Multiple mini-interview test characteristics: 'tis better to ask candidates to recall than to imagine

Best practices for interviewing applicants for medical school admissions: a systematic review

INTRODUCTION

Interviews are commonly used to select applicants for medical school, residency, and fellowship. However, interview techniques vary in acceptability, feasibility, reliability, and validity. This systematic review investigated the effectiveness of different interview methods in selecting the best qualified applicants for admission to medical school and developed a logic model to implement best practices for interviewing.

METHODS

Five electronic literature databases were searched for comparative studies related to interviewing in medical schools from inception through February 1, 2021. Inclusion criteria included publications in English that compared different methods of conducting a selection interview in medical schools with a controlled trial design. General study characteristics, measurement methodologies, and outcomes were reviewed. Quality appraisal was performed using the Medical Education Research Study Quality Instrument (MERSQI) and the Oxford Risk of Bias Scale. Based on these findings, a logic model was constructed using content analysis.

RESULTS

Thirteen studies were included. The multiple mini-interview (MMI) was reliable, unbiased, and predicted clinical and academic performance; the virtual MMI increased reliability and lowered costs. For unstructured interviews, blinding interviewers to academic scores reduced bias towards higher scorers; student and faculty interviewers rated applicants similarly. Applicants preferred structured over unstructured interviews. Study quality was above average per the MERSQI, risk of bias was high per the Oxford scale, and between-study heterogeneity was substantial.

DISCUSSION

There were few high-quality studies on interviewing applicants for admission to medical school; the MMI appears to offer a reliable method of interviewing. A logic model can provide a conceptual framework for conducting evidence-based admissions interviews.

Effect of station format on the psychometric properties of Multiple Mini Interviews

BACKGROUND

Given the widespread use of Multiple Mini Interviews (MMIs), their impact on the selection of candidates and the considerable resources invested in preparing and administering them, it is essential to ensure their quality. Given the variety of station formats used and the degree to which that factor resides in the control of training programmes that we know so little about, format's effect on MMI quality is a considerable oversight. This study assessed the effect of two popular station formats (interview vs. role-play) on the psychometric properties of MMIs.

METHODS

We analysed candidate data from the first 8 years of the Integrated French MMIs (IF-MMI) (2010-2017, n = 11 761 applicants), an MMI organised yearly by three francophone universities and administered at four testing sites located in two Canadian provinces. There were 84 role-play and 96 interview stations administered, totalling 180 stations. Mixed design analyses of variance (ANOVAs) were used to test the effect of station format on candidates' scores and stations' discrimination. Cronbach's alpha coefficients for interview and role-play stations were also compared. Predictive validity of both station formats was estimated with a mixed multiple linear regression model testing the relation between interview and role-play scores with average clerkship performance for those who gained entry to medical school (n = 462).

RESULTS

Role-play stations (M = 20.67, standard deviation [SD] = 3.38) had a slightly lower mean score than interview stations (M = 21.36, SD = 3.08), p < 0.01, Cohen's d = 0.2. The correlation between role-play and interview stations scores was r = 0.5 (p < 0.01). Discrimination coefficients, Cronbach's alpha and predictive validity statistics did not vary by station format.

CONCLUSION

Interview and role-play stations have comparable psychometric properties, suggesting format to be interchangeable. Programmes should select station format based on match to the personal qualities for which they are trying to select.

Are different station formats assessing different dimensions in multiple mini-interviews? Findings from the Canadian integrated French multiple mini-interviews

BACKGROUND

Multiple mini-interviews (MMI) are used to assess non-academic attributes for selection in medicine and other healthcare professions. It remains unclear if different MMI station formats (discussions, role-plays, collaboration) assess different dimensions.

METHODS

Based on station formats of the 2018 and 2019 Integrated French MMI (IFMMI), which comprised five discussions, three role-plays and two collaboration stations, the authors performed confirmatory factor analysis (CFA) using the lavaan 0.6-5 R package and compared a one-factor solution to a three-factor solution for scores of the 2018 (n = 1438) and 2019 (n = 1440) cohorts of the IFMMI across three medical schools in Quebec, Canada.

