How To Master The Multiple Mini Interview (MMI)
This article is excerpted from The MedEdits Guide to the Medical School Interview: MMI and Traditional: Everything you need to know.
This article is excerpted from The MedEdits Guide to the Medical School Interview: MMI and Traditional: Everything you need to know.
The Multiple Mini Interview (MMI) is a station-based interview used to assess an applicant’s “soft skills,” qualities, characteristics, values, ideals, and decision making skills.
In contrast to a traditional one on one interview, a typical MMI interview consists of a circuit of eight to 10 stations through which interviewees rotate. All stations are usually in a single hallway, making it easy for applicants to move from station to station. Often referred to as the “speed dating’ interview, the MMI presents a new scenario, task, or situation and a new evaluator at each station.The circuit also includes rest stations (usually two), which offer the opportunity to use a bathroom. Interviewees are allowed a total of 10 minutes at each station before they have to move on to the next. The interviewee spends the first two minutes outside the room at each station reviewing the scenario, question, or task that he or she will have to talk about or complete in the room. The next eight minutes are then spent in the room discussing the scenario, role playing, or completing the required task.
Keep in mind, however, that the exact set up of an MMI will vary from one institution to another. Some medical schools may have only six stations whereas others have hybrid interviews, which are a combination of the MMI and a traditional interview.
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The Multiple Mini Interview was initially developed by McMaster University School of Medicine in Canada. Studies have shown that the MMI decreases interviewer and evaluation bias and can better predict a future medical student’s performance, professionalism, and performance on clinical tests than the traditional interview. These data, together with a move towards holistic admissions in the United States, have resulted in more and more medical schools’ favoring this interview style over the traditional one- on- one interview. We anticipate that every year more medical schools will replace traditional interview formats with the MMI.
Here is the standard set up and sequence for each MMI station:
Bell rings indicating the start of the next station.
Applicant takes a clipboard posted outside the station or posted on the station door and has two minutes to read the scenario, role, question, or task. The instructions are often slightly vague, which is deliberate.
Bell rings indicating the interviewee can enter the room, where another copy of the scenario or task is available for reference..
Applicant has eight minutes to discuss the scenario, role play, complete the required task, or answer the posted question.
Bell rings indicating the end of the session and applicant exits the room. Feedback is never provided in the room.
Applicant proceeds to next station and the cycle starts again.
Evaluator rates applicant after he or she exits.
The entire MMI circuit lasts anywhere from 70 – 100 minutes depending on the institution.
Here is a typical roster of the type of subjects you can expect to address at various stations on an MMI interview day:
Applicants are usually, but not always, allowed to jot down notes during this process but typically have time for that only during the two minute period before entering the room.
A scenario- based discussion is the most typical type of MMI station, usually ethical in nature, and can involve every day scenarios, those that take place in a medical setting, or real-life medical or policy scenarios that present an ethical dilemma. In this type of scenario, the rater will usually have follow up questions for the interviewee. These questions will be individually tailored and based on each interviewee’s approach to the scenario.
The key to success in an MMI interview is to think quickly and communicate your thoughts succinctly, clearly, and logically. Raters are also assessing a student’s ability to consider all aspects of a problem or situation so becoming adept at this is key. To illustrate your ability to think critically, you must also know what information you don’t have or you could use to make a more informed decision.
Since some stations involve current issues or polices in medicine, it is smart to read about policy issues in healthcare. This is not because you need to have knowledge for the MMI interview but because understanding the current climate in medicine will improve your ability to think critically about challenging policies. We recommend periodic review of the Kaiser website for this purpose.
We advise students to practice their ethical decision making skills while preparing for the MMI. When faced with an ethical dilemma or situation, you must demonstrate your ability to think and consider all aspects of the situation as well as the ramifications of all possible decisions. It is also essential to consider the perspective of each “stakeholder” in a scenario, whether a patient, a husband or sister, a nurse, a hospital, or another entity that’s involved. By doing so, you will demonstrate your thoughtfulness, empathy, and maturity.
Understanding bioethical principles and some basics about ethical decision making will also help students prepare for the ethically based scenarios in the MMI. Below are five common ethical principles that come into play when discussing ethical scenarios during the MMI. You don’t need to use the “labels” we have given these elements during the interview, but having a basic understanding of them during a discussion of an ethical scenario will allow you to better navigate that scenario and not miss any crucial considerations.
