andrew shulman, doctor communication, Hopwood vs. Texas, left on longwood, medical school admissions, medical school interviews, pre-med advising, social skills for doctors, UT Southwestern medical school
Medical schools try to teach aspiring doctors a hefty “body of knowledge” (as it is usually referred to) including basic bioscience, how the body works in health, how the body fails in illness, and what seems to work in improving the course of disease. Would students and their future patients and colleagues be better served if schools devoted time and effort towards improving the social skills of doctors-to-be?
The traditional qualities that mark high school and college students for a future in medicine are an interest in science and math and facility in answering test questions about both. The classic answer to the ubiquitous interview question “Why do you want to be a doctor?” is “because I like science and want to help people.” Along with speaking to a lack of originality, the stock answer reveals a lack of communicative verve. As the culture of medicine is becoming more collaborative and as patients expect to dialogue with their physicians, rather than passively listen to pre-prepared speeches, physicians are increasingly required to be skilled communicators. The complexity of today’s medical data and the profusion of novel treatments require doctors to serve as teachers if they will be able to help patients make good decisions. Perhaps seeking out technically proficient science types, at best high-functioning introverts, at worst socially oblivious dorks, may not be the best selection criteria for the future of medicine.
In the July 10th Times, Gardiner Harris profiles an effort by the nation’s newest medical school to select applicants with social skills. As do all medical schools, Virginia Tech Carilion invites applicants to their Roanoke, VA campus for interviews with deans and faculty. The innovation is a rapid-fire series of speed dating style interviews where applicants discuss ethical quandaries in medicine instead of favorites ’80s movies or the last season of “The Bachelor”. Applicants are lined up in a corridor not unlike an outpatient clinic and read a prompt taped on to the door describing an ethically ambiguous medical situation. After two minutes to primp and collect themselves, the applicants enter the room, flash a game show host smile, and discuss the situation with an interviewer for eight minutes. A buzzer sounds, the applicants return to the hallway, shift over to the next closed door and the process repeats. The interviewers give each chat a numerical score and try to jot down some comments. The actual questions used are top-secret, but examples provided to applicants included something to the effect of: Is it ethical to give patients unproven alternative therapies? Should pediatricians support parents who want to circumcise newborn boys? (Wait, seriously?) Are insurance co-pays for medical visits appropriate?
The structured speed interview, known as the Multiple Mini Interview (MMI for short), is the brainchild of McMaster University Professor Dr. Harold Reiter. MMI scores have been shown to be predictive of performance on medical licensing exams that take into account patient communication and medical decision making even when taken 3-5 years after the speed interviews. Dr. Reiter’s research has shown that situational interviews catch character flaws better than personal interviews and that evaluators rarely alter scores arrived at in the first 5 minutes of an interaction (proof that you never get a second chance to make a first impression). 13 Canadian medical schools and at least 8 in the US, including big names like Stanford and UCLA, are using the MMI in their applicant selection process. When it comes to sexy trends in medical education, this is about as hot as it gets.
It will be interesting to see if the speed dating medical interview will alter the balance between cocktail personalities and stereotypical nerds in medical school classes. In my medical school class of almost 225, selected in part with 2 or 3 traditional 30 minute sit-down talks, there were plenty of both types. The UT Southwestern medical school class 2 years before mine was selected in the aftermath of Hopwood v. Texas (This was the 1996 federal court case which barred the University of Texas Law School from using race as a factor in admissions decisions. The Supreme Court declined to hear an appeal of Hopwood on procedural grounds but abrogated the decision in 2003 with Gratz v. Bollinger, which allowed race to be a factor as long as not in the form of quotas). By our rough calculations at the time, that class was 70% male, mostly white, and with many sterling exceptions, was well below the median in the social skill department. Maybe my class, with ample colorful characters, was an attempt to even things out? By the way, how is it possible that law schools still select students almost purely on numerical criteria with no interviews of any kind?
Efforts such as the MMI are indicative of a larger movement to revamp the medical profession into one that is more interpersonally charismatic and emotionally adept. Certainly screening out applicants with undiagnosed personality disorders through structured interviews is a step in the right direction. The goal of creating intuitive and compassionate physicians will ultimately require a more significant move away from the science and math-focused notion of what best prepares young people to become physicians.
I’m reminded of a pre-medical adviser at my Harvard undergraduate house who did his very best to discourage our friends with non-science majors from applying to medical school. This adviser perfectly fit the stereotype of the physician-scientist totally devoid of personality. I would never voluntarily be his patient. Fortunately, my classmates were not deterred and were quite appropriately accepted to more prestigious medical schools than me and many of the scientists. Physicians-to-be who can communicate and collaborate with a wide range of folks will naturally be people who have practiced these skills. The medical community will need to re-evaluate its stubborn reliance on organic chemistry and physics as gatekeepers and instead take greater notice of humanities skills, maturity, and life experience. Although it is hard to teach social skills, anyone who has ever been on a date knows that they are pretty easy to recognize.