Trends concerning a common medical school interview question, revisited

Abstract

Purpose: To assess the validity of asking prospective medical school students about their planned field of practice during their admissions interview at one United States allopathic medical school, and to compare and contrast the results with the results from a similar study conducted in 2004.

Methods: Anonymous one-page surveys were voluntarily filled out and immediately collected from matriculated freshman medical students who wished to participate in this Institutional Review Board (IRB) approved study.

Results: Ninety five medical students voluntarily completed and returned the anonymous survey; 82 were filled out correctly. Of the 82 respondents, 32 were uncertain about the field of medicine they plan to pursue. Of the 50 remaining respondents who felt certain of their future direction, 58% (29/50) reported telling the truth when asked about their future direction during the admissions interview, 34% (17/50) were not completely forthcoming and truthful, and 8% (4/50) were not asked at all.

Conclusions: The findings of this study, along with the findings from our 2004 study, strongly suggest that asking prospective medical students during their medical school interview what type of medicine they wish to practice may not yield valid responses.

Practice points

• During the process of evaluating prospective medical students for entrance into medical it is not uncommon during the admissions interview to ask prospective medical students about the field of medicine they wish to practice, though this may not yield valid responses.

• Applicants may find themselves not being completely truthful due to various influences and ideas.

• When considering inquiring about an interviewee's field of pursuit it is advantageous to evaluate the purpose of asking what field of medicine they wish to pursue.

Background

Most United States medical school admission committees use a compilation of variables to help them decide whether or not to accept a medical school applicant into their program. Such variables include the applicant's primary application, Medical College Admission Test (MCAT) scores and grade point average (GPA), letters of recommendation, secondary (often called supplemental) application, and personal interviews. Of course, each medical school admission committee is unique, and not all use the same measurements in contemplating and granting acceptance. For example, not all medical schools require secondary applications to be completed. Some admission committees will send out supplemental applications to a majority of their applicants, where others are much more selective. Secondary applications are often a compilation of questions not covered on the primary application, which medical schools can use as a tool to obtain more information and insight on applicants to their program. For most committees, the MCAT scores and GPA are used as the initial screening tool in determining which candidates will possibly be granted an interview, as noted by Puryear and Lewis (1981); Mitchell (1987); Edwards et al. (1990); Nowacek et al. (1996); Elam et al. (2002); and Albanese et al. (2003). It is not uncommon for admission committees to utilize minimum requirements for MCAT scores and GPA when deciding which applicants will receive secondary applications or interviews. The interview process is then used as the deciding factor for granting acceptance, as has been noted by Rosenburg (1973) and Arnold et al. (1984). As stated by Johnson and Edwards (1991) after a prospective student is granted an interview, interview ratings ranked first in importance in selecting candidates at United States medical schools.

Interviews are used as a means by which a medical school admission committee can become better acquainted with the applicant in a more personal manner. During the interview, various questions are asked of the applicant, and the applicant in turn is given an opportunity to ask any questions concerning the medical school. The interview provides the last chance for prospective students to set themselves apart from their peers; therefore, most applicants prepare thoroughly for the interview. There are multiple on-line discussions and websites dedicated to the medical school interview process, all offering hundreds of potential questions and scenarios for applicants to contemplate before their actual interview. One common theme covered in preparatory interview material is how to answer the question ‘What type of medicine do you wish to practice?’ The most commonly recommended answer in on-line discussions is to declare oneself undecided or entertaining the thought of primary care. Not all applicants feel comfortable answering this question and many find themselves not being completely forthcoming and truthful with their responses. There are a multitude of factors that may play a role in discouraging prospective medical students from being completely truthful. These factors include uncertainty, fear of saying the wrong thing, prior interview experiences, competition amongst applicants, as well as advice from other applicants.

The main purpose of this study was to ascertain the validity of asking a prospective medical school student during their interview, ‘What type of medicine do you wish to practice?’

Methods

A one-page survey, IRB approval sheet, and information packet about the research were provided to every incoming medical student at a particular medical school orientation. An explanation of the research was presented and the surveys were voluntarily filled out and immediately returned in a confidential manner.

