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New Med School Screening Recommendations to Assess Ethics, Professionalism

by Thomas R. Collins •

McMaster University School of Medicine near Toronto began using the MMI in 2005 after an evaluation period of about two years. The idea stems from the Objective Structured Clinical Exam, which measures clinical competence using a similar station-style format. Robert Whyte, MD, assistant dean of the undergraduate medical education program at McMaster’s Michael G. DeGroote School of Medicine, said admissions officials figured, “‘Well, if we can do that to see if people have acquired the skills to be doctors, then maybe we could use the same concept to see if people have the skills or attributes to enter medicine in the first place.’”

McMaster gets about 4,500 applicants to med school. They take an online version of a test that assesses the relevant student characteristics, and just under 600 of them are chosen to go through the MMI process.

“We all have bias,” Dr. Whyte said. “Our bias is minimized when we have more of us doing a sample of an applicant.” Success on the MMI has correlated with success in clerkship performance and on licensing examinations (Med Educ. 2007;41:378-384.). “The MMI predicts best for how residents do on the communication part and the more non-technical or more non-academic characteristics of physicians,” he said.

Core Competencies

The AAMC is turning to a holistic admissions process, in which new, improved tools will be recommended to medical schools to assess med school applicants beyond their academic talent. Here are the characteristics, called core competencies, that the AAMC hopes to evaluate:

Interpersonal

  • Service orientation;
  • Social and interpersonal;
  • Cultural competence;
  • Teamwork; and
  • Oral communication.

Interpersonal

  • Integrity and ethics;
  • Reliability and dependability;
  • Resilience and adaptability; and
  • Capacity for improvement.

Fifteen of the 17 medical schools in Canada are now using the MMI. The MMI is not used nearly as much in the U.S., but it is catching on. The University of Cincinnati College of Medicine was the first U.S. institution to use this process.

Stephen Manuel, PhD, assistant dean of admissions at the University of Cincinnati College of Medicine, said he was skeptical at first, wondering whether it was really possible to assess a student in just eight minutes. When he saw the MMI in action, his doubts were erased, he said. “When you interview someone for a job, they don’t just interview with one person,” Dr. Manuel said. “You want people with different perspectives.”

The traditional interviewing process at medical schools is seriously flawed, he said, a statement that he noted is not only supported by the research literature but can also be seen anecdotally in Internet chat rooms in which students trade stories about their interviews. He described it this way: “Student No. 1: ‘Interview went great. He’s from New York, I’m from New York. We talked about the Mets.’ Student No. 2: ‘Interview went horrible.’ You will see such diversity in the students and how they were treated during the interview, how they felt about the interview and how they were assessed.”

Bias Is Inevitable

Barry Conchie, who leads the global leadership research and development program for Gallup, a company that helps corporations and organizations find executives, said that when screening is flawed, it can result in hiring exactly the wrong kind of person for the job. For instance, humility is often given as a top trait companies want in a leader, but that trait actually negatively correlates with the qualities of a top-performing leader.