As a Software Engineer at MD Anderson Cancer Center, you are not just writing code; you are building the digital infrastructure that supports one of the world’s most renowned cancer research and treatment institutions. Your work directly impacts the ability of clinicians, researchers, and administrative staff to deliver life-saving care. You will be tasked with developing, maintaining, and scaling software solutions that manage complex clinical data, streamline hospital operations, and facilitate cutting-edge oncology research. This role requires a unique blend of technical rigor and mission-driven empathy. You will navigate high-stakes environments where system reliability and data integrity are non-negotiable. Whether you are optimizing backend services or integrating departmental systems, your contributions directly influence the operational efficiency of the center. Expect to work within a highly collaborative, multidisciplinary ecosystem where you will interact with both technical peers and non-technical stakeholders who rely on your expertise to solve critical health-tech challenges. ##### Tip The hiring process at MD Anderson Cancer Center is known for being thorough and occasionally lengthy. Patience and persistence are key traits for successful candidates navigating their recruitment pipeline.
Initial Screening
reportedCandidates undergo an initial screening with Human Resources.
What to demonstrate
- Candidates undergo an initial screening with Human Resources
- Depth in Programming Problem Solving
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.
Technical Interviews
reportedCandidates participate in technical interviews with the hiring manager.
What to demonstrate
- Candidates participate in technical interviews with the hiring manager
- Depth in Programming Problem Solving
How to prepare
- Answer aloud and timed: Describe a time you had to learn a new technology or framework under a tight deadline.
- Answer aloud and timed: How do you balance the need for rapid feature delivery with the necessity of maintaining robust, bug-free code?
Peer Reviews
reportedPotential peer reviews with members of the department or related teams occur.
What to demonstrate
- Potential peer reviews with members of the department or related teams occur
- Depth in Programming Problem Solving
How to prepare
- Answer aloud and timed: Describe a situation where you had to explain a complex technical concept to a non-technical stakeholder.
- Answer aloud and timed: Tell me about a time you disagreed with a team member or manager regarding a technical direction. How did you resolve it?
PracHub editorial advice for the preparation topics above.
Structure your answers
Use the STAR method (Situation, Task, Action, Result) to keep your behavioral answers concise and impactful.
Emphasize impact
In your examples, clearly state how your code or system improved the user experience or saved time for clinical staff.
Research the mission
Familiarize yourself with the core values of MD Anderson Cancer Center; they are looking for people who are invested in the center’s goal of ending cancer.
Prepare for follow-ups
Interviewers may ask deep-dive questions about your previous projects; be ready to defend your architectural decisions.
Choose a category, try a prompt, then open its approach, worked solution or follow-up when you need it.
How do you balance the need for rapid feature delivery with the necessity of maintaining robust, bug-free code
How do you balance the need for rapid feature delivery with the necessity of maintaining robust, bug-free code?
Approach
- Restate the input: its shape, its size, and what is guaranteed about it.
- Name the brute-force solution and its complexity before improving on it.
- Choose the data structure from the access pattern, not from familiarity.
- State the target complexity and say which constraint rules the naive version out.
Follow-up
- How does this change if the input no longer fits in memory?
- What is the worst case, and how likely is it on real data?
Merge partitioned event streams into one ordered feed with bounded lateness
The read-model service consumes 64 log partitions carrying about 4,000 events per second in total. Each partition is ordered within itself, but partitions drift by up to 30 seconds, and the activity feed must present a tenant's events in occurred_at order. Produce the merge. State its complexity, the buffer it requires in events and in bytes, what happens when one partition is idle, and what you do with an event that arrives after you have already emitted its position. Payloads average 1 KB.
Approach
- Merge with a min-heap over the 64 partition heads keyed on (occurred_at, event_id): O(log P) per event and O(n log P) overall. The tie-break on event_id is what makes the output deterministic when two partitions carry the same millisecond, which matters because the feed is paginated and a non-deterministic order reorders pages under the reader.
- Emitting the heap head is only correct once every partition has produced everything up to that timestamp, so the emit condition is a watermark: the minimum across partitions of the highest occurred_at seen, less the allowed lateness. Events are held until the watermark passes them, which is what turns individually ordered streams into a jointly ordered one.
- Size the buffer from the lateness rather than guessing: 4,000 events per second times 30 seconds is 120,000 buffered events, and at 1 KB each about 120 MB of heap. That number is the real price of the ordering guarantee and belongs in front of whoever asked for it.
- Handle the idle partition explicitly, because it fails the feed rather than corrupting it: a partition with no traffic never advances its own maximum, so the watermark freezes and output stops entirely. Either every partition emits a periodic idle marker carrying the broker's current time, or the watermark falls back to wall clock for a partition silent beyond a threshold.
Follow-up
- The lateness budget is raised to five minutes. What is the new buffer, and what besides memory changes?
- The consumer restarts. Where does it resume from, and what does the feed look like for the first 30 seconds?
