Interview guides · Precision Medicine Group

Precision Medicine Group Software Engineer Interview Guide

Precision Medicine Group Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

As a Software Engineer at Precision Medicine Group, you will play a critical role in transforming how life sciences organizations utilize complex clinical, genomic, and operational data. The software you build directly supports the delivery of precision medicine, enabling researchers and clinicians to design more effective trials and accelerate the path to targeted therapies. This is a high-stakes domain where data accuracy, system reliability, and secure architectures are paramount to patient outcomes and regulatory compliance. Your work will focus on building robust, scalable platforms that ingest, process, and analyze massive biological and clinical datasets. You will collaborate closely with cross-functional teams, including data scientists, clinical trial specialists, and product managers, to translate intricate scientific requirements into performant software systems.

This guide is scoped to a Software Engineer candidate at Precision Medicine Group.

Focus areas

Backend engineering fundamentals
Depth in backend technologies
System design (backend-focused)

The Precision Medicine Group interview process

Precision Medicine Group candidates report 3 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

HR Screen

Initial screening with HR to discuss your background and assess fit for the role.

What to demonstrate

Initial screening with HR to discuss your background and assess fit for the role
Depth in Backend engineering fundamentals

How to prepare

Be able to walk your CV end to end in two minutes, and say why this company specifically.
Have your salary expectations, notice period and location constraints ready, and ask for the rest of the loop in writing.

Skills Testing Sessions

Multiple sessions focused on evaluating your technical skills and competencies.

What to demonstrate

Multiple sessions focused on evaluating your technical skills and competencies
Depth in Backend engineering fundamentals

How to prepare

Answer aloud and timed: How do you ensure high availability and fault tolerance in a distributed backend architecture?
Answer aloud and timed: Walk me through a challenging architectural decision you made in a previous project, including the trade-offs you evaluated.

Final Interview

Concluding interview with executive leadership, which may include behavioral questions.

What to demonstrate

Concluding interview with executive leadership, which may include behavioral questions
Depth in Backend engineering fundamentals

How to prepare

Answer aloud and timed: Walk me through your professional background and highlight the projects that best demonstrate your technical growth.
Answer aloud and timed: Tell me about a time you had to learn a new technology quickly to deliver on a critical project deadline.

Where candidates lose points

Detail Your Backend Decisions

When discussing past projects, do not just list the technologies you used. Explain why you chose them, the alternatives you considered, and the trade-offs you made.

Demonstrate Global Mindset

Show that you are comfortable and experienced in working with diverse, distributed teams. Highlight any past experience managing cross-border projects or collaborating with offshore developers.

Communication during the hiring process can sometimes stall

Do not hesitate to proactively follow up with your recruiter if you experience a period of silence.

Questions & practice

Collapse a redelivered event batch into per-aggregate high-water marks

Easy · hashing · at-least-once · aggregation

You drain a batch of up to 5,000,000 events, each (aggregate_id BIGINT, aggregate_version INT, event_type, payload). The log guarantees order within one aggregate only; the batch merges 64 partitions, and a relay failover has redelivered a range, so an older version for an aggregate can appear after a newer one. Given a map of last_applied_version per aggregate, produce the events worth applying, at most one per (aggregate_id, version), plus the count discarded. Target O(n) time. State the memory for 2,000,000 distinct aggregates and what you do when it does not fit.

Approach

One pass, one hash map from aggregate_id to the highest version kept, and a discard counter. An event whose version is at or below last_applied_version for its aggregate is dropped without further work, which is the whole reason the event carries its version rather than a delta. O(n) expected time, O(d) space in distinct aggregates.
Keep the maximum, never the last occurrence. The redelivered range means the final appearance of an aggregate in the batch can be an older version than one seen earlier in the same batch, so last-wins applies stale state over newer state and the projection regresses with no error anywhere.
Cost the memory instead of calling it large: an 8-byte key plus a 4-byte version is 12 bytes of payload, and an open-addressed table held at a 0.7 load factor costs roughly 17 bytes per entry before per-slot metadata, so 2,000,000 aggregates is tens of megabytes in a native layout and several times that in a runtime that boxes both key and value.
If the distinct set exceeds memory, partition on hash(aggregate_id) mod P and reduce each partition independently. Every event for one aggregate hashes to the same partition, so the per-partition result is exact and the merge is concatenation rather than a second reduction.

Follow-up

The payload is a patch rather than a snapshot, so applying only the highest version loses the intermediate changes. What changes in your reduction?
How do you detect that version 7 arrived while version 6 was never delivered, and what should the consumer do about the gap?

