Regardless of your faith background, it makes sense that The 10 Commandments were recorded and passed down for centuries.
Morality and ethics are QUITE complex, and the human consciousness only has so much capacity. Having a set of 10 rules that covers all ground is not only convenient, but also logical. Sure, it’s reductive, but that’s the whole point. It needs to be.
I’m no Moses, but I wanted to give you 10 Commandments for the MMI Interview - a set of mantras to uphold and apply to ANY scenario you see in the MMI format.
In an MMI, you’ll never be able to fully predict the questions you receive, so the best you can do is have strategies and frameworks that you can continuously draw upon.
So, without further ado...
We make exceptions for people all the time in real life, but you can’t afford to do this in the MMI interview.
If you make exceptions to any rules, whether consciously or not, you’ll come off as someone who oversteps boundaries and cannot abide by regulations. NOT a good look for an aspiring doctor.
If you’re in an MMI scenario where you know someone has done something wrong (cheated on a test, vandalized property, broken patient confidentiality, etc.), you MUST hold them accountable.
In other words, you often have to be the “bad guy” who confronts someone, tattles on them, or escorts them to the proper authorities. DON’T let people off the hook, whether they’re actors or hypothetical characters in an ethical prompt.
The MMI prompts typically only give you partial information, and on top of that, the information will often trap you into making certain assumptions.
For example, consider this prompt:
Two patients need a liver transplant, but there is only one liver available at the time. Tell the interviewer how you would decide between: a 64-year-old retired politician who is a recovering alcoholic, or a 26-year-old mother of three who is on welfare.
Many people will see this and assume that there’s no donor/transplant list in this scenario. I mean, if there were a list, this prompt wouldn’t even exist, right?
WRONG. You need to start from scratch and take nothing for granted. ANY doctor would be forced to consider something like the donor list, so don’t avoid it!
It can be hard to back up so significantly in your thought process and decision making, especially when the prompt is already complex. But in a prompt like the one above, failing to start from scratch could show you as oblivious, or worse, negligent.
Candidates are often concerned with the length of their responses, fearing that they won’t be able to fill all the time in their MMI stations.
However, it’s important to remember that the interviewers usually have follow-up questions based on your responses. By talking for all eight minutes in a station, you will be depriving yourself the opportunity to receive these guiding questions.
Additionally, if it’s an acting station, you’ll want to ask a lot of questions and give the actors a lot of options, just so you can get them talking. Acting stations are awkward enough, but they’re even worse if you’re stuck yammering the whole time.
In some MMI scenarios, it might feel like you already have all the evidence you need. You also might feel anxious and hyper-focused on the task at hand, but keep in mind that your role as an investigator is never finished.
For example, consider this prompt:
ACTING STATION: You are working on a group project with 5 other students. One of the students, Emma, doesn’t show up for meetings or if they do show up – she is late and leaves early. She has put very little effort into the group project but shows up on the day of the presentation and tries to take credit for the project. Talk to Emma.
Okay, you can’t be the exception to the rule, so you can’t let Emma off the hook. So you’re going to confront Emma and turn her over to the professor, right?
Maybe. You don’t have enough evidence yet. You need to give Emma the benefit of the doubt and approach her from a place of concern, asking questions to suss out the reason behind her negligence.
Maybe Emma’s grandma just died. Maybe her parents just kicked her out of the house. Maybe she’s struggling with a drug or alcohol problem.
These all seem extreme, but you need to give her a chance to “drop a bomb” on you. If the actor has a secret, and you don’t discover it, you’ve essentially failed. DON’T stop searching.
In some ethical dilemmas, you can escape or skirt the decision-making process by calling upon some higher authority. There’s a reason why we have laws as a society and why we have bosses in the workplace. We need strict rules and arbiters of the system so that we can navigate these grey ethical areas that present themselves.
Sure, you want to explore all other options first. But in some cases, you won’t be left with that many choices. It’s important to know about the legal issues that apply to you as a student, a potential doctor, or a resident of your city/state. In some situations, you’ll be limited by confidentiality, or oppositely, you’ll be obligated to report a serious safety concern.
Don’t use these higher authorities as a cop-out, but definitely call upon them when appropriate.
It’s a fallacy to think that MMI scenarios have one “best” solution - the truth is that the scenarios could play out in a number of different ways, and your stance or approach should hinge on certain variables or conditionals.
Let’s consider our negligent group partner, Emma, from before:
“If the group discovered a serious personal issue in Emma’s life, I would offer to help Emma find support on campus and suggest talking to the professor as a group to explain the situation.”
“If Emma hesitated to give us a valid excuse, but seemed troubled, I would try to talk to her in private after the group meeting in case she was too embarrassed or afraid to speak in front of the group.”