RESULTS

The three-factor solution was retained, with discussions, role-plays and collaboration stations all loading adequately with their scores. Furthermore, all three factors had moderate-to-high covariance (range 0.44 to 0.64). The model fit was also excellent with a Comparative fit index (CFI) of 0.983 (good if > 0.9), a Tucker Lewis index of 0.976 (good if > 0.95), a Standardized Root Mean Square Residual of 0.021 (good if < .08) and a Root Mean Square Error of 0.023 (good if < 0.08) for 2018 and similar results for 2019. In comparison, the single factor solution presented a lower fit (CFI = 0.819, TLI = 0.767, SRMR = 0.049 and RMSEA = 0.070).

CONCLUSIONS

The IFMMI assessed three dimensions that were related to stations formats, a finding that was consistent across two cohorts. This suggests that different station formats may be assessing different skills, and has implications for the choice of appropriate reliability metrics and the interpretation of scores. Further studies should try to characterize the underlying constructs associated with each station format and look for differential predictive validity according to these formats.

Construct validity of multiple mini interviews - Investigating the role of stations, skills, and raters using Bayesian G-theory

Background: One popular procedure in the medical student selection process are multiple mini-interviews (MMIs), which are designed to assess social skills (e.g., empathy) by means of brief interview and role-play stations. However, it remains unclear whether MMIs reliably measure desired social skills or rather general performance differences that do not depend on specific social skills. Here, we provide a detailed investigation into the construct validity of MMIs, including the identification and quantification of performance facets (social skill-specific performance, station-specific performance, general performance) and their relations with other selection measures.Methods: We used data from three MMI samples (N = 376 applicants, 144 raters) that included six interview and role-play stations and multiple assessed social skills.Results: Bayesian generalizability analyses show that, the largest amount of reliable MMI variance was accounted for by station-specific and general performance differences between applicants. Furthermore, there were low or no correlations with other selection measures.Discussion: Our findings suggest that MMI ratings are less social skill-specific than originally conceptualized and are due more to general performance differences (across and within-stations). Future research should focus on the development of skill-specific MMI stations and on behavioral analyses on the extents to which performance differences are based on desirable skills versus undesired aspects.

Multiple Mini-Interviews: Current Perspectives on Utility and Limitations

The growing role of healthcare professionals urged admissions committees to restructure their selection process and assess key personal attributes rather than academic achievements only. Multiple mini interviews (MMIs) were designed in 2002 to assess such domains in prospective healthcare professions. Being a high-stake assessment, the utility and limitations of MMI need to be explored. The purpose of this article is to review the available evidence to establish its utility. The claim of the reliability is verified by the studies assessing the effect of number of stations, duration of stations, format and scoring systems of stations and number of raters assessing the applicants. Similarly, by gathering evidence concerning its content validity, convergent/divergent correlation and predictive ability, validity is ensured. Finally, its acceptability and feasibility along with limitations is discussed. This article concludes by providing recommendations for further work required to deal with the limitations and enhance its utility.

Qualitative Analysis of Multiple Mini Interview Interviewer Comments

OBJECTIVE

Qualitative studies of the Multiple Mini Interview (MMI) have investigated the attitudes and thoughts of prospective students and interviewers (i.e., raters) on the MMI interview, but none have examined rater's written assessments. Concerns regarding what the MMI measures, especially across and within each interview, have sparked investigations to determine how and what raters are measuring. Raters communicate their student evaluation(s) through numerical ratings and written comments that provide score context. This study explores rater's written comments to better understand the specific information gathered during the MMI process that contributes to interviewee evaluations.

METHODS

Randomized data from two US medical schools were examined with no numerical scores or other information about the interviewee provided to reviewers. In reviewing the rater comments, common words and phrases were identified to help construct themes that characterized the content (domains). Authors reviewed each other's notes and comments regarding themes and worked together to verify themes for accuracy.

RESULTS

Using a directed content approach to content analysis and reviewing the rater's comments, the results indicate that raters are focused on seven different domains: perspective taking, presentation, qualities, communication, coherence, comprehension, and non-verbal. Many of the rater comments contained multiple themes.