Truthfulness means telling the truth to someone who has the right to know even if that truth is painful. By the same token, it is a doctor’s obligation to keep information confidential. For example, if a patient is diagnosed with terminal cancer, truthfulness dictates that the doctor must tell the patient about the diagnosis even though this will be difficult news to hear. However, if the patient asks the doctor not to disclose this information to the patient’s spouse, the doctor is ethically obligated to keep this information confidential.
Autonomy refers to each person’s right to make his or her own choices, including those related to medical care. This means she can refuse necessary treatment or disregard a doctor’s instructions. You will often be faced with scenarios in which a patient wants to refuse treatment or not do what the doctor feels is best.
This refers to the patient’s right to understand the risks and benefits of any medical procedure he is about to undergo. This also means the patient must understand what might happen if the procedure is not carried out.
Beneficence means “doing good” or doing what is in the patient’s best interests whereas nonmaleficence means to “do no harm” or avoiding harm. In all scenarios, you must do good and make decisions that are in the best interest of anyone involved in the scenario. Likewise, you must not make any decisions that might result in harm to any of the stakeholders in the scenario.
It is important to be fair to all people. This seems obvious but, in all scenarios, always consider every element of the situation and how you can be most fair to all of the stakeholders.
The MMI also evaluates critical thinking skills, which typically come into play in scenarios that involve ethical issues in policy and healthcare. The Kaiser Family Foundation has an excellent website that discusses current policy issues. I advise students to review this material periodically during the interview season. By familiarizing yourself with the issues you will develop an understanding of the ethical challenges involved in many policies, which will offer you a comfortable foundation for the MMI. No one expects you to be a policy expert, however, so don’t be alarmed if you encounter an unfamiliar policy or issue at your interview.
The MMI is not testing your knowledge. What is crucial is how you use your previous knowledge and experiences to reason through the scenario with the information you already have. As I have mentioned, demonstrating that you understand all sides of a situation and can consider the viewpoints and consequences for all stakeholders in a scenario are key. Raters want to see that you can reason through issues relevant to society.
Also imperative is to understand that there is never a “right answer” for ethical scenarios. And rarely is there a “perfect” resolution, and expressing that is fine as long as you demonstrate how you’ve come to that conclusion. What raters want to see is that you can adopt a stance, defend that stance, and discuss issues related to it. Your rater may have knowledge that you do not, which enables him to challenge you a bit. What is key is to stay strong and not to waver.
While it isn’t always possible, talking about your own life experiences and how they might relate to a prompt can serve multiple purposes. First of all, this gives you the chance to talk about yourself and offer more information about your attributes and suitability for a career in medicine. It also helps to explain your thought process, how you came to your conclusions about a given scenario, and how you think. At most MMI interviews raters will encourage you to infuse your own experiences when discussing a scenario or in an acting station. However, keep in mind that you should talk about your life experiences only when it is appropriate.
At these stations raters will inform the interviewee about his or her role in the scenario before the session begins. An actor who will play another “role” in the scenario also will be present, along with an evaluator. These stations typically involve an “uncomfortable” confrontation with the actor that might relate to giving bad news or asking why the actor hasn’t followed through on something or was dishonest in some way. The interviewee, who plays the role of the interviewer in the scenario, speaks with and engages the actor as if in a real life encounter. The rater grades the interviewer on this interaction.
Many applicants really enjoy the opportunity to role play, but others are not comfortable in this setting. If you have any acting experience, this kind of station should be easy! When you read an acting prompt, immediately do your best to “get in character.” Assume the role you are assigned, start thinking like that person, and come up with what you will say first to the actor. The key to role playing scenarios is also to be flexible and to listen carefully. Engage the actor and be as open as possible so the actor is comfortable talking to you. Since this station is about dialogue, it is important to go with the flow in these scenarios. You really can’t predict how the actor will respond to your initial statement or question in the room. Also offer your own life experiences to the actor when it’s appropriate.
