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Multiple Mini Interview (MMI): Winning Strategies From Admissions Faculty ispublishedbyMD2B,POBox300988,Houston,TX77230-0988.
www.MD2B.net
www.TheSuccessfulMatch.com
NOTICE:Theauthorsandpublisherdisclaimanypersonalliability,either directlyorindirectly,foradviceorinformationpresentedwithin.The authorsandpublishershaveusedcareanddiligenceinthepreparationof thisbook.Everyefforthasbeenmadetoensuretheaccuracyand completenessofinformationcontainedwithinthisbook.Thereadershould understand,however,thatmostofthebook’ssubjectmatterisnotrootedin scientificobservation.Therecommendationsmadewithinthisbookhave comefromtheauthor’spersonalexperiencesandinteractionswithfaculty, residents,andstudentsovermanyyears.Thereisconsiderablevariabilityin theadmissionsprocessfromonemedicalschooltoanother.Therefore,the recommendationsarenotuniversallyapplicable.Noresponsibilityis assumedforerrors,inaccuracies,omissions,oranyfalseormisleading implicationthatmayariseduetothetext.
©2016bySamirP.DesaiandRajaniKatta
Allrightsreserved
Nopartofthispublicationmaybereproduced,storedinaretrievalsystem, ortransmitted,inanyformorbyanymeans,electronic,mechanical, photocopying,recording,orotherwise,withoutthepriorwrittenpermission ofthepublisher.
PrintedintheUnitedStatesofAmerica
ABOUTTHEAUTHOR
SamirP.Desai,M.D.
Dr.SamirDesaiservesonthefacultyoftheBaylorCollegeofMedicinein theDepartmentofMedicinewhereheisactivelyinvolvedinmedical studentandresidenteducation.HeisamemberoftheClerkshipDirectors inInternalMedicine,andtherecipientofmultipleteachingawards.Heisan authorandeditor,havingwrittensixteenbooksthattogetherhavesoldover 200,000copiesworldwide.
Heistheco-authorofthe Medical School Interview: Winning Strategies from Admissions Faculty,ahighlyacclaimedbookthathas helpedthousandsofapplicantsdeliveracompellingandpowerfulinterview performance.Hisbook Success in Medical School: Insider Advice for the Preclinical Years providespreclinicalstudentswithdetailedknowledgeand guidancetoexcelandpositionthemselvesformatchsuccesslaterin medicalschool.Tohelpstudentslowerthecostofattendingmedicalschool andpositionthemselvesforresidencymatchsuccess,hewrotethebook Medical School Scholarships, Grants, & Awards.
Severalyearsago,heco-authored The Successful Match: 200 Rules to Succeed in the Residency Match,awell-regardedbookthathashelped thousandsofresidencyapplicantsmatchsuccessfully.Heisalsothecoauthorof Success on the Wards: 250 Rules for Clerkship Success.Thisbook hashelpedstudentsmakethedifficulttransitionfromthepreclinicalto clinicalyearsofmedicalschool. Success on the Wards isarequiredor recommendedresourceatmanyU.S.medicalschools,providingproven strategiesforsuccessinpatientcare,write-ups,rounds,andothervital areas.
Asafacultymember,hehasservedonthemedicalschooladmissions andresidencyselectioncommittees.Hiscommitmenttohelpingpremedical andmedicalstudentsreachtheirprofessionalgoalsledhimtodevelopthe websiteTheSuccessfulMatch.com.Thewebsite’smissionistoprovide
medicalschoolandresidencyapplicantswithabetterunderstandingofthe selectionprocess.ApplicantsinterestedinpartneringwithDr.Desaito elevatetheirinterviewperformancecanlearnmoreabouthismedical schoolmockinterviewserviceatTheSuccessfulMatch.com.
AftercompletinghisresidencytraininginInternalMedicineat NorthwesternUniversityinChicago,Dr.Desaihadtheopportunitytoserve aschiefmedicalresident.HereceivedhisM.D.degreefromWayneState UniversitySchoolofMedicineinDetroit,Michigan,graduatingfirstinhis class.
