Three tips to connect with your MD_PhD interviewerMultiple mini interviews, commonly referred to as MMIs, are a major interview component in the MD admissions process. According to the AAMC, “the MMI is designed to measure competencies like oral communication, social and non-verbal skills, and teamwork that are important indicators of how an applicant will interact with patients and colleagues as a physician.” The format of MMIs ensures that no single interviewer’s opinions about an applicant are over-emphasized. Additionally, these interviews are usually closed file, meaning that the interviewers have not read applicant primary or secondary applications prior to the interview. The interview itself consists of a variety of stations, each with its own prompt and evaluator. Schools test everything from critical thinking, to knowledge about the current healthcare system, to having applicants role-play complex situations with professional actors. Regardless of the specific topic, it’s best to prepare for a variety of stations. 

General Tips

Regardless of the prompt, it is to maintain your composure at all times. Many times, MMIs include a stress-based component where the interviewer will purposefully put on a stern look or challenge the applicant’s points of view. As the British government once said to their people prior to the outbreak of World War II, remember to keep calm and carry on. 

Second, it’s important to admit mistakes and acknowledge any gaps in your knowledge. The interviewers have heard dozens of answers to a prompt at a station, and they’ll be able to tell when an applicant is feeding them a story that is (forgive my language) a load of malarkey. They don’t need a novella explaining why you’re unfamiliar with a topic, but it’s best to acknowledge what you don’t know and move forward with your answers. 

MMIs are conducted under a restricted time interval. Usually, applicants are given 1-2 minutes to read and think about a prompt, followed by 5-7 minutes to answer the prompt. Thus, it is important to remain concise. Responses tend to be easier to follow when they get to the point. 

MMIs, at their core, are subjective. Applicant responses are ranked and compared to the responses of their peers. As such, answers that are organized and well-communicated stand out. Utilizing that 1-2 minutes of planning before speaking is critical to constructing a unique and nuanced argument that impresses interviewers. 

The most critical aspect to the MMI is practice. There is no substitute for practice. Going through the ropes of formulating answers to MMI questions under a time limit is the best way to prepare for interview day. I recommend doing this multiple times with an audience who is familiar with the process and can provide relevant feedback. 

General types of MMI questions

The following are the types of MMI questions you are most likely to encounter in this process. Please note that this is not a comprehensive list, but rather a list of the most common types you’ll encounter.

  1. Ethics and Morality Scenarios: These questions present an ethically difficult scenario and require the interviewee to describe their thought process to work through the situation. 
  2. Policy Questions: These questions ask applicants to describe their thoughts on an aspect of the healthcare system, usually with respect to current events. 
  3. Acting Stations: These are stations where interviewees interact with a professional actor under the purview of an evaluator to work through a scenario. 
  4. Personal Questions: At these stations, the interviewee is asked to discuss an anecdote from their life in response to a prompt. 
  5. Quirky Questions: These stations consist of unusual questions to inspire creative thinking from the applicant. 
  6. Collaborative Questions: Here, interviewees must work together, usually in pairs, to complete a task that requires communication and teamwork. 
  7. Traditional Mini interview: These stations are usually longer than the normal MMI stations where applicants sit with a high-ranking faculty member and have a traditional interview. 

Now let’s try out an example!

The most difficult station among the multiple mini interviews is the ethics and morality station. This station begins with a scenario that is ethically ambiguous and requires the interviewee to reason through multiple perspectives and layers of complexity. We will use a  five-step process to reason through this type of question.  

Example MMI Station: 

Statistics have shown that effects of advanced age, such as changes in vision and response time, may adversely affect elderly drivers' abilities to drive safely. As a matter of fact, many doctors are considering recommending that their older patients cease driving as a precaution for personal and public safety. Do you think older drivers should give up driving when they reach a certain age?

Step 1: Restate the prompt

Concisely restating the prompt ensures that you stay on topic with clarity and direction. This step should be no more than a sentence or two. For our example, a sentence acknowledging that the focus of this question is on the topic of older drivers giving up their licenses is more than sufficient. 

Step 2: Address ethical stakes

The second step is to delve into what makes this question difficult to answer, proving that you see its many facets. Many times, an understanding of the four basic bioethical principles can help interviewee identify these facets quickly. These principles are Autonomy (the respect for the patient's right to self-determination), Beneficence (the duty to 'do good’), Non-Maleficence (the duty to 'not do bad'), and Justice (ensuring the treatment of people equally and equitably).

Addressing the ethical stakes helps you organize your thoughts and proves that you have the ability to think critically. In this step, you may also want to address the pros and cons of each side to the issue, while thinking both on a macro and micro scale. 

In our scenario, I would suggest focusing on the issues of Autonomy, Non-Maleficence and Justice. On one hand, if you were to revoke the licenses of the elderly based on age and health, this would have implications for their autonomy. For example, it may restrict their ability to acquire groceries and seek out healthcare, thus impacting their overall quality of life. On the other hand, if you were to allow elderly individuals with impacted vision and response times to drive, this may endanger both their lives and the lives of others, which brings in Non-Maleficence and Justice. I would recommend briefly expanding on these competing ethical stakes. 

Step 3: Explore the facets

This is your opportunity to show a deeper understanding of the issue and investigate potential ways to address it. Creativity and out-of-the-box thinking are welcome for this step! Verbalize what else you would like to learn about the issue and examine the implications of certain decisions related to the issue. This is your chance to float the impact of different solutions before firmly siding with a single solution. 

In our scenario above, there is much to explore. For example, you could explore this problem in the context of governmental aid. In many countries, the government works with taxi services to provide subsidized transportation for seniors at a low cost. Another direction would be discussing the creation of a new driving exam for seniors to ensure that healthy, elderly individuals wouldn’t be unfairly discriminated against. A third direction would be discussing the viability of a community support program to educate elderly individuals on taking advantage of telehealth and delivery services to avoid driving unless absolutely necessary. 

Step 4: Take a stance

Now that you’ve brought up several solutions to the problem, it’s time for you to take a stance. This should be done in a straightforward manner, taking into consideration only the information you have available from the scenario. A strong stance is one that is supported by the evidence and takes into account the ethical considerations previously discussed. 

In our scenario, you could state something like, “Given the information provided, I would recommend that older drivers give up their drivers licenses once they reach a certain age.” Your stance should be blunt, direct, and concise. 

Step 5: Discuss the ethical, legal, and professional implications of your stance

In this final step, it is your job to discuss why you have taken a particular stance and the implications of taking such a stance. Since you are wearing the hat of a physician, this is your chance to examine the impact your decision would have on society and patients. No decision is perfect, so discuss the pros and cons of your decision and how you came to making it. Remember to include any ethical, legal, or professional limitations you’d need to uphold if relevant.  

For our example, you could discuss that recommending that older individuals should give up their licenses is informed by the concern for their and others’ safety. Next, acknowledge the implications of that decision, such as that it may lead to feelings of shame in these individuals and may indeed make their lives more difficult. You could also mention that you would not make this recommendation for patients who are still medically capable of operating a vehicle, or that you would find a way to support those negatively impacted by this decision. These are not the only things you can say, though - this is but one way to interpret and answer this MMI scenario. There are always multiple answers - choose an answer that makes the most logical sense to you.

These five steps, with practice, will provide a robust backbone upon which answers to MMI scenarios can be planned and executed with grace and eloquence.

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