Acing The Multiple Mini Interview (MMI) Format
For Medical School Admissions

The Multiple Mini Interview (MMI) may be the wave of the future in medical school interviewing. The MMI is now utilized at over 50 medical schools around the world. Once a school has adopted the MMI, they have retained it, and none have ever switched back to more traditional interview formats. So the MMI appears to be here to stay. Do you know how to prepare for the MMI? Do you know how to succeed with this format and get a high score?

I have been helping prospective medical students prepare for the MMI format for some time now, and I have discovered a set of 12 success strategies that have helped them do very well on it. I also have a checklist of 14 mistakes I have seen candidates make on the MMI and I have a list of hundreds of examples of MMI questions, scenarios and tasks. I'll share some of those with you later in this article.

First, let's discover what the MMI is all about.

The MMI assesses the "soft skills" of maturity, collaboration, communication, empathy, critical thinking, the ability to cope with ambiguity, ethical decision-making, attention to detail, cultural sensitivity, and current healthcare and societal issues. The MMI is not intended to test specific knowledge in the medical field or to assess prior academic, scientific or clinical knowledge. Applicants are not tested on mathematical or scientific formulas, not asked to solve scientific problems, not asked to complete true-false or multiple choice test questions, or asked to create diagrams or flow charts. The MMI allows the school to systematically assess the characteristics and attributes which are deemed to be important components in becoming a competent physician. The MMI tests how well an applicant can "think on their feet" and the degree of "emotional intelligence" they possess.

The MMI Process

The MMI is a series of seven to nine interview stations consisting of timed interview scenarios. Candidates rotate through the stations, each with its own interviewer and scenario, question or task. Each module or station is about eight minutes or less. There is usually a two-minute break between stations, with a total of nine applicants participating. The entire MMI process takes about two hours.

The applicant waits outside the examination room and reads, posted on the wall, a description of the next task, scenario or question they will need to face. They have two minutes to read and formulate their strategy. Then a bell rings, and all candidates enter their individual room to meet the interviewer. Some rooms will have an additional "actor" who will assist in a role-play of a scenario. The prompt is posted on the outside wall before going in to talk with the interviewer and it's also in the room, so at any point during the eight-minute interview the applicant can reference the question. Applicants are given a clipboard with paper and pencil, so they can make notes during the two minutes they have outside.

The MMI has three types of situations for the applicant to handle: a question, a scenario or a task. Instructions for tasks and scenarios given to applicants are vague by design. They are created that way as a sort of "medical Rorschach test", so applicants can go in multiple directions with their response. Interviewers may probe applicant's answers, disagree with them, interrupt them, or even debate them.

The interviewers will not discuss any aspects of the MMI process or of how the applicant is doing on the interview itself. Each station is graded on a scale from 1 to 10, with 1 being the best possible score. Applicants are given an aggregate interview score at the end of the MMI based on their performance in each individual station. If there is time, applicants may find themselves engaged in small talk with the interviewers.

The MMI interviewer may provide prompts designed to direct the applicant in each station. Applicants are urged to listen carefully to these cues so they can take advantage of any new information that may be introduced. Interviewers are a combination of school faculty, graduates, staff, and students who have been trained specifically for the MMI process at that institution. Each interviewer remains at the same station through the MMI while the applicants rotate. The MMI is a blind format. The interviewers do not have any background on the applicants.

The MMI: Psychometrically Sound

The MMI has demonstrated an ability to minimize unconscious interviewer bias (positive or negative) and to be more reliable than one-on-one interviews by using multiple "raters", or interviewers. Applicants who do poorly on one station (or who don't have favorable chemistry with one interviewer) have the immediate opportunity to perform better on another station.

The MMI test reliability is markedly higher compared to other interview formats. This gives the MMI higher predictive validity, which can predict future applicant performance much better than standard interview styles, including panel, group or behavioral interview formats. Traditional, one-on-one interview formats can be negatively influenced by inherent biases, expectations, and perspectives of an individual interviewer. The MMI overcomes these limitations. Harasym, et al. showed that interviewer variability accounted for up to 56% of the total variance in interview ratings.

Examples Of MMI Questions, Scenarios And Tasks

Remember, the MMI is not all scenario-based role-play, which many people tend to believe. The MMI can ask you a standard question, ask you to complete a task, or have you role-play a scenario. Here are some examples.