CONCLUSION

Raters' MMI comments provide the context for numerical scores allowing admissions committees to more fully understand a candidate's strengths or weaknesses. Identifying the themes in rater comments can ultimately assist the admissions committee to more comprehensively understand assessment elements that raters are using and consider important during the MMI evaluation.

Multiple Mini Interview as an admission tool in higher education: Insights from a systematic review

Objectives

Multiple Mini Interviews (MMI) have been conducted across the globe in the student selection process, particularly in health profession education. This paper reported the validity evidence of MMI in various educational settings.

Methods

A literature search was carried out through Scopus, Science Direct, Google Scholar, PubMed, and EBSCOhost databases based on specific search terms. Each article was appraised based on title, abstract, and full text. The selected articles were critically appraised, and relevant information to support the validity of MMI in various educational settings was synthesized. This paper followed the PRISMA guideline to ensure consistency in reporting systematic review results.

Results

A majority of the studies were from Canada, with 41.54%, followed by the United Kingdom (25.39%), the United States (13.85%), and Australia (9.23%). The rest (9.24%) were from Germany, Ireland, the United Arab Emirates, Japan, Pakistan, Taiwan, and Malaysia. Moreover, most MMI stations ranged from seven to 12 with a duration of 10 min per station (including a 2-min gap between stations).

Conclusion

The results suggest that the content, response process, and internal structure of MMI were well supported by evidence; however, the relation and consequences of MMI to important outcome variables were inconsistently supported. The evidence shows that MMI is a non-biased, practical, feasible, reliable, and content-valid admission tool. However, further research on its impact on non-cognitive outcomes is required.

Twelve tips for constructing a multiple mini-interview

Health professions the world over value various competencies in their practitioners that are not easily captured by academic measures of performance. As a result, many programs have begun using multiple mini-interviews (MMIs) to facilitate the selection of candidates who are most likely to demonstrate and further develop such qualities. In this twelve-tips article, the authors offer evidence- and experience-based advice regarding how to construct an MMI that is fit for purpose. The tips are provided chronologically, offering guidance regarding how one might conceptualize their goals for creating an MMI, how to establish a database of stations that are context appropriate, and how to prepare both candidates and examiners for their task. While MMIs have been shown to have utility in many instances, the authors urge caution against over-generalization by stressing the importance of post-MMI considerations including data monitoring and integration between one's admissions philosophy and one's curricular efforts.

The reliability of a portfolio of workplace-based assessments in anesthesia training

PURPOSE

Competency-based anesthesia training programs require robust assessment of trainee performance and commonly combine different types of workplace-based assessment (WBA) covering multiple facets of practice. This study measured the reliability of WBAs in a large existing database and explored how they could be combined to optimize reliability for assessment decisions.

METHODS

We used generalizability theory to measure the composite reliability of four different types of WBAs used by the Australian and New Zealand College of Anaesthetists: mini-Clinical Evaluation Exercise (mini-CEX), direct observation of procedural skills (DOPS), case-based discussion (CbD), and multi-source feedback (MSF). We then modified the number and weighting of WBA combinations to optimize reliability with fewer assessments.

RESULTS

We analyzed 67,405 assessments from 1,837 trainees and 4,145 assessors. We assumed acceptable reliability for interim (intermediate stakes) and final (high stakes) decisions of 0.7 and 0.8, respectively. Depending on the combination of WBA types, 12 assessments allowed the 0.7 threshold to be reached where one assessment of any type has the same weighting, while 20 were required for reliability to reach 0.8. If the weighting of the assessments is optimized, acceptable reliability for interim and final decisions is possible with nine (e.g., two DOPS, three CbD, two mini-CEX, two MSF) and 15 (e.g., two DOPS, eight CbD, three mini-CEX, two MSF) assessments respectively.

CONCLUSIONS

Reliability is an important factor to consider when designing assessments, and measuring composite reliability can allow the selection of a WBA portfolio with adequate reliability to provide evidence for defensible decisions on trainee progression.

A systematic review of stakeholder views of selection methods for medical schools admission

BACKGROUND

The purpose of this paper is to systematically review the literature with respect to stakeholder views of selection methods for medical school admissions.

