UC San Diego Health Software Engineer Interview Guide

The 60-second brief

A Software Engineer at UC San Diego Health occupies a unique position at the intersection of cutting-edge academic research and critical patient care. Unlike traditional tech environments, your work here directly impacts clinical outcomes, the efficiency of healthcare delivery, and the security of sensitive patient data. You are not just writing code; you are building the digital infrastructure that allows doctors, researchers, and patients to interact with complex medical data in real-time. The role is highly varied, ranging from developing patient-facing applications and portals to engineering backend systems that integrate with electronic health records (EHR) like Epic. You might find yourself working within a specific research lab, a clinical department, or the broader Health Information Services team.

This guide is scoped to a Software Engineer candidate at UC San Diego Health.

Focus areas

• Cloud Services Knowledge
• Security Knowledge
• Infrastructure Knowledge

The UC San Diego Health interview process

UC San Diego Health candidates report 2 rounds over 2-4 weeks. The stages below are what candidates describe, not a published process.

Initial Conversation

Begin with a discussion with a Director or Principal Investigator to overview skills and role impact.

What to demonstrate

• Begin with a discussion with a Director or Principal Investigator to overview skills and role impact
• Depth in Cloud Services Knowledge

How to prepare

• Answer aloud and timed: How do you ensure high availability for a mission-critical service?
• Answer aloud and timed: Describe your experience with containerization and orchestration (e.g., Docker, Kubernetes).

Technical Rounds

Engage in intensive technical interviews with peer engineers and hiring managers focusing on previous projects and technical decision-making.

What to demonstrate

• Engage in intensive technical interviews with peer engineers and hiring managers focusing on previous projects and technical decision-making
• Depth in Cloud Services Knowledge

How to prepare

• Answer aloud and timed: What are the most important factors to consider when designing a cloud-based data storage solution?
• Answer aloud and timed: How do you handle database migrations in a production environment with high traffic?

Where candidates lose points

Understand the Mission

UC San Diego Health is a top-tier academic medical center. Showing that you understand the impact of your work on patients and researchers will set you apart from candidates who only focus on the code.

Prepare Your "Project Story

Have 2–3 projects ready to discuss in extreme detail. Be ready to explain the "why" behind your choices, the challenges you faced, and the ultimate outcome.

Be Professional and Precise

During the interview, maintain a high level of professionalism. The healthcare environment values precision and clear, respectful communication.

If you are interviewing for a lab-based position, research the Principal Investigator's (PI) recent publications

Showing an interest in their specific research area can be a major advantage.

Questions & practice

Canonicalise a request body into a stable idempotency fingerprint

Medium · parsing · canonicalisation · hashing

idempotency_key.request_fingerprint is a SHA-256 over the method, path and canonicalised body, and a retry whose fingerprint differs must be rejected with 422 rather than served the stored response. Write the canonicaliser. Bodies are JSON up to 256 KB nested at most 32 levels; clients vary key order, whitespace and unicode escaping, and some send 64-bit ids as JSON numbers. Produce a deterministic byte string such that semantically identical bodies match and any semantic difference does not. State your complexity and name two normalisations you refuse to perform.

Approach

1. Parse once into a tree, then re-serialise under fixed rules: object keys sorted, array order preserved, one escaping convention, no insignificant whitespace. Parsing is O(n) and sorting keys is O(k log k) per object, so O(n log n) overall with O(depth) stack, and the 32-level cap is enforced during parsing because hostile nesting is how a canonicaliser becomes a stack overflow.
2. Sort keys by their UTF-8 bytes and say why the obvious implementation is wrong in some runtimes: a default string comparison that orders by UTF-16 code units places surrogate pairs, meaning code points from U+10000 up, below U+E000 to U+FFFF, which is not UTF-8 byte order, so two services written in different languages disagree on the same document.
3. Do not re-encode numbers through a double. IEEE-754 binary64 represents integers exactly only up to 2^53, so normalising a 19-digit id through a float changes it, and 1 against 1.0 cannot be reconciled without deciding whether they are the same value. Preserve the literal token, and require ids as strings at the API boundary if you want them comparable.
4. Reject duplicate keys rather than picking one. JSON permits them and parsers disagree, most keeping the last, so any choice you make ties the fingerprint to a parser detail that the code handling the request does not necessarily share.

Follow-up

• A client sends the same logical request with an extra field your API ignores. Same key, different fingerprint, so you return 422. Is that the right answer?
• Where does the fingerprint get computed relative to request decompression and the body-size limit?