Don’tforgetaboutourbookforthetraditionalmedicalschoolinterview: Medical School Interview: Winning Strategies from Admissions Faculty
CONTENTS
Title Copyright Dedication
AbouttheAuthor
Chapter1:Introduction
Chapter2:ImportanceofMMI
Chapter3:QualitiesAssessedbyMMI
Chapter4:MMIFormat
Chapter5:MMIInterviewers
Chapter6:MMIExperiencesofPriorInterviewees
Chapter7:EvaluatingYourPerformance
Chapter8:BasicsofPreparation
Chapter9:Question/DiscussionStationPreparation
Chapter10:Scenario/ActingStationPreparation
Chapter11:Task/CollaborationStationPreparation
Chapter12:MMIScenarios
Chapter13:MMIandYourFuture
Chapter14:PreclinicalYearsofMedicalSchool
Chapter15:MedicalSchoolScholarships&Awards
Anexcerptfromthebest-sellingbook Success on the Wards: 250 Rules for Clerkship Success
Anexcerptfromthebest-sellingbookThe Successful Match: 200 Rules to Succeed in the Residency Match
OthergreatbooksfromMD2B
References
Chapter1 Introduction
“Finally!”Thepatient,visiblyfrustrated,continuedloudlywithhis complaint.“I’minsomuchpain.Thatlastnursedidnothingforme.Ikept callingforher,andittookaneternityforhertocome.Thatwentonall nightlong.Icouldn’tsleep.Icouldn’trest.It’slikeshewaswatchingTVor something.Ihopeyoucandobetter.”
Thisisthetypeofexchangethatcouldoccurinanyhospital. However,thisparticularencountertookplace,notinahospital,butduringa medicalschoolinterview.
PlayingtheroleofnursewasSarah,a25-year-oldapplicantwhohad desperatelywantedtobecomeaphysicianeversincechildhood.Her chancesofsuccesshingedonherabilitytointeracteffectivelywithanactor playingtheroleofanangrypatient.
Earlyincollege,Sarahhadsufferedfromavarietyofsymptomsthat leftherweakandtired.Multiplevisitstospecialistafterspecialistfailedto yieldadiagnosis,andSarah’sgradessuffered.Oneyearlater,with diagnosisfinallyinhand,shewasappropriatelytreatedandmadeafull recovery.Bythattime,however,thedamagehadbeendoneandherGPA hadplummeted.
Determinedtoreachherprofessionaldreams,Sarahpersistedand excelledinherremainingcourses.Hopefulthatmedicalschoolswould understandhersituation,sheappliedasacollegesenior.Shefailedto receiveevenasingleinterview.Aftermeetingwithanadvisor,itwasclear thatherbiggestobstaclewasalowGPA.
Followinggraduation,sheenrolledinatwo-yearpost-baccalaureate program.Severalmonthsintothisnewprogram,sheappliedagainto
medicalschool.Sadly,theoutcomewasthesame.Althoughinitially shaken,sheperseveredandmaintaineda4.0GPA.
Inthefallofhersecondyearasapost-baccalaureatestudent,she openedanemail.“Thankyouforapplyingto…Aftercarefulreviewofyour applicationmaterials,ouradmissionscommitteewouldliketoinviteyou foraninterview…”Itwasherthirdattempt,andshewaselatedtoseethat herhardworkanddeterminationhadfinallypaiddividends.Nowallthat remainedbetweenherandaseatinmedicalschoolwastheadmissions interview.
Atthisparticularschool,arelativelynewandinnovativeinterview technique,knownasthemultipleminiinterview(MMI),wasinplace.To understandwhy,ithelpstotracetheoriginsoftheMMI.In2001,onthe westendofLakeOntario,inanareaknownastheGoldenHorseshoe,a smallgroupofmedicalschooleducatorsattheMichaelG.DeGroote SchoolofMedicineatMcMasterUniversityinitiatedaninterestingpilot project.Eighteengraduatestudentswererecruitedtoactas“medicalschool candidates.”Thesestudentswereaskedtoparticipateinaseriesofbrief interviews.Eachinterviewstationwasdesignedtomeasureacertainnoncognitivequalityorskilldeemedimportantinfuturedoctors.Interviewees interactedwithadifferentinterviewerorraterateachstation.