METHODS

An electronic search of nine databases was conducted between January 2000-July 2014. Two reviewers independently assessed all titles (n = 1017) and retained abstracts (n = 233) for relevance. Methodological quality of quantitative papers was assessed using the MERSQI instrument. The overall quality of evidence in this field was low. Evidence was synthesised in a narrative review.

RESULTS

Applicants support interviews, and multiple mini interviews (MMIs). There is emerging evidence that situational judgement tests (SJTs) and selection centres (SCs) are also well regarded, but aptitude tests less so. Selectors endorse the use of interviews in general and in particular MMIs judging them to be fair, relevant and appropriate, with emerging evidence of similarly positive reactions to SCs. Aptitude tests and academic records were valued in decisions of whom to call to interview. Medical students prefer interviews based selection to cognitive aptitude tests. They are unconvinced about the transparency and veracity of written applications. Perceptions of organisational justice, which describe views of fairness in organisational processes, appear to be highly influential on stakeholders' views of the acceptability of selection methods. In particular procedural justice (perceived fairness of selection tools in terms of job relevance and characteristics of the test) and distributive justice (perceived fairness of selection outcomes in terms of equal opportunity and equity), appear to be important considerations when deciding on acceptability of selection methods. There were significant gaps with respect to both key stakeholder groups and the range of selection tools assessed.

CONCLUSIONS

Notwithstanding the observed limitations in the quality of research in this field, there appears to be broad concordance of views on the various selection methods, across the diverse stakeholders groups. This review highlights the need for better standards, more appropriate methodologies and for broadening the scope of stakeholder research.

Response distortion on personality tests in applicants: comparing high-stakes to low-stakes medical settings

The current study examined the degree to which applicants applying for medical internships distort their responses to personality tests and assessed whether this response distortion led to reduced predictive validity. The applicant sample (n = 530) completed the NEO Personality Inventory whilst applying for one of 60 positions as first-year post-graduate medical interns. Predictive validity was assessed using university grades, averaged over the entire medical degree. Applicant responses for the Big Five (i.e., neuroticism, extraversion, openness, conscientiousness, and agreeableness) and 30 facets of personality were compared to a range of normative samples where personality was measured in standard research settings including medical students, role model physicians, current interns, and standard young-adult test norms. Applicants had substantially higher scores on conscientiousness, openness, agreeableness, and extraversion and lower scores on neuroticism with an average absolute standardized difference of 1.03, when averaged over the normative samples. While current interns, medical students, and especially role model physicians do show a more socially desirable personality profile than standard test norms, applicants provided responses that were substantially more socially desirable. Of the Big Five, conscientiousness was the strongest predictor of academic performance in both applicants (r = .11) and medical students (r = .21). Findings suggest that applicants engage in substantial response distortion, and that the predictive validity of personality is modest and may be reduced in an applicant setting.

Personal domains assessed in multiple mini interviews (MMIs) for healthcare student selection: A narrative synthesis systematic review

OBJECTIVES

To examine the personal domains multiple mini interviews (MMIs) are being designed to assess, explore how they were determined and contextualise such domains in current and future healthcare student selection processes DESIGN: A systematic review of empirical research reporting on MMI model design was conducted from database inception to November 2017.

DATA SOURCES

Twelve electronic bibliographic databases.

REVIEW METHODS

Evidence was extracted from original studies, and integrated in a narrative synthesis guided by the PRISMA statement for reporting systematic reviews. Personal domains were clustered into themes using a modified Delphi technique.

RESULTS

A total of 584 articles were screened. 65 unique studies (80 articles) matched our inclusion criteria of which seven were conducted within nursing/midwifery faculties. Six in 10 studies featured applicants to medical school. Across selection processes, we identified 32 personal domains assessed by MMIs, the most frequent being: communication skills (84%), teamwork/collaboration (70%), and ethical/moral judgement (65%). Domains capturing ability to cope with stressful situations (14%), make decisions (14%), and resolve conflict in the workplace (13%) featured in fewer than ten studies overall. Intra- and inter-disciplinary inconsistencies in domain profiles were noted, as well as differences by entry level. MMIs deployed in nursing and midwifery assessed compassion and decision-making more frequently than in all other disciplines. Own programme philosophy and professional body guidance were most frequently cited (~50%) as sources for personal domains; a blueprinting process was reported in only 8% of studies.

