you to perform. In the long term however we must always ensure that all patients are better educated about the impact of lifestyle choices in the longevity of their dental treatments such as smoking, oral hygiene measures or high sugar consumption in order to avoid these dilemmas occurring in the future.
The other patient is quite young to have dental implants and if she has gum disease, this also reduces the chances of implant success. Finally, the older patient has more chance that the implants will last a lifetime as eventually all dental treatment needs replacing. With the younger patient, what if she loses further teeth and then there is no more funding for that but that could also apply to the smoker patient.
However, the implants will likely need replacing at some point in her life but what if she could not afford to and if there is no funding? Finally, make sure that implants can be placed clinically if she is pregnant but that depends on the clinical processes such as having x-rays and how the stage of pregnancy may interfere with a long process of implant treatment which can take many months. You could mention that the younger patient has more risk of future complications through continued resorption of alveolar bone which only dental implants can stop.
The 4 Ethical Pillars Of Medicine
At University Expert, we always prepare our students in any type of ethical question for both traditional panel and MMI interviews often using the 4 Pillars.
Another Dental MMI Example With Answer
A 24 year old man called Baz is upset by his teeth and describes them as being ‘sticking out’ and ‘looking like a rabbit’. You as a dentist carry out a full dental examination and find no clinical evidence that he requires orthodontics and unfortunately he is not eligible according to IOTN NHS criteria for ortho. The man however is emotional and even explains how he has been tormented for his teeth and this has affected his mood. His medical history identifies that he has a diagnosis of anxiety disorder and depression for which he is on tricyclics.
How would you approach in order to speak to Baz about the treatment plan findings and in moving forward?
After any dental health examination, you would have a proper diagnosis and which you need to convey to your patient using non-dental jargon. Even with the initial Dental History, do not assume or ask leading questions. Therefore, try to ask the questions with some intro questions to ease the conversation so that the patient is more willing to volunteer relevant information. Words or ideas to convey are such as being calm, also staying calm and composed whilst being able to adequately show empathy and understanding which are essential to being a good and effective dentist.
Avoid Technical Dental Terminology To Patients
As mentioned already, use simple non-dental jargon or language so always speak in layman terms rather than scientific language unless necessary to explain a diagnosis. Use the technique to ask the patient to “repeat back what you have told me” to ensure calibration is consistent and coherent. Listen actively – Using eye contact, verbal and non-verbal communications.
React appropriately to the patient’s emotions and concerns even if the patient is confrontational at times. Find out the information that your examiner is searching for from you and therefore make sure to actually ask all of the points specified in the question. Give all options to patients.
How To Not Answer The Question
Even if the patient acts overly emotional, you should be wary of not becoming too emotional in front of the patient. Another factor is showing a lack of empathy and being generic when presenting, leading to a corporate feel rather than caring and empathising with your patient. Another pitfall is not covering the information and not asking all of the questions as specified.
Not coming up with a solution or attempting to solve the patient’s dilemma is definitely to be avoided and always therefore ensure they are happy with how you are dealing with the fact that he can’t be treated. This ties with inadvertently giving false hopes in order to protect the patient by sugar coating the situation. This includes promising things which are unrealistic.
An Ethical Dental Interview Situation
A seven year old girl comes into your dental clinic with caries in many of her back teeth and your clinical treatment plan is that they need to be extracted. You explain this to the girl’s mother who disagrees with you and does not want the teeth to be extracted. How do you approach this situation?
Points To Answer
Firstly, listen to address the parent’s concerns and find out why exactly she does not want the teeth of her child to be removed e.g. perhaps she thinks there are significant risks associated with the procedure to extract or what will happen afterwards. You would try to convince the mother that the treatment is in the girl’s best interests and in line with GDC principles. There will be an element of explaining to the mother what will happen if her teeth are not extracted which will help come to a well informed decision.
Points To Mention In Your Answer
Competency and consent come in and since the patient is 6 years old it is unlikely that she is competent to make her own decisions. (If the patient was older and was Gillick competent, this situation is then less simple.)
Although Gillick Competence allows for a child up to the age of sixteen to make their own decision regarding their dental care, they must be able to understand and retain all the information given to them as well as communicate it back. This does not apply here and so she would require a parent or legal guardian to consent for her.
An important point is that of Autonomy which means respecting a patient’s ability to make their own decisions as patients have a right to decide about their own dental healthcare. Beneficence canters around so always doing what is best overall for a patient. The dentist should explain the importance of the treatment, as well as what the implications are if the teeth are not extracted which can lead to complications for the child.
Another MMI Dental Ethical Question
A 12-year old boy called Rob is having dental care and the dentist informs the parent that he will need to have treatment. The patient then asks the clinician to explain the treatment he will be having. What should you do next?
Points To Answer
A good answer should include that it is always good practice to explain procedures to any patient but in terms of consent, the dentist needs to assess his capacity so talk about Gillick Consent. If he was unable to understand the implications of the diagnosis/treatment, it is correct that he is told in a simple manner concurrent to his understanding. Telling the parents that it is his duty to talk to the boy and obtain consent no matter what his capacity is, is incorrect because this is not that he deserves the right to decide and if you were in their position you would want to do the same also.
