The Ugly Truth About Multiple Mini-Interviews in Medical School Admissions

To the Editor: Multiple mini-interviews (MMIs) are increasingly used in the selection process for medical school admissions. Compared with traditional interviews, MMIs boast improved reliability by employing a series of scenario-based ratings. MMIs also better predict performance during clerkships and in other clinical settings. But what are MMIs actually measuring? While schools have adapted MMI scenarios to assess abilities as diverse as empathy, teamwork, and moral reasoning, these assessments have not been validated. Furthermore, the high reliability of ratings across disparate scenarios leads me to speculate that the ratings are not indicative of particular abilities but, rather, representative of a more fundamental impression. In fact, research in social psychology shows that impressions are dictated by two universal perceptions: warmth and competence.1 These perceptions occur quickly and reliably in social interactions and account for more than 80% of the variance in behavioral assessments. Though helpful in evolutionary times, such primitive perceptions would be worrisome if they formed the basis for MMI ratings. Two pieces of evidence advance this worry. First, MMIs shortened from eight to five minutes yield similar reliability,2 suggesting a disproportionate influence of rapid perception. Second, MMI performance correlates with self-assessments of extraversion,3 a factor largely encapsulated by the warmth dimension. Should similar research continue to accrue, we must grapple with the morality of basing medical school admissions decisions on spontaneous impressions of candidate warmth and competence. One could reason that MMIs are an appropriate metric for identifying skilled providers: Because warmth and competence are stably intuited, perceptions of MMI raters will likely correspond to those of patients—who of course have the ultimate say in evaluations of care. I submit, however, that MMIs not only prioritize baseless judgments but also get it backwards: The candidates best suited for the medical profession are those who, in the face of continued, unfavorable appraisals throughout their lives, are nonetheless able to succeed. MMIs do these candidates a great disservice by further handicapping them in the admissions process. Jason Parad, MBE, MPHFirst-year student, University of California, San Francisco, School of Medicine, San Francisco, California; [email protected]