Janine C. Edwards

The interview in the admission process

Significant demographic, legal, and educational developments during the last ten years have led medical schools to review critically their selection procedures. A critical component of this review is the selection interview, since it is an integral part of most admission processes; however, some question its value. Interviews serve four purposes: information gathering, decision making, verification of application data, and recruitment. The first and last of these merit special attention. The interview enables an admission committee to gather information about a candidate that would be difficult or impossible to obtain by any other means yet is readily evaluated in an interview. Given the recent decline in numbers of applicants to and interest in medical school, many schools are paying closer attention to the interview as a powerful recruiting tool. Interviews can be unstructured, semistructured, or structured. Structuring involves analyzing what makes a medical student successful, standardizing the questions for all applicants, providing sample answers for evaluating responses, and using panel interviews (several interviewers simultaneously with one applicant). Reliability and validity of results increase with the degree of structuring. Studies of interviewers show that they are often biased in terms of the rating tendencies (for instance, leniency or severity) and in terms of an applicants sex, race, appearance, similarity to the interviewer, and contrast to other applicants). Training interviewers may reduce such bias. Admission committees should weigh the purposes of interviewing differently for various types of candidates, develop structured or semistructured interviews focusing on nonacademic criteria, and train the interviewers.

A survey of basic technical skills of medical students.

Purpose. In 1998, the Medical Schools Objectives Project (MSOP) Report listed the minimum routine technical procedures that graduating medical students should be proficient to perform. The authors conducted a survey to determine to what extent basic technical skills are being taught formally and how student competence in these skills is being evaluated in U.S. medical schools. Method. A questionnaire of five items, designed to supplement existing information in CurrMIT, the national curriculum database for medical schools, was transmitted electronically via the AAMC listserv to associate deans for academic affairs. Results. Sixty-two of the 126 medical schools (52%) responded to the survey. Most agreed that graduating medical students should be proficient to perform basic technical skills. Fifty-five percent of the respondents required students to keep logs of procedures performed. A majority responded that their students were proficient to perform venipuncture, IV placement, suturing lacerations, Foley catheter placement, and arterial puncture. The responding schools stated that few students are proficient in thoracentesis and intubation of children and neonates. Conclusions. It is likely that half of the medical schools are not attaining the MSOP objective of rigorously teaching and evaluating technical procedures. Currently, more measures and more sophisticated measures of physicians’ performance are being implemented in medical practice. The authors’ findings call attention to this educational need and act as a stimulus to improve this aspect of medical education.

An Admission Model for Medical Schools.

Complex societal issues affect medical education and thus require new approaches from medical school admission officers. One of these issues—the recognition that the attributes of good doctors include character qualities such as compassion, altruism, respect, and integrity—has resulted in the recent focus on the greater use of qualitative variables, such as those just stated, for selected candidates. In addition, more emphasis is now being placed on teaching and licensure testing of the attributes of the profession during the four-year curriculum. The second and more contentious issue concerns the system used to admit white and minority applicants. Emphasizing character qualities of physicians in the admission criteria and selection process involves a paradigm shift that could serve to resolve both issues. To make this or any paradigm shift in admission policy, medical schools must think about all the elements of admission and their interrelationships. A model of medical school admission is proposed that can provide understanding of the admission system and serve as a heuristic guide. This model consists of (1) the applicant pool; (2) criteria for selection; (3) the admission committee; (4) selection processes and policies; and (5) outcomes. Each of these dimensions and the interrelationships among the dimensions are described. Finally, a hypothetical example is provided in which the model is used to help a medical school change its admission process to accommodate a new emphasis in the schools mission.

Developing Disaster Preparedness Competence: An Experiential Learning Exercise for Multiprofessional Education

Background: The hurricane disasters of 2005 and the threat of pandemic infectious diseases compel medical educators to develop emergency preparedness training for medical students and other health care professional students. Description: This article describes an experiential exercise for learning a number of the general core competencies in the 2003 AAMC report titled “Training Future Physicians about Weapons of Mass Destruction.” A modified tabletop exercise for medical and veterinary students, which was developed and implemented in 2005, is described. The exercise focused on Highly Pathogenic Avian Influenza (HPAI), an emerging infectious disease scenario that raised the possibility of biological attack. The students were assigned roles in small groups, such as community physicians, hospital personnel, public health officials, veterinarians, school nurses, and emergency managers. Fifteen faculty members were recruited from these various areas of expertise. Pre- and posttesting of medical students showed significant gains in knowledge. The authors describe the scenario, small-group role playing, study questions, injects, Web sites and readings, and evaluation tools. Conclusions: This experiential exercise is an effective, inexpensive, and easily adapted tool for promoting multiple competencies in mass health emergency preparedness for a variety of health care students including medical, veterinary, public health, and nursing students.