CONCLUSIONS

Nursing, midwifery and allied healthcare professionals should develop their theoretical frameworks for MMIs to ensure they are evidence-based and fit-for-purpose. We suggest a re-evaluation of domain priorities to ensure that students who are selected, not only have the capacity to offer the highest standards of care provision, but are able to maintain these standards when facing clinical practice and organisational pressures.

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

BACKGROUND

Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

AIM

To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

METHOD

Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

RESULTS

Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

CONCLUSIONS

While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.

Validity: one word with a plurality of meanings

Validity is one of the most debated constructs in our field; debates abound about what is legitimate and what is not, and the word continues to be used in ways that are explicitly disavowed by current practice guidelines. The resultant tensions have not been well characterized, yet their existence suggests that different uses may maintain some value for the user that needs to be better understood. We conducted an empirical form of Discourse Analysis to document the multiple ways in which validity is described, understood, and used in the health professions education field. We created and analyzed an archive of texts identified from multiple sources, including formal databases such as PubMED, ERIC and PsycINFO as well as the authors' personal assessment libraries. An iterative analytic process was used to identify, discuss, and characterize emerging discourses about validity. Three discourses of validity were identified. Validity as a test characteristic is underpinned by the notion that validity is an intrinsic property of a tool and could, therefore, be seen as content and context independent. Validity as an argument-based evidentiary-chain emphasizes the importance of supporting the interpretation of assessment results with ongoing analysis such that validity does not belong to the tool/instrument itself. The emphasis is on process-based validation (emphasizing the journey instead of the goal). Validity as a social imperative foregrounds the consequences of assessment at the individual and societal levels, be they positive or negative. The existence of different discourses may explain-in part-results observed in recent systematic reviews that highlighted discrepancies and tensions between recommendations for practice and the validation practices that are actually adopted and reported. Some of these practices, despite contravening accepted validation 'guidelines', may nevertheless respond to different and somewhat unarticulated needs within health professional education.

CASPer, an online pre-interview screen for personal/professional characteristics: prediction of national licensure scores

Typically, only a minority of applicants to health professional training are invited to interview. However, pre-interview measures of cognitive skills predict for national licensure scores (Gauer et al. in Med Educ Online 21 2016) and subsequently licensure scores predict for performance in practice (Tamblyn et al. in JAMA 288(23): 3019-3026, 2002; Tamblyn et al. in JAMA 298(9):993-1001, 2007). Assessment of personal and professional characteristics, with the same psychometric rigour of measures of cognitive abilities, are needed upstream in the selection to health profession training programs. To fill that need, Computer-based Assessment for Sampling Personal characteristics (CASPer)-an on-line, video-based screening test-was created. In this paper, we examine the correlation between CASPer and Canadian national licensure examination outcomes in 109 doctors who took CASPer at the time of selection to medical school. Specifically, CASPer scores were correlated against performance on cognitive and 'non-cognitive' subsections of both the Medical Council of Canada Qualifying Examination (MCCQE) Parts I (end of medical school) and Part II (18 months into specialty training). Unlike most national licensure exams, MCCQE has specific subcomponents examining personal/professional qualities, providing a unique opportunity for comparison. The results demonstrated moderate predictive validity of CASPer to national licensure outcomes of personal/professional characteristics three to six years after admission to medical school. These types of disattenuated correlations (r = 0.3-0.5) are not otherwise predicted by traditional screening measures. These data support the ability of a computer-based strategy to screen applicants in a feasible, reliable test, which has now demonstrated predictive validity, lending evidence of its validation for medical school applicant selection.

Reliability and acceptability of six station multiple mini-interviews: past-behavioural versus situational questions in postgraduate medical admission

BACKGROUND

The multiple mini-interview (MMI) is increasingly used for postgraduate medical admissions and in undergraduate settings. MMIs use mostly Situational Questions (SQs) rather than Past-Behavioural Questions (PBQs). A previous study of MMIs in this setting, where PBQs and SQs were asked in the same order, reported that the reliability of PBQs was non-inferior to SQs and that SQs were more acceptable to candidates. The order in which the questions are asked may affect reliability and acceptability of an MMI. This study investigated the reliability of an MMI using both PBQs and SQs, minimising question order bias. Acceptability of PBQs and SQs was also assessed.

