One of the Bright Young Things Tutors recalls their Oxford Interview for Medicine. This is following on from our initial blog on Medicine entrance at Oxford.
Oxford Medicine Lady Margaret Hall and Christ Church
Despite applying to Christ Church I was offered accommodation in my automatically assigned second choice college, Lady Margaret Hall (LMH). On arriving at LMH, the day before my first interview, I was informed that I would have the privilege of attending four interviews, two in each college.
Interview 1: Lady Margaret Hall:
This interview had just two interviewers, a man and a woman, who were both very friendly and made me feel very relaxed. We just sat on easy chairs around a coffee table which added to the informal atmosphere. The interview started off with a question about my trip to Romania, which was known territory and so got me settled in before the scientific grilling began:
o Describe what would happen if a mole pellet of sodium ions was dropped into a beaker of pure water (in terms of bonding) – This was simply testing my knowledge of diffusion from AS-Biology and my ability to apply my AS-Chemistry bonding theory to explain it: including how the solution is in dynamic equilibrium when the pellet has completely diffused, since the intermolecular bonds are constantly breaking and reforming.
o Similarly, what would happen with a mole pellet of caesium ions?
o Which would diffuse faster? – We talked about ionic radius, and I agreed that it would be sensible to assume that the sodium would diffuse faster because its ions are smaller. He then asked me represent this information on a graph, ie plotting ionic radius against rate of diffusion. I wasn’t sure if the graph was exponential or not but he just wanted a simple positive or negative relationship.
o The caesium ions actually diffuse faster than the sodium ions? How would you explain this anomaly? – This could again be explained using simple AS Chemistry bonding theory. The sodium ion has a smaller ionic radius, yet the same effective nuclear charge as the caesium ion, so the ion-dipole attractions between the sodium ions and water molecules are stronger than with caesium. This means that the sodium pellet takes longer to diffuse since the bonds between the ions and the water harder to break, ie the pellet gets surrounded in a ‘cushion’ of bonded water molecules.
o Outline the structure of the plasma membrane. – Again this was simple AS Biology knowledge.
o How do sodium ions get across the plasma membrane? – I briefly explained the process of facilitated diffusion and how the trans-membrane proteins act as ion channels. He then asked why the ions couldn’t simply diffuse across the bilayer (ie by simple diffusion) and I explained that only lipid soluble molecules could diffuse directly across the bilayer. We then went on to talk about the hydrophilic heads and hydrophobic tails of the phospholipids in the bilayer.
o How can the channel be in contact with both the hydrophobic tails of the phospholipids and the sodium ions? – I didn’t really get this, since I talked about how proteins weren’t soluble in water, they formed colloidal suspensions, but he cut me down saying that some were very soluble in water. He then said it was simply to do with the structure of the protein being different on the inside than on the outside.
o How do ion channels specify between different ions, since sodium channels will not aid the diffusion of calcium ions? It took me a while to get this. I started suggesting it was to do with different ionic charges (though that was only really applicable to this one example) and then different ionic radii. He asked if I happened to know the ionic radii of sodium and calcium ions, and I assured him that I didn’t! The radii are very similar so I went on to suggest a link between enzyme active sites and protein channels, ie that they have a specifically shaped binding point. He confirmed that this was the right idea and then went on to ask how an ion that has bound to the top of a channel then makes its way through that channel and across the membrane, ie how the channel works. I tried to continue the link with enzymes and said that it could have something to do with non competitive inhibition, but he explained that it was much simpler, and that the charges on the ions repelled each other, thus forcing the ions through the channel.
The second interviewer then took over and we talked about stem cells. Thankfully I had read up about this and so had quite a good understanding of the topic.
o What is a stem cell?
o What triggers a stem cell to differentiate into a specialised cell? How does this happen?
o What are the main differences between somatic and embryonic stem cells and how can they be manipulated?
Interview 2: Lady Margaret Hall:
This interview was on ethics. Instead of being asked direct questions, I was given a number of scenarios to discuss:
o Arthritis: I was shown two photographs of arthritic hands, one belonging to a teenage girl and the other to an elderly woman. I was then asked say what should be done in each case to help the patient. This varied from drugs such as pain-killers and anti-inflammatories to physiotherapy and support group referrals.
o Embryo Screening: I was again shown photographs. This time it was three genetic diseases of varied seriousness, from a cosmetic disease to one where the baby, once born, would only live a few days (in great pain and distress). After each case was outlined, my task was to decide for each whether a pregnant couple, who already had a child with the particular condition, should screen for the disease, and then if an abortion would be appropriate.
o Criteria for transplant cases: Despite being assured there were no yes or no answers to ethics questions, I had to decide which criteria should be taken into consideration when deciding whether a patient qualified for an organ transplant…e.g. lifestyle (smoking and drinking), age, sex etc.
o Liver transplant: I had to decide which of the three critical patients should get the one available liver. The patients were: a baby who would lead a healthy life with a new liver, but could develop kidney problems; a 48 year old man who was an alcoholic; a 68 year old woman who had worked overseas for a charity her whole life and apart from the liver problem was perfectly healthy.