Identify the heaviest tenants in a five-minute window under memory pressure

Medium · top-k · heavy hitters · streaming

The edge service handles about 3,000 requests per second across roughly 50,000 tenants, peaking near 9,000. Expose the 50 heaviest tenants by request count over the trailing five minutes so limits can be tightened before one tenant's backfill starves the fleet. You may not retain five minutes of raw records. Give the exact solution and its memory, then the bounded-memory approximation with its error stated as a formula, and say which you would ship and at what tenant cardinality that choice changes.

Approach

1. Do the exact version first, because it is affordable at this cardinality: a ring of 300 one-second counters per tenant, advanced lazily, is 1,200 bytes of counters per tenant and roughly 60 to 90 MB for 50,000 tenants with overhead. Carry a running total and subtract the bucket you overwrite so a window read is O(1) rather than 300 adds.
2. Extract the top 50 with a size-k min-heap over the tenant sums: O(d log k) for d tenants, against O(d log d) to sort them all. Maintaining the heap continuously instead of on query requires a tenant-to-heap-index map, because incrementing a count already inside the heap means sifting from a known position, and without that map you rebuild the heap on every request.
3. State the approximation precisely rather than gesturing at sketches. Misra-Gries with m counters retains every item whose true count exceeds N/(m+1), and each retained count underestimates the truth by at most N/(m+1). With m = 1,000 and N = 900,000 requests in the window the error is roughly 900 requests, which is fine for spotting a tenant sending 50,000 and useless for ranking two tenants 200 apart.
4. Say what breaks when the window slides: Misra-Gries and Space-Saving are insert-only and cannot be decremented as records age out. The workable construction is one summary per sub-window, say ten seconds, with 30 summaries merged at query time, and the merged error is the sum of the per-summary errors, so the bound degrades linearly in the number of sub-windows.

Follow-up

• The heaviest tenant is heavy because of one export job rather than user traffic. Should the limiter treat those as the same tenant?
• Two tenants sit tied at the boundary of the top 50. Does your answer flap, and does the flapping matter?

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

1. 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.
2. 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.
3. 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.
4. 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?

Denormalise tenant onto revisions and backfill it live

Hard · denormalisation · online migration · backfill

resource_revision (revision_id, resource_id, version, actor_user_id, change_kind, patch, request_id, created_at) has 400M rows and no tenant column; tenant_id lives only on resource. Two reads need it: a tenant-scoped audit feed ordered by created_at DESC, and an offboarding purge. Both join back to resource today. Justify adding tenant_id to resource_revision against those two reads, name the anomaly the copy introduces and the constraint that prevents it, then give the ordered migration for a live table taking 1.2k writes/second — the lock each step takes, how the backfill is batched, and where each step stops being reversible. PostgreSQL 16.

Approach

1. Justify from the access path rather than from taste. Without the column, the audit feed either scans resource_revision by created_at and discards other tenants' rows, or resolves the tenant's resource_ids first and probes with them — both proportional to the tenant's whole history rather than to one page. With (tenant_id, created_at DESC, revision_id DESC) it is a seek that stops at 50 rows, and the purge becomes a ranged delete instead of a join.
2. Name the cost exactly: a second copy of a fact can disagree with the first. Make the disagreement unwritable rather than documented — add UNIQUE (resource_id, tenant_id) on resource so it can serve as a foreign-key target, then FOREIGN KEY (resource_id, tenant_id) REFERENCES resource (resource_id, tenant_id) on the revision table. A revision can then only ever carry its parent's tenant.
3. Step one, expand: ALTER TABLE resource_revision ADD COLUMN tenant_id BIGINT NULL, with no default, so it is a catalogue change and no rewrite. It still needs ACCESS EXCLUSIVE for an instant, and that instant queues behind the longest open transaction on the table while every later query queues behind it — set lock_timeout to 2s and retry rather than wait.
4. Step two, dual-write: deploy the writer that populates tenant_id on every new revision while reads still use the join. Reversible by redeploying the previous build, because nothing reads the column yet.

Follow-up

• The backfill is half finished and a rollback is required. What state is the table in, and what does the previous build do with a half-populated column?
• How do you verify the backfill actually finished, given rows are still being inserted while it runs?