METHODS

Forty candidates applying for a postgraduate medical admission for 2016-2017 were included; 24 examiners were used. The MMI consisted of six stations with one examiner per station; a PBQ and a SQ were asked at every station, and the order of questions was alternated between stations. Reliability was analysed for scores obtained for PBQs or SQs separately, and for both questions. A post-MMI survey was used to assess the acceptability of PBQs and SQs.

RESULTS

The generalisability (G) coefficients for PBQs only, SQs only, and both questions were 0.87, 0.96, and 0.80, respectively. Decision studies suggested that a four-station MMI would also be sufficiently reliable (G-coefficients 0.82 and 0.94 for PBQs and SQs, respectively). In total, 83% of participants were satisfied with the MMI. In terms of face validity, PBQs were more acceptable than SQs for candidates (p = 0.01), but equally acceptable for examiners (88% vs. 83% positive responses for PBQs vs. SQs; p = 0.377). Candidates preferred PBQs to SQs when asked to choose one, though this difference was not significant (p = 0.081); examiners showed a clear preference for PBQs (p = 0.007).

CONCLUSIONS

Reliability and acceptability of six-station MMI were good among 40 postgraduate candidates; modelling suggested that four stations would also be reliable. SQs were more reliable than PBQs. Candidates found PBQs more acceptable than SQs and examiners preferred PBQs when they had to choose between the two. Our findings suggest that it is better to ask both PBQs and SQs during an MMI to maximise acceptability.

Impact of sociodemographic characteristics of applicants in multiple mini-interviews

BACKGROUND

Multiple mini-interviews (MMI) are commonly used for medical school admission. This study aimed to assess if sociodemographic characteristics are associated with MMI performance, and how they may act as barriers or enablers to communication in MMI.

METHODS

This mixed-method study combined data from a sociodemographic questionnaire, MMI scores, semi-structured interviews and focus groups with applicants and assessors. Quantitative and qualitative data were analyzed using multiple linear regression and a thematic framework analysis.

RESULTS

1099 applicants responded to the questionnaire. A regression model (R²=0.086) demonstrated that being age 25-29 (β = 0.11, p = 0.001), female and a French-speaker (β = 0.22, p = 0.003) were associated with better MMI scores. Having an Asian-born parent was associated with a lower score (β = -0.12, p < 0.001). Candidates reporting a higher family income had higher MMI scores. In the qualitative data, participants discussed how maturity and financial support improved life experiences, how language could act as a barrier, and how ethnocultural differences could lead to misunderstandings.

CONCLUSION

Age, gender, ethnicity, socioeconomic status and language seem to be associated with applicants' MMI scores because of perceived differences in communications skills and life experiences. Monitoring this association may provide guidance to improve fairness of MMI stations.

Validity of a new assessment rubric for a short-answer test of clinical reasoning

BACKGROUND

The validity of high-stakes decisions derived from assessment results is of primary concern to candidates and certifying institutions in the health professions. In the field of orthopaedic manual physical therapy (OMPT), there is a dearth of documented validity evidence to support the certification process particularly for short-answer tests. To address this need, we examined the internal structure of the Case History Assessment Tool (CHAT); this is a new assessment rubric developed to appraise written responses to a short-answer test of clinical reasoning in post-graduate OMPT certification in Canada.

METHODS

Fourteen physical therapy students (novices) and 16 physical therapists (PT) with minimal and substantial OMPT training respectively completed a mock examination. Four pairs of examiners (n = 8) participated in appraising written responses using the CHAT. We conducted separate generalizability studies (G studies) for all participants and also by level of OMPT training. Internal consistency was calculated for test questions with more than 2 assessment items. Decision studies were also conducted to determine optimal application of the CHAT for OMPT certification.

RESULTS

The overall reliability of CHAT scores was found to be moderate; however, reliability estimates for the novice group suggest that the scale was incapable of accommodating for scores of novices. Internal consistency estimates indicate item redundancies for several test questions which will require further investigation.