1. Enter the room and speak to the "patient" about their drug addiction.
   
   
2. Enter the room and respond to a picture, photograph or painting.
   
   
3. Respond to the question, "Should doctors be allowed to go on strike?"
   
   
4. Tell a patient that they have less than three months to live. Here you must actually role-play this scenario with an actor.
   
   
5. A relatively healthy patient sees you and has a slight limp. They immediately ask for a handicap car placard. How do you proceed? This scenario could be answered verbally, as in "I would take the following approach...", or this could be a role-play with an actor.
   
   
6. Enter the room and sit in a chair, back to back with the "actor". Describe to them the picture you have in your hand and guide them in drawing that picture, without using terms that actually describe what the object is.
   
   
7. Enter the room and use the lite-bright machine to create what you believe to be the best representation of "health or medicine, or a doctor", in your mind. The interviewer will ask questions as you go.
   
   
8. Write an essay on how you would go about reducing smoking and chewing tobacco use among teens at the national level.

There are generally no "wrong answers", but applicants are encouraged to be open-minded on matters such as abortion, euthanasia, and other common, yet controversial medical ethics issues. The goal is to look at all sides of an issue, pro and con, consider all stakeholders, and then take a stand on one aspect of that, and then to support that answer.

Once you begin coaching with me, I also have hundreds of specialized medical school questions I help you with around medical ethics, medical scenarios, traditional medical school questions, communication, current healthcare trends and societal issues and many other topic areas.

12 MMI Success Strategies

The MMI can be quite tricky and it can be intimidating. The only way to become confident and turn in a great performance is to prepare well, and to prepare early. Here is a sampling of strategies that can help you in an MMI situation.

1. Read the posted task, scenario or question carefully. Make sure you understand it fully. Begin to formulate possible responses. Think broadly and creatively.
   
   
2. Visualize how you'd like this station to play out. Picture yourself successfully navigating the situation.
   
   
3. Organize your thoughts and have a mental checklist or outline of your process.
   
   
4. Compose yourself before you enter the room. Take three very deep, slow breaths. Knock on the door briskly and enter with a smile. Walk right to the interviewer and shake the interviewer's hand, and introduce yourself, using your full name, not just your first.
   
   
5. Be centered and calm and take your time when you move about, and when you leave the room.
   
   
6. You do not need to utilize the entire time you have in the room. You will have two minutes to read and "game out" your response to the post while you are in the hallway. You can end your response early, as long as you've done and said everything you need. The sooner you enter the room the more time you have to respond. If you take too long in the hallway crafting your response, the interviewer may perceive you as indecisive, afraid, disorganized or sloppy.
   
   
7. Have a formula for answering questions. Paraphrase the question back to the interviewer. Tell them how you will approach the answer. Give them an outline or roadmap so they can follow you. Discuss all sides of the issue. Conclude by taking a stand on one choice, and back up your decision with solid reasoning. Use stories and examples from your life if appropriate.
   
   
8. Make sure you practice under timed circumstances. You must feel in advance the urgency to rapidly formulate your ideas and deliver cogent, thoughtful, reasoned, organized responses to each challenge. You may find that hiring a coach to help you craft these answers, role-play and prepare using mock interviews can be very helpful. This creates mental toughness and poise under pressure.
   
   
9. You may decide to leave two minutes for the interviewer to ask you questions. If the interviewer doesn't have any questions, you can summarize your comments.
   
   
10. Remember that the MMI tests emotional intelligence, so you want to use some rapport-building techniques in the room.
    
    
11. While it is important to be "comfortable in silence", this is not the time or the place to be silent! Utilize small talk, get to know the interviewer and be personable and warm.
    
    
12. Thank the interviewer and shake their hand one final time as you exit.

When you begin coaching with me, I give you a specialized 20-point medical scenario-answer checklist tool that helps you triage, organize and deliver potent scenarios.

14 Mistakes Candidates Make On The MMI

There is not a medical school applicant who is not nervous about undergoing an interview. Interviews put everyone on edge. When it comes to the MMI, an applicant's nerves are intensified, due to the ambiguous nature of the test, the requirement to actually act out responses, and the rapid pace of the entire day.

The worst mistake applicants make is to believe that the quality of their answers is without flaws. I receive calls and emails from students weekly who want last-minute coaching right before their interview. Some want this session the day before the interview! This is a disaster in the making. I have yet to encounter a student who has ideal answers, and ideal delivery of that content. Everyone needs to tweak and improve their material to some degree. If that is the case, how can this be accomplished mere days before such an important interview? It can't. How can these new answers be rehearsed? They can't. This adds huge stress to the applicant and can cause mental confusion. The remedy? Start early with coaching so you can practice, practice, practice. Correct practice and high-quality practice is what makes you feel confident going into the MMI. There is no substitute for practice.

