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UW Medicine Software Engineer Interview Guide

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

The 60-second brief

A Software Engineer at UW Medicine plays a pivotal role in bridging the gap between cutting-edge medical research and clinical excellence. Unlike traditional tech environments, your work here directly impacts patient outcomes, the efficiency of healthcare delivery, and the advancement of life-saving medical discoveries. You are not just writing code; you are building the digital infrastructure that supports one of the world's leading academic health systems. In this role, you will contribute to a diverse array of products, ranging from high-scale electronic health record (EHR) integrations and patient portals to specialized research databases and bioinformatics tools. The complexity of the work is high, often involving the management of sensitive data under strict HIPAA regulations while ensuring system reliability in a 24/7 clinical environment.

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

Focus areas

  • Software Engineering (Role-specific)
  • Coding/Programming Problem Solving
  • Technical Interviewing

The UW Medicine interview process

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

Phone Screen

Initial contact to align on expectations and assess candidate fit.

What to demonstrate

  • Initial contact to align on expectations and assess candidate fit
  • Depth in Software Engineering (Role-specific)

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.

Intensive Rounds

A series of in-depth interviews focusing on technical skills and problem-solving.

What to demonstrate

  • A series of in-depth interviews focusing on technical skills and problem-solving
  • Depth in Software Engineering (Role-specific)

How to prepare

  • Answer aloud and timed: How do you handle concurrency issues in a high-traffic web application?
  • Answer aloud and timed: Describe your process for debugging a memory leak in a production environment.

Onsite Panel

Panel interview where candidates present to and are questioned by a group of 5-10 people.

What to demonstrate

  • Panel interview where candidates present to and are questioned by a group of 5-10 people
  • Depth in Software Engineering (Role-specific)

How to prepare

  • Answer aloud and timed: What are the security implications of storing patient data in a public cloud environment?
  • Answer aloud and timed: Tell me about a time you had to explain a technical limitation to a non-technical stakeholder.

Where candidates lose points

Research the Department

UW Medicine is vast. Before your interview, find out which specific department or lab you are interviewing with and look up their recent research or clinical initiatives.

Prepare for the Panel

Practice speaking to a group. When answering, try to engage multiple people on the panel, not just the person who asked the question.

Highlight Security

In every technical answer, consider the security and privacy implications. At UW Medicine, data protection is a top priority.

Be Transparent

If you don't know an answer, walk the interviewer through your thought process on how you would find it. Honesty and a logical approach are valued more than "faking it."

Questions & practice

Find overlapping job attempts and peak concurrency from lease records

Medium · sweep line · intervals · leases

A day of job_run history yields about 50,000,000 attempt records: (job_run_id, job_type, attempt, started_at, finished_at which is NULL when the worker died, lease_expires_at). Leases expire on a clock, so a job that outran its lease ran twice. Produce (a) every job_run_id whose attempts overlapped in wall-clock time and (b) the peak number of simultaneously running attempts per job_type with the minute it occurred. Target O(n log n). State how you treat a NULL finished_at and what clock skew does to your answer.

Approach

  1. Define the interval before sorting anything: an attempt occupies [started_at, COALESCE(finished_at, lease_expires_at)). finished_at is observed and lease_expires_at is only a promise, so every attempt without a finish contributes an estimate and the whole result is a lower bound on overlap rather than an exact count.
  2. For peak concurrency, sweep: emit 2n endpoints, sort by (timestamp, kind) with ends ordered before starts at equal timestamps, then walk the sequence maintaining a counter per job_type and record each type's maximum with its timestamp. O(n log n) dominated by the sort, O(n) space, or O(1) extra if the sort is external and the walk streams.
  3. For overlap detection, do not compare attempts pairwise. A single global sort by (job_run_id, started_at) gives both the grouping and the order; within a group, keep the maximum end seen so far and report an overlap exactly when the next start is less than that running maximum, which is one linear pass after the sort.
  4. Half-open intervals matter and are easy to get wrong: with closed intervals an attempt ending at the same millisecond another begins reads as concurrency two, and across 50,000,000 records that artefact swamps the real signal.