Diff a projection against the primary without per-row point reads

Hard · reconciliation · range hashing · throttling

The listing projection has drifted and some rows show a stale version. The primary holds 40,000,000 resource rows across 12,000 tenants while serving 1,200 writes and 14,000 reads per second. The obvious repair, reading each resource row and comparing its version against the projection, is correct and would eventually finish. Explain precisely why it is unacceptable here, then give a diff that finds the differing rows, state its complexity, and make it safe to run against a live primary. Replication lag is usually under 100 ms and is not bounded.

Approach

Quantify the naive cost rather than calling it slow: 40,000,000 point reads at even 0.5 ms each is over five hours serialised, and the only lever is concurrency, which is exactly what you cannot spend. The primary's pool is sized for the write path, and 40,000,000 random reads evict the buffer cache that sustains the 85 percent cache hit rate, so the audit degrades the system it is auditing.
Replace random access with one ordered pass per side. Both sides can be read in (tenant_id, resource_id) order, which is a sequential scan on each and a merge join in O(n) time and O(1) memory. For a dense diff that is the whole answer, and it reads the primary once instead of 40,000,000 times.
For the expected sparse case, compare range hashes instead of rows: partition the key space, compute per range an order-independent aggregate over hash(resource_id, version), compare aggregates, and descend only into ranges that differ. With d differing rows and branching factor B, at most d ranges mismatch per level, so the drill-down examines O(d log_B(n/d)) ranges and reads full rows only in mismatching leaves.
Aggregate with a sum modulo 2^64 or a multiset hash, never XOR. XOR is order-independent but self-cancelling, so two rows wrong in the same way, or a row duplicated on one side, leave the range aggregate matching and the range is declared clean.

Follow-up

The diff reports 900 stale rows. How do you decide between patching those rows and rebuilding the projection from resource_revision?
Same job, but the projection lives in a search index that cannot be scanned in key order. What changes?

Track a rolling failure rate per destination for circuit decisions

Easy · sliding window · ring buffer · circuit breaker

The egress service delivers about 1,500 webhooks per second across roughly 40,000 destinations, each call bounded by a 10 second timeout. Maintain, per destination, the failure rate over the trailing 60 seconds so a caller can ask before dispatch whether the circuit should open. Attempts arrive as (destination_id, finished_at_ms, outcome). Requirement: amortised O(1) per attempt, with total memory bounded by the destination count rather than by traffic. Give the structure, its exact memory, and the rule that stops a destination with three attempts from opening a circuit.

Approach

Name the exact-deque version and then reject it as the default. Holding timestamps and advancing a tail pointer past anything older than now minus 60 seconds is a correct two-pointer window at amortised O(1) per attempt, but its memory tracks in-window traffic, so one destination in a retry storm holds hundreds of thousands of entries while thousands of quiet destinations hold none.
Use a ring of 60 one-second buckets per destination, each bucket a pair of counters for attempts and failures. On an attempt, advance the ring by the elapsed whole seconds, zeroing at most min(elapsed, 60) buckets, then increment the head. That is amortised O(1) with a fixed footprint per destination.
State the footprint: 60 buckets times two 4-byte counters is 480 bytes of payload per destination, so 40,000 destinations is roughly 20 to 25 MB with per-entry overhead, bounded by the catalogue rather than by the rate. The cost is granularity, since the oldest bucket ages out in whole seconds, which is far tighter than the decision needs.
Require a minimum sample before the circuit may open. A destination with three attempts and three failures reads as 100 percent and is not evidence; a floor of roughly 20 attempts in the window makes the ratio meaningful, and below that floor use a run of consecutive failures as the trigger instead.

Follow-up

The fleet is 30 instances and each sees roughly a thirtieth of a destination's traffic. Where does the rate actually live, and what does a per-instance answer get wrong?
A destination answers in 9.5 seconds and succeeds. It is not failing but it is consuming your per-destination concurrency. What signal should open the circuit here?

Explain why the owner filter ignores the listing index

Medium · composite index · query plans · sort elimination

The only index on resource is (tenant_id, status, updated_at DESC, resource_id DESC). A new endpoint returns one user's resources across all statuses, newest created first: WHERE tenant_id = $1 AND owner_user_id = $2 ORDER BY created_at DESC LIMIT 20. On a tenant with 2M rows it takes 900 ms and EXPLAIN shows a sort above a large scan. Explain precisely why the existing index cannot serve it, give the index that can, and state which of these the new index still will not help: owner_user_id alone across tenants; the same query ordered by updated_at. PostgreSQL 16.