Track a rolling failure rate per destination for circuit decisions
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?
Denormalise tenant onto revisions and backfill it live
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
- 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.
- 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.
- 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.
- 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?
Hold a per-tenant active cap against concurrent creates
A tenant on the standard plan may hold at most 50 resources with status='active'. The create handler runs SELECT count(*) FROM resource WHERE tenant_id = $1 AND status = 'active', compares to 50, then inserts. Two creates arrive 3 ms apart on different instances and the tenant lands at 51. Name the anomaly, say whether PostgreSQL 16 READ COMMITTED or REPEATABLE READ prevents it and why, then give an implementation that holds the cap at READ COMMITTED with the exact statements. Finally, say what changes when the cap is 'at most one running export per tenant' on job_run.
Approach
- Name it: write skew. The two transactions read an overlapping set and write disjoint rows, so there is no row-level conflict for the engine to detect and each commit is individually legal.
- Rule out the levels precisely. READ COMMITTED takes a fresh snapshot per statement and takes no lock on the counted rows, so both see 49. PostgreSQL's REPEATABLE READ is snapshot isolation: it removes non-repeatable reads and phantoms within the snapshot but still admits write skew, because the anomaly is not a re-read of a changed row, it is a read of a set that a concurrent transaction invalidates. Only SERIALIZABLE closes it, by tracking the read dependency and aborting one transaction with SQLSTATE 40001 — a guarantee that exists only if the application re-runs the whole transaction from the read.
- Convert the set predicate into a single-row conflict: keep tenant.active_resource_count and run UPDATE tenant SET active_resource_count = active_resource_count + 1 WHERE tenant_id = $1 AND active_resource_count < 50 in the same transaction as the INSERT. Zero affected rows is the cap, returned as 409. The row lock serialises the decision at any isolation level, and contention is bounded to one tenant's row — which is also the fair-scheduling unit, unlike a global counter that would convoy every tenant behind one row.
- State the cost you just took on: a counter is a second source of truth that can drift, so every path that changes status must adjust it inside the same transaction, and a periodic reconciliation has to exist, with resource_revision as the authority for what the count should have been.
Follow-up
- A resource moves from archived back to active. Which statements change, and what breaks if the counter update and the status change land in different transactions?
- The cap becomes plan-dependent and a plan can change mid-month. Where does the number 50 live, and who reads it?
Explain your process for ensuring code quality and scalability in a large-scale enterprise application.
Explain your process for ensuring code quality and scalability in a large-scale enterprise application.
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?
Relay committed events to the log without gaps or reordering
outbox_event rows are written in the same transaction as the state change and carry aggregate_type, aggregate_id, aggregate_version, payload and status, with a partial index on (created_at, event_id) WHERE status = 'pending'. The relay publishes about 4k events/second to a partitioned append-only log keyed by aggregate_id, with one leader per partition range holding a lease. Consumers must never miss an event; they may see one twice. Design the claim-publish-mark loop, and state exactly what consumers observe when a leader's lease expires while it is mid-batch.
Approach
- Claim with SELECT ... WHERE status='pending' ORDER BY created_at, event_id LIMIT $batch FOR UPDATE SKIP LOCKED inside a transaction. SKIP LOCKED lets several relay workers share a range without serialising on each other's rows, and the partial index keeps the claim proportional to the backlog rather than to a table that is overwhelmingly published rows. At 4k/second a batch of 500 is eight claims per second, each an index scan of 500 entries.
- Publish before marking, never the reverse, and say why it is a choice. Marking first loses the event outright if the process dies in the gap, and the loss is silent - nothing remains to retry, and it surfaces later as a projection missing a row. Publishing first can repeat the event, and repetition is what every consumer is already built to survive. That single ordering is the whole at-least-once guarantee.
- Preserve the only ordering on offer. Partition by aggregate_id and never publish two events for one aggregate concurrently: claim in (created_at, event_id) order and publish sequentially within an aggregate, or hash aggregate_id to a worker slot. Order across aggregates is not available at any price here, which is why the event carries aggregate_version and the full fact rather than a delta - a consumer can then discard what it has already applied without coordinating with anyone.
- State the failover behaviour precisely, because it is the consistency-versus-availability decision in this design. A lease expires because the holder is slow, and no mechanism distinguishes that from dead, so for the length of the lease window two leaders can publish the same claimed batch. The system accepts duplicates to avoid stalling publication for every aggregate in the range whenever one worker pauses. Consumers deduplicate on (aggregate_id, aggregate_version) and drop anything at or below what they have applied.
Follow-up
- The relay is down 40 minutes and 9.6 million rows are pending. What does catch-up do to the primary, and what changes in the claim loop to survive it?
- A consumer insists it never received an event. Which single query settles whether the relay lost it, and what does each answer look like?
How do you approach debugging a critical system failure in a production environment?
How do you approach debugging a critical system failure in a production environment?
Approach
- Establish what changed and when, before forming any theory.