Replace offset paging on the resource feed with keyset

Easy · keyset pagination · composite index · sort order

resource holds resource_id, tenant_id, owner_user_id, title, body_ref, version, status ('draft','active','archived','deleted'), created_at, updated_at, deleted_at, with an index on (tenant_id, status, updated_at DESC, resource_id DESC). The listing endpoint returns active resources for one tenant, newest update first, 50 per page, today with LIMIT 50 OFFSET n. Tenants reach page 400 and rows are created while they read. Write the keyset query, define what the cursor carries and how it is encoded, and say which part of the index each predicate uses. Assume PostgreSQL 16.

Approach

1. Name the two failures separately. OFFSET 20000 makes the server produce and discard 20,000 rows, so page cost grows with depth rather than with page size. Independently, any write that changes how many rows sort above the offset moves the window between two fetches, and the direction decides which anomaly you get: an insert lands at the head of updated_at DESC and pushes already-returned rows down past the boundary, so they are returned a second time; a delete above the offset, or a row whose updated_at is bumped above the cursor, pulls rows up and one is never returned at all. Nothing in the response reveals either.
2. Write the seek: WHERE tenant_id = $1 AND status = 'active' AND (updated_at, resource_id) < ($2, $3) ORDER BY updated_at DESC, resource_id DESC LIMIT 50. The row-value comparison is one index range rather than a disjunction, and both columns are NOT NULL, which is what makes that comparison well defined.
3. Map each predicate onto the index: tenant_id and status are equality on the leading columns, (updated_at, resource_id) is the range, and the ORDER BY matches the index order so no Sort node appears and the scan stops after 50 rows. The DESC in the definition only matters for mixed directions — a plain ascending btree on the same columns is read backwards for this query.
4. Put both sort columns in the cursor and nothing the client can tamper with into another tenant: base64 of (updated_at, resource_id), validated server-side, with tenant_id taken from the principal.

Follow-up

• The client asks for 'jump to page 400'. What do you offer instead, and what does the honest version cost?
• Sort order becomes user-selectable across four columns. How many indexes is that, and which would you refuse to add?

How do you ensure high availability for a mission-critical service?

Medium · Technical and Cloud Infrastructure

Approach

1. Fix the scope first: who calls this, how often, and what they do when it fails.
2. Name the read and write paths separately; they rarely have the same bottleneck.
3. Choose a partition key and say what query it makes expensive.
4. 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?

What are the most important factors to consider when designing a cloud-based data storage solution?

Medium · Technical and Cloud Infrastructure

Approach

1. Fix the scope first: who calls this, how often, and what they do when it fails.
2. Name the read and write paths separately; they rarely have the same bottleneck.
3. Choose a partition key and say what query it makes expensive.
4. 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 the difference between horizontal and vertical scaling and when to use each.

Medium · Technical and Cloud Infrastructure

Approach

1. Fix the scope first: who calls this, how often, and what they do when it fails.
2. Name the read and write paths separately; they rarely have the same bottleneck.
3. Choose a partition key and say what query it makes expensive.
4. 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?

What are the best practices for securing a public-facing API?

Medium · Security and Compliance

Approach

1. Say who the caller is and what they do when the call fails halfway.
2. Define the identity of a request so a retry cannot double-apply it.
3. Separate accepted, pending, failed and confirmed; they are different facts.
4. Design the error taxonomy before the success shape; callers branch on it.

Follow-up

• What happens if the caller retries after a timeout?
• How does a client discover it is on an old version of this contract?

How would you design a system to ensure that only authorized personnel can access specific patient records?

Medium · Security and Compliance

Approach

1. Fix the scope first: who calls this, how often, and what they do when it fails.
2. Name the read and write paths separately; they rarely have the same bottleneck.
3. Choose a partition key and say what query it makes expensive.
4. 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?

What role does encryption play in your current development process?

Medium · Security and Compliance

Approach

1. Clarify what is being asked and what a complete answer contains.
2. State your assumptions explicitly before working the problem.
3. Say what you would check first and why it is the highest-information step.
4. Work from the requirement backwards to the design.

Follow-up

• What assumption would you test first?
• How would you know your answer was wrong?

Listing latency scales with page size, not with filters

Easy · n+1 · latency · query batching

The tenant listing endpoint reads resource filtered by tenant_id and status, ordered by updated_at DESC, and returns each row plus the owner's display name from app_user and the actor of that resource's latest resource_revision. p99 is 55 ms at 10 rows per page and 1.4 s at 200. Database telemetry shows 401 statements per request, each under 1 ms, and nothing in the slow-query log. Diagnose the cause and give the fix, stating the statement count per request and the p99 you expect afterwards.