Other than asking ethnicity, age, gender, MCAT scores, and GPA, our survey focused on three main areas. First, students were asked if they were questioned during their medical school interview about the aspect of medicine they plan on pursuing in the future. Secondly, we asked the students if, at the time of their interview, they had a good idea what aspect of medicine they would like to pursue. Lastly, the subset of students who felt fairly certain as to the aspect of medicine they would like to pursue were asked to tell us if they were completely forthcoming and truthful in their interview responses, and if not, to explain why. The students were provided with a checklist of options regarding why they were not completely forthcoming and truthful, and they were also given the opportunity to explain themselves if the checklist did not coincide with their reasoning.

Results

Out of 103 medical students, a total of 95 voluntarily completed our anonymous survey. Eighty-two surveys were filled out correctly, revealing 32 students who were unsure of the field of medicine they plan to pursue (Figure 1). Out of the 50 respondents who reported having an idea of the aspect of medicine they plan to pursue (Figure 2), 58% (29/50) reported being truthful in their responses when asked, 34% (17/50) were not completely forthcoming and truthful, and 8% (4/50) were not asked at all.

Figure 1. Number of students certain of future direction-Vs- number of students uncertain of future direction.

Figure 2. Number of students certain of future direction who were completely truthful, not completely truthful, or not asked about their planned future direction.

From the subset of students who were certain of their future direction, the 17 who responded that they were not completely forthcoming and truthful during their interview gave varying reasons for their lack of candor, with some students checking and/or listing more than one reason (Table 1).

Table 1.  Responses from students certain of future direction who stated they were not completely forthcoming and truthful during their interview process

Number of responses	Reasons
11	My desire goes against the goal of the college of medicine, such as trying to develop physicians who will practice medicine in rural areas.
8	Heard from sources that revealing true desire could possibly hinder my interview.
8	Interviewed by a MD outside of the aspect of medicine I am interested in.
7	Was not sure how the interviewer would react.
2	Felt uncomfortable during the interview.
3	Others:
	Psychiatry is viewed negatively by many.
	I want to be a dermatologist/allergist.
	I did not want to say I do not know.

Other than the number of respondents, there were no differences noted between students uncertain as compared to those certain of future direction (Table 2a). In regards to the students certain of future direction, a difference was noted in regards to MCAT scores between the subset of students completely truthful, not completely truthful, and those not asked about their future direction (Table 2b).

Table 2a.  Comparison of gender, average age, composite MCAT, and average GPA between students uncertain of future direction as compared to those certain of future direction

	Uncertain of future direction	Certain of future direction
Gender	19♀, 13♂	29♀, 21♂
Average age	24	24
Composite MCAT	29.63	28.87
Average GPA	3.80	3.70

Table 2b.  Comparison of gender, average age, composite MCAT, and average GPA of those certain of their future direction who were completely truthful, not completely truthful, or were not asked about their planned future direction

	Certain of future direction	Certain of future direction	Certain of future direction
	Completely truthful	Not completely truthful	Not asked
Gender	18♀, 11♂	9♀, 8♂	2♀, 2♂
Average age	23	24	24
Composite MCAT	28.25	30.12	28.25
Average GPA	3.69	3.72	3.69

Our current results and our 2004 findings (Kelley & Ray 2004) show definite similarities. In our 2004 study, out of 53 correctly returned surveys, 21 students were unsure of the field of medicine they were planning to pursue. Out of the 32 remaining surveys in which respondents reported having a good idea of the aspect of medicine they plan on pursuing, 81% (26/32) were truthful in their responses about their plans while 19% (6/32) were not completely truthful.

The reasons provided by the six students who were not completely truthful closely mirror the responses obtained in our current study. As with our current study, our 2004 study (Kelley & Ray 2004) provided the students with a checklist of options regarding why they were not completely forthcoming and truthful, as well as gave them the opportunity to explain themselves if the checklist did not coincide with their reasoning. The number of responses from our 2004 study (given in parenthesis) and reasons are as follows, with some students listing more than one reason: (1) ‘I stated I was open to primary care when I am actually not’, (4) heard from sources that revealing my true desire could possibly hinder my interview, (2) my desire goes against the goal of the college of medicine, such as trying to develop physicians who will practice medicine in rural areas, (3) was interviewed by a MD outside of the aspect of medicine I am interested in, (1) was not sure how the interviewer would react, and (1) felt uncomfortable during the interview.