Follow-up

  • A handler is not idempotent and you have found 400 overlapping jobs. Which of them actually caused damage, and what would you query to find out?
  • Peak concurrency for one job_type is 4 against a configured cap of 4. Is the cap working, or is the data hiding attempts that never started?

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?

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

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

Explain the difference between an inner join and an outer join and when you would use each in a clinical datab

Medium · Technical & Domain Knowledge

Explain the difference between an inner join and an outer join and when you would use each in a clinical database.

Approach

  1. Name the grain you start from and join outward from it.
  2. Check whether any join is one-to-many before aggregating, or the sums inflate.
  3. Say which index the query would use, and what makes it unusable.
  4. Handle the rows that do not match: that is usually the actual question.

Follow-up

  • How does the query change if that join becomes one-to-many?
  • What happens to this when the table is ten times larger?

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 would you design a system to ensure 100% data integrity for patient records during a migration?

Medium · Technical & Domain Knowledge

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 security implications of storing patient data in a public cloud environment?

Medium · Technical & Domain Knowledge

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?

Describe your process for debugging a memory leak in a production environment.

Medium · Technical & Domain Knowledge

Approach

  1. Establish what changed and when, before forming any theory.
  2. Pick a bisection that eliminates candidates whichever way it turns out.
  3. Check the instrumentation before believing the symptom.
  4. Separate the trigger from the cause; the deploy is rarely the bug.

Follow-up

  • What would you look at first, and what would it rule out?
  • How would you tell a cause from a coincidence here?

Suggested practice checklist

Built from the rounds and topics UW Medicine candidates report.

Day 1 — Map the UW Medicine loop

  • Write out the reported sequence: Phone Screen, Intensive Rounds, Onsite Panel.
  • 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 Software Engineering (Role-specific)

  • Spend the session on Software Engineering (Role-specific), which UW Medicine candidates report being tested on.
  • Write one worked example in Software Engineering (Role-specific) and time yourself on it.

Deliverable: One timed worked example in Software Engineering (Role-specific).

Day 3 — Work Coding/Programming Problem Solving

  • Spend the session on Coding/Programming Problem Solving, which UW Medicine candidates report being tested on.
  • Write one worked example in Coding/Programming Problem Solving and time yourself on it.

Deliverable: One timed worked example in Coding/Programming Problem Solving.

Day 4 — Work Technical Interviewing

  • Spend the session on Technical Interviewing, which UW Medicine candidates report being tested on.
  • Write one worked example in Technical Interviewing and time yourself on it.

Deliverable: One timed worked example in Technical Interviewing.

Day 5 — Answer out loud: Technical & Domain Knowledge

  • Answer aloud, timed: How would you design a system to ensure 100% data integrity for patient records during a migration?
  • Answer aloud, timed: Explain the difference between an inner join and an outer join and when you would use each in a clinical database.

Deliverable: Spoken answers to 2 reported Technical & Domain Knowledge question(s), under time.

Day 6 — Answer out loud: Behavioral & Leadership

  • Answer aloud, timed: Tell me about a time you had to explain a technical limitation to a non-technical stakeholder.
  • Answer aloud, timed: Describe a situation where you had a conflict with a team member. How did you resolve it?

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

Day 7 — Dry run for UW Medicine

  • Run one full mock under time, then write down the two questions you most want to ask your interviewers.

Deliverable: A completed timed mock and two questions to ask.

Behavioural preparation

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

How do you handle concurrency issues in a high-traffic web application?

Medium · Technical & Domain Knowledge

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 time you had to explain a technical limitation to a non-technical stakeholder.

Medium · Behavioral & Leadership

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 situation where you had a conflict with a team member. How did you resolve it?

Medium · Behavioral & Leadership

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?

What draws you to UW Medicine specifically, rather than a traditional "Big Tech" company?

Medium · Behavioral & Leadership

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?

Give an example of a project where you had to learn a new technology very quickly.

Medium · Behavioral & Leadership

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 prioritize your tasks when you have multiple high-priority requests from different departments?

Medium · Behavioral & Leadership

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?