Approach

Separate the two jobs an index does. For filtering, a composite btree is seekable only on a left prefix, so with no predicate on status the scan can at best range over tenant_id and test owner_user_id per row; PostgreSQL 16 has no btree skip scan to jump the unconstrained column.
For ordering, the index is sorted by (status, updated_at) within a tenant and not by created_at, so the LIMIT cannot stop early: every matching row is read and then sorted. That is the 'Sort Method: top-N heapsort' line, and it is why the plan reads 2M rows to answer with 20.
Derive the replacement from the access path — equality, equality, then the ordering column: CREATE INDEX CONCURRENTLY ON resource (tenant_id, owner_user_id, created_at DESC). The scan seeks to the (tenant, owner) range and walks 20 entries in order, so the Sort node disappears along with the row-read.
Treat INCLUDE (title, status) as conditional, not free. An index-only scan still visits the heap for any row whose page is not marked all-visible, so on a table taking 1.2k writes/second the win depends on autovacuum keeping the visibility map current, and the wider index costs more on every insert.

Follow-up

90% of rows are status='active'. Would a partial index WHERE status = 'active' change your answer, and for which of the three queries?
A dashboard runs this for 40 owners in one page load. What changes about the design?

Keep soft-deleted accounts from blocking re-registration

Easy · soft delete · unique constraints · engine differences

app_user holds user_id, tenant_id, email CITEXT, password_hash (NULL for SSO principals), email_verified_at, auth_version, status ('invited','active','suspended','deactivated'), created_at, updated_at, deleted_at. Two live accounts for one address inside a tenant must be impossible, but an address freed by a soft delete must be reusable, and the same tenant may delete and re-register it repeatedly. Write the uniqueness DDL for PostgreSQL 16, then the equivalent for MySQL 8 where partial indexes do not exist, and say what each permits once three deleted rows already hold that address.

Approach

Start from what is actually unique: not (tenant_id, email), but (tenant_id, email) among live rows. PostgreSQL says that directly — CREATE UNIQUE INDEX app_user_live_email ON app_user (tenant_id, email) WHERE deleted_at IS NULL. A full constraint over the same two columns burns the address permanently the first time someone deletes an account.
Keep case-insensitivity in the type or the index, never in the application: CITEXT as given, or UNIQUE (tenant_id, lower(email)) as an expression index where the extension is unavailable. A case-sensitive unique column is exactly how two accounts for one human appear.
For MySQL 8 the predicate has to move inside the key: add a discriminator column that is a constant 0 while the row is live and is set to user_id on delete, with UNIQUE (tenant_id, email, deleted_marker). Live rows share the constant and still collide; deleted rows differ from each other and stop colliding.
State the NULL variant and its dependency: leaving the marker NULL for deleted rows also works, because a unique index treats NULLs as distinct — true in MySQL, and true in PostgreSQL only under the default NULLS DISTINCT, which PostgreSQL 15 lets you reverse. Check the polarity against the three existing deleted rows: constant-on-live is what preserves the collision you want, and reversing it silently admits duplicate live accounts.

Follow-up

A deleted account re-registers with the same address the next day. Do the old resource rows follow the new user_id, and how does the API keep the two principals apart?
How do you honour an erasure request while resource_revision.actor_user_id still references this table?

How do you optimize database queries and handle indexing when working with large, complex datasets?

Medium · Backend & System Architecture

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

Explain your approach to designing secure, RESTful APIs that handle sensitive health or personal data.

Medium · Backend & System Architecture

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

How do you ensure high availability and fault tolerance in a distributed backend architecture?

Medium · Backend & System Architecture

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

Walk me through a challenging architectural decision you made in a previous project, including the trade-offs

Medium · Backend & System Architecture

Walk me through a challenging architectural decision you made in a previous project, including the trade-offs you evaluated.

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

Every query on one table stalls for forty seconds mid-deploy

Medium · lock contention · ddl · migrations

During a release on PostgreSQL, every query touching resource times out for about 40 seconds and then recovers with no intervention. The release ran one migration, ALTER TABLE resource ADD COLUMN archived_reason TEXT, and the migration log shows it completing in 6 ms. Unrelated tables showed no change in error rate. Explain how a 6 ms statement caused a 40-second stall, give the ordered checks you would run on a live system to confirm it, and give the migration procedure that prevents a repeat.

