Multiple Mini Interview (MMI) NHS, Healthcare Systems and Hot Topics Syllabus

List five typical members of a hospital multidisciplinary team besides doctors.

Nurses, physiotherapists, occupational therapists, pharmacists, dietitians, speech and language therapists, social workers and healthcare assistants are common MDT members.

What is the difference between an allied health professional (AHP) and a doctor?

AHPs are clinically trained professionals (e.g. physiotherapists, paramedics, radiographers, dietitians, occupational therapists) who are distinct from doctors, nurses and dentists, and provide diagnostic, therapeutic and rehabilitative services.

Why is good teamwork and communication important in an MDT? Give two patient-safety reasons.

It reduces errors and duplication, ensures continuity and holistic care, allows shared decision-making, and means handovers transfer accurate information. Poor communication is one of the commonest root causes of clinical errors.

Identify three major current workforce pressures facing the NHS.

Staff shortages/vacancies (notably nurses and GPs), burnout and poor staff retention, reliance on expensive agency/locum staff, an ageing workforce, and recruitment/retention difficulties post-pandemic and post-Brexit.

What is the NHS Long Term Workforce Plan (2023) and what is one of its headline aims?

A 15-year plan to expand the NHS workforce. It aims to train more staff (e.g. roughly doubling medical school places to around 15,000 a year by 2031), improve retention, and reform working/training models.

Explain the difference between staff 'recruitment' and 'retention', and why retention matters.

Recruitment is attracting and hiring new staff; retention is keeping existing staff in post. Retention matters because trained, experienced staff are costly to replace, and high turnover harms continuity, morale and patient safety.

What is 'burnout' and why is it a particular concern for the medical workforce?

Burnout is a state of physical and emotional exhaustion, cynicism/depersonalisation and reduced sense of accomplishment from chronic workplace stress. It increases sick leave, error rates and staff leaving, worsening existing shortages.

What is the main demographic driver increasing demand on the NHS?

An ageing population: people are living longer, often with multiple long-term conditions (multimorbidity), which increases demand for complex, ongoing care and social support.

Define multimorbidity and explain why it strains the health system.

Multimorbidity is the presence of two or more long-term (chronic) conditions in one person. It complicates treatment, increases polypharmacy and appointments, and requires coordinated care across multiple services, raising cost and complexity.

What is meant by the 'inverse care law' (Tudor Hart, 1971)?

The principle that the availability of good medical care tends to vary inversely with the need of the population served: those who need care most often have the least access to it.

Distinguish between health 'demand', 'need' and 'supply'.

Need is what people would benefit from (clinically defined). Demand is what people ask for or seek. Supply is what is actually provided. These often diverge, e.g. unmet need or demand exceeding supply.

Why is funding the NHS becoming less sustainable over time? Give three pressures.

An ageing population, rising prevalence of chronic disease, expensive new drugs and technologies, rising patient expectations, and workforce/pay costs all push demand and cost up faster than funding grows.

What is rationing in healthcare, and give an example of how the NHS rations care.

Rationing is the allocation of limited resources by deciding who gets what care. Examples include NICE cost-effectiveness thresholds (QALY), waiting lists, eligibility criteria, and not funding certain treatments.

What are the Wider (Social) Determinants of Health?

The non-medical, social, economic and environmental factors that shape health, such as income, education, employment, housing, environment, social support and access to services. They account for a large share of health outcomes.

According to Dahlgren and Whitehead's model, what are the layers of influence on health from inner to outer?

From the centre outward: 1) fixed individual factors (age, sex, genetics), 2) individual lifestyle factors, 3) social and community networks, 4) living and working conditions, and 5) general socioeconomic, cultural and environmental conditions.

What are 'health inequalities' and why do they matter ethically and economically?

Health inequalities are unfair and avoidable differences in health across population groups (by income, ethnicity, geography, etc.). They matter because they are unjust, often preventable, and impose costs on society and the health system.

What did the Marmot Review (2010, 'Fair Society, Healthy Lives') highlight?

It highlighted the social gradient in health (the lower one's social position, the worse the health) and recommended action on social determinants to reduce health inequalities, emphasising 'proportionate universalism'.

Name four of the biggest modifiable risk factors for non-communicable disease in the UK.

Smoking (tobacco), poor diet/obesity, physical inactivity, and excessive alcohol consumption. These drive cardiovascular disease, cancer, type 2 diabetes and respiratory disease.

What is obesity defined as using Body Mass Index (BMI), and how is BMI calculated?

Obesity is a BMI of 30 or more (overweight is 25-29.9). BMI is calculated as $$\text{BMI} = \frac{\text{mass (kg)}}{[\text{height (m)}]^{2}}$$

Why is antimicrobial resistance (AMR) considered a major public health threat?

Overuse/misuse of antibiotics drives bacteria to become resistant, making infections harder or impossible to treat, raising mortality, lengthening illness and threatening routine surgery and cancer therapy. It is a global 'slow pandemic'.

What is the difference between primary, secondary and tertiary prevention?

Primary prevention stops disease occurring (e.g. vaccination, healthy lifestyle). Secondary prevention detects and treats disease early (e.g. screening). Tertiary prevention reduces impact/complications of established disease (e.g. rehabilitation).

State the Wilson and Jungner criteria principles for a worthwhile screening programme (any four).

The condition should be an important health problem; there should be a recognisable latent/early stage; a suitable, acceptable test exists; an effective accepted treatment exists; facilities for diagnosis/treatment are available; the test is cost-effective; and case-finding is continuous.

Name three national screening programmes offered by the NHS.

Examples include cervical screening, breast screening (mammography), bowel (colorectal) cancer screening, abdominal aortic aneurysm screening, diabetic eye screening, and antenatal/newborn screening.

Define sensitivity and specificity of a screening test, with formulas.

Sensitivity is the proportion of true cases correctly identified: $$\text{Sensitivity} = \frac{TP}{TP + FN}$$ Specificity is the proportion of true non-cases correctly identified: $$\text{Specificity} = \frac{TN}{TN + FP}$$

What is 'lead-time bias' in screening?

Lead-time bias is the apparent increase in survival time that occurs simply because screening diagnoses a disease earlier, even if the date of death is unchanged. It can make screening look more beneficial than it truly is.

Give two potential harms of screening programmes.

Overdiagnosis and overtreatment of conditions that would never have caused harm; false positives causing anxiety and unnecessary investigation; false negatives giving false reassurance; and the resource cost.

How can technology and AI improve NHS care? Give two concrete examples.

AI can aid diagnosis (e.g. reading scans/retinal images, detecting cancers earlier), triage and risk-prediction, and reduce administrative burden. Other tech includes electronic health records, telemedicine and remote monitoring/wearables.

What are the main risks or ethical concerns of using AI in healthcare?

Algorithmic bias and inequity, data privacy and consent, accountability/liability for errors, the 'black box' lack of explainability, over-reliance/deskilling, and the need for human oversight and regulation.

What is meant by 'global health equity', and name one major global health inequality.

Global health equity is the fair distribution of health resources and outcomes between and within countries. Examples of inequality include vast differences in life expectancy, vaccine access (as in COVID-19), and maternal/child mortality between high- and low-income countries.

Outline the key ethical concerns raised by emerging science such as gene editing (e.g. CRISPR) and designer babies.

Concerns include safety of heritable (germline) edits, consent of future generations, the line between therapy and enhancement, equity of access (a 'genetic divide'), eugenics and the slippery slope, and the need for strict regulation and ethical oversight. UK law currently bans heritable genome editing in humans.