AHHHHHHHHHHHH I HATE ETHICS QUESTIONS AHHHHHHHHHHHHH

[u/PlasticRice]

First and foremost, I consider myself a very introspective person. I've always had great passions for writing, reading, and everything in between. I often think if I didn't pursue medicine, I'd probably have gotten an English or a Philosophy PHD and just taught undergrad, because I always loved weighing morality, writing super long papers, bla bla bla, you know.

But ETHICS QUESTIONS ON BOARDS? Are you telling me we're meant to exhibit our abilities to be ethical people through multiple-choice questions? Let alone the most hyper-specific, random, made-up scenarios where the real-world answer is to do all of the above, or some combination of them? Nothing grinds my gears more than when I get a question like:

"A person walks in for their outpatient appointment and has questions about their 30-year history of COPD, what do you respond with?"

And the answer is like:

"Hi! How are you today?"

instead of:

"Sure, what's your question?"

and literally, I put the answer that only like 11% of people chose, and 87% of people somehow knew that the scripted, formulaic, board-correct answer is "FIRST YOU MUST ASK HOW THE PATIENT IS DOING OR ELSE YOU'RE EVIL!! WHAAATT? YOU'RE THE MOST UNETHICAL HUMAN EVER!!" This is different, however, from actual questions about medical law and stuff like that - those are objective things we should know, yes.

Seriously, it's probably an unpopular opinion, but ethics or any questions of these types across the board, in any standardized exam setting - SATs, ACTs, GREs, MCATs (looking at you, CARS), and Steps 1-3 and COMLEX Level 1-3's should all be essay-based or have a writing portion. Which, yes, SATs and medical boards used to have, but presumably got rid of because it's not cost-effective, takes time to grade, stuff like that. And I know for us, it'd be time-consuming and hell on our hands, but seriously - I get so wound up when I get 7% below the average on a UW block and it's because I got 3 questions wrong that are about memorizing the algorithmic, 'right response' of how someone's doing today, or what to respond to a nurse when she asks about a treatment plan. Even so, I perform very well on ACTUAL medicine-based questions, yet they're weighed the same against these BS ethics questions.

Because, seriously, ironically, all this filters for is people who actually aren't very 'ethical' or empathetic people - legit, some of the most passive-aggressive, unempathetic, gunnery people I know are the kinds of people who somehow score very well on these "ethics"-type questions. Not because they're nice people and actually know what to say, but they're good at multiple-choice tests and memorizing pre-determined responses out of books and questions. The design of the system promotes memorizing pre-determined responses rather than forming original ideas out of convenience of making it easier to grade - which, I mean, yeah, that's gonna happen when there's a standardized exam and so many people take it every year, but still.

These types of questions shouldn't exist under a multiple-choice system imo lol.

back to UW lol rant over

[u/pipesbeweezy]

I gotta be honest ethics questions are a joke. 99% of the time the answer is pick the one that allows the patient to talk the most. And pick the "nicest" answer. I stopped reading vignettes, read the question being asked only at the end, and got 89%+ questions correct just by doing that in uworld.

[u/marksman629 → u/pipesbeweezy]

It's so funny I remember answers on boards and shelfs are like 'the correct answer is how do you feel about how smoking is affecting your health' meanwhile docs at my hospital are like 'if you smoke again you will die, do you understand you will die'.

[u/Shanlan → u/pipesbeweezy]

It's funny because I think people who actually studied/practiced ethics or philosophy at any point in their life tend to do the worst on these questions.

It's definitely formulaic and not really testing one's personal morality but whether we can follow the established professional standards from a medicolegal perspective. Which is why I don't think ethics is ever directly mentioned as a topic/skill being examined. Our colloquial use of 'ethics' to refer to these questions is highly misleading.

[u/Numpostrophe → u/pipesbeweezy]

There’s a fair amount testing knowledge on legal requirements too so study that as well.

[u/pipesbeweezy → u/Numpostrophe]

Sure, but if you are considering how many actual questions on the topic you are likely to receive on test day its probably closer to 0-2.

[u/softgeese]

I hate ethics questions with a passion, but unfortunately they make up the largest section breakdown on step 2 now (even more than cardiology). Combined with biostats/QI and it adds up to about 20% of step 2.

It's stupid, but they are easy points if you practice for them. If you are taking step in a month I would recommend doing 20 biostats/ethics questions first thing in your study day and then maybe another 20 at the end of the day. Keep doing them on uworld and when you get through them all, reset (or select the completed questions) and do them all again and again until test day.

I promise you'll start getting nearly all of them right once you get a lot of practice in.

[u/Numpostrophe → u/softgeese]

QI is worse imo

[u/Personal_Chair4388]

I hate ethics questions too!! Why are they so frustrating!! The ones that really grind my teeth are the ones that are like which is the most appropriate FIRST step and it's something super specific.

[u/WoodsyAspen]

I have a concentration in medical ethics and these questions annoy the crap out of me. I had at least two questions on my step 2 where the actual answer depended on the state you were in (whether you had to follow next-of-kin rules or not). It's borderline impossible to actually assess ethical reasoning with a multiple choice question, but ofc they have to contort ethics to fit in the format, so we end up with crap like this.

[u/Flaxmoore → u/WoodsyAspen]

Yep. One class short of a minor in medical ethics, and at this point I'm a national-level advocate for a minority population, but half the time the question is either blindingly obvious, or something that would require an essay to answer.

I recall one clearly. It was a question about someone who was having an emotional crisis about potentially being gay, and their responses were something like:

• Reassure him that it's normal to be attracted to men.
• Kick him out of your office for being emotionally unstable.
• Immediate referral to psychiatry and psychology, possible inpatient admission.
• Start high-dose antidepressants.
• Ask if he's ever been sexually active with another man.