Promisingresultsledtoalarger,morerobuststudyin2002,thistime withrealmedicalschoolcandidates.Asthedatawasanalyzed,itbecame clearthattheeducatorswereontosomethingbig.Thenewinterview techniqueshowedhighoveralltestreliability.1 Subsequentresearch demonstratedthatitwassuperiortothetraditionalinterviewasapredictor ofmedicalschoolclinicalperformance.2
Justtwoyearslater,in2004,McMasterUniversityintroducedthe MMItotheworldofmedicalschooladmissions.Sincethen,theMMIhas beenadoptedbynumerousmedicalschools.Itsreachhasexpandedbeyond medicalschoolstoincludeveterinary,dentistry,andpharmacyschools.In 2008,theUniversityofCincinnatiCollegeofMedicinebecamethefirst medicalschoolintheUnitedStatestoadoptthisnewinterviewtechnique. Sincethen,interestinMMIhasexplodedamongallopathicandosteopathic medicalschools.Atthetimeofthisbook’swriting,over30U.S.medical schoolsutilizedtheMMIintheadmissionsprocess.
Formedicalschoolapplicants,theMMI’sarrivalrepresentedamajor changeinthemedicalschooladmissionsprocess.Change,especiallyinthe highstakesworldofadmissions,oftencausesgreatanxietyforstudents, parents,andadvisors,andtheMMIwasnoexception.Foryears,medical schoolshadutilizedthetraditionalinterviewformat,aone-on-oneorpanelbasedinterviewexperiencewhereapplicantsansweredquestions,suchas “Tellmeaboutyourself”and“Whydoyouwanttobeadoctor?”
Manystudentsspentmonthspreparingforthetraditionalinterview, andtherewasaplethoraofbooksavailabletohelpguidepreparation.There werealsonumerousadvisorsskilledinmockinterviewing.Withenough practiceandtherightguidance,studentscouldfeelconfidentintheir interviewskills.
WiththearrivaloftheMMI,everythingchanged.Tomaintainvalidity andobjectivity,medicalschoolsbeganrequiringintervieweestosignforms preventingreleaseofMMIinformationtoothers.Ondiscussionforums, medicalstudentswhohadtakenpartinMMIswererelegatedtodelivering genericadvicesuchas“Beyourselfandtrytoenjoyit.”
AdvisorsandapplicantsturnedtotheInternetformorespecific information.AtthewebsitesofthoseschoolsutilizingtheMMIformat, littlecouldbefoundbeyondbasicinformationaboutitsstructureandthe reasonswhyschoolschosetoadoptthenewtechnique.“Thestrongest adviceistounderstandthebasicstructure,timelimit,andnumberof stations,”wroteoneschoolintheSouth.3 “Itisnotrecommendedthatyou trytoprepareforspecificMMIquestions,”wroteanotherschool.4
SarahfacedthesechallengeswhenshepreparedfortheMMI.Witha dearthofspecificinformationtoguideherpreparation,shefelt understandablynervousonherinterviewday.
HowdidSarahhandletheopeningscenario?
Priortoenteringtheroomwiththeactorplayingtheangrypatient,Sarah wasgiventhefollowinginformation:
Duringshiftchange,yournursecolleagueinformsyouofa“problem patient”thatyouwillbetakingcareof.Shereportsbeing“harassed”all nightlongbyrepeatedrequestsformorepainmedication.“Ifollowed thedoctor’sorders,andtherewasnoextrapainmedicationIcould give.”Asthenightprogressed,theirencountersbecameincreasingly tenseandhostile.“Igavehimpainmedicationaboutanhourago.He’s notdueformoreforanothertwohours.Goodluckwiththisone,”she says.“You’regoingtoreallyneedit.”Entertheroomasthepatient’s newnurse.
Patient:Finally.I’minsomuchpain.Thatlastnursedidnothingforme.I keptcallingforher,andittookaneternityforhertocome.Thatwentonall nightlong.Icouldn’tsleep.Icouldn’trest.It’slikeshewaswatchingTVor something.Ihopeyoucandobetter.
NurseSarah:Well,Icanpromiseyouthatshewasn’twatchingTV.What canIhelpyouwith?