Interview 3: Christ Church:
Unlike at Lady Margaret Hall, this interview featured questions on all aspects of
medicine…scientific, social and ethical, asked alternatively by a panel of three interviewers. Before entering, I was given an article from a medical journal to read. It was about how memories are formed and manipulated (particularly erased) and the difference between short-term and long-term memories. I didn’t get the article finished before I was called in but I was assured that was okay.
o The Article: The interview began with questions on the article. It was obviously a test of how much I remembered from just reading something once. After being asked to give the general jist of the article I was then asked more detailed questions, for example outlining the experiments carried out in the research and even the names of the drugs mentioned (which I didn’t get!). I was then asked what I thought the social implications of erasing memories and I talked all about the film ‘Eternal Sunshine of a Spotless Mind’…it seemed like a good idea at the time.
o Why do you want to be a doctor?: The notorious question was asked to ease me into the more difficult ones, though I find it quite hard. I didn’t realise until afterwards that I pretty much recited the first paragraph of my personal statement…not a good idea if you want the answer to come across as heartfelt and spontaneous.
o Ethics – HIV: In this role-play situation I was a GP with a female patient who had recently tested positive for HIV. I had to make decisions on her treatment. Firstly I was to decide what to do, apart from actual treatment. This included support groups etc. Then the situation become progressively more complicated and I had to make ethical decisions like whether I should / could tell one of my male patients, who had been sexually involved with the woman, about the positive HIV test. Finally I was told that my patient (the female one) was pregnant, but not eligible to give birth on the NHS since she wasn’t an EU national. I then had to make a case to my bosses on why she should be allowed to have her baby on the NHS.
o Qualities to be a doctor: I was asked what qualities are required to be a good doctor and how my musical commitments might prepare me for such a profession. I was also asked to describe an individual case that I had seen whilst on work experience.
o Enzyme-substrate equations: To end this interview I had to work through the basic principles of enzyme-substrate equations with the main tutor. This activity was a combination of biology and chemistry and some maths. Unfortunately I really didn’t understand what was going on, despite it actually being very simple. The tutor was very patient and helped me through and after the interview I was glad to hear that no one had really got a firm grasp of what was going on.
Interview 4: Christ Church:
The final interview was similar to the third. It was held in what seemed to be a tutor’s study, which was small and cosy with four arm-chairs around a small table. Again there were three interviewers who took turns to ask me questions on all aspects of medicine.
o NHS: To start the interview we discussed the social side of medicine, particularly the issues that were currently in the news. I was asked how I thought the NHS should be funded, and who should decide where the money goes (ie doctors/politicians etc). I was also asked my views on whether people who smoke / are alcoholics / are obese should be denied treatment or made to pay for it.
o Atherosclerosis: Firstly I was asked if I knew what atherosclerosis was and what caused it. Then I was told to imagine that it was caused by different strains of bacteria, instead of the non-contagious life-style causes. Based on this assumption, I was shown a series of four graphs which linked the presence of different strains of bacteria with the degree of thickening of the artery walls (ie atherosclerosis). After studying these graphs I was asked to say what each of them showed, and whether they proved that the bacteria caused atherosclerosis. This involved spotting flaws in the experiment. During this part of the discussion I was asked how you could determine the degree of thickening of the arteries…e.g. an angiogram etc. After discussing the flaws in the experiment I was asked to devise an experiment to prove that the bacteria caused atherosclerosis.
o Kidneys: Despite not having studied the kidneys since GCSE I was informed that we were going to devise a first-year physiology experiment. I had to give a brief outline of kidney structure and function. We then built on my limited GCSE knowledge by talking about the kidney function in A-level terms…e.g. water potential, carrier proteins and channels. The physiology experiment was determining the rate of kidney function. The tutor took me through everything step by step so nothing was above my level of understanding. We looked at what leaves the blood at the kidneys, ie urea and other substances like penicillin. We then used these to determine the rate of filtration of the blood by the kidneys [by looking at the concentration of urea in the blood before and after filtration and the same for penicillin]. The time factor required was simply the time interval between two consecutive excretions.
Advice for Future candidates
Make sure you are up to date with current medical stories in the news (BBC health is probably sufficient) and maybe think about some of the controversial ethical issues (i.e. rationing of healthcare resources, euthanasia etc). In general, just go into the interview with an open mind, and don’t be afraid to say what comes into your head, even if it sounds stupid- it’s better to say the wrong answer than not speak at all. Another important thing is – if you have highlighted an area of interest on your personal statement, ensure you have read up about it because they will ask you!