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An approach to the multiple mini interview (MMI):
- Synthesize, Don’t Summarize
- Clarify Context
- Weigh both sides
- Examine the best possible outcomes
- Name the Ethical Tension
- Take the Opportunity for Empathy
- Answer the Question
- Include Appropriate Caveats
Synthesize, Don’t Summarize
- Most students start their answer their multiple mini interview (MMI Interview) questions with a restatement of the question. This is fine. But it isn’t excellent.
- A synthesis statement demonstrates that you read and understood the question, AND that you immediately bring some elevated insight to the response.
- A synthesis statement typically alludes to the ethical tension but it can also reference current events (for questions related to hot issues in medicine) and very relevant personal experience (do not stretch to make this fit).
- Naming assumptions that you’re making when giving your response.
- Weighing both sides in a more traditional pro-con manner.
- Asking out loud the kinds of questions you would need answered in order to make the best possible decision.
- Using ‘2x2 If-Then’ Tables to articulate anticipated outcomes of various scenarios.
- For questions that ask you to make a choice between people – classically, these questions ask you who should get an organ in a time of need – or between Option A or B, think about these questions in terms of 2x2 tables. So, if you have to give a kidney to one of two people, what are the best and worst possible outcomes for each choice?
- In an MMI Interview, this might sound like, “If I select the 80 year old patient – I really don’t care if he is a professor or not because occupation shouldn’t matter – then the best outcome is that he lives another 20 years. The worst outcome is… If I select the 20 year old, then the best outcome is… and the worst outcome is…
- Often, questions will offer you a choice between Option A and B. But, a critical thinker will be able to entertain Option C. And maybe D. Depending on your background, you may know that dialysis is a reasonable temporizing measure for people on kidney transplant waiting list and maybe it can be leveraged to help make the decision easier: Everyone gets a kidney. If you have no technical knowledge of medicine – and this will NOT be held against you in an MMI – then I am sure you could imagine that there are Ethics Boards and other people that will weigh into a decision. Asking for assistance after reasonable thought and description of the question is entirely reasonable as an Option C, if you have already done the work thinking through Option A and B.
Name the Ethical Tension
- Name the opposing conflicts in the scenario:
- i.e. personal autonomy versus public health
- i.e. protecting patient confidentiality versus protecting the public
- i.e. maintaining a personal friendship versus following the duty to report
- This doesn’t need to include lots of legal terms or medical ethics terms, it just needs to be a clear statement of the inner conflict you’re sensing and seeing in answering the question.
Take the Opportunity for Empathy
- This is where you simply put yourself in the shoes of everyone involved in the scenario.
- Some often missed elements include the perspectives of the public, the person or group being cast ‘in the wrong’ by the scenario and unsympathetic bosses, landlords, teachers, professors, doctors, lawyers.
- This can be as simple as saying “I would sit and have a conversation with this person and ask ‘What is going on for you? Share with me how you see this situation?”
- Often taking the opportunity for empathy comes naturally when you’re clarifying context but make a point to think how you can think about the perspectives of al parties in your answer.
Answer the Question
- Never leave an interviewer wondering whether or not you would or would not report a colleague, give the organ to the younger patient, etc.
- You want to leave the impression that – even in imperfect conditions – you have the ability to make a decision and act based on what you know and what you learned.
Example Multiple Mini Interview (MMI) Question & Answer:
You are a medical student on a general surgery rotation. Your staff physician has delegated your learning to her Chief Resident who has a great surgical reputation and performs most operations with minimal supervision. On your first day, you report to him and he says, “I don’t care what you do, just don’t get in my way.” How do you approach this situation?Synthesize: “I am on a rotation where there is a lot to learn – general surgery – and I don’t have a teacher which leaves my learning at risk. Also, my chief – who I am supposed to look up to – is neglecting his duties so that he can spend more time in the OR and my Staff Physician likely has no idea or doesn’t care.”
Clarify Context: “I would need to discuss with my fellow medical students to see if this particular general surgery service has a bad reputation for teaching, or if anyone else has had this problem. I also need to know if I am the only medical student assigned to this service, or if there is a group of us being neglected….”
Clarify Context (Cont’d): “…then I need to see if there are any Junior Residents who I can follow along to get something out of this rotation. I also need to figure out who from the medical school deals with situations like these so if I need some guidance, I can get some.”
Opportunity for Empathy: “A Chief Resident is a really tough job. I bet he is sleep deprived, underfed and preparing for his final certification exams. Maybe he has had some really tough cases or maybe this is how all medical students are treated on general surgery rotations at this hospital, and he doesn’t know any better. Regardless, I am also in a vulnerable position because I don’t know if I can pass my exams or meet the requirements of the rotation if I don’t see any patients or any surgeries.”
Ethical Tension: “If I take steps and go above the Chief, I know I risk a poor evaluation and suffering while I am here. If I don’t, I might not pass the rotation. So it’s a matter of keeping the peace or standing up for what is right.”
Answer the Question: “Though I feel for this Chief, part of the job of being Chief is to teach medical students. I am here to work and I will show up early to work every day to gather lab results, examine my patients, discuss their progress with the nurses and see how my patients are doing. I will show this Chief that involving me in the care of the patients actually makes his life easier. Through this, I hope to convince him to take me seriously as a learner. However, if this doesn’t happen despite my efforts, I will work with the medical school to figure out who to talk to in order to improve the situation, if not for me, then for the next rotation. It is unfair to put a medical student in a situation that is hostile to learning but I also know that I have to make the most of any situation.”
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