NEW MEDICAL SCHOOL ADMISSION PROCESS DOESN'T REDUCE DIVERSITY

(SACRAMENTO, Calif.) — Under-represented minorities fare as well as others in an increasingly popular method of selecting medical school students known as the Multiple Mini Interview, or MMI, according to new research from the UC Davis School of Medicine.

Published online in the journal Academic Medicine, the study provides some reassurance that the MMI — a series of short, focused assessments often equated with “speed dating” — does not disadvantage applicants who are black, Latino or from lower socioeconomic backgrounds. The process limits applicants’ opportunities to tell their personal stories, which traditionally played a role in assuring medical school diversity.

“Medical school classes need to be diverse to ensure a physician workforce that reflects the patient populations they treat,” said Anthony Jerant, professor of family and community medicine at UC Davis and lead author of the study. “It doesn’t appear that the MMI conflicts with that goal, at least not at our school.”

During the MMI process, applicants go through a series of 10-minute stations focused on particular qualities such as problem solving, communication, integrity and resilience. They must demonstrate with different evaluators, or raters, that they have what it takes to succeed in medical school and, ultimately, as physicians.

For the study, Jerant and his colleagues examined data from the 2011, 2012 and 2013 UC Davis medical school application cycles to determine whether MMIs helped or hindered applicants’ admission outcomes based on race, ethnicity or economic background.

Race and ethnicity were determined from self-reported information on medical school applications. Rather than relying solely on self-report to determine socioeconomic status, the researchers developed a sophisticated, multi-component score that accounted for factors such as growing up in an underserved area, family participation in financial or nutrition assistance programs, and receiving financial-need based scholarships.

“Many studies ask students, ‘Are you socioeconomically disadvantaged? Yes or No,’” said Jerant. “Our approach was more nuanced in recognizing that not all disadvantaged applicants will self-identify as such.”

When all the numbers were crunched, the researchers found that minority status had no impact on MMI scores. While applicants from disadvantaged socioeconomic backgrounds had lower scores, the difference was very small and did not affect admission decisions.

“The MMI is part of a holistic admissions process that considers grades, undergraduate and graduate studies, prior experiences in medicine and other factors that may help applicants become good physicians,” said study senior author Mark Henderson, associate dean for admissions and outreach. “When all these factors were combined, UC Davis School of Medicine applicants from lower socioeconomic backgrounds came out okay.”

The findings are good news for medical schools around the country that have adopted the MMI. Jerant noted, however, that the study was only conducted at UC Davis, which has a long tradition of inclusion and diversity, and additional research should dig deeper into the results.

“We need to follow up on why applicants with lower socioeconomic status had slightly lower scores,” said Jerant, who is a medical school teacher and applicant screener. “This deserves further examination in studies that include a number of public and private medical schools in various regions of the country.”

The authors also recommend studies that measure the effects of rater bias on admissions decisions. Theoretically, multiple raters should reduce the impact of an individual’s preconceptions about individual applicants. Whether or not that is true is unknown.

The current study also showed evidence that the MMI process may disadvantage male applicants, which needs to be closely watched given that women now outnumber men in the medical profession.

“We will continue to evaluate our student selection processes to make sure they don’t conflict with our commitment to diversity,” said Henderson, who leads a UC-wide study of MMI known as the California Longitudinal Evaluation of Admissions Practices.

Additional UC Davis authors were Tonya Fancher, Joshua Fenton, Kevin Fiscella, Francis Sousa and Peter Franks.

The study, “How Medical School Applicant Race, Ethnicity, and Socioeconomic Status Relate to Multiple Mini Interview–Based Admissions Outcomes: Findings from One Medical School,” is online at http://journals.lww.com/academicmedicine/toc/publishahead.

The research had no external funding.

More information about the UC Davis School of Medicine is at http://www.ucdmc.ucdavis.edu/medschool/