University of North Dakota School of Medicine and Health Sciences (MD) Medicine InterviewFormat, Questions & Prep Tips

Why UND School of Medicine — and why North Dakota? What connects you to this state and its healthcare challenges?

The defining UND question. Demonstrate knowledge of North Dakota: the sparsely populated Great Plains geography, the Standing Rock and Turtle Mountain tribal nations, agricultural occupational health, the oil boom health impacts in western ND, and the severe primary care shortage in rural counties.

What do you know about Native American health disparities, and why is this an area you are committed to addressing?

Be specific: higher rates of diabetes, cardiovascular disease, substance use disorder, and suicide among American Indian/Alaska Native populations; the underfunding of the Indian Health Service; historical trauma as a social determinant; and the importance of culturally safe care. Avoid appropriating Indigenous culture — show respect and knowledge, not saviorism.

You are the only physician in a small North Dakota town of 1,500 people. A patient presents with a condition you have never treated. What is your obligation?

Rural generalism ethics: acknowledge your limits, consult telemedicine and specialty referral pathways (telehealth is widely used in ND), stabilise and transport if needed, and continue learning. Show you can practice at the edge of your competence with appropriate guardrails.

You are a family physician on a reservation and a patient comes in reluctant to follow your recommended treatment because it conflicts with traditional healing practices they use. How do you approach this?

Cultural safety in Indigenous health: honor the traditional practice, explore whether it conflicts with or can complement the biomedical treatment, engage a tribal health liaison or community health representative, and never ask a patient to choose between their culture and their care.

UND uses a distributed clerkship model where students train in small communities across North Dakota. What are the educational advantages and disadvantages of this approach?

Advantages: breadth of clinical conditions, community immersion, mentorship from rural generalists. Disadvantages: fewer rare subspecialty cases, less peer learning, variable resource availability. Show you have researched the model and are genuinely comfortable with its trade-offs.

North Dakota has an opioid crisis driven partly by the oil patch workforce in the western part of the state. As a family physician in Williston, ND, how do you approach opioid prescribing and management?

Context-specific rural opioid ethics: PDMP, buprenorphine treatment in a rural setting with limited addiction specialists, naloxone co-prescription, harm reduction approach, and understanding the occupational injury pipeline that drives opioid demand in extractive industry communities.

A farmer in rural North Dakota presents with depression but refuses mental health referral because he believes "real men don't see shrinks." How do you approach the conversation?

Agricultural community mental health. Acknowledge the cultural norm without endorsing it. Use destigmatising framing: farmers operate heavy machinery and need to be mentally sharp for safety reasons. Introduce farmer-specific mental health resources (Farm Aid, Farmer Stress Hotline) and frame treatment as a practical tool.

Should the federal government increase funding to the Indian Health Service to bring it to parity with Medicaid or Medicare reimbursement rates? Argue a position.

IHS is chronically underfunded at approximately 40–60% of comparable federal programs. Argue that treaty obligations, the trust responsibility, and documented health outcome disparities create a legal and ethical mandate for funding parity. Acknowledge fiscal constraints and legislative pathway challenges.

What specific type of rural medicine interests you most — family medicine, emergency medicine, obstetrics, or another field — and how does UND's training prepare you for it?

UND graduates are often rural generalists who need broad skills. Discuss the distributed clinical model's breadth, the IHS affiliate training sites, and how the specific specialty you mention fits rural practice patterns in ND.

In 20 years, describe a successful career built from your UND training.

Describe rootedness in a specific rural ND or upper Midwest community. A practice in Dickinson, ND; a tribal health center in Fort Yates; or a critical access hospital in Jamestown. Show commitment, not ambiguity about whether you will stay in the region.

Role-play: You are the only physician on call at a small North Dakota critical-access hospital and must tell a family (played by the interviewer) that their relative needs to be transferred by air to a tertiary center hours away, and they are frightened and reluctant to be separated. Begin.

Explain clearly why local care cannot meet the need, address the fear of distance and separation, and convey that transfer is in the patient's best interest while staying calm. This captures rural-generalist reality in ND — honesty, empathy, and decisiveness under resource limits.

You are told the Indian Health Service is funded at roughly 40 to 60 percent of comparable per-capita federal health spending, and shown corresponding disparities in chronic-disease outcomes for American Indian populations in North Dakota. How do you connect the funding figure to the outcomes, and what is the physician's role?

Link chronic underfunding to access, staffing, and infrastructure gaps that drive worse outcomes, while situating it within treaty obligations and the federal trust responsibility. Discuss culturally safe care and advocacy. Avoid framing disparities as cultural deficits.

A rural North Dakota patient on a buprenorphine program relapses and misses appointments. The nearest addiction specialist is hours away. Do you continue treating them yourself, and how do you decide?

Apply a harm-reduction, non-punitive frame: relapse is part of the disease, abandonment increases overdose risk, and rural scarcity means you may be the only realistic option. Discuss intensifying support and telehealth consultation rather than discharging the patient. Fits ND's oil-patch opioid context.

You are a family physician on a North Dakota reservation and a community health representative tells you, gently, that your clinic's approach is alienating elders. How do you receive and act on that feedback?

Listen without defensiveness, treat the CHR as an expert bridge to the community, and demonstrate willingness to change clinic practices. Shows cultural safety and humility — recognizing the community as partner, not recipient, which is central to UND's Indigenous-health mission.

UND's distributed model places students in small communities for extended clinical training rather than concentrating them at one academic center. Beyond exposure, how does that design shape the kind of physician it produces?

Argue that longitudinal immersion in small communities builds breadth, comfort with autonomy and uncertainty, relationship-based care, and a realistic sense of rural practice — increasing the chance graduates stay. Acknowledge the trade-off of fewer rare subspecialty cases. Shows genuine engagement with the model.