In the late 1990s, medical faculty at McMaster University in Hamilton were growing increasingly frustrated with the interviews used to evaluate medical school applicants. Even the most conscientious interviewers, it seemed, were biased, and there was often no correlation between the interview process and the subsequent performance of students. “The way we were admitting students was approaching being unethical,” explains Jack Rosenfeld, a professor emeritus in pathology and molecular medicine at McMaster. “The interview process was letting in people who should not have gotten in and excluding people who should have.”
So Rosenfeld and his colleagues proposed a radical new system called the Multiple Mini Interview (MMI). Instead of rattling off prepared responses to typical interview questions, applicants would have to work through 10 to 12 eight-minute stations where they’d respond to carefully scripted actors, tackle ethical dilemmas or try to solve hands-on problems—all under the watchful eyes of a group of interviewers.
The MMI was a success: a 2004 study published in the journal Medical Education found that it succeeded in diluting the effects of interviewer bias and provided valuable insights into an applicant’s abilities. A 2007 follow-up study found significant correlations between MMI results and later performance on clinical clerkships and national licensing exams.
Now, five years after McMaster implemented the MMI—in the face of aggressive resistance from the health care establishment—12 of Canada’s 17 medical schools have adopted the practice. In fact, the MMI that McMaster pioneered has spread to universities in England, Australia and New Zealand.
How applicants are judged remains a closely guarded secret. Medical schools provide little information on how to prepare, and at most universities anyone taking the MMI is required to sign a confidentiality agreement. Med schools are serious about keeping the mystery in how the MMI works; one applicant who snuck into a training session for judges (specific questions were not discussed) was banned from applying for seven years.
Happily, Maclean’s is under no such restrictions. We spoke to medical school faculty, successful and unsuccessful applicants, and people who served as MMI judges to find out what happens during the interview process—and what kind of person med schools are looking for.
How to prepare
While the MCAT (medical college admission test) exam reveals an applicant’s knowledge base, the MMI is designed to assess “soft skills”: communication, problem solving, judgment, life experience, ethics, professionalism, empathy and so on. Of course, being empathetic is not something you can simply study up on in the month before the interview. And that’s why the MMI is famously difficult to prepare for.
Common approaches include practising example questions that are posted online and reading up on medical ethics issues in academic journals. Some schools offer mock MMI sessions, but at least one successful applicant interviewed for this article chose not to take it. “I think I did well because I was just myself, genuine. I didn’t have formulated answers,” said first-year McMaster med student Rachel Lamont. “A lot of people had what they were going to say planned. That’s not natural.”
Rosenfeld also cautioned against practising. When asked how best to prepare, he quoted his colleague, a high-profile American neuroscientist: “The only way to prepare is to start reading when you’re 15, and read everything that you can.”
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