Approach

1. Read the counters before forming a theory. 401 statements for 200 rows is one driver query plus two per row, and sub-millisecond execution with an empty slow-query log rules out a bad plan. The time is round trips, which is why it is invisible in every per-query metric and scales with rows returned rather than with filter selectivity.
2. Name the two per-row statements from their normalised text: a single-row app_user lookup by user_id, and a resource_revision lookup by resource_id ordered by version DESC LIMIT 1. Confirm by dropping those two response fields and watching the statement count fall to one. That locates the calls in the serialisation layer, not the repository.
3. Check that the arithmetic accounts for the whole gap. Measure one round trip to the replica in isolation; 400 trips at roughly 3 ms of network plus 0.2 ms of execution is about 1.3 s on top of a 55 ms baseline, which matches. If the multiplication had fallen short, the N+1 would only be part of the story and you would keep looking.
4. Batch both lookups. Collect owner_user_ids and resource_ids from the driver query, then issue WHERE tenant_id = $1 AND user_id = ANY($2) for the users, and PostgreSQL's SELECT DISTINCT ON (resource_id) ... WHERE resource_id = ANY($2) ORDER BY resource_id, version DESC for the latest revision, which the UNIQUE (resource_id, version) index serves directly. On an engine without DISTINCT ON, use a lateral join or a row_number window. Three statements per request at any page size.

Follow-up

• The page size is capped at 200 today. What breaks first if it is raised to 2,000, and is it still this bug?
• How do you stop the next N+1 from reaching production, given that no individual query is slow and the endpoint's tests pass?

Suggested practice checklist

Built from the rounds and topics UC San Diego Health candidates report.

Day 1 — Map the UC San Diego Health loop

• Write out the reported sequence: Initial Conversation, Technical Rounds.
• 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 2 reported rounds, with the weakest marked.

Day 2 — Work Cloud Services Knowledge

• Spend the session on Cloud Services Knowledge, which UC San Diego Health candidates report being tested on.
• Write one worked example in Cloud Services Knowledge and time yourself on it.

Deliverable: One timed worked example in Cloud Services Knowledge.

Day 3 — Work Security Knowledge

• Spend the session on Security Knowledge, which UC San Diego Health candidates report being tested on.
• Write one worked example in Security Knowledge and time yourself on it.

Deliverable: One timed worked example in Security Knowledge.

Day 4 — Work Infrastructure Knowledge

• Spend the session on Infrastructure Knowledge, which UC San Diego Health candidates report being tested on.
• Write one worked example in Infrastructure Knowledge and time yourself on it.

Deliverable: One timed worked example in Infrastructure Knowledge.

Day 5 — Answer out loud: Technical and Cloud Infrastructure

• Answer aloud, timed: How do you ensure high availability for a mission-critical service?
• Answer aloud, timed: Describe your experience with containerization and orchestration (e.g., Docker, Kubernetes).

Deliverable: Spoken answers to 2 reported Technical and Cloud Infrastructure question(s), under time.

Day 6 — Answer out loud: Security and Compliance

• Answer aloud, timed: What are the best practices for securing a public-facing API?
• Answer aloud, timed: How would you design a system to ensure that only authorized personnel can access specific patient records?

Deliverable: Spoken answers to 2 reported Security and Compliance question(s), under time.

Day 7 — Answer out loud: Behavioral and Project Experience

• Answer aloud, timed: Tell me about a project where you had to work with a non-technical stakeholder. How did you ensure the requirements were met?
• Answer aloud, timed: Describe a difficult technical problem you solved recently. What was your approach?

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

Behavioural preparation

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

Describe your experience with containerization and orchestration (e.g., Docker, Kubernetes).

Medium · Technical and Cloud Infrastructure

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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 database migrations in a production environment with high traffic?

Medium · Technical and Cloud Infrastructure

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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 identified a security vulnerability in your code. How did you remediate it?

Medium · Security and Compliance

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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 project where you had to work with a non-technical stakeholder. How did you ensure the require

Medium · Behavioral and Project Experience

Tell me about a project where you had to work with a non-technical stakeholder. How did you ensure the requirements were met?

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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 difficult technical problem you solved recently. What was your approach?

Medium · Behavioral and Project Experience

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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 a situation where a teammate disagrees with your architectural choice?

Medium · Behavioral and Project Experience

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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?

Walk us through a project from your resume that you are particularly proud of.

Medium · Behavioral and Project Experience

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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?