Exceptional academic ability will always be essential for physicians who must be skilled at processing and integrating large amounts of information. These academic skills tend to correlate well with grades and test scores. But faced with two applicants who are both exceptional academically, how does a medical school determine which one to accept?
For decades, the OHSU School of Medicine (and most medical schools) has made these determinations by relying, in large part, on two interviews, each an hour long. Information and clues gleaned from these interviews, combined with references, essays and descriptions of life experience, give an indication of other important physician attributes, such as empathy, honesty and an ability to deal with ethical complexity. But this approach is imperfect, largely because it depends so significantly on the perspective of just a few people.
Improving this process is at the heart of the groundbreaking new “multiple mini interview” (MMI) model that the OHSU School of Medicine will introduce this year. “The success of this new model depends on broad community participation,” said Cynthia Morris, PhD, MPH Assistant Dean of Admissions, OHSU School of Medicine. “While the time commitment is not huge for our volunteers, the impact is enormous.”
The framework that determines who is accepted to medical school has implications far broader than an individual applicant’s future. Physicians play an integral role in shaping the health care delivery system. Now, as the heath care system is rapidly evolving, many of these non-academic attributes are taking on a new importance. For instance, one important change already underway is the movement toward innovative delivery models, like medical homes, that rely on teams of health care professionals working side-by-side to manage a patient’s care.
“Attributes that enhance team-based health care, like communication skills, comfort with mutual decision-making and respect for other health professions will be increasingly important,” said Mark Richardson, MD, MBA, Dean, OHSU School of Medicine. “The MMI process will help in our ongoing goal to always be educating the types of physicians most needed by society.”
OHSU is not alone in its interest in modifying the evaluation process. Over the past several years, a growing attention to and body of research on this topic resulted in the MMI model. However, the OHSU School of Medicine is among the first in the US to put this model into action.
“This is a bold move for OHSU, one of fewer than 10 medical schools in the United States – including Stanford and UCLA, who've adopted the formal testing protocol called the MMI, for multiple mini interview. Will the brilliant still get in? Yes. Will a brilliant candidate who is tone-deaf to people, clueless to situational dynamics, and unyielding in collaboration with others get in? Likely not,” wrote the Editorial Board of The Oregonian on July 10, 2011, after interviewing Dr. Morris.
MMI testing works by placing applicants in seven to nine successive stations. At each station, an applicant may be presented with a standardized scenario or questions that requires the applicant to discuss a health-related issue with an interviewer or rater; interact with a standardized confederate in a scenario while a rater observes; interact with another applicant to complete a structured task; or answer a traditional interview question. The scenarios are constructed in ways that allow observers to assess an applicant’s behavior and whether or not the desired holistic attributes appear to be present. The applicant has a few minutes to absorb the information and think about a response. In some stations, the scenario will involve interacting with actors who are also confederates in the scenario.
Each station measures different attributes, such as responsibility, ethical and moral judgment, communication skills, management skills, problem solving, self awareness, teamwork and conflict resolution. For instance, to measure an aptitude for teamwork, a scenario may require one applicant to draw a diagram based upon a second applicant’s oral description. At another station to measure empathy and communication skills, an applicant may counsel a colleague who needs to board a plane for her job but has a fear of flying. At each station, a rater observes the response and completes a formatted scorecard for each applicant. These are then tallied over all the stations. The interview day will also include a traditional one-on-one interview but in a shorter, more focused format.
“Given that it takes nearly a decade to educate a physician, it will be some time before we can measure the impact of this approach on our health care system and physician community,” said Dean Richardson, “but we are convinced this is the right move now and we hope to involve many members of different health professions and the community to become engaged in it.”
VOLUNTEERS NEEDED TO SERVE AS STATION RATERS
Volunteers should be physicians (practicing or retired), clinicians, scientists or others with a connection to health care and a strong interest in contributing to identifying future physicians. Experience in evaluations or testing situations would be ideal, but not essential.
Selected volunteers will participate in a 90-minute training session in September and then sign up for at least three sessions of rating the medical school applicants. The MMI sessions with students will take place during the months of October to March. Each session is three hours, either morning or afternoon, and volunteers would need to be present for the entire session. The scoring is completed during the session and there is no preparation ahead of time necessary.
For additional information, please contact Lori Toner, Administrative Admissions Manager, 503-494-5950
- "Creating healthy doctors begins in medical school," July 15, 2011, The Oregonian Editorial Board
- "New for Aspiring Doctors, the People Skills Test," July 10, 2011, The New York Times
- "MMI: A New Hope," Aug 25, 2011, blog entry by OHSU medical student Yassar Arain, MS4