I was pathetically nervous for my first multiple mini interview (MMI). It was 2007. I was interviewing at a med school. They asked me a question about breast-feeding. I do not know what the question was. I do not recall my answer. I do, however, recall the intense corporal anxiety associated with me fumbling for an answer to the question. I was so focused on figuring out the correct answer that I did not spend any time telling that interviewer about my relationship to the topic, how I think, the way I problem-solve, or who I am. I did poorly on that interview. And I was not accepted that year.
Since 2007, I have participated in three MMI interviews as a candidate and two more as an evaluator at McMaster med school. Of the dozens of MMI questions I have encountered since my first MMI experience, I only felt very well prepared - substance wise - for a handful. I only had pre-designed answers for those questions that had to do with me and my life.
There is no use trying to pre-design your answers for the majority of MMI questions. There is a lot of value, however, in reflecting on the various experiences that you've had that lead you to the moment of the interview. There is also a lot of value in reflecting on your own opinions, your moral persuasions, your own biases and your own view of the major issues facing our public today.
If we could, we would try out potential doctors in the clinic and in the hospital to test their suitability for the profession. But, this is completely unrealistic. All we can do is leverage a system that is designed to have each candidate paint us a picture of who they may be as a physician. We can then map our impression of each candidate onto the clinical setting based on their responses to how they would behave or respond in a variety of stressful, ethically-nebulous situations.
What is that system?
It is the MMI. This unique, and now popular, interview format began in 2002 at McMaster University as part of a research project aimed at understanding how to select for the kinds of medical students that would eventually become humane, and competent doctors. McMaster was hyper-aware that medical schools across Canada & the United States were graduating students about which patients frequently complained. The Official Interviewer Manual is in the public domain and it explains how McMaster uses the MMI to select for specific traits in their student body.
At an MMI, each candidate is asked to participate in a variety of short problem-based stations. Traditionally, these stations last for 10 minutes each and there are 12 stations in each interview. However, there are many variations on these details. Each station involves something new: a new patient (actor - here's how to ace the MMI interview acting stations), a new issue to problem solve around, a debate, a team-building exercise. For the details of the MMI you will take, please review the website of the individual institution.
Schools all around the continent now use the MMI, and non-medical schools are even now on-board with the assessment tool, such as the Michener Institute for Applied Health Sciences.
Does the system work?
First, we have to mention that the MMI is not perfect and in a previous blog we highlighted some shortcomings inherent in multiple mini interviews.
Here is a 2013 systematic review synthesized over 10 years of MMI research. The most important questions that MMI researchers ask are:
1. Is the MMI at least as good as a traditional panel interview in predicting future performance on medical licensing exams?
2. Is the MMI at least as good as a traditional panel interview in predicting professionalism in practice?
The systematic review found that the answer to the first question is: Yes. The answer to the second question? Not sure, more research is required. The findings persist for assessment of MMI performance as a valid predictor of licensing performance for international medical graduates (IMG) (http://www.ncbi.nlm.nih.gov/m/pubmed/19493182/). In their 2009 study of MMI validity for licensing exam performance predictions, Eva et al write "although a complementary predictive relationship has consistently been observed between grade point average and MMI results, the extent to which cognitive and non-cognitive qualities are distinct appears to depend on the scope of practice within which the two classes of qualities are assessed" (http://www.ncbi.nlm.nih.gov/m/pubmed/19659490/). That is, in some practice settings, there are professional skills that matter but have nothing to do with the cognitive assets employed on the licensing exam. Conversely, there are practice settings for which the professional skills required match the cognitive and non-cognitive skills assessed in the licensing exam perfectly. So, when it comes to figuring out if the MMI will predict things like possible future complaints from regulatory bodies, the verdict is still out.
Though it was originally designed as a vehicle for assessing personal traits and professional acumen in medical students, it is claimed that the MMI is actually a great predictor of cognitive performance as assessed by the licensing exams. Licensing exams do, however, have sections dedicated to the legal and ethical issues of medical practice but do not test their deployment in a simulated clinical setting.
How do I do well on the MMI? 6 Pro Tips Below!!!
First, as you may already know and as evidence shows, you must practice with realistic timed simulations and get expert feedback for your responses to learn from your mistakes.
MMI Interview Tip #1
Relax: Examiners and actors want you to be at ease so they can get to see the real you. No one wants this to be stressful. No one is out to watch you fail. Everyone wants to have an interesting conversation with you.
MMI Interview Tip #2
Thoughtful Quality: Take your time to say a few things of substance rather than rushing into a topic with a bunch of cliched phrases while you buy yourself time to think up something good. Just take a second. Take a deep breath. Square your shoulders. Smile warmly. You already have something of substance to say because you’ve been practicing, reading and journaling widely.
MMI Interview Tip #3
Empathy: When situations call upon you to be in relationship with another person, situate all your actions and positions from an “If I was in their shoes, what would this be like?” perspective. This shows intellectual adaptability and humane situational analysis skills. And it’s what is asked of doctors every day, all day.
MMI Interview Tip #4
Ethical Acumen: Know your ethical principles and the legal framework for controversial issues. Read Doing Right by Philip Herbert and be prepared to draw upon the terminology in framing your responses.
MMI Interview Tip #5
Don’t force the story, but try to tell it: Often, you will see no direct parallel between the MMI question and your own life. That’s ok. Don’t try to worm in a story about your time on the water polo team when they’re asking you about end of life care. But if the question is about handling conflict, definitely share some insight into your life and particular situations.
MMI Interview Tip #6
Practice with realistic mock MMIs and get expert feedback: Lastly, as I mentioned above, I believe everyone should get professional MMI prep coaching or someone with the expertise to set up a mock MMI with you and provide you with expert feedback. The pudding is in the practice and the only way to prepare is through high-fidelity practice. So put on your suit. Get your little sister to play act an MMI scenario from the internet and get feedback from a family member or friend who is a practicing medical doctor. Or enroll in one of our MMI prep programs and we will put you through the ringer so you’re ready come game day. Guaranteed or your money back!
About the Author
Dr. Ashley White, a former admissions committee member at McMaster, former MMI evaluator, and a family physician.
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