For aspiring doctors in Australia, January marks the interview season, when dreams are made or dismantled. I had missed out on two rounds of offers to medical school before receiving an interview call in an era when academic merit was typically the sole entry criterion and the admitting class had been nearly filled.
I recall a curious but interesting conversation about my itinerant global life and penchant for writing mixed in with a bit of teen philosophy. Unbelievably, that interview got me one of the remaining seven places out of some 1,000 contenders. For allowing me to live my dream, I say thank you to the faculty each year by returning as an interviewer.
Things have changed since I was a student. Now, an interview is a compulsory aspect of admission to many medical schools, including mine. You can’t fail the interview and enter medicine on academic strength alone. A slightly less dazzling score paired with an impressive interview, however, can be the ticket.
The interview itself has undergone serial transformation – no longer “just a chat” (it probably never was), it’s now a heavily vetted tool with multiple interview stations, manned by different types of interviewers including community representatives. It doesn’t examine fact but what’s called “situational judgement”. By placing aspirants in situations that they may reasonably find themselves in as a medical student, it assesses key traits like empathy, reasoning, maturity, conflict-resolution, ability to communicate and ethical thinking. It is difficult “to teach to the test” because there are no trick questions or best answers.
I was surprised then to discover that the University of Queensland had dumped its medical interview altogether, saying that it does not add value beyond academic results and was a poor predictor of academic performance. Medical schools guard their decisions like state secrets so I am not privy to their data but the report did get me thinking about the kind of doctors we want to create and how we go about selecting them.
Associate professor Margaret Hay, the academic director of admissions at Monash University – where I studied – says that a career in medicine remains wildly popular. Each year, she receives 4,000 applications.
Of these, I can confidently say that 1,000 would make an excellent choice… for 250 places.
Like hundreds of other volunteer interviewers, I take my job seriously. As a hospital clinician, I regularly encounter its end product. I know that it is far easier to teach someone how to prescribe chemotherapy or treat hypertension than it is to impart a moral compass. And while no one comes across as a sociopath in the interview, thoughtful, deliberate and ethical youngsters do stand out. Weaved amongst some necessarily rehearsed answers are spontaneous accounts of the impoverished next-door neighbour who can’t decide between buying food or seeing the doctor, the dad who is a nurse to the entire street, the doctor grandma who hates missing the school concert but sometimes loves her patients more, and the friend whose suicide attempt was the impetus for studying medicine.
These conversations provide an important insight into the person behind the marks. Being able to articulate a vision to a stranger is also a good way of checking one’s own resolve, for to successfully study medicine, sentiment (because I want to) is every bit as important as logic (because I can). I can think of a few candidates over the years who have reconsidered their preference because of the kind of issues the interview forces them to contemplate. Better now than later, when the impact of perceived failure is much more lasting.
Hay is about to publish data showing a strong correlation between interview performance and successful navigation of the clinical years when medical students step outside the lecture theatre into the hospital environment. If validated, this will be an important reason to retain and aggressively improve the quality of interviews. Rescuing a student from a faltering clinical performance or worse, salvaging a struggling intern, is deeply troubling and very costly.
A 2013 Beyondblue survey found that medical students and young doctors were most at risk of experiencing psychological distress. 20% of students and 10% of doctors had thought about suicide in the previous year. Whenever I see distressed students or doctors, the reason is never because they are not smart enough and almost always because of difficulty with interpersonal communication that spills insidiously into all other areas of their life.
Dr. Google and associates can come to the rescue with factual knowledge but they are no good at teaching you how to think ethically, behave with genuine empathy, and figure out your rightful place in the profession. There is brilliance in the corridors of medicine but equally, drama, intrigue and ruthless competition for a spot on a fairly narrow pedestal. Personal integrity, then, is the single most important attribute of a good doctor. Of course a perfect high school score attests to a student’s quality but then, medicine is no stranger to high achievers who can’t get along with each other and who deceive their patients and peers, so entry based on academic merit alone can’t be the answer.
Nonetheless, whenever I am interviewing, there is a voice in the back of my head that argues that the interview is seeking a particular type of person. So while fostering a breed of articulate, empathetic and ethical doctors, could we be excluding the eccentric but gifted future Nobel laureate? After all, it’s all very well for clinicians to be good communicators but nothing beats communicating good news about a ground-breaking discovery.
But is it truly possible for one person, age 18, to be a gifted thinker and talented communicator? A gentle colleague who despaired of bedside medicine was about to quit when he was rescued by a career in the lab where he went on to make exceptional discoveries that he simply could not have done without his knowledge of medicine. Watching him fret was painful; witnessing his sparkling news conferences is a treat. He figures he would have failed the interview. Margaret Hay would say that all doctors need human skills. And of course, not all brilliant scientists are inaccessible. Barry Marshall, the Nobel laureate, seems like the kind of convivial doctor who could simultaneously regale patients and juggle Petri dishes.
It’s said that Einstein was an inarticulate adolescent, stubborn and rejecting of authority. Tears streamed down his face when he felt moved. Fortunately, he didn’t want to be a doctor, while a young Sigmund Freud switched to medicine in aid of his romantic life when he realised that a scientific career would not pay the bills. He was addicted to cigars and cocaine, whose salutary benefits, including a cure for hysteria and depression, he advocated. I wonder how Freud would have tackled the modern medical interview!
Incontrovertible proof of the benefit of the medical interview may still be on its way, and it’s quite possible that every now and then it misses the mark. Call me biased but after 10 years of being on the other side as an interviewer, I consider the medical interview an apt reminder to present and future doctors that their chosen profession is in equal parts science and art.