Patient:Haven’tyouheardanythingthatI’vesaid?Ineedsomepain medication.Howaboutgettingmesome?Theothernursetoldmetotry somebreathingexercises.Canyoubelievethat?We’retalkingaboutreal painhere.Elevenoutoften,doyouhearme?
NurseSarah:I’msureit’selevenoutoften.Now,we’vealready…
Patient:Idon’tlikeyourcondescendingtone.
NurseSarah:Iwasn’tbeingcondescending.WhatIwastryingtosay whenyouinterruptedmewasthatyou’vealreadybeengivenpain medication.You’renotdueforanotherdoseforanothertwohours.
Patient:Areyoukiddingme?I’mtryingtotellyouthatI’minpain.And you’retellingmethatIhavetowaitfortwohours.Doyouknowwherethe doctoris?Whydon’tyoucallhim?Youandthatothernurse–Idon’tgetit. Whydidyougointonursing?You’resupposedtohelppeople.
NurseSarah:Thepainmedicationthat’sbeenorderedhasbeengivento you.Ireallythinkyoushouldcalmdown.Maybeifyoudo,yourpain wouldbemoretolerable.
Patient:Howdareyoutellmetocalmdown?Idemandtotalktoyour supervisor.I’mgoingtotellherthatyou’rerefusingtogivemepain medication.
NurseSarah:I’vealreadytoldyou.There’snomedicationthatanyone’s holding.You’vegottenwhat’swrittenfor.
Patient:Justcallthedoctor.Andbringthenursesupervisorintoo.
AnalyzingSarah’sanswer
Sarahlefttheencounterfrustrated.Whatwentwrong?Howcouldshehave avoidedthisoutcome?Theangrypatientorpersonscenarioisfrequently partoftheMMIcircuit.AsyoureadthroughSarah’sdialoguewiththe patient,wereyouabletoidentifythefactorsthatledtothisunsuccessful encounter?I’velistedanddescribedtheseinthefollowingbox.
ItwasobviousthatthepatientwasupsetbutSarah didnot acknowledgethepatient’semotionsorfeelings.“Youseemveryupset” wouldhavebeenonewayforSarahtodoso.
Sarahneverinvitedthepatienttosharehisstoryandfullyvent.Itwas clearthatthepatienthadmuchonhismind.Sarahneededtomakethe patientfeelthathewasbeingheard.
Sarahfailedtoshowsympathyorregretforthepatient’ssituation. “I’mreallysorryyouhadtogothroughallthis”wouldhavebeen effective.
Sarahlosthercomposure.Atonepoint,thepatientcommentedonher condescendingtone.Atanotherpoint,Sarahaskedthepatientto“calm down.”Settinglimitswhensomeoneisangryisseldomeffective.In suchsituations,it’simportanttokeepyourcool.
Sarahneverexploredanyothersolutions.Aparticularlyeffective techniqueistoaskthepatientforhisthoughtsonpossiblesolutions. “Doyouhavesomesuggestionsonwaystosolvetheproblem?”
Throughthisprocess,Sarahmayhavebeenabletofindanacceptable solution.“Here’swhatIsuggest…”
TheangrypatientisacommonscenariointheMMIbecauseit’ssucha commonscenarioinmedicine.Patients,whenfacedwiththestressof illness,sometimesactinuncharacteristicways.Theymaylashoutattheir doctorsandnursesformanyreasons.Beingsickenoughtobehospitalized isfrighteningformostpeople.Patientscommonlyfeelafraid,confused,and powerless.Theyfeelthattheyhavenocontroloverwhat’shappeningto them.Physicalfactors,suchasacuteorchronicpain,mayalsoplayarole. Dealingwithbadnewsthatimpactsprognosis,dealingwiththeriskofa disability,andtherealitiesoflivingwithalife-threateningillness:allof theseareobviouslyseverestressors.
Sometimesthehealthcaresystemitselfcanbethecause,asinlong waitingtimesforatest,oranintrusiveprocedure,ordeniedinsurance claims.Atothertimes,thepatient-physicianrelationshipwillcausea patienttolashout,suchaswhenaphysicianisperceivedasarrogantor disrespectful.Understandthattheremaybeanumberoffactorsatplay whenapatientlashesoutatyou,andthat,inmostcases,youshouldn’ttake itpersonally.