Example Of An Ethical MMI Dental Interview Question
This scenario came up at a UCLAN dentistry interview during 2019 and went as follows: Imagine that you are a dental student shadowing in a general NHS dental practice and notice two students discussing a patient. One of the students says to you that the other one is breaching patient confidentiality. In which circumstances could the disclosure of patient information be justified and confidentiality is not being breached? Explain your viewpoint.
Be aware of the 9 GDC principles and in particular that the GDC Principle 4.2 states that you must protect the confidentiality of patients’ information and only use it for the purpose for which it was given. It is crucial to know that all personal information belongs to patients and not dentists to freely make this available to anyone but there are caveats.
Unless a patient has allowed disclosure of their personal information for a specific scenario, it would be going against the GDC Principles as mentioned above as no one should have unauthorised access to information hence including the patient’s written records and speaking about patients in any open environment. Telling the panel of interviewers that as long as they anonymise it, there is nothing wrong with what they’re doing which is clearly incorrect and breaching Principle 4.2. If asked however you can go into explaining that confidentiality can never not be broken as there can be certain instances when it can be.
When Can Dental Confidentiality Be Broken?
So let’s have a look at when confidentiality can be broken. These are certain bodies such as dental payment Insurance Companies as it is quite common for insurance companies who are acting for the patient or other healthcare professionals who are in charge of taking care of the patient such as their financial matters.
Another situation is in a court and this includes when ordered to do so by court by identification of missing people or as a witness. This is a common scenario as many people can only be identified by their dental records in severe accidents such as a plane crash or a train wreck. This could be a justifiable reason to cite and reasoning behind it is that it would help give closure to families or relatives who are concerned and also help the criminal justice system with closing and investigating cases.
Also, however not common if there is a severe Dental Emergency and it is a matter of life or death where the patient is unable to give consent. In the above scenario it can sometimes be appropriate to break confidentiality in the best interests of the patient. Ultimately, the patient will have autonomy on their information. However, there may be scenarios where you are obliged to disclose confidential information.
Dental Ethics Interview MMI Scenario With Tips
This question occurred in a Plymouth dental school interview and the example was as follows: You notice one of your students, Lee, doing work experience at the Town Dental Practice and Cosmetic Centre but you see Lee looking at his colleague student’s confidential records out of curiosity. The practice manager then calls you in and questions you.
Apparently Lee had been speaking to his neighbours in a shop, and telling him about his mother’s treatment so the mother has now made a complaint to your manager who has called you in for a discussion to discuss the next steps. What points will you bring up? Firstly, explain the ethical issues as breaches can lead to patients losing faith in the dental practice and in dentists as professionals so that in the future patients may not come to see their dentist, or if they do come, they may withhold personal information vital to a history, diagnosis, and dental treatment planning.
Show how this is unfair on patients. Show that you understand it is unfair on the patient as they will not want any third party to know about their specific medical and dental treatment issues. The practice manager will talk about Professionalism which is how you adhere to the GDC standards that are expected of you, and how you take responsibility for implementing them. Appropriate attitudes and behaviours with patients and colleagues need to be considered too as the dental team is a whole unit to deliver the best patient care.
There has to be a balance however so you can’t be overly harsh in the punishment. He has made a mistake and needs to learn from it. But clearly he doesn’t deserve a Fitness to Practise hearing and negated from future practice. The manager cannot not do anything because this is neglecting the situation at hand, so you need to show an awareness of the ethical issues. In ethical scenarios, avoid not being able to define dentistry professionalism as you should understand its fundamentals.
Manchester Dental School Interview Questions
You are the team leader in a group session and you find out that in your team one person has been bullying the other person. The person being bullied is afraid to report this because of the consequences.
What would you do in this scenario?
Speak to the person being bullied. It is important to reach out to the person who is being bullied to try to understand their fears.
Do not break the news to the team. The person being bullied is clearly worried about repercussions of telling anyone. So it is better to speak to the bullied person first, before blurting anything out in a team meeting
There was also another similar question in the same sitting where a member of your team who is not performing well and putting effort in.
What Should You Do In This Scenario?
Firstly, always speak to that team member and have a casual chat with that team member individually in a private setting away from others. You would want to reach out to find out what is going on in their personal life to search for deeper problems or issues.
Also ask in an open frank way about how they are finding the work e.g. is it a case of them not putting effort or maybe them struggling with the difficulty of the work? You could later on gain a peer assessment where It may be useful to speak to other team members to gain a peer assessment of their colleagues’ performances as This will enable you to better understand the team. Always be impartial and avoid Jumping to conclusions.
Don’t jump to the conclusion that this team member is being lazy or incompetent as He could have some family issues, or may be struggling with other things. It is important to speak to the team members 1-to-1 in a quiet private room. Instead of putting pressure and pile even more work on the team member, It is better to speak to the person in question before altering any work on them. If they are struggling, this will only make the situation worse and could dampen the confidence and eventually the morale.
We hope that the above tips are helpful and if ever you need further guidance on an upcoming dental interview, just fill out a contact form on the website at www.universityexpert.co.uk or ring directly as we have a good track record in ensuring students get their place to study dentistry.