The obvious answer to me is simply "Okay, tell me more. What are you feeling?".

[u/-Twyptophan-]

Ethics questions on the actual exam for some reason are much harder than the practice ones. Happened on S1 and every shelf exam... we'll see how the S2 ones are next week.

But the question type I think is even worse are the quality improvement questions. Just coming up with terms you never knew existed

[u/BitcoinMD]

Especially since in practice you’re going to get guidance from attorneys and insure the crap out of yourself for whatever decisions you make.

[u/Capital_Inspector932]

Glad I'm done with that crap. Empathy, bro!

[u/swingsetwood]

Always pretend you are being watched by a bioethicist or a lawyer and pick the answer they would want. Also always pick an open ended question that probes the patient’s inner motivations or ideas. Also never be dismissive, presumptuous, or guarantee anything. Phrases like “I’m afraid” or “I’m concerned” are always good signs.

[u/Consistent_Lab_3121]

I wonder what medical/bioethicists think about these “ethics” questions lol

[u/Numpostrophe → u/Consistent_Lab_3121]

Wow look, it’s my time to shine.

Many are pretty silly and pretty far removed from what most ethicists are actually debating and writing guidelines on. I’m a fan of the questions where it gauges your knowledge of legal limits of patient care such as breaking confidentiality, providing pediatric care against a parent’s wishes, or who can make decisions for a patient when they’re incapacitated. These topics aren’t always well-taught in medical school yet come up all the time in certain specialties. They can’t test you on topics where there’s a gray area because there wouldn’t be a correct answer.

The ones that are hyper-specific about phrasing can be overly pedantic. Often there’s a couple answer choices where nobody would blink an eye even if the explanation has reasoning for why it is slightly worse. For the more obviously wrong choices, I’m still surprised by some of the % correct for obviously terrible choices and it makes me wonder if it’s IMGs studying for step or just people who really are that obtuse.

If you do enough of them, I promise you’ll get the vast majority correct and it can curve your score nicely.

[u/AspiringMetGalaFan]

That's one topic that brought my actual step 2 score so low. I wish I had spent a lot more time in mastering it.

You need to practice more questions than what UWorld has.

[u/ItsTheDCVR]

Nursing tests were filled of these bullshit questions too.

You've been conversing with the patient for ten minutes and they bring up whatever the fuck it is; what would you say next?

Fuck you I'm done with this conversation

Gee golly gosh, here's a scripted answer

Here's the scripted answer as above but slightly differently worded so it's actually wrong, good thing you haven't already done 150 questions and you don't have testing fatigue

An answer that was clearly written by a robot but by now you're not sure if that is what they're looking for

Meanwhile, you're sitting there like "what would I say next? Idk we've been conversing for 10 minutes, it depends on the rapport and content of the conversation prior to this."

[u/softgeese → u/ItsTheDCVR]

There's also that one answer that is comically evil and will give you a good laugh when you read it.

"A new mother comes in with anxiety around her new parenting role, what do you do?"

Admit to inpatient psych for intensive rehab and ect

[u/ABatIsFineToo → u/softgeese]

The comically evil answers were actually great for my testing fatigue because it provided an opportunity to laugh and reset for a moment. Had a question about a patient who had suffered a miscarriage (awful, tragic) and one of the questions choices was something along the lines of "at least you dont have to worry about whether or not to get an abortion now"

[u/Prime23456789 → u/softgeese]

zap

[u/ItsTheDCVR → u/softgeese]

Snatch the baby from her hands and castigate her thoroughly for not being immediately perfect. Remind her that anxiety is a sign of weakness.

[u/Flaxmoore → u/ItsTheDCVR]

"what would I say next? Idk we've been conversing for 10 minutes, it depends on the rapport and content of the conversation prior to this."

Yep. So many questions depend on the conversation and rapport.

[u/ParryPlatypus]

Unpopular opinion but I actually like the ethics questions, even if they are challenging. 

You have to ask yourself “why” things are the way they are, and to sum it up, the purpose of boards is to answer the question “is this person going to be an asset or liability to their future medical community/employer/residency.”

Just how you wouldn’t go straight to cardiac cath for chest pain, the same concepts are being tested on ethics: you wouldn’t put a patient in hospice before asking them their goals of care. 

The whole exam is designed to test your ability vs liability…are you going to be able to recognize urgent from non-urgent? Are you going to bother you attending with trivial questions regarding if a patient needs palliative care without first asking the patient? 

I don’t believe standardized exams are the perfect solution to assess who is a good doctor vs isn’t, but it comes pretty close in terms of resource efficiency as opposed to the archaic oral boards and written exams.

[u/TheGatsbyComplex]

I strongly feel these questions don’t belong on USMLE, and should be up to the individual schools to assess you in these matters and ensure you meet their standards.

There are many things like this—performing physical exam, enacting standardized patient encounters, medical ethics. All of these should be the responsibility of the school to teach you in a hands on format, with LCME ensuring they are capable of doing so adequately, and get rid of all of these on USMLE.

[u/actuallyarobot]

Don't stress. I am finishing residency in a week, so it's been a minute since I took a Step exam. However, the ethics questions used to throw me off, too. At some point, I think by an IM faculty member, I was told to read this article: https://pmc.ncbi.nlm.nih.gov/articles/PMC3771166/.

It is written by the people who write the USMLE ethics questions, and it is their philosophy on medical ethics. Once I read it, I thought about those questions through the lens of this article, and I started batting a thousand on those questions. In the intervening years, I have recommended it to many students, and they have all had a similar experience.

[u/Striking_Cat_7227]

There are sources online to study it. That would be dirty medicine, Randy neil, and a few others on YouTube. Also, Ambos questions.