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Those dreaded history questions

Posted on February 1st, 2009 by Rob.

I personally never ask candidates about history of medicine as I think it’s slightly unfair and I’m not sure what relevance it has to a medical student applicant; however, many older interviewers love asking about history of medicine and debate that it shows a commitment to the career, a wider reading ability, and demonstrates intellectual ability.

History of medicine is certainly not a starting point and will usually only be asked if the interview is going well and the interviewers really want to push you a little. For example if they were considering a preferential offer. I therefore think that it would be unwise to spend lots of time researching this area for your interview. You should however have a key event and key person in mind.

Typical questions might be:

1. What event in the history of medicine do you think has saved most lives?
2. Who in the history of medicine do you think has contributed most?
3. Do you know of any key events in the history of medicine?

It’s obviously safe to say that large drops in death rates can be contributed to public health measures such as underground sewerage systems and flushing toilets and it could be argued that these advances far outweigh anything that a doctor has achieved eg the advent of antibiotics.

A significant era in the history of medicine followed the Second World War. “Advances in surgical technique, new ideas about the nature of disease and huge innovations in drug manufacture vanquished in three short decades most of the common causes of early death” (James Le Fanu). ‘The Rise and Fall of Modern Medicine’ by James Le Fanu talks about twelve definitive moments in modern medicine. I highly recommend a read of this book.

1. 1941: Penicillin
2. 1949: Cortisone
3. 1950: Streptomycin, Smoking and Sir Austin Bradford Hill
4. 1952: Chlorpromazine and the Revolution in Psychiatry
5. 1952: The Copenhagen Polio Epidemic and the Birth of Intensive Care
6. 1955: Open Heart Surgery – The Last Frontier
7. 1961: New Hips for Old
8. 1963: Transplanting Kidneys
9. 1964: The Triumph of prevention – The case of Strokes
10. 1971: Curing Childhood Cancer
11. 1978: The First ‘Test-Tube’ Baby
12. 1984: Helicobacter – The Cause of Peptic Ulcer

Undeniably these were all key points in the history of medicine. Which do you think was most significant and why? For example hip replacements allow people that would have previously been immobile to continue leading a fulfilling and mobile life. Of course you don’t have to choose one of these as your personal favourite.

Allow me to explain number 3, 1950: Streptomycin, Smoking and Sir Austin Bradford Hill, (my favourite) a bit more. Before 1950 what doctors did and what we knew about medicine was determined by everyday practice – what doctors observed – what seemed to work. However, the curing of TB (streptomycin) and the link between smoking and lung cancer changed this because both required statistics to prove. This changed the way that medicine was practiced for good. This was the advent of ‘evidence based medicine’ – the use of statistics to prove the causality or decide which treatment works best. Therefore for me the biggest event in medical history was the realisation of evidence based medicine and the design of the double blind trail because this isn’t a cure for a single disease but a new way of working entirely that affects every new drug and the treatment of every disease. If I had to choose a single person to nominate as contributing the most to medicine it would have to be Sir Austin Bradford Hill as he was the leading force for this shift towards evidence based medicine.

I must stress to you that you shouldn’t just learn my answer and regurgitate it at interview. Remember that you are fairly unlikely to be asked about this but if you are have a key moment of your own that really does interest you and make sure you know why it interests you.

Tags: Interview

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