By Gardiner Harris, New York Times, July 10, 2011
Dr. Leora Horwitz, an assistant professor of medicine at Yale, recalled an incident in her residency at Mount Sinai Medical Center in New York when a medical student marched into the hospital room of an elderly minister surrounded by his wife and several parishioners.
“And he announces in front of everyone: ‘We found the reason for your problem. The syphilis test is positive,’ ” Dr. Horwitz said. “It was a devastating event for the family and the whole church, and this student had no sense for that.”
Even more dangerous is when poor communication becomes so endemic that the wrong operations are performed. A 2002 study published in The Annals of Internal Medicine of one such incident found that the patient, doctors and nurses went along with the mistaken treatment because they were used to being kept in the dark about medical procedures. A survey by the Joint Commission, a hospital accreditation group, found communication woes to be among the leading causes of medical errors, which cause as many as 98,000 deaths each year....
At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical.
The new process has enormous consequences not only for the lives of the applicants but, its backers hope, also for the entire health care system. It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.
At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note.
The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.
Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.
The system grew out of research that found that interviewers rarely change their scores after the first five minutes, that using multiple interviewers removes random bias and that situational interviews rather than personal ones are more likely to reveal character flaws, said Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, who developed the system.