CONCLUSION

Future validity studies should consider discriminating the clinical reasoning competence of OMPT trainees strictly at the post-graduate level. Although rater variance was low, the large variance attributed to error sources not incorporated in our G studies warrant further investigations into other threats to validity. Future examination of examiner stringency is also warranted.

How Different Medical School Selection Processes Call upon Different Personality Characteristics

Background

Research indicates that certain personality traits relate to performance in the medical profession. Yet, personality testing during selection seems ineffective. In this study, we examine the extent to which different medical school selection processes call upon desirable personality characteristics in applicants.

Methods

1019 of all 1055 students who entered the Dutch Bachelor of Medicine at University of Groningen, the Netherlands in 2009, 2010 and 2011 were included in this study. Students were admitted based on either top pre-university grades (n = 139), acceptance in a voluntary multifaceted selection process (n = 286), or lottery weighted for pre-university GPA. Within the lottery group, we distinguished between students who had not participated (n = 284) and students who were initially rejected (n = 310) in the voluntary selection process. Two months after admission, personality was assessed with the NEO-FFI, a measure of the five factor model of personality. We performed ANCOVA modelling with gender as a covariate to examine personality differences between the four groups.

Results

The multifaceted selection group scored higher on extraversion than all other groups(p<0.01), higher on conscientiousness than both lottery-admitted groups(p<0.01), and lower on neuroticism than the lottery-admitted group that had not participated in the voluntary selection process. The latter group scored lower on conscientiousness than all other groups(p<0.05) and lower on agreeableness than the multifaceted selection group and the top pre-university group(p<0.01).

Conclusions

Differences between the four admission groups, though statistically significant, were relatively small. Personality scores in the group admitted through the voluntary multifaceted selection process seemed most fit for the medical profession. Personality scores in the lottery-admitted group that had not participated in this process seemed least fit for the medical profession. It seems that in order to select applicants with suitable personalities, an admission process that calls upon desirable personality characteristics is beneficial.

How effective are selection methods in medical education? A systematic review

CONTEXT

Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years.

METHODS

A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design.

RESULTS

Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness.

CONCLUSIONS

Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

Past-behavioural versus situational questions in a postgraduate admissions multiple mini-interview: a reliability and acceptability comparison

BACKGROUND

The Multiple Mini-Interview (MMI) mostly uses 'Situational' Questions (SQs) as an interview format within a station, rather than 'Past-Behavioural' Questions (PBQs), which are most frequently adopted in traditional single-station personal interviews (SSPIs) for non-medical and medical selection. This study investigated reliability and acceptability of the postgraduate admissions MMI with PBQ and SQ interview formats within MMI stations.

METHODS

Twenty-six Japanese medical graduates, first completed the two-year national obligatory initial postgraduate clinical training programme and then applied to three specialty training programmes - internal medicine, general surgery, and emergency medicine - in a Japanese teaching hospital, where they underwent the Accreditation Council for Graduate Medical Education (ACGME)-competency-based MMI. This MMI contained five stations, with two examiners per station. In each station, a PBQ, and then an SQ were asked consecutively. PBQ and SQ interview formats were not separated into two different stations, or the order of questioning of PBQs and SQs in individual stations was not changed due to lack of space and experienced examiners. Reliability was analysed for the scores of these two MMI question types. Candidates and examiners were surveyed on this experience.

RESULTS

The PBQ and SQ formats had generalisability coefficients of 0.822 and 0.821, respectively. With one examiner per station, seven stations could produce a reliability of more than 0.80 in both PBQ and SQ formats. More than 60% of both candidates and examiners felt positive about the overall candidates' ability. All participants liked the fairness of this MMI when compared with the previously experienced SSPI. SQs were perceived more favourable by candidates; in contrast, PBQs were perceived more relevant by examiners.

CONCLUSIONS

Both PBQs and SQs are equally reliable and acceptable as station interview formats in the postgraduate admissions MMI. However, the use of the two formats within the same station, and with a fixed order, is not the best to maximise its utility as an admission test. Future studies are required to evaluate how best the SQs and PBQs should be combined as station interview formats to enhance reliability, feasibility, acceptability and predictive validity of the MMI.