Approach

Separate the statement's duration from the lock's duration. ADD COLUMN with no default is a catalogue-only change and genuinely runs in milliseconds, but it requires ACCESS EXCLUSIVE, and it cannot acquire that until every transaction already touching the table has finished.
Account for the queueing, which is the part that surprises people. A lock request that is waiting blocks later requests for conflicting modes behind it rather than letting them overtake, so one long-open transaction holds the DDL and the DDL holds all the traffic. The stall length is set by the longest open transaction, not by the size of the change.
Confirm on a live system in this order: pg_stat_activity for that table ordered by xact_start, looking for the oldest transaction and specifically for state = idle in transaction; then pg_locks where granted = false to find the waiter; then join them on pid to name blocker and blocked. pg_blocking_pids() does that join for you and is the fastest single call.
Prevent rather than merely time it better. Set lock_timeout to a second or two on the migration session so the DDL abandons the queue after a bounded wait and is retried, instead of holding it for as long as the oldest transaction lives. Be exact about what that buys: queries arriving during the wait still queue behind the pending ACCESS EXCLUSIVE request, so each attempt costs them up to one lock_timeout of added latency. The outage goes from 40 seconds to about one second per attempt, not to zero. Also run migrations away from deploy-time peaks, and put a statement timeout and an idle-in-transaction timeout on the analytics role that opens the long transactions.

Follow-up

The same release also wants NOT NULL on that column. What is the sequence that gets there without a long lock?
Your lock_timeout retry fails ten times in a row because the analytics transaction is always open. What do you change?

Suggested practice checklist

Built from the rounds and topics Precision Medicine Group candidates report.

Day 1 — Map the Precision Medicine Group loop

Write out the reported sequence: HR Screen, Skills Testing Sessions, Final Interview.
For each round, write one sentence on what it is judging, from the description above, and mark the one you are least ready for.

Deliverable: A one-page map of the 3 reported rounds, with the weakest marked.

Day 2 — Work Backend engineering fundamentals

Spend the session on Backend engineering fundamentals, which Precision Medicine Group candidates report being tested on.
Write one worked example in Backend engineering fundamentals and time yourself on it.

Deliverable: One timed worked example in Backend engineering fundamentals.

Day 3 — Work Depth in backend technologies

Spend the session on Depth in backend technologies, which Precision Medicine Group candidates report being tested on.
Write one worked example in Depth in backend technologies and time yourself on it.

Deliverable: One timed worked example in Depth in backend technologies.

Day 4 — Work System design (backend-focused)

Spend the session on System design (backend-focused), which Precision Medicine Group candidates report being tested on.
Write one worked example in System design (backend-focused) and time yourself on it.

Deliverable: One timed worked example in System design (backend-focused).

Day 5 — Answer out loud: Backend & System Architecture

Answer aloud, timed: How do you optimize database queries and handle indexing when working with large, complex datasets?
Answer aloud, timed: Explain your approach to designing secure, RESTful APIs that handle sensitive health or personal data.

Deliverable: Spoken answers to 2 reported Backend & System Architecture question(s), under time.

Day 6 — Answer out loud: Behavioral & Experience

Answer aloud, timed: Walk me through your professional background and highlight the projects that best demonstrate your technical growth.
Answer aloud, timed: Tell me about a time you had to learn a new technology quickly to deliver on a critical project deadline.

Deliverable: Spoken answers to 2 reported Behavioral & Experience question(s), under time.

Day 7 — Answer out loud: Leadership & Collaboration

Answer aloud, timed: How do you approach leading or collaborating with engineers across different time zones, cultural backgrounds, and locations?
Answer aloud, timed: Describe a scenario where you disagreed with a peer or stakeholder on a technical direction. How did you resolve the conflict?

Deliverable: Spoken answers to 2 reported Leadership & Collaboration question(s), under time.

Behavioural preparation

Behavioural rounds judge the decision you made and what it cost.

Walk me through your professional background and highlight the projects that best demonstrate your technical g

Medium · Behavioral & Experience

Walk me through your professional background and highlight the projects that best demonstrate your technical growth.

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

Tell me about a time you had to learn a new technology quickly to deliver on a critical project deadline.

Medium · Behavioral & Experience

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

How do you handle situations where there is ambiguity in project requirements or technical specifications?

Medium · Behavioral & Experience

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

Describe a time you received constructive feedback on your code or system design. How did you respond and impl

Medium · Behavioral & Experience

Describe a time you received constructive feedback on your code or system design. How did you respond and implement changes?

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

How do you approach leading or collaborating with engineers across different time zones, cultural backgrounds,

Medium · Leadership & Collaboration

How do you approach leading or collaborating with engineers across different time zones, cultural backgrounds, and locations?

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

Describe a scenario where you disagreed with a peer or stakeholder on a technical direction. How did you resol

Medium · Leadership & Collaboration

Describe a scenario where you disagreed with a peer or stakeholder on a technical direction. How did you resolve the conflict?

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

How do you mentor junior developers or ensure high code quality across your engineering team?

Medium · Leadership & Collaboration

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?