Typically you will be presented with a problem related to the actor and are asked to help the actor work through that problem. So, before you go in the room, consider what your stance will be. How do you hope to help the actor? What questions to you want to ask? Try to think of more than one solution to the “problem.” Make suggestions and give options. Always serve as an advocate and ally for the actor in the room. Offer concrete ways to help.
Working as a member of a team is vital in medicine so teamwork stations are pretty common on MMI interviews. Teamwork stations usually involve two applicants working together on a simple task. Usually students must have their backs to each other so communication is only verbal. You will typically have two teamwork or task stations on interview day. At one teamwork station you will be asked to be the “giver” and will give direction for a complex task to another applicant. At another you might be asked to be the “receiver” and take direction from a fellow applicant. This station usually has two raters – one is assigned to each interviewee. In teamwork exercises, when you are asked to complete a task, typically with another student, effective communication skills are imperative. You will be evaluated by your ability to work with someone else, to listen, and to communicate effectively. Most of the tasks are complex, or even impossible, so you must not lose patience or get frustrated when you are on either “end” of this task. Tasks usually involve drawing, completing a puzzle, building Legos or another type of structural element, or doing origami.
Approached the right way, task and collaboration stations can actually be quite fun. My primary advice is to stay calm, speak clearly, listen attentively, and don’t get frustrated!!! Also be sure not to interrupt the person speaking. In these stations you also will be asked to be the “receiver” and complete a task based on directions given by another student. Or you will be asked to be the “giver” by offering guidance to another student who is completing a task.
The tasks offered are often quite complex or even impossible. This is not an accident. Raters want to know that you can communicate and listen effectively under duress and that you won’t get frustrated or lose patience when things aren’t going so smoothly or easily. Typical task stations involve drawing a picture, doing origami, or building something with Legos or another material. If you do feel frustrated, remember the scenario is only eight minutes and soon will be over. This is not a test of whether or not you can complete a task or instruct someone else to; it is a test of your patience, communication skills, and ability to work with others.
What you should do depends on whether you are a “giver” or a “receiver.”
If you are a giver:
If you need more direction and aren’t sure what to do don’t be afraid to ask politely for more instruction: “I think I understand what you are trying to say, but, I am not 100% sure. Could you please explain that last step again?”
Don’t interrupt the giver.
If the giver seems stumped or frustrated, offer support: “This seems like a really tough task. I think you are doing a great job offering direction.”
Many MMI interviews have “standard question” stations where applicants are asked common interview questions such as:
Rest stations offer the opportunity to take a break. There is no preparation needed. Try your best to clear your mind and don’t think about the previous stations you have completed.
During your first semester of medical school, your anatomy team (5 students to 1 cadaver) is holding a review session on Thursday evening for the big midterm on Friday. Your cousin’s wedding is that weekend (out of town) and you had planned to attend – leaving Thursday and returning Sunday. What will you do?
First, you will summarize the prompt:
As I understand it, I am a member of an anatomy team and we have a huge exam on Friday. Yet I had already planned to go away for my cousin’s wedding, which would result in my missing a review session on Thursday as well as the midterm on Friday. Is this correct?
Here the applicant does two things. First, she summarizes the prompt quite well to make sure she fully understands what is going on. Then, at the end of her summary, she “checks in” with her interviewer to make sure she is on track. Doing this type of check in satisfies two objectives. The interviewee makes sure she is on track and also sets the stage for possible dialogue with her rater, which can break the ice and make for a more comfortable and less stressful interview experience.
Next, Identify the issues.
It seems to me that several issues are at play here. First of all, I have an obligation to my team to contribute to the review session. As a team member, I would like to contribute to our work towards the midterm preparation. I also have an obligation to myself and the medical school. Making up an anatomy final would be a major headache (I would think). More important, as a medical student I am serious about my education and wouldn’t want to miss such an important exam.
Here our applicant identifies the issues, acknowledges her responsibility to her teammates, and illustrates that she is serious about her studies and wants to do well.
In this next step, our student seeks out more information that will help her decide how to proceed.
I would like to know how far it is to my cousin’s wedding from my medical school. Would it be possible to go to the review session and the exam and travel to the wedding on Friday night? I’d also like to know if I have committed to anything at the wedding. Am I a bridesmaid? Did I offer to help her with something on Thursday? If so, is there someone else who can help with those tasks?
