What to Expect and How to Prepare

by Carleen Eaton, M.D.

Prehealthadvising.com

Introduction
Originally developed by researchers at McMaster University and widely used by Canadian medical schools, the Multiple Mini-Interview (MMI) has recently been adopted by several U.S. medical schools as part of the admissions process. An MMI typically consists of six to ten timed stations through which applicants rotate. At each station, the applicant is presented with a question, scenario or task. Since MMIs are significantly different than the traditional interview, becoming familiar with the structure, logic and expectations of an MMI will help make interview day less uncertain.
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Background
Understanding the reasons for the use of an MMI requires a look at the overall goal of the medical school admissions process. Medical schools seek to admit individuals who will make not only excellent students, but ultimately become outstanding physicians. As any patient knows, the best physicians are those who are not simply repositories of information; they are ethical, caring professionals and excellent communicators. The MMI was created as a potentially more effective means of assessing qualities that lie outside the realm of grades and test scores.
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The traditional interview process allows an applicant to interact with one or more interviewers and provides an opportunity for the school to assess the interpersonal skills of an applicant. However, each applicant will not necessarily be interviewed by the same interviewer or interviewers. Some interviewers may be less challenging in general or a better fit for particular applicants, thus providing those applicants with an advantage. In addition, standard interview questions may not reveal an individuals communication skills, problem-solving abilities, level of professionalism or other skills important for the practice of medicine. The MMI approach uses a series of stations to assess specific skills and qualities and assigns the same interviewer to rate all applicants at a station in order to address some of the weaknesses of the standard interview format.
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Structure
Although the exact set-up varies from school to school, an MMI usually includes six to ten stations from eight to ten minutes in duration with a group of applicants rotating through the stations. The instructions for the station may be posted outside the room and the applicant is given two minutes to read and analyze the instructions prior to entering the room. Typically, six to eight minutes are allocated to completing the station before moving on to the next one. Types of stations may include:

Ethical dilemmas or questions about policy or social issues. The instructions describe a situation and then ask the candidate to discuss the ethical or other issues involved. The interviewer may follow up with questions designed to probe the applicants response.

Interactions with an actor. At these stations, the applicant is provided with a scenario involving an individual who is played by an actor. The applicant may need to give the individual bad news, confront the person about a problem or gather information. An observer present in the room will rate the applicant based on his or her interaction with the actor.

Standard interview questions. An MMI may include one or more stations with traditional interview questions such as Why did you apply to this school? or Describe an obstacle that you have overcome.

A task requiring teamwork. Since the ability to work as part of a team is essential to medicine, some stations involve two applicants working together to complete a task.

Essay writing. Some schools include an essay component as part of the interview process so a station may involve responding to a prompt in writing. This station may be longer than the others to allow for the applicant to formulate and write the response.

A rest station. An interview takes a lot of energy, since the applicant is on the whole time and being presented with challenging tasks at every station. Fortunately, many MMIs include a rest station. Avoid spending the break time rehashing previous questions and what you should have said or done. Clear your mind and get ready for the next station.

Preparation
MMIs are distinctly different from the traditional med school interview and therefore require a unique approach to preparation. Schools may provide you with a list of sample questions which you can use to help guide your preparation; however, preparing for these interviews does not require knowledge of the exact questions being asked. Instead, an applicant should focus on developing his or her ability to formulate a logical, thorough response within a strict time frame. Although the scenarios may not involve medical issues, familiarity with bioethics issues can be helpful in understanding the approach to ethics issues in general. Also, start reading about current events and policy issues. This will hone your ability to analyze the various sides of a problem and to see the costs and benefits of a particular approach. To prepare for stations involving an actor, consider the steps you would take when interacting with an individual in a difficult situation. What questions would you ask? What is required for effective communication? One of the major challenges of this set-up is the strict time limit for each station; therefore, practice under timed circumstances is important. Once you have completed the initial phase of preparation, try addressing scenarios that you have not seen before within the ten minute total time allowed by a typical MMI.

Conclusion
Although MMIs can be challenging, they also offer applicants the chance to demonstrate skills and qualities that are not always evident on a written application. The existence of numerous stations, each with a different interviewer, also frees applicants from the worry of the med school interview consisting of interactions with only one or two individuals with whom they may not happen to click. The use of MMIs has continued to expand and may replace traditional interviews at more medical schools in the coming years. Therefore, students preparing to apply to medical school would benefit from a thorough understanding of this interview method.

References
1. Eva, K.W.; Reiter, H.I.; Rosenfeld, J.; Norman G.R. An admissions OSCE: the multiple mini-interview. Medical Education. 2004, 38, 314-326. 2. Edwards, J.C.; Johnson, E.K.; Molidor J.B. The interview in the admission process. Academic Medicine. 1990, 65, 16775.

3. Kreiter, C.D.; Yin, P.; Solow, C.; Brennan, R.L. Investigating the reliability of the medical school admissions interview. Adv Health Sci Educ Theory Pract. 2004, 9(2),147-59. Dr. Carleen Eaton is a graduate of the UCLA School of Medicine. She has been advising applicants to medical, dental and veterinary school as an admissions consultant for over seven years and is the founder of
Prehealthadvising.com. Her admissions blog is available at prehealthadvising.com/blog.