“If it appears that Emma is simply neglecting her duties, I would try to re-establish a set of expectations for the group and have everyone sign off on them.”
“If Emma didn’t correct her actions over the next few meetings, I would inform the professor about the situation and ask for his or her guidance.”
These conditional statements are like a cheat code for ethical dilemmas, because they let you create your own criteria for answering the question, while also showing yourself as someone who can think ahead and anticipate different outcomes.
The MMI scenarios can subconsciously narrow your thinking or your scope of consideration, and you have to fight against this.
For example, consider this scenario:
You are running for an elected campus position as a class representative against one other opponent. One night a week before election day, several of your own posters were vandalized with insensitive graffiti that disparaged you or your character. Several of your friends tell you that the perpetrators were close allies of your opponent, and that it appears your opponent was involved in the act. What actions would you take?
While focusing on the task of gathering evidence and confronting your opponent, it would be easy to lose sight of the bigger picture.
In other words, what’s the effect of this crime on the larger campus community? Did the vandalism include slurs or hate speech? Has the vandalizer struck other areas of campus? How many students are likely to have seen it, and how much would it affect the ethics of the campaign race?
These considerations might seem tangential, but they’re effective in showing you as outward-thinking and conscientious. As a doctor, your actions could have huge consequences on people, both directly and indirectly, so THINK BIG.
We’ve written about the “Rate My Doc” ethical prompt before, and it’s perfect for illustrating this commandment in action:
Hypothetical situation: A co-worker shows you the “rate my doc” website where many of your patients have anonymously complained about your apparent lack of concern about their health and the high cost of your services. What would you do?
When doing mock interviews, I’ve seen students overreact to this scenario, slipping into very dangerous territory. Their responses sounded something like this:
“I would not take the criticism from ‘Rate My Doctor’ lightly. If I felt like any of the reviews or complaints were unwarranted, or outside of my responsibility and control, I would try to issue a formal response on the website to provide more information and clarity. If needed, I would want to exonerate myself before anything becomes accepted as popular opinion.”
If it needs to be said, please DON’T cross these crucial professional or personal boundaries. There are several healthy and productive ways to respond to this dilemma without directly interacting with the Rate My Doc website.
You have two minutes to read an MMI prompt, take notes, and gather your thoughts. You must use this time wisely in order to have the most success.
What should you write down in your notes? QUESTIONS! Write as many questions as you can possibly think of.
Let’s consider an example:
One of your patients, a 17-year-old male, has disclosed that he has been having unprotected sex with other men and wants to take PrEP so that he can reduce his chances of contracting HIV. You try to recommend alternative courses of action, but he is adamant about his choice and says that he will deny it vehemently if you inform his parents and will simply find a way to buy it from a friend or on the black market. How do you handle this situation?
What you DON’T KNOW is just as important as what you DO KNOW:
What do I know about PrEP? Pre-viral, prescribed, pill
Can I treat him as an adult? Or do I have to tell his parents? What are the laws where I’m practicing?
How frequent is he having unprotected sex? How many partners? Has he been tested?
Why does he refuse other forms of protection? Motivations? What’s the best rhetoric for a 17-year-old?
How does he talk about the black market? Aggressive threat or passing comment? How much does he know about the risks?
Making a list of questions will give your response a clear path to follow, while also letting you eat up some more time with all your considerations.
As important as it is to consider ALL the information, ALL the perspectives, ALL the possibilities, YOU MUST take a stance!
During mock interviews, I’ve seen students give brilliant responses, with all kinds of insightful considerations, but then they never actually explain the actions they’d take or where they officially stand on the issue.
Let’s consider this example:
Due to the shortage of physicians in rural communities, it has been suggested that medical programs preferentially admit students who are willing to commit to a 2- or 3-year tenure in an under-serviced rural area upon graduation. What do you think would be the implications of such a policy? Would it work, and at what cost?
One time, I had a candidate who asked some important questions that I had never considered for this prompt:
“Would the 2- or 3-year tenure occur after residency, or would it be encompassed within residency?”
“What does ‘preferentially admit’ mean exactly? A certain quota for their incoming classes? Tuition waivers?”
“How much would candidates be vetted beyond their ‘willingness?’”
The candidate went on like this for a while, and I was impressed to see him turn this prompt inside out. He also discussed the fact that many schools have already implemented these screening/recruiting strategies on an informal level.
He sounded really smart, but he never answered the question about whether he thinks the policy would indeed work or not.
Even if you’re dealing with a complex, multifaceted problem, you need to make sure you’re taking a definitive stance. You can (and should) qualify what you say, but if you don’t follow through with a clear answer, you’ll likely lose points for that station.
Still have questions about the MMI? What commandments should we add to our list? Let us know in the comments below, and we’ll respond to you personally!
Best of luck with your MMI interviews! Thou shalt crush it.