Conclusions/Comments

Medical school admission committees commonly ask prospective medical students during their interview, ‘What type of medicine do you wish to practice?’ Clearly not all committees have the same interest in or place the same weight on the answer. Research looking at the medical school admissions process as a way to generate a specific type of medical doctor has been carried out multiple times by authors including Madison (1994); Loony et al. (1998); Rabinowitz & Paytner (2000); Rabinowitz et al. (2001); Neilson (2003); Curran & Rourke (2004) and Campos-Outcalt et al. (2004). As concluded by Looney et al. (1998); applicant data at the time of admission decisions are of limited value for identifying those who will eventually become generalist physicians or practice in a rural area. For medical school admission committees that have attempted to focus on and accept applicants with certain profiles in the hopes that they will pursue a certain field of medicine; the results of our study suggest merely asking prospective students about the field of medicine they wish to pursue may not be the most valid avenue to achieve the desired student pool, as applicants’ perception of a school's ideal candidate may influence how they represent themselves in the interview.

A multitude of factors may contribute to prospective medical students’ reluctance to be completely forthcoming and truthful when asked about the field of medicine they wish to pursue. Those applicants fortunate enough to receive an interview after enduring the application process are often concerned with potentially saying something the admissions committee might frown upon. According to our results, students may be reluctant to reveal their future plans when they are being interviewed by a medical doctor with a different area of interest, when they have heard from other students that revealing their true desire could possibly hinder their interview, when they feel uncomfortable during their interview, when they are not sure how the interviewer will react, and when they have a desire to pursue an aspect of medicine that may go against the mission of the college of medicine, such as trying to develop physicians who will practice medicine in rural areas.

The findings of this study, along with the findings from our previous study (Kelley & Ray 2004), strongly suggest that asking prospective medical students during their medical school interview, ‘What type of medicine do you wish to practice?’ may not yield valid responses. It may be useful for medical schools to evaluate their purpose for asking this question of a prospective medical student. This study supports the notion that considering an interviewee's desire to pursue a certain field of medicine should have little bearing on the decision to accept or reject an applicant since interviewees may not be completely truthful due to various influences and ideas.

Admittedly, this study is limited in scope, examining a single entering medical school class at a single institution, and does not claim to be universally applicable to every United States medical school admission committee. Furthermore, this research does not imply that the current medical school admission process is invalid or unimportant. On the contrary, without the interview, the medical student body would perhaps suffer by having less diversity. The subjectivity of the interview allows committee members no only the means for bringing together individuals with different backgrounds and ideologies, but also for taking into consideration the needs and concerns of their surrounding communities. Medical schools have an enormous social responsibility to strive to educate future medical doctors to fill all the various niches in society, from future academic departmental chairs to rural practitioners. If the admissions process were based merely upon the objective measurements that prospective medical students submit, medical schools would have a substantially more difficult time in fulfilling their social responsibilities.

There are limitations in this study that must be addressed. First, it would be advantageous to conduct this study on a larger scale at numerous other medical schools, especially with the findings that 34% of the students who felt certain as to the field of medicine they desire to pursue were not completely truthful. Secondly, due to the anonymous nature of the survey, as with all anonymous surveys, it is impossible to validate if the responses received were truthful and valid themselves. Thirdly, since the anonymous survey was given to incoming students some time after their actual interview; the students’ responses may not have been completely accurate due to any inability to recall the actual events of their interview at this particular institution. Lastly, additional surveys may provide insight into whether or not students were accurate in their own predictions about their planned field of practice.

Additional information

Notes on contributors

S. R. Kelley M.D.

SCOTT R. KELLY is 2nd year surgical resident at Good Samaritan Hospital in Cincinnati Ohio and will be pursuing a fellowship in trauma and critical care. He has an interest in the education of medical students.

M. A. Ray M.D.

MALIA A. RAY, M.D. is a 3rd year medicine/pediatrics resident at Children's Hospital in Cincinnati Ohio. She will be pursuing a pulmonary critical care fellowship with a focus on cystic fibrosis. Malia is extremely interested in the medical school admissions process and the different methods of evaluation used between various institutions.

B. J. Tsuei M.D.

BETTY J. TSUEI, M.D. is an associate professor of surgery in the department of surgery, division of trauma and critical care, at the University of Cincinnati. One of her main interests is in the education of residents and medical students.