By Jeremiah Fleenor, MD, MBA
In recent months and years, the popular press and scientific journals have seen an increased interest in the multiple mini-interview (MMI) with regards to medical school admissions. It seems to be the new buzz word in the admissions circles. As one would expect, there is a bit of skepticism from the applicants and a touch of intrigue regarding the new format. This is very appropriate for any new process, especially one that plays such a big part in your future as a physician.
The emergence of the MMI brings with it many new questions:
-Why are medical school admissions committees (ADCOM) switching to this new format?
-What was wrong with the old way they did interviews?
-What are the admissions committees looking for?
-Why are some schools using the MMI and others not?
I hope to answer these questions in this two part series. The information is vital for your success and will likely provide you with a leg up on your fellow applicants. It will also provide some welcomed peace of mind.
In The Beginning
It’s not hard to understand that admissions committees want two general skills from the physicians they graduate: to be smart and personable. This after all is the stereotypical view of a physician: an intelligent, caring person. Now I’m using these two categories very broadly, especially personable, but let’s look at each one in more detail to gain a better understanding.
It is no secret that patients expect the doctors caring for them to be smart. The field of medicine is a demanding one that requires a certain cognitive ability from physicians in order for them to be competent and successful. A doctor needs to have a certain ability to process and critically analyze information to functionally do his or her job. We’re not breaking any new ground with these statements.
The shocker may come when you learn just how smart medical schools expect you to be. According to the Medical School Admission Requirements (MSAR), the average GPA and MCAT scores for the 2011 admissions cycle were 3.5 – 3.75 and 30, respectively. Those are some high marks and they just seem to climb every year.
Admissions committees’ love of applicants with good grades is not likely to change either. They have solid data backing up their strong commitment to only let in applicants with high marks. Multiple studies have shown that “preadmission GPA” is the best predictor of success in medical school with regards to the didactic component of training. In other words, the higher the GPA, the more likely the applicant will successfully complete/pass the courses and certification exams that focus on the didactic (non-clinical) components of medical school. It’s just that simple.
Even more broad than the category of a physician’s mental capacity is that of his/her personality. From the admission committee’s point of view your personality consists of your ability to communicate, your attitude, how you interact with others, your ability to empathize and your ethical tone. These traits and characteristics are what I mean when I use the term “non-cognitive.” Of note, non-cognitive doesn’t mean that whatever is being assessed doesn’t require thought. When you are going through a multiple mini-interview you will be thinking a great deal. It simply is meant to communicate that the evaluation is assessing the components of an applicant’s overall personality and not their cognitive function.
Why do admissions committees even care about your personality? To put it bluntly and simply, once you have crossed the threshold of sufficient cognitive ability, nearly the entirety of your success as a physician is determined by these above factors. In other words, your “bedside manner,” conscientiousness and ability to get along with co-workers, determines how successful you will be as a clinician; both in the clinical years of your medical education and, I would argue, throughout your career as a practicing physician. That’s rather significant and why admissions committees try so hard to determine the personality of each applicant.
To date, admission committees largely have used the medical school interview to help them determine the strengths and weaknesses of an applicant’s personality. This usually consists of two, approximately 20-45 minute long interviews with members of the admissions committee. These people are usually physicians, researchers or current medical students associated with the university. Once the interview is complete, the interviewers try to communicate their assessment of the applicant’s personality to the ADCOM. The admissions committee then comes to a consensus and makes a decision on the applicant.
This all seems well and good but the rub comes when you start to look at how accurate the interviewers are at predicting the personality, and in turn, success, of any given applicant. The truth of the matter is, they’re not very good at all. With regards to the scoring of an applicant by an interviewer, here’s how disparagingly one journal article puts it, “…despite acceptable interrater reliability in some cases, a candidate’s score may still be attributable, in large part, to chance”.
One of the ways in which researchers attempt to study personality with regards to medical students is via an Objective Structured Clinical Examination (OSCE). This is a type of test that measures clinical skills and takes into account your ability to communicate and interact with patients and co-workers. In some ways an OSCE score is a proxy for personality. It’s not a perfect way to assess these aspects of a person but does a reasonable job and is the preferred format to date.
A study published in 2004, showed that the personal interview was able to predict the mean performance on an OSCE at .06. To understand this more, a score of 1 would mean that for every unit increase in the interview score would result in the same unit increase on the OSCE score. A score of -1 would essentially mean the opposite or that the interview score and the OSCE score were inversely related. And a score of 0 would mean that the interview can’t tell you one way or another how a student will perform. So a score of 0.06 means that the interview was little better than the toss of a coin in predicting how well an applicant would perform in clinical areas.
Chance?! A coin toss?! I sure wouldn’t want my future hopes and dreams of becoming a physician coming down to a roll of the dice or a 50/50 proposition and I suspect you feel the same way. The good news is that more and more U.S. medical schools are starting to feel this way as well and are adopting a more ethical and predictive way to assess applicants.
Enter the MMI
Please check back later for Part 2 of this series on the MMI. We will cover the logistics of an MMI and look at the data that supports its use. This will provide a look behind the scenes of the ADCOMs and shed some light as to why the MMI is gaining such increased acceptance abroad and in the U.S.
If you have any questions please email Dr. Fleenorn, author of The Medical School Interview: Secrets and a System for Success 2nd ed., at [email protected].
Part one of a two part series. Return next week for part two.
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