- Pick a bisection that eliminates candidates whichever way it turns out.
- Check the instrumentation before believing the symptom.
- 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?
Built from the rounds and topics MD Anderson Cancer Center candidates report.
Prepare, practise & reflect
One practical outcome each day. Spend longer where you need it.
0 / 7 done01Map the MD Anderson Cancer Center loop
- Write out the reported sequence: Initial Screening, Technical Interviews, Peer Reviews.
- 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.
02Work Programming Problem Solving
- Spend the session on Programming Problem Solving, which MD Anderson Cancer Center candidates report being tested on.
- Write one worked example in Programming Problem Solving and time yourself on it.
Deliverable: One timed worked example in Programming Problem Solving.
03Work Software Engineering Fundamentals
- Spend the session on Software Engineering Fundamentals, which MD Anderson Cancer Center candidates report being tested on.
- Write one worked example in Software Engineering Fundamentals and time yourself on it.
Deliverable: One timed worked example in Software Engineering Fundamentals.
04Work Analytical Reasoning
- Spend the session on Analytical Reasoning, which MD Anderson Cancer Center candidates report being tested on.
- Write one worked example in Analytical Reasoning and time yourself on it.
Deliverable: One timed worked example in Analytical Reasoning.
05Answer out loud: Technical Proficiency and Problem Solving
- Answer aloud, timed: How do you approach debugging a critical system failure in a production environment?
- Answer aloud, timed: Explain your process for ensuring code quality and scalability in a large-scale enterprise application.
Deliverable: Spoken answers to 2 reported Technical Proficiency and Problem Solving question(s), under time.
06Answer out loud: Behavioral and Interdisciplinary Collaboration
- Answer aloud, timed: Describe a situation where you had to explain a complex technical concept to a non-technical stakeholder.
- Answer aloud, timed: Tell me about a time you disagreed with a team member or manager regarding a technical direction. How did you resolve it?
Deliverable: Spoken answers to 2 reported Behavioral and Interdisciplinary Collaboration question(s), under time.
07Dry run for MD Anderson Cancer Center
- 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.
Expand any day for tasks and deliverables. Your progress is saved on this device.
Behavioural rounds judge the decision you made and what it cost.
Describe a time you had to learn a new technology or framework under a tight deadline.
Describe a time you had to learn a new technology or framework under a tight deadline.
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 situation where you had to explain a complex technical concept to a non-technical stakeholder.
Describe a situation where you had to explain a complex technical concept to a non-technical stakeholder.
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 disagreed with a team member or manager regarding a technical direction. How did you
Tell me about a time you disagreed with a team member or manager regarding a technical direction. How did you resolve it?
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 working in a highly regulated environment where compliance and documentation are prioritized
How do you handle working in a highly regulated environment where compliance and documentation are prioritized?
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?
Give an example of a project where you collaborated with multiple departments to reach a common goal.
Give an example of a project where you collaborated with multiple departments to reach a common goal.
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?
- 01
Describe a time you had to learn a new technology or framework under a tight deadline.
- 02
Describe a situation where you had to explain a complex technical concept to a non-technical stakeholder.
- 03
Tell me about a time you disagreed with a team member or manager regarding a technical direction. How did you resolve it?
- 04
How do you handle working in a highly regulated environment where compliance and documentation are prioritized?
Why does the hiring process take so long?
Due to the complexity of the organization and the critical nature of the work, internal processes for approval and vetting are extensive. Expect multiple rounds of interviews and potentially long waits between stages.
MD Anderson Cancer Center Software Engineer candidate reports ↗How can I stand out to the hiring team?
Focus on your ability to work in a team-oriented, mission-driven environment. Showing that you understand the specific challenges of healthcare software—such as data security and system uptime—is a major advantage.
MD Anderson Cancer Center Software Engineer candidate reports ↗Is there a specific technical stack I should focus on?
While the stack varies by team, focus on demonstrating mastery of fundamental computer science principles and your ability to learn new tools quickly.
MD Anderson Cancer Center Software Engineer candidate reports ↗What topics does MD Anderson Cancer Center test in interviews?
MD Anderson Cancer Center interviews most often cover Communication Skills, Presentation Skills, Program Management, Project Management, and Research project presentation. The exact emphasis depends on the specific role you apply for.
MD Anderson Cancer Center Software Engineer candidate reports ↗Sources & methodology 3 sources ↗
No official company page is cited. Rounds and questions come from candidate reports and PracHub editorial material; each source shows the date it was read.
- 01MD Anderson Cancer Center Software Engineer candidate reports ↗
Company-reported rounds, questions and FAQ.
Candidate reports · Accessed 2026-09-22 - 02PracHub Software Engineer practice ↗
PracHub practice material, not company-reported.
PracHub page · Accessed 2026-09-22 - 03PracHub preparation framework ↗
PracHub preparation guidance.
PracHub page · Accessed 2026-09-22
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