Here are the most common mistakes applicants make when it comes to preparing for and performing at the MMI.

1. Applicants guess about the quality of their body language and eye contact.
   
   
2. Applicants practice only in their heads. The actual interview requires verbal responses.
   
   
3. Applicants don't know how to structure their answers so they are logical, organized and understandable.
   
   
4. Applicants don't time their practice sessions.
   
   
5. Applicants don't understand how to use rapport techniques.
   
   
6. Applicants don't know how to identify and handle "trick" questions.
   
   
7. Applicants don't know how to tell a story properly.
   
   
8. Applicants don't know how to gracefully "control the clock" so they feel more in control.
   
   
9. Applicants don't understand the method called "active listening", so they can deal with behavioral, hostile, personal, or baiting questions.
   
   
10. Applicants don't know how to "sell themselves".
    
    
11. Applicants don't know how to artfully recover if they lose their place or go blank.
    
    
12. Applicants don't know how to ask questions to create a conversation, or how to find unusual questions that make them stand out from other applicants.
    
    
13. Applicants don't know how to use mental training techniques to help them remain calm and focused throughout the entire MMI ordeal.
    
    
14. Applicants don't know how to prepare to get in the "zone" so they can give a great interview.

History Of The MMI

The MMI began at McMaster University Medical School near Toronto Canada in 2004, and since then, has been used by many medical, dental and pharmacy programs, and in other schools around the world. The MMI was developed from the Objective Structured Clinical Examination (OSCE). The OSCE is used by many health and medical programs to assess a student's application of clinical skills and knowledge. Reference: https://en.wikipedia.org/wiki/Objective_structured_clinical_examination

The MMI is being used as a medical school program admissions test by the majority of schools in Canada, and Australia since 2008.

The University of Cincinnati College of Medicine initiated an MMI pilot program in 2008, and launched their official MMI testing program that same year. This was the first use of the MMI at any medical program in the United States.

The MMI is also utilized in schools for chiropody, dental hygiene, medical laboratory technology, nuclear medicine technology, pharmacy, physiotherapy and occupational therapy, veterinary medicine, ultrasound technology, and X-ray technology.

Medical Schools Using The Multiple Mini Interview

In The United States:

1. Albany Medical College
   
   
2. Central Michigan University College of Medicine
   
   
3. Cooper/Rowan School of Medicine
   
   
4. Duke University School of Medicine
   
   
5. Michigan State University College of Human Medicine
   
   
6. New York Medical College
   
   
7. Oregon Health and Science University
   
   
8. Robert Wood Johnson Medical School, at Rutgers University
   
   
9. Stanford Medical School
   
   
10. David Geffen School of Medicine at UCLA
    
    
11. New York University School of Medicine
    
    
12. Universidad Central del Caribe School of Medicine, in Puerto Rico
    
    
13. University of Arizona College of Medicine
    
    
14. University of California Davis School of Medicine
    
    
15. University of California Riverside School of Medicine
    
    
16. University of Cincinnati College of Medicine
    
    
17. University of Massachusetts Medical School
    
    
18. University of Mississippi School of Medicine
    
    
19. University of Missouri-Kansas City School of Medicine
    
    
20. Virginia Tech Carilion School of Medicine
    
    
21. Western Michigan University School of Medicine

In Canada:

1. McMaster University Medical School
   
   
2. Queens University
   
   
3. McGill University
   
   
4. UBC Faculty of Medicine (British Columbia)
   
   
5. Northern Ontario School of Medicine
   
   
6. University of Alberta
   
   
7. University of Calgary
   
   
8. University of Montreal
   
   
9. Dalhousie University
   
   
10. University of Sherbrooke
    
    
11. University of Laval
    
    
12. University of Manitoba

Prepare Well, And Prepare Early For MMI Success

Navigating the MMI so you can arrive at a high score is a major accomplishment. When you can do that, you are well on your way to a satisfying career in medicine. You have just spent many years as an undergraduate, and studied long hours. You have spent a lot of time on medical school applications. When it comes to preparing for the MMI, don't sell yourself short. Prepare fully, and prepare well. Do that and you'll walk into the MMI and actually look forward to showing the interviewers "what you have", and how you can become a wonderful medical professional. Good luck!