Medical How Can Introverts (And Anyone Else) Do Well on the MMI?

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The Multiple Mini Interview (MMI) was designed at McMaster University in Canada to better evaluate an applicant’s interpersonal skills and predict performance in medical school. Like all other interviewers, MMI interviewers are looking for problem solving, communications skills, and the ability to listen to and respond to another person. The benefit of the MMI (to you, the applicant) is that it reduces the possibility that a single interaction will reflect poorly on you. One bad interview could be due to nerves, the interviewer having a bad day, or other factors beyond your control. If you have 8-10 chances, it has more validity and reliability. Studies have indeed shown that students who were accepted based on the MMI also perform better on their medical licensing exams. With that information, it was adopted by other schools and is the sole method of interviewing at many allopathic and osteopathic schools in the U.S, as well as medical, veterinary, dental and pharmacy schools throughout the world.

As with all new ideas, MMIs have a potential downside. A study from UC Davis published in 2012 showed that applicants with higher extroversion and agreeableness scores performed better on the MMI and were more likely to be accepted. Which begs the question: Does the MMI disadvantage introverts? And if so, will excluding introverts change the face of medicine for the worse? It’s important to remember that this study was done at one school and during one application cycle, and may have been influenced by a variety of factors. Until more research is available, there is no way to say for sure if introverts are being rejected in higher numbers than in the past. It’s also important to note that not all introverts were rejected, nor were all extroverts accepted (the trends were mainly seen at both ends of the introversion-extroversion scale).

We all have a comfort zone on the extroversion-introversion spectrum, and can change where we are at any given moment, depending on the setting, the people we are around, and our mental preparation. So how does a person who leans to the introvert end of the scale do better on the MMI? If extroverts are better communicators in a brief interaction, how can introverts become stronger in this area? The key is to exercise your extroversion muscles. Extroverts tend to excel at quick thinking, networking, collaborating, and conveying their ideas quickly. They also tend to appear happy, and to enjoy interacting with people. Introverts also have some key advantages. Most sessions are done in a one-to-one setting rather than a panel style, which is in the introvert’s comfort zone. In fact, introverts often excel in one-on-one settings because of their strength in listening, empathizing, problem-solving, and thoughtful communication (as opposed to small talk). If you think about it, all these skills are keys in a strong doctor-patient relationship. The main risk is that an introvert could be rated lower than an extrovert if they take too much time to start talking, or don’t get a chance to showcase their natural listening and empathizing ability. The key for an introvert is to calm themselves down multiple times and in multiple scenarios, and to do that, you need to practice.

Here are some tips for getting ready for the MMI.

In the weeks leading up to your MMI:

  1. Pick your wardrobe like an extrovert. Since introverts are at risk of blending into the background, it helps to wear something professional, yet with a touch of personality. A colored shirt, blouse or tie can give you the aura of extroversion. It will give others the impression that you are self-assured, and might even add to your confidence.
  2. Practice your smile. Your goal is to come across as friendly, so if you tend toward the serious side of life (many great doctors do), set an alarm several times a day to remind you to smile. Ask your friends and family which smile looks best. If you do it enough, eventually it will feel more natural. Research even suggests that smiling can improve your mood, so try practicing when you are having a bad day.
  3. Be true to yourself. It’s also okay to show your calm, focused and more serious side. This is who you are, but just don’t let these qualities make you appear unfriendly.
  4. Practice conversations. Talk with friends in 5-8 minute blocks about various topics, then ask them for feedback. Did they think you were following a pre-rehearsed script, or did you appear natural and in the moment? If their answer was a script, practice talking about topics you have never really thought about (eg does television prepare children for adult life, and if so, how?). Force yourself to be creative in your topics. This will help you be ready for the MMI question you have never considered before.
  5. Project confidence about why you are a good “fit” for their school. This is important for any interview, but in the MMI you only have a few minutes to convey it, so you need to be focused on what is important. Think about the word “fit” and make sure your answer is specific (and hence different) for each school you interview at. Be very specific: I like the __ program at your medical school, because it will allow me to ___. Talk about how your academic goals and the school’s strengths are similar. Do not talk about how you love their city (everyone does) or why they are such a great school (they already know this). Avoid generalizations that do nothing to reinforce YOUR fit there.
  6. Avoid arrogance. Introverts are sometimes better at this than extroverts, who are at risk for appearing overly confident. However, introverts can often appear aloof, especially when they are concentrating on their thoughts. If an interviewer mistakes this concentration for arrogance, they are going to rank you low on their list. When you are thinking about an answer, give clues about what you are doing. Practice saying phrases such as, “That’s a complicated question,” “I need to think about that one,” “There are a lot of factors to consider here,” and, “My thoughts on this are…” then start thinking aloud. Which brings us to the next tip…
  7. Show them you can think on your feet. This is easier for extroverts, but not impossible for an introvert who is more inclined to think things through. It just takes practice. Talk to yourself when studying for exams, deciding what to wear, or considering what you will fix for dinner. It’s a matter of turning something you do naturally in your head into a verbal process, and not being afraid to do it in front of others. Self-talk is actually a skill that comes naturally to introverts, and many introverts wonder for years if they are a little bit crazy because of it. Turn it outside and show your interviewer how your mind works. They will recognize it as the skill it really is.
  8. Show your problem-solving ability. Unlike extroverts, introverts don’t just say whatever pops into their head. When faced with a decision, they tend to think things through methodically and come up with a list of possible directions to take. This is comparable to the physician’s technique of creating a differential diagnosis, plan, and subsequent treatment options for a patient. Again, the key is to practice doing this out loud, especially in situations where you need to make a quick decision. If you can learn to do your problem-solving out loud and within a few minutes, you will score high points.
  9. Show that you can listen and consider various perspectives. This is also an introvert’s strength, so play it up. Pay attention to what the other person is asking. Be in the moment and show that you can engage in natural back and forth conversation. You may feel your nerves creeping up on you and suddenly forget all the great things you were going to talk about, but that’s ok! This is not about what you memorized, but rather, about what you hear. Show them you can listen and repeat their ideas back with a new perspective.
  10. Don’t sound like a “know it all.” Introverts sometimes appear arrogant because they are so excited to share their knowledge with others. They fail to notice how they come across. They may also be more afraid of looking stupid or not knowing an answer, so they ramble on about topics even if they don’t understand them. The key is to appear curious and ready to learn. Medical schools do not expect you to know a lot thus far, so if you don’t know an answer, say so in a way that is not apologetic or defensive. Instead, use this as an opportunity to show your eagerness to learn more about the topic. Be honest and express your lack of experience. Ask some clarifying questions, and be sure to say how you would go about learning more. Your spirit of investigation is more important than your knowledge. Every physician must look things up sometimes, so show that you are willing and able to find an answer.
On the Day of the MMI:

How do you stay calm when you feel like everything is riding on this moment? Take a page from the work of David Burns, author of the bestseller, “Feeling Good.” Burns talks about the cognitive distortions that tend to make us more anxious. One of the biggest is our tendency towards “all or none” thinking. We know we are engaging in “all or none” thinking when you use any of the following dichotomous terms:

• always/never

• success/failure

• everyone/no one

• everything/nothing.​

In addition, we are setting ourselves up for anxiety when we think in terms of absolutes, such as:

• perfect

• disastrous

• best

• worst

• only​

All of these words lead us to “catastrophize” events that otherwise could be seen as the normal ups and downs of life. If we can learn to ditch these absolutes in favor of more tolerable possibilities, such as good enough, passable, decent, acceptable, average, not too bad, our anxiety will not feel as extreme.

The basis for this comes from the Cognitive Behavioral Therapy (CBT) school, which tells us that our emotions follow our thinking. Let’s pretend for a moment that you think to yourself, “All my dreams are riding on this moment. If I don’t get in to this med school, I will never be a doctor. This is the only school I want to go to.” Now, these thoughts may or may not be true, however it helps to remind yourself that any statement with absolute words in them is unlikely to be true. The real problem is, IF you believe these statements are true, you will feel the pressure, and your emotional level will be higher than is helpful.

On the other hand, if you can teach yourself to think, “I have plenty of chances to do well today. Many of the schools I applied to are a good fit for me. If I don’t get in this year, I can apply again and be stronger for this experience,” you are less likely to feel such intense anxiety. Again, these thoughts may or may not be true, although they do not have absolute words, so they are more inclusive and more possible. The key is, IF you can make yourself temporarily believe them, you will naturally be in a calmer, and more receptive place for an interview. This will allow you the focus you need to show the introvert strengths that come naturally to you, and the extrovert strengths that you have practiced.

And finally, if you remember only one thing from this article, this is it: smile at every person you meet on interview day. Smiling can move a person’s impression of you from the lower end of the introversion-extroversion scale into the middle range. This range is where plenty of part-time introverts are accepted into medical school. Smiling makes you look happy, which leads the school to believe you like their program (and who doesn’t want to be liked?). Smiling also makes people feel more relaxed around you, and chances are that a relaxed interviewer will rate you higher than a tense interviewer. And lastly, smiling helps you feel calmer and more focused, which in turn allows you to share your natural introvert strengths. The fact is, medicine needs introverts, but it needs introverts who can step outside their own emotions and make others feel relaxed. It needs introverts who have the ability to share their thoughts with others. It needs introverts who are able to move up and down the extroversion scale when needed. So be yourself, but practice these extraversion tools for good measure.

After the MMI:

One of an introvert’s strength is writing, so sending a thank you is an easy way to showcase your ability. If a school specifically requests not to send one, it is wise to respect their request. Otherwise, a single thank you to the admissions director is usually your best bet. It should show your genuine gratitude for how they made you feel on interview day. If an interviewer or staff member went out of their way for you, and it feels right to thank them individually, go ahead and do so. But in most cases, a single thank you to the director is enough. Your note can include the names of anyone who was especially helpful, although I don’t recommend you send emails to everyone on the MMI who spoke to you, or list 20 names in your note.

The best way to feel confident going into your interview is to be absolutely sure you’ve taken the right steps to prepare. A mock interview and feedback from an Accepted admissions expert will provide you with personalized guidance and feedback and help you put your best foot forward on interview day. Contact us to get started!

Suzi Schweikert is a former UCSD School of Medicine adcom member who has mentored students in healthcare programs for over 20 years. She has a BA in English Lit from UCLA, an MD from UCSD, and an MPH from SDSU. Want Suzi to help you get Accepted? Click here to get in touch!

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This article was originally posted on blog.accepted.com.
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