Our student asks more questions and lets the rater know that she can think through this scenario and ask the questions that will help her make an informed decision about what to do. The rater may or may not offer answers to these questions but, by recognizing she doesn’t have all of the information, the student shows she’s able to see all sides of the situation.
Who are the Stakeholders?
If I left school on Thursday, I’d be letting my teammates down and I’d also be creating more work for my anatomy professor, who would need to help me make up the test. I would also be potentially compromising my own academic success and reputation. If I go to the wedding later than I had originally planned, I am potentially hurting my cousin, perhaps creating more work for someone else if I have committed to helping with the wedding.
Here our student clearly identifies everyone who might be affected by her decisions, including people not named in the scenario. She shows she can see the impact of her decision on many people and, in doing so, demonstrates her selflessness and empathy.
I actually had a similar experience recently. My good friend was having an engagement party that just happened to fall on the night I had to travel to New Orleans to present my research poster at a national meeting. This was a very important meeting that was the culmination of a year of work. I felt badly about hurting my friend; the party was really important to her. But then I told her I’d take her out for a nice lunch in the city on my own to celebrate.
By demonstrating she has been in a similar situation in her own life, our student demonstrates her commitment to her work and career. She also shows she’s able to reach compromises and that friendships are important to her.
My responsibility to my classmates and my education must come first. I would do everything in my power to explain this situation empathetically to my cousin and that I would hope to travel to the wedding on Friday after the final. If I had any responsibilities related to the wedding, I would find out who could take them over to avoid stressing my cousin.
Our student gives a clear and unwavering response to the question that was asked of her (always pay attention to what is actually being asked of you). Her rater might challenge her on this response but she knows not to waver.
I think my decision would satisfy all involved parties and would not compromise my own success or that of my classmates or my cousin’s wedding.
A quick concluding phrase to wrap it all up is a great way to end a response!
Your 36-year-old cousin, who is positive for the BRCA (breast cancer) gene, has just been diagnosed with stage 2 breast cancer, meaning the cancer is still contained within the breast. Your cousin tells you she does not believe in traditional medicine and is refusing the treatment her doctor advises. Instead, she plans to drink “anti-angiogenic” organic green juices hourly and walk barefoot in the grass to absorb the earth’s vibrations and stimulate her immune system. What do you do? Would you try to convince her to choose traditional or alternative therapies?
As I understand the prompt, my cousin has a recent diagnosis of breast cancer and would rather use alternative medicine than more traditional medical therapies. Is this correct?
Our applicant quickly summarizes the prompt and asks the rater to verify that she is on target.
There are several concerning issues here. First of all, I want the best for my cousin. As someone who believes in traditional therapy, and because it seems she is a high risk patient, I would encourage her to follow her doctor’s orders. Assuming my cousin understands the risks of refusing therapy, however, neither I nor her doctor can force her to accept the recommended traditional therapies. At the same time, the “treatment” plan she has decided to follow is unlikely to be therapeutic.
Here the interviewee clearly states the issues, recognizing that her cousin has the right to refuse treatment and cannot be forced to engage in treatments to which she has not consented.
Missing or much needed information
I would want to know if my cousin has been told about the benefits and risks of treatment. Has she read the literature and does she know about her chances of survival with traditional therapies? Does she know which of an array of traditional therapies are options for her type of disease? Has she looked into the alternative therapies in which she’s interested ? Are there any data to support what she wants to do? I would also want to know if the alternative therapies might be harmful in any way.
By asking the right questions, our student targets the missing information that might allow her cousin to make an informed decision. Perhaps her cousin hasn’t actually reviewed any data and has a doctor who doesn’t supply the information that would answer these questions. In asking the right questions, the interviewee shows that her cousin may be making a decision without all of the information she needs.
As a relative, I have the best interests of my cousin in the forefront of my mind. Her doctor does as well. I would also want my cousin to consider her loved ones and children, if she has any. For whom else is she responsible? Her decision about how to treat her breast cancer will impact many people besides herself.
Bringing up the obvious stakeholders, herself, the cousin, and her doctor, are great and our applicant goes beyond this to recognize that every decision a patient makes influences many others.
The student has no life experiences that relate to this prompt and so skips this part of the analysis.