Sarahclearlydidn’tperformwellduringthisscenario.Fortunately,for Sarah,thiswasn’tarealadmissionsinterview.Thiswasamockinterview experienceinwhichIplayedtheroleofpatient.AfterIanalyzedher performance,Sarahwasabletobetterunderstandwherethingswentwrong. Shewasthenabletoimplementseveralstrategiestoeffectivelyhandlethis typeofsituation,asyou’llseeinthefollowingencounter.
Youarethenursemanageronabusyhospitalfloor.Oneofyournurses isupsetafteradifficultpatientencounter.Thepatientwasin considerablepainbutthenursewasunabletogivehimanything becausethenextdoseofpainmedicationwasnotscheduledforanother severalhours.Asshetriedtoexplainthesituation,thepatientbecame
quiteangryandquestionedthenurse’sdedicationtoherprofession.Hurt bythis,thenurselostcontrolofheremotions,andthesituation escalated,withthepatientrequestingtospeakwiththenursemanager. Thepatientisnowwaitingforyouintheroom.Entertheroom.
NurseManagerSarah:HelloMr.Smith.I’mthenursemanageronthe floor.Iunderstandyouwantedtospeakwithme.Howareyoufeeling?
Patient:Terrible.I’minalotofpainandnooneseemstocare.
NurseManagerSarah:Canyoutellmewhathappened?
Patient:Ijustwantsomemedicationtohelpmewiththispain.It’snowso bad–nineoutoften.I’vejustbeensittingherehopingandwaitingfor medication.ThenursetoldmethatifIcalmeddown,thatImightfeel better.Canyoubelievethat?Ineedsomepillsorevenashot.Ineed something.I’mreallyhurting.
NurseManagerSarah:SoletmeseeifI’veunderstoodthesituation. You’reinalotofpain,andyoudon’tfeellikethecurrentpainmedicationis providingyouwithenoughrelief.
Patient:Yes,that’swhatI’msaying.Ineedsomethingstrongerthanwhat I’mgetting.Itoldthenursethis,andshekepttellingmetocalmdown.I askedhertohelpme,andshekepttellingmethatitwasn’ttimeforthenext dose.Iaskedhertocallthedoctor,andshedidn’tlooktoohappyabout that.
NurseManagerSarah:I’msorrythatyou’reinsomuchpain.Itsounds likeyouwouldfindithelpfulifIreachedouttoyourdoctor.That’s somethingIcando.I’llcallandlethimknowthatyourpainmedicationis
notkeepingthepainundercontrol.Perhapshecanmakeanadjustmentto themedicationorstopbyandtakealookatyou.
Patient:Iwouldlovethat.Idon’tknowwhyit’ssohardtofindthedoctor.
NurseManagerSarah:Letmegoandcallthedoctor.Let’sseeifwecan comeupwithaplantoaddressthis.Howdoesthatsoundtoyou?
Patient:Thatsoundswonderful.
NurseManagerSarah:BeforeItakecareofthat,Iwantedtoseewhatelse Icandoforyou.Iknowyou’reuncomfortable,andIapologizeforthat.Is thereanythingelseIcandotohelpyou?Areyoucold?Doyouneeda blanket?Howaboutasnack?
Patient:WouldyoumindturningtheTVonforme?
Inthefollowingpages,you’lllearnhowtocreatethistypeof response.
Aresponsethatconfirmsthatyouhavethequalitiesthatthismedicalschool seeks.Thetypeofresponsethatconfirmstotheinterviewerthatyouarethe perfectfitfortheirmedicalschool.
Inthenext200+pages,we’llreview,indepth,themultiplemini interview.You’lllearnhowcriticaltheinterviewisintheadmissions process.TheAssociationofAmericanMedicalColleges(AAMC) evaluatedtheimportanceof12variablesonadmissionsdecisions.5 Of these,theMCATscorewasratedsixth.CumulativescienceandmathGPA wasratedthird.Whatwasthemostimportantvariable?
Themostimportantfactorinadmissionsdecisionswas,infact, theinterview.