Sustainability of Partnership Projects: A Conceptual Framework and Checklist

BACKGROUND There is growing recognition that the health care delivery system in the United States must make major changes. Intervention projects focusing on quality and patient safety offer the potential for reshaping the future of medicine. Sustainability of the Partnerships for Quality (PFQ) projects and other patient safety and quality improvement projects that provide evidence of effectiveness is essential if progress is to be made. METHODS For the purposes of these projects, a conceptual framework and a checklist for sustainability were developed. The framework consists of two dimensions: (1) the goals--what is to be sustained--and (2) elements for sustainability--infrastructure, incentives, incremental opportunities for involvement, and integration. The checklist is designed to trigger planning for sustainability early in a projects design. Specific questions about each of the elements can cue planners and project leaders to build in the goals for sustainability and change processes. RESULTS A pilot test showed that the framework and checklist are relevant and helpful across a variety of projects. DISCUSSION AND CONCLUSION Two extended examples of planning and action for sustainability from the PFQ projects are described. It is too early to claim sustainability for these project. However, continued monitoring for at least three years with the checklist could result in valuable national data with which to design and implement future projects.

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results

OBJECTIVE To investigate the effectiveness of a quality improvement educational program in rural hospitals. DESIGN Hospital-randomized controlled trial. SETTING PARTICIPANTS A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. INTERVENTION The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. MAIN OUTCOME MEASURES Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. RESULTS No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. CONCLUSIONS While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

Promoting Regional Disaster Preparedness among Rural Hospitals.

CONTEXT AND PURPOSE Rural communities face substantial risks of natural disasters but rural hospitals face multiple obstacles to preparedness. The objective was to create and implement a simple and effective training and planning exercise to assist individual rural hospitals to improve disaster preparedness, as well as to enhance regional collaboration among these hospitals. METHODS The exercise was offered to rural hospitals enrolled with the Rural and Community Health Institute of the Texas A&M University System Health Science Center, and 17 participated. A 3-hour tabletop exercise emphasizing regional issues in a pandemic avian influenza scenario followed by a 1-hour debriefing was implemented in 3 geographic clusters of hospitals. Trained emergency preparedness evaluators documented observations of the exercise on a standard form. Participants were debriefed after the exercise and provided written feedback. RESULTS Observations included having insufficient staff for incident command, facility constraints, the need to further develop regional cooperation, and operational and ethical challenges in a pandemic. CONCLUSIONS The tabletop exercise gave evidence of being a simple and acceptable tool for rural medical planners. It lends itself well to improving medical preparedness, analysis of weak spots, development of regional teamwork, and rapid response.

Beyond affirmative action: one school's experiences with a race-neutral admission process.

The authors first review the national debate about affirmative action programs, examine the results of these programs in higher education, and present data from 1995 through 1999 for minority enrollment in U.S., California, and Texas medical schools. Population projections for the state of Texas indicate a national trend that minority groups will outnumber the current majority early in the new millennium. A brief review of studies of the practice patterns of minority physicians concludes that minority physicians serve patients of their own races and/or ethnicities, poor patients, and Medicaid patients in disproportion to their numbers. This rationale, as well as the humanitarian need to develop all persons to their highest potential, led the Texas A&M University Health Science Center College of Medicine to develop a race-neutral process for admission. Changes in the admission process are described and preliminary results are presented. This article is written to stimulate other medical colleges to engage in an ongoing dialog about admission criteria and processes that can effectively select applicants who fit the mission of each medical college and who, as physicians, will care for patients who are members of this countrys burgeoning minority groups.

Surgery resident selection and evaluation. A critical incident study.

This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members andfour senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.

the Effects of Differently Weighting Interview Scores on the Admission of Underrepresented Minority Medical Students

PURPOSE Seeking to admit medical students who will later practice medicine in underserved areas, but faced with the national debate over affirmative action programs, the authors evaluate the effects that giving different weightings to academic and interview scores have upon the acceptance or rejection of certain applicants. METHOD The authors reviewed the admission records of 439 applicants to Texas A&M University College of Medicine in 1996-97. They compared the applicants actually admitted (accepted under a formula that equally weighted the two scores) with applicants who would have been admitted if the formula had weighted the interview scores at either 60% or 70% and the academic scores at either 40% or 30%. RESULTS Weighting the academic score at 40% and the interview score at 60% produced little change in the make-up of the admissions. Weighting the academic score at 30% and the interview score at 70%, however, would have resulted in offers of acceptance to three additional underrepresented minority applicants, two of whom were disadvantaged students. CONCLUSION Readjusting the weights of the criteria by which applicants are offered admission to medical schools may help meet the goal of educating doctors who will practice in underserved communities. More research must be done to explore other adjustments to admission criteria.