In this lesson, I’m going to show you how to plan and answer questions like you might get in an MMI style interview.
The MMI format strives to increase the number of interviewers and to pose questions that require students to think more deeply about how to solve problems, much like a physician would do in treating and interacting with a patient.
Though at first, many schools moved exclusively to MMI style interviews, most now do a sort of hybrid—part MMI and part traditional interview. The reason for this is that the combination of the two kinds of interviews provides a more complete picture of how well an individual is suited to be a medical doctor.
The format of MMIs is to have interviewees travel between several “stations.” Upon arrival at each station, they are presented with a situation and typically given a minute or two to ponder the problem before meeting with a panel to give an answer. You are given about 8 minutes to answer, typically. This is because the questions that come up in an MMI will be deeper in nature than those in a standard interview and will have many dimensions. Categories of questions one might find in an MMI include:
- general ethical dilemmas;
- complexities of personal interactions;
- privacy issues;
- legal issues;
- economic considerations;
- personal responsibility;
- standard style interview questions;
- acting (interacting with actors portraying people in a situation);
- essay writing.
I’ll remind listeners here that interviews are not fill-in-the-blank type exams. They require you to think of and consider all of the factors in a complex situation, especially in the MMI format. Let’s try one on for size.
“Your father has received a diagnosis of Lou Gehrig’s disease and has a likely prognosis of less than one year to live. The disease is almost always fatal and quality of life degrades considerably en route to death. Your father lives in a state with doctor-assisted suicide and says he is considering it. He asks you to give him a frank assessment of this path. What do you tell him?”
Answering MMI questions well requires you to be able to frame the issue, as I discussed in the last lesson. This means, first of all, that though you may have opinions, they are not what you lead with. You first need to identify and describe to the committee all of the core issues relating to the problem so that it is possible to think clearly and objectively about it.
For this problem, here are some of those issues:
- You are related to the patient, so this is not a standard doctor-patient relationship. Your relationship with your father will likely color your response. Impartiality will be more difficult.
- To qualify for physician assistance a patient is legally required to meet certain criteria. Knowing what the legal constraints are is important. One note—if you are not from, and aren’t interviewing in a state with such laws, then you don’t need to know exactly what the law is. On the other hand, if you are from such a state, and/or are interviewing in a state with such laws, you darn sure better read up on the law before your interview.
- With respect to doctor-assisted suicide, there is an enormous divide between those who believe the physician should never hasten a patient’s death (anti-doctor-assisted suicide) and those who believe that a physician’s job to maintain quality of life may include helping a person to end it on their own terms (pro-doctor-assisted suicide). You should, of course, elaborate on these positions more than I am doing here.
- Though doctor-assisted suicide is ultimately a decision for the patient, assuming all legal requirements are met, there are almost always other people to be considered. Their needs, fears, and perspectives need to be discussed with your father.
- How do you feel? Your father has asked for a frank assessment. Part of that includes your professional opinion, but since there is a family relationship, you need to let your father know what your feelings are and how they complicate your ability to give a completely impartial answer to his question.
With these concerns laid out, you could move forward and describe what advice you would give in view of all of these factors. It is most important that your recommendation has a rational, not emotional, basis, and that it takes into consideration the issues you have identified.
Sometimes, students have a hard time framing the issue because they have strong feelings on the subject and they let their personal view on the matter color their analysis. It is essential that you not do this. You must, as fully as possible, describe all perspectives equally and impartially. Being able to take oneself out of the picture is an important skill for a physician to possess.
The biggest mistakes students typically make on MMI-style questions are not adequately framing the question and then diving in to give their opinion too quickly. If you do this, what you will discover is that you will essentially be done answering the question in about a minute or two, but you’ve still got six or seven minutes to go. When that happens, students begin repeating what they’ve said. One sure way to convince people you don’t have much to say is to repeat yourself. I would say, avoid, avoid, avoid, but that would be repeating myself :-).
Here are a few MMI type questions you can think about on your own
- What do you think about abortion?
- What do you think about the widespread use of recreational marijuana?
- You are working in the emergency room and a child badly needs a blood transfusion to survive. As you are getting it ready, you learn that the parents are religious fundamentalists who have previously gone to court to stop medical treatments on their children. What do you do?
In this lesson, I discussed a strategy for answering MMI type questions and gave a few to practice on. In the next lesson, I’ll talk about online interviews.