How To Ace The Multiple Mini Interview (MMI) Breaking Bad News Acting Stations
Multiple mini interview (MMI) acting stations (aka role-play scenarios) or scenarios are designed to make you uncomfortable and to see how you battle discomfort. They force you to suspend disbelief long enough to bring your own values, empathy and communication skills into a totally artificial situation. The actor will be doing an excellent job of suspending disbelief and you must buy in to the scene in order for you to think about it clearly and honestly.
For example, if the MMI acting station asks you to break bad news to a patient, you need to realize - and behave according to - the gravity of the situation. You need to be able to recognize that this is one of those conversations in a person’s life that they will later describe as “the moment everything changed.” If you have a weird grin on your face because you are denying the “realness” of the scenario, the evaluator has no choice but to assume you aren’t aware of your facial expressions and aren’t a strong communicator. The best performers in these stations buy in to the scenario without making the scenario all about them. It is always about the patient. It is ALWAYS about the patient (or those under your care, depending on the acting station that could mean your patients, your students, your employees, etc.)
Doctors (dentists, pharmacists and other healthcare professionals) are involved in an untold number of these situations in their lives. And that’s the entire point of the multi-mini interview. We can’t try everyone out at medical school. We can’t have you in clinic with us for a few months to see how it goes. We only have the MMI to simulate real enough situations that hopefully serve to tell us something about you as a person. And this is crucial. Even if the scenario asks you to break bad news to a friend or to fire an employee or debate the quality of science education, it is really all about you as a potential doctor. If you’re trying to figure out how to act in a situation, ask yourself what a doctor would do because that’s the standard the evaluators are interested in.
When it comes to breaking bad news in an acting station, the SPIKES Protocol developed by Dr. Walter Baile, is really the go-to for a guiding light.
MMI Acting Station/Scenario Example:
I will use the SPIKES Protocol to represent a dialogue between a candidate and an actor during an MMI acting station where the candidate is asked to share a very unexpected test result with a patient:
- Candidate: Hi, my name is Ashley. How are you today? (Make Eye Contact, Shake Hand, Point to the Chair to Encourage Actor to Sit)
- Actor: I feel great, thanks. I would love to know my test results.
- Candidate: Absolutely. How have you been feeling since we last met?
- Actor: I feel quite well. Life is stressful, there is a lot going on at home. One of my children is struggling at school and my partner is travelling for work a lot. I feel overwhelmed some times.
- Candidate: That does sound overwhelming. What kinds of support do you have at home?
- Actor: I have my mother and my eldest daughter is a huge help. But she’s leaving for college soon and I will absolutely be sad to see her go, but so proud of her at the same time, you know?
- Candidate: I absolutely hear that. Congratulations to your daughter. We have a lot to discuss today. Would you like to have your daughter or mother or partner here before we get started?
- Actor: No, no, I don’t want to burden them with coming all the way down here. It’ll be fine.
- Candidate: Ok, great. So let’s go back to why we ran these tests in the first place. What’s your understanding of why we ordered the last scan?
- Actor: Well, I have had this headache for a long time and you just wanted to make sure it was nothing.
- Candidate: Right, that’s right. So how would you like to hear the results? Would you like to go over it line by line or do you want just the important stuff?
- Actor: Oh no, that sounds scary. Should I be scared?
- Candidate: The scan revealed some information that I wasn’t expecting. We found something serious and that’s why we are going to take the time to review today. How does that sound?
- Actor: Ok, fine, but tell me: Do I have cancer?
- Candidate: Unfortunately, the scan shows that there is a growth on the right side of your brain. I cannot tell you right now for sure that it’s cancer, but that is what we will figure out today when we arrange follow up.
- Actor: (silence…allow the silence)
- Candidate: This is really difficult to hear. I am sorry this is happening.
- Actor: I can’t believe it. I have a brain tumour?
- Candidate: Let’s go through the results together and I can answer your questions. Yes, you have a brain tumour. However, what that means for you and your health is not yet clear.
- Actor: (starts to cry)
- Candidate: I am sorry I don’t have a tissue here. (allow the silence and the crying). I know this isn’t what you were expecting today. And I am sure it isn’t what you wanted to hear.
- Actor: What do I do now?
- Candidate: First, I think the next hard thing will be sharing with your family. I am happy to have them come in so we can do that together. I know that some people have lots of questions in these situations but the moment I say the word “tumour” they can’t think straight anymore. It can be so helpful to have a loved one in the room going over the details.
- Actor: Yes, I think that’s a good idea. My husband is home tomorrow and so is my daughter. I think we should come back. I feel so awful all of a sudden - what are they going to do without me?
- Candidate: I think there is a lot to talk about with your family, and I am happy to facilitate.
- Actor: Ok, oh my god, this is so strange…It feels unreal…I have a brain tumour. (starts to cry again).
- Candidate: (nods head. sits comfortable in silence.) This is news I don’t like giving but it doesn’t mean there isn’t hope.
- Actor: So what do I have to do now?
- Candidate: I think it’s best if we could sit down with you and your family tomorrow to talk through everything. But in the meantime, are you comfortable if we go over some of the options for treatment? And next steps?
- Actor: Yeah, I think so. I might forget everything, this feels so weird, so you might have to repeat yourself tomorrow.
- Candidate: That’s no problem at all, I am here for you. You’re going to have a team of people helping and we will do whatever you feel you’re up to in terms of approaching this problem.
Often, in the stem of the question in a multiple mini interview acting scenario, you won’t be given details about the particular diagnosis. In the above sample acting station, I made up some general details about the scenario to make it feel more real. I wouldn’t recommend getting too specific because you’re not a doctor and some of the specifics won’t make sense. You risk annoying your evaluator if you make up fake medicine.
The entire point of this station is to let the actor’s emotional presentation lead the interview. When someone is upset, don’t just ramble on and on because you’re uncomfortable. Don’t talk about how this is similar to something that happened to you, thereby making the scenario all about you. Try to do what you can to comfort the person. Often, this means introducing some safe silence into the situation. It means putting yourself in their shoes and thinking through what you might need if the situation were reversed.
MMI acting stations are about being a decent human being. There is no real trick to them. If you spend the whole station in your head trying to figure out the perfect thing to say at the perfect time, you will seem cold to the actor and the evaluator. Get into the situation and try to experience it authentically and you will do well.
Best of luck!
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About the Author
Dr. Ashley White, a former admissions committee member at McMaster, former MMI evaluator, and family physician.
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