To the Editor:

Many students who graduate Bridgewater-Raritan High School pursue careers in the health professions, myself among them. We aspire to one day satisfy the public and moral expectation that physicians be competent and compassionate, willing to practice medicine with integrity and a strong ethical code.

Yet although medical schools take every precaution in selecting benevolent individuals to be trained as physicians, there exists a dangerous minority of health care practitioners that may be negligent, lack compassion or in some cases even demonstrate criminal intent. These doctors are disciplined by state medical boards with consequences ranging from probation to license revocation, most often due to violations of professionalism. The Archive of Internal Medicine reported in an international study that 5 percent of doctors have recurrent issues in their medical practices that warrants such action.

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With their very low rates of applicant acceptances, the admissions process is arguably the most critical evaluation medical schools can provide. Thus, this process is integral to ensuring benevolent individuals are accepted that hold the non-cognitive skills of interpersonal ability, maintenance of integrity, ethical behavior, and professionalism. Admissions committees largely rely on the interview for this purpose. Most medical schools use a traditional format much like that used in job interviews; a candidate sits in a room with either a single or a panel of interviewers and is typically evaluated for 20 to 50 minutes. Candidates are asked to answer questions or to elaborate on experiences described in their applications, after which the interviewers rate the students based on their responses. While this interview format is quite popular, its validity in assessing non-cognitive skills is questionable.

According to the journal Academic Medicine, ratings of candidates’ performances in personal interviews often depend more on the interviewers than the candidates themselves, with interviewer variability accounting for 56 percent of the variance in candidate ratings. A candidate’s score may largely be attributed to chance: being interviewed by an “easy,” compatible interviewer who influences the rest of the team positively will result in a higher score as opposed to a “hard” interviewer who does not see eye-to-eye with the candidate. Because these teams often receive a candidate’s background information beforehand, bias can be difficult to avoid. Furthermore, this interview format suffers from the halo effect, where a bad start to an interview can negatively color the interviewers’ perceptions throughout its entirety as responses cannot truly be considered independently in a single session. Such enormous biases and inter-rater variance should be considered unethical and unacceptable in an assessment tool designed to evaluate a candidate’s characteristics and not the interviewers’.

Recognizing this dilemma, McMaster University launched an alternative interview format: the Multiple Mini Interview. Rather than relying on a single evaluation session to assess a candidate’s non-cognitive skills, multiple stations are established in separate rooms operated by one interviewer and one examiner each. Every station presents a unique scenario which a student must address in less than ten minutes. After addressing a station’s scenario, the candidate rotates to the next one until all stations have been visited. This interview format dilutes the effects of interrater variance, reduces the halo effect and context specificity, and largely eliminates bias as interviewers do not receive background information on the candidates. Compared to the personal interview, the MMI correlates far better with scores on medical school Objective Structured Clinical Examinations, which largely evaluate non-cognitive skills.

For those planning to attend medical school, preparation for the MMI can include familiarization with medical ethics and contemporary issues in medicine, developing communication skills, and obtaining experience helping others. Considering the great efficacy with which the MMI is able to test for critical non-cognitive skills such as professionalism, perhaps the expansion of its implementation can prevent the aforementioned 5% of problem medical school graduates from becoming practicing physicians.

Tim Ganapolsky