Doctors save lives, but they can sometimes be insufferable know-it-alls who bully nurses and do not listen to patients. Medical schools have traditionally done little to screen out such flawed applicants or to train them to behave better, but that is changing.
Above is the provocative introduction from a July 10th New York Times article discussing a supposedly new trend championed at Virginia Tech Carilion, the newest medical school in the USA, which has eschewed the traditional sit-down medical school admissions interviews in favour of multiple mini interviews (MMI). This format uses fast-paced, often ethically-based questions to assess candidates on their interpersonal and communications skills.
Is the NYT introduction an accurate assessment of the medical profession? Pretty much anyone can be said to act in any manner “sometimes,” but surely past medical admissions officials would take umbrage at the notion that they did little to screen out students likely to blatantly ignore patients or belittle nurses. And is changing from a single, long interview to many shorter ones really more likely to elicit these negative qualities?
The true innovation of the MMI, at least as described in the article, is the emphasis on assessing interviewees not only on their lives and experiences, but in forcing on-the-spot thinking that is less amenable to rehearsed responses. It also allows candidates to interact with more than one proctor, so that multiple opinions on their suitability can be entertained. But such allowances are not limited to the MMI format; they could be made in a more traditional interview structure as well, such as by using longer interviews administered by multi-assessor panels.
Adoption of the MMI has been slow in the US (the article notes that 8 stateside schools use it), but it has been heartily embraced in Canada, where 13 of 17 medical schools have adopted the system. Perhaps the trend toward MMI’s, particularly in Canada, and the desire to “weed out the students who look great on paper but haven’t developed the people or communication skills we are looking for” is pushing out students who followed a more traditional path to medicine.
Like it or not, studying medicine requires a grounding in life sciences. This truism emphatically does not mean that only students with an academic background in the subject are suitable for medicine. But why shouldn’t schools want to recruit the student who studies life science, develops a passion for it, chooses medicine out of a desire to apply this passion to sick patients, and can speak thoughtfully about that course of action?
Just as tradition and inertia should not preclude new ideas from being adopted, the push to adopt new techniques does not mean that those already extant are worthless. Take an example from my field of radiation oncology: technology has rapidly advanced in the past couple of decades and shows no sign of letting up. This has been a great boon to both doctors and patients, as treatments provide better control of disease with fewer side effects. But improving access to established treatments, such as through current efforts to regionalize cancer care, will greatly improve our ability to treat cancer on a population level, and perhaps save as many lives or more than fancy machines that improve survival only slightly compared to the previous generation.
In pushing for change or new ideas, responsible opinion leaders need always be wary of moving to far to the opposite end of the proverbial spectrum. There are reasons why existing systems were put in place – and often it is because they had demonstrated good results, or at least acceptable ones, which are not without value. Improvement is always necessary, but if the improvement process causes useful parts of current systems to be thrown out, then resources will be needlessly expended for less benefit. Don’t let the means serve as a substitute for the ends, or we may end up with just as many nurse-bullying doctors as we had before.