Cross-sectional evaluation of an asynchronous multiple mini-interview (MMI) in selection to health professions training programmes with 10 principles for fairness built-in.

OBJECTIVES: We aimed to explore the psychometric properties of the first known online asynchronous multiple mini-interview (MMI) designed for fairness with subgroup analyses by key characteristics, usability and acceptability. DESIGN: Cross-discipline multimethod evaluation. SETTING: One UK University. PARTICIPANTS: Applicants to nