Sunday, July 17, 2011

Screening for social skills in med school admissions

Like everyone, I've heard plenty of stories of doctors who egregiously lack bedside manner, and I've certainly had my share of face-to-face encounters with them. But I'm nonetheless troubled by what may be a new trend in medical admissions policies, reported on by last Monday's New York Times:

Doctors save lives, but they can sometimes be insufferable know-it-alls who bully nurses and do not listen to patients. Medical schools have traditionally done little to screen out such flawed applicants or to train them to behave better, but that is changing.
At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical....
The first thing I thought of when I read this were all the Aspie people I know who can't help being insufferable know-it-alls with poor listening skills but who nonetheless but might make excellent contributions to medical research. How would they fare during the Virginia Tech application process?
At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note. 
“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion.
Nor is Virginia Tech the only school seeking to screen applicants based on social skills: 
Dr. Charles Prober, senior associate dean at the Stanford University School of Medicine, said Stanford always valued social skills in students — particularly the ability to work collaboratively with colleagues and establish trust with patients — but did not have a reliable way of ferreting these skills out until adopting mini interviews.
Med schools seem to be forgetting that not all MDs work with nurses and patients--or in environments where teamwork skills are essential:
Administrators at Virginia Tech Carilion say teamwork has become so essential to medicine that the school not only chooses its students based on their willingness and ability to collaborate effectively, but also requires students to take teamwork classes.
Thus, for Virginia Tech anyway, passing the social skills tests is a rigid requirement for admission:
“Our school intends to graduate physicians who can communicate with patients and work in a team,” said Dr. Cynda Ann Johnson, the dean of the Virginia Tech Carilion School of Medicine, which opened in August 2010. “So if people do poorly on the M.M.I. [the above-described "multiple mini interview"], they will not be offered positions in our class.”
Wouldn't it make more sense to use screening tools like the M.M.I. later on in the process, and only for those specializations that actually require people skills?


gasstationwithoutpumps said...

All but a few M.D. positions require people skills. Research positions are better filled with Ph.D. doctors, as M.D. is essentially preparation for a service job.

The standard Ph.D. training may favor Aspies slightly, as it calls for intense focus sustained for a long time.

Anonymous said...

Agreed, gasstation. I'm not sure that MD's have to be tops in social skills (not like clergy, social workers, etc). But they do have to be at least average, and we've all met or dealt with those few that cause real harm through their inabiiity to listen or see things through someone else's eyes.

Katharine Beals said...

A couple of letter writers in Today's Times also raise the concern that this process will screen out shy people who are sensitive listeners but my take time (i.e., a few years of med school) to build up their confidence.

Anonymous said...

That is a more valid concern, Katherine. One would hope for a more sensitive evaluation instrument than just whether the person makes good eye contact and is quick to respond to comments and questions. It's my experience that medical professionals do value the "good insight but not very blabby" type of person.

Amanda said...

I wonder whether they have really thought this through. First, there are many different career paths for doctors with wildly differing personal skill requirements. And secondly, trying to identify such things as a propensity to work collaboratively may be futile. Compare with the serious work that has been done by Teach for America to identify what predicts high teacher performance - see here (the meat is on page 3 of the article) and here - and the resulting specification of what they are looking for .

I think that the things that TFA doesn't specify - such as a propensity to collaborate, widely found in teacher job descriptions, or in-depth subject knowledge, or experience of working with deprived children - are as interesting as the ones they do.

ChemProf said...

Part of this is a push for med schools to train more GPs and fewer specialists. There's also just a general trend toward de-emphasizing basic science (like physics or organic chemistry) in favor of more biology and biochem (which has to be somewhat dumbed down if it doesn't require the full year of organic). The sense is that this is better for a "more diverse" crop of doctors, or at least that's the argument that's being made. But it does make less room for the "left brained" among us!