On your mark, get set, interview!

Norbert von der Groeben

Gabriel Garcia, associate dean of MD admissions, monitors med school candidates as they rotate through a series of 10 eight-minute interviews. The new system replaces the previous method: one hour-long interview.

It’s speed dating on steroids. In 10 mini-interviews of eight minutes each, Stanford medical school candidates rush from room to room, station to station, congregating in suits and skirts in a connecting hallway for a two-minute break to prepare for the next interview. They all are hoping the same thing: to make a good impression.

“YOU MAY NOW READ THE SCENARIO IN FRONT OF YOUR STATION,” booms an authoritative voice over a loudspeaker. 1 minute, 58 seconds and counting.

But the shaky hands and sweaty underarms aren’t due to dating tension. This year, the medical school administration has taken a long, hard look at the admissions interview process for how to choose next year’s 86 new students — and made a big change.

Instead of the traditional hour-long interview with a faculty member, the medical school has instituted a new interview process from Canada called the Multi-Mini Interview, or MMI.

It’s a timed circuit of short interviews with scripted questions. The process is completed in a two-hour period and is designed to measure character and critical-thinking skills rather than scientific knowledge. Its goal: to pick out the best future doctors.

Which explains why 10 fresh-faced candidates are waiting outside each of the 10 doors in a hallway in the Li Ka Shing Center for Learning and Knowledge on a recent Monday in December looking to make a match. What fun. It’s Match.com for med schools.

“YOU MAY NOW ENTER THE ROOM. YOU HAVE EIGHT MINUTES TO DISCUSS THE SCENARIO.”

Up and down the hallway, 10 doors open. Ten doors close.

The applicants enter their respective interview rooms, greet their interviewers with broad smiles and politely sit down to discuss the question or scenario that was written on a piece of paper outside the door.

“I’m anxious to hear your thoughts, your hopes and fears,” says the interviewer in Room 1 by way of a greeting.

“This is one of those typical medical school sorts of questions,” says the interviewer in Room 5.

“It’s pretty simple. What should a physician do and why?” says the interviewer in Room 8.

A political question gets posed in Room 9; a personal question in Room 6; and in Room 7, two candidates stand back-to-back, one giving the other instructions on how to perform a specified task such as solving a puzzle.

The actual questions posed must remain confidential to ensure no future candidates receive any unfair advantage, but examples of previously used prompts go something like this:

“You’re a family practitioner seeing a 75-year-old woman in practice who reveals to you that she’s being physically abused by her husband. What do you do?”

And:

“You’re a pre-med student and have been studying for your biochem exam till midnight. You come back to your dorm room and your roommate tells you that she’s decided to cheat. What do you do?”

At first, the candidates stumble over words; they repeat, “absolutely” too often, or stare at their feet too long.

But as the minutes pass, the nerves calm, and meaningful discussions bloom. They talk about their hopes and fears, their successes and failures. They talk about how to battle disillusionment, how to change the world, when to make sacrifices. They show how they can work as a team. They communicate. Then, in mid-sentence….

The date ends.

“STOP YOUR DISCUSSION. CANDIDATES NOW EXIT THE ROOM.”

The new interview process which originated at McMaster University medical school in Ontario, was instituted at Stanford in November as part of the rolling admissions process.

This year, the school received 6,300 applications for the 86 spots opening in the fall 2011 class. That number has since been winnowed down to 450 candidates, chosen on the evidence of academic accomplishments, relevant life experiences and personal qualities detailed in their applications. Now, those chosen few have been invited to participate in the multiple mini-interview.

The results of the MMI will be considered within the context of the rest of the application by the Committee on Admissions, whose members make the final selection.

“At this stage, all of our candidates are academically ready for medical school,” said Gabriel Garcia, MD, associate dean for MD admissions. “What we want to measure next are the more personal traits that aren’t so easy to measure: compassion, ethics, critical thinking, interpersonal skills.”

Administrators chose to make the switch away from the traditional interview because they felt it was inadequate for determining who would make the best future doctors.

The MMI, which McMaster began using in 2002, has gone through extensive research and studies that conclude the process is more successful at doing just that. The new process has caught on. Since 2005, the majority of Canada’s medical schools and 15 U.S. medical schools have switched.

And so far, no one’s switched back.

Proponents list among the benefits of this multiple assessment technique: its precisely defined structure that enhances the validity and reliability of the results; its ability to dilute the effect of a single bad interview; its use of multiple interviewers to minimize the impact of individual bias; and its use of a variety of different interviewers — from doctors to nurses to patients within the community — to rate the candidates helps better predict who will make a good doctor. Indeed, according to psychological studies, it can successfully measure personal traits such as ethics and compassion.

At Stanford, the deans were particularly drawn to the MMI's ability to measure those often illusive but key traits that are essential to predicting who will become a great doctor. “My bias is toward thoughtful, caring physicians who connect with the patient,” said Charles Prober, MD, senior associate dean for medical education. “We want leaders, but those with interpersonal skills and empathy. I do not want to graduate a medical student from our school who wouldn’t be comfortable taking care of a patient.”

Scott Rubin, a longtime Stanford patient who received a heart transplant in 1985, signed up as a interviewer for one reason: the chance to help select tomorrow’s doctors. He jumped at the opportunity.

“I’m looking for compassion first,” Rubin said. “I represent the patient. Finally, we’re going to have some input in choosing the doctors of the future.”