The medical school interview – a key determinant in the admissions process and, ultimately, in the physician workforce – appears to skew for or against applicants depending on their age, gender and self-identified disadvantaged socioeconomic status.
Based on a large, multi-institutional University of California study, researchers found important differences between the traditional interview format and the newer Multiple Mini Interview (MMI) format, which features a series of short interactions with a range of evaluators, including actors who role-play scenarios that help assess important physician competencies.
The study, published in the journal, Academic Medicine, is believed to be the first multi-institutional study in the nation to evaluate outcomes of the applicant interview process. The findings have important implications for admissions committees in determining the best methods for student selection, particularly for institutions interested in developing physicians who better reflect the communities in which they serve.
Data from a consortium of five University of California schools, consisting of nearly 5,000 medical school applicants who completed 7,516 interviews from 2011 to 2013, was retrospectively assessed. Two of the campuses – UC Davis and UCLA – utilized the MMI, in which candidates are rated while visiting up to 10 stations over a period of about two hours. Stations typically involve problem-solving tasks, communication and teamwork. The other three schools – UC Irvine, UC San Francisco and UC San Diego – used traditional interviews, in which candidates undergo two one-on-one interviews of up to an hour in length each.
Available student data included age, gender, race/ethnicity, self-identified socioeconomically disadvantaged status, undergraduate GPA, MCAT score, and interview scores. Race/ethnicity was further classified as whether or not it was underrepresented in medicine (UIM).
Key findings from the new study were:
- Women consistently outperformed men in interviews, regardless of interview method
- Disadvantaged students performed worse with MMIs, but better with traditional interviews than their counterparts; a similar effect was not observed for UIM interviewees
- Higher GPA was associated with lower MMI scores, but unrelated to traditional interview scores (no association was found with MCAT scores)
- Older applicants fared better than younger applicants on both interview types
“Disadvantaged students are often ones we want to attract to our programs because they are more likely to return to underserved communities as doctors,” said Mark Henderson, lead author of the study and professor and vice chair for education in the Department of Internal Medicine at UC Davis. “Knowing that they perform more poorly on MMIs should give an institution pause if they are considering adopting this format.”
Henderson, who also serves as the UC Davis School of Medicine's associate dean for admissions, speculated that traditional interviews likely offer more opportunities than do the more structured, fast-paced MMIs for disadvantaged students to present themselves optimally. Traditional interviews provide more time and freedom to discuss hardships a student has overcome, and in addition, unlike in the MMI, the interviewer has the student application in hand and has a better sense of the student’s background.
“We must find ways to increase the number of doctors in underserved areas, and these findings can provide important clues on how to accomplish this,” Henderson added.
The study’s findings also showed that women performed better than men in both types of interviews, something reflected in nationwide trends, where women now make up more than half of medical school classes. Previous, smaller studies have shown that women perform better than men in both interview formats. The article notes that one university in Australia did away with interviews completely, and their proportion of male medical students rose dramatically.
“I think a process that favors good communication skills is a positive thing in medicine,” said Henderson. “Patients often complain that doctors don’t listen to them or don’t explain their problems adequately, so selecting for good communicators is important.”
The researchers noted the findings do have limitations. The study’s design did not determine why there were differences in interview performance across schools. For example, the finding that some applicants had a better performance on the traditional interview and a worse performance on MMIs could reflect differences between the methods employed at each medical school (e.g., rater training, station content, implementation processes). The authors suggest it would be helpful to now explore the interview method versus its design and content to determine how it may affect applicant performance.
Other study authors were senior author Peter Franks, along with Erin Griffin, Anthony Jerant, Julie Rainwater and Francis Sousa, all with UC Davis; Carolyn Kelly, UC San Diego; Theodore Hall, UCLA; Ellena Peterson, UC Irvine; and David Wofsy, UC San Francisco.
The study was partially funded by a grant from the Edward J. Stemmler Medical Education Research Fund of the National Board of Medical Examiners (M.Henderson, principal investigator), and by the Center for a Diverse Healthcare Workforce (T.Fancher, principal investigator), a collaboration between UC Davis School of Medicine, the Betty Irene Moore School of Nursing at UC Davis and UC San Diego School of Medicine. The center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #UH1HP29965, titled Academic Units for Primary Care Training and Enhancement (AU-PCTE). The purpose of the UC Davis AU-PCTE is to conduct research to support schools of health in their efforts to ensure a more diverse student body, faculty and health care workforce. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. government.