As I begin my 4th year interviewing prospective medical students, I am reminded of how challenging it is to figure out which applicants will possess all of the characteristics that I would want in my own doctor.
There is little question that we need to rethink the way we educate medical students to meet the needs of a changing healthcare system. Medicine is no longer a paternalistic practice where the doctor tells the patient what to do. Not only are patients becoming more empowered to participate in the own care, but they also have information at their fingertips about their own conditions and can access online discussion groups to talk with other patients about their shared experiences. The blog Wing of Zock looks at innovative ways to redesign medical education.
But how do we make sure the students we accept into medical school are the people who will be successful in this new environment? Currently college students who want to become doctors have to take pre-med requirements – courses like chemistry, organic chemistry, biology, physics and calculus – and do well in those courses. Then they need to take a standardized test, called the Medical College Admission Test (MCAT). Although an interview is also part of the admission process, research shows that interviews do not do a good job of predicting who will be a good clinician.
So how do we identify applicants who will be compassionate, will work well in teams (in “pit crews” rather than as “cowboys” as articulated by Dr. Atul Gawande), understand how to use social media, be able to promote shared decisionmaking – and also have the capability to master the scientific material? Grades and MCAT scores are designed to help identify people who will do well in the science courses in medical school and interviews have been used to help identify people who will do well with the clinical work.
But, in addition to being poor predictors of clinical success, research has shown that medical school interviews tend to be biased because interviewers make a judgement about the applicant within the first few minutes. To overcome these problems, some schools are experimenting with a process called the “Multiple Mini-Interview” or MMI. In this system, each applicant has multiple (usually 8) short interviews – each with a different person. Each interviewer is given one specific question or scenario to ask each applicant. The scenarios are specifically designed to find out if the applicant has certain traits that are desirable in a doctor such as communication skills, teamwork, ethical thinking and problem solving ability. Because each applicant is asked to discuss all 8 scenarios and each interviewer discusses the same scenario with all of the applicants, this is meant to minimize bias.
Researchers have been studying the MMI for several years and so far it looks like the process may be better at predicting clinical success than a single (longer) interview. And there appears to be less bias since applicants who do poorly discussing one scenario but do well with the other 7 will still score well overall.
Time will tell if the MMI is truly a better way to select our future doctors.