You’lllearnwhytheMMIissoimportanttoadmissionsofficers.It’swidely recognizedthatthebestphysicianshavemorethanjustgreatscoresand grades.Themosteffectivephysiciansdisplayanumberofnon-academic attributes.Thesetraitsaredifficulttoevaluate,andadmissionsofficersrely ontheMMItohelpassessthesetraits.“Ourschoolintendstograduate physicianswhocancommunicatewithpatientsandworkinateam,”writes Dr.CyndaJohnson,DeanoftheVirginiaTechCarilionSchoolofMedicine. “SoifpeopledopoorlyontheMMI,theywillnotbeofferedpositionsin ourclass.”6
HowcanyoutellwhichqualitieswillbemeasuredduringyourMMI? Unlessyou’reprivytoinsideinformationatthatschool,youcan’tknowfor sure.However,everyschoolwillcreateitsMMItoassessforthosequalities orskillsthatithasdeemedimportantinitsfuturestudents.InChapter3,I’ll showyouhowtodeterminethosequalitiesandskills.
Ialsoreview,indetail,otherimportantaspectsoftheMMI.You’ll understandwhotheraters(interviewers)are,howthey’llinteractwithyou, andwhatthey’relookingfor.InChapter5,you’llalsolearnabouttheirpet peeves,aswellasthebehaviorsandattitudesthatwouldleadthemtoflag youasanunsuitablecandidate.Willyourinterviewerschallengeyou?They absolutelywill,andI’llshowyouhowtorespondtotheseprobing questionsinacompellingmanner.Whatelsedoyouneedtobeconcerned about?Inonestudy,researchersdescribedtheconcernsraisedby interviewerswhohadbeentaskedwithaskingapplicantscertaininterview questions.Amajorconcerninvolved“assessorfatigue.”Whatisit,andhow coulditaffectyourperformance?7
You’llalsohearfrominterviewees.Inonestudy,10%ofparticipants ratedtheMMIasworsethanthetraditionalinterview.7 Whatwerethe problemareascitedbyinterviewees?Whatcausedthemthemostdifficulty? Howcanyouavoidtheirmistakes?
“Therearenorightorwronganswers,”writesoneMidwesternU.S. medicalschool.8 Isthattrue?Aretherereallynorightorwronganswers? Asreassuringasthissounds,thereareclearlywronganswers.InChapter7, I’llpresentthetypesofanswersthatcanremoveanapplicantfrom consideration.You’llseehowsuchanswerscaneasilysurfaceinthehigh stakessettingoftheMMI.You’lllearnhowtoavoidtheseresponses,and deliveranswersthatyieldhighinterviewscores.
Ibreakdowntheprocessofdevelopinganddeliveringpowerful answerstoMMIquestionsinchapters8–11.You’llthenbeabletoutilize thesestrategieswithourexamplequestions.Thiswillhelpprovidethe practiceneededtoelevateyourperformance.Witheachquestion,task,or scenario,Iprovideasampleanswerwithathoroughexplanationofwhat makestheresponsesoeffective.
Therecommendationsinthisbookarebasedonmultiplesources. Throughoutthebook,you’llseequotesfrommanydifferentadmissions officers.AlthoughtheMMIisarelativelynewinterviewtechnique,there’s beenasubstantialbodyofresearchonthetopic.I’veincludedtheresultsof theseresearchstudies,whichhaveshapedandguidedmy recommendations.Lastly,therecommendationsarebasedonextensive discussionswithapplicantsaswellasadmissionsfaculty.I’veservedonthe admissionscommitteeatBaylorCollegeofMedicineforover10years,and interactedwithadmissionsofficialsatnumerousmedicalschools.Inow provideinterviewpreparationservicesformedicalschoolapplicants.Inthis book,asinmypreviousbooks,I’veappliedacombinationofevidencebasedadviceandinsiderknowledge.
I’veseenwherestudentshaveexcelledininterviews,andI’veseen wherethey’vefailed.Inthenext200+pages,you’lllearnhowtoapply theselessonstoyourowninterviewpreparation.It’stakenyearsofintense workforyoutoreachthispoint,andreceivinganinvitationtointerviewisa strongvoteofconfidencefromthemedicalschool.Inthefollowingpages, you’lllearnhowtomakethemostofthisopportunityinordertoreachyour goal:medicalschool.