When talking to my cousin, I would explain my concern that she might be rejecting the therapy that would lead to the best outcome. I would encourage her to speak with her doctor to get the information and data she needs to make an informed decision. I would also offer to help her gather that data. We could do literature searches or even get a second opinion. After we collected all of the information I would then sit down with her and try to reason through everything in an intelligent and logical way. Assuming the traditional therapies showed better outcomes, I would advise her to choose the traditional route. Or, assuming the alternative therapy wasn’t dangerous according to her doctor, I’d suggest she pursue the nontraditional therapies in conjunction with the traditional.
This response shows that our student is smart, a great critical thinker, and someone who is empathetic and understanding. He doesn’t judge his cousin for wanting to choose an alternative therapy, but instead seeks out the information he will need so his cousin can make an educated decision. He becomes his cousin’s advocate and ally in this process.
In conclusion, I would suggest my cousin follow her doctor’s orders, but I would also allow her to come to that decision on her own by collecting the available evidence to support that choice.
Short, sweet, and smart conclusion!
A mother brings in her 6-year-old daughter, who is having a severe asthma attack and comes to the hospital for “a few breathing treatments.” You explain to the mother that the child is so sick that she needs to be admitted to the hospital for treatment. The mother refuses to let her child stay, however, saying that this has happened before, and she can treat her daughter at home with the medications she has from her home country in Mexico, from where they recently came. What would you do in this situation?
Premature babies, fewer than 24 weeks gestation, have low survival rates, and those that do survive often have poor outcomes. Yet most of these babies receive extensive medical care and have prolonged stays in the intensive care unit. What are the issues involved?
You are driving and, even though you know you shouldn’t be doing this, you respond to a text you receive while stopped at a red light. You mistakenly take your foot off the brake and rear end the car in front of you. The driver, visibly irate, emerges from the car and is walking to your car while yelling that he is calling the police. What do you say to this man?
So, how should you prepare for an MMI interview?
Practice under timed circumstances.
You will have two minutes to read and consider each scenario before going into the interview. Becoming adept at creating an outline in your mind and doing this efficiently will decrease nervousness and anxiety. When you read a scenario consider what information is MISSING or what other information could help you make an informed decision.
Because you have only eight minutes per station, you want to make sure you can communicate your points effectively. By the same token, you don’t want to have too little to say! Understanding how long eight minutes “feels” when discussing a scenario will make you more comfortable on interview day. This means you should practice addressing scenario responses by timing yourself.
Practice multiple prompts on any given day.
MMI interview days are tiring and, while adrenaline is likely to get you through a day even if you are tired, practicing a series of prompts will help you avoid fatigue at the MMI.
Read the Kaiser website so you are familiar with current issues in medicine. Search the web for other useful sites. We also like the New York Times and Wall Street Journal health sections. The idea is not to attain knowledge, necessarily, but to gain an understanding of current issues and ethical dilemmas.
Practice role playing.
It is actually fun once you get the hang of it!
Finally, consider having a mock interview with MedEdits! We have helped hundreds of applicants successfully prepare for MMI (and traditional) medical school interviews.
After a medical school interview, you want to take notes about everything you observed and everyone you met during your interview day. If you have multiple interviews, the specific experiences and observations you have may become muddled. Also write down the name and contact information for each of your one on one interviewers. You will need this later!
We first suggest that you follow any specific rules a medical school may have regarding post interview follow up and communications. Some medical school request that students don’t write thank you notes, letters of intent, or letters of interest. In contrast, more and more schools actually request update letters and letters of intent. The majority of medical schools that do allow communication prefer you send them via email; however, some have online portals to submit additional information and others request only snail mail paper communications. Whatever a school’s contact policy, be sure you adhere to it! You should be able to find this information on a medical school’s website or the school may send you follow up information after your interview day.
For MMI interviews, we discourage trying to follow up and thank every “rater” you have during your interview. However, many MMI interviews, as I have mentioned before, are actually hybrid interviews with traditional stations. As a general rule, it is best to formally thank anyone with whom you have had a one on one interview or anyone with whom you truly connected during the interview day. Because handwritten thank you notes are one way lines of communication and typically end up in the garbage, we recommend email thank you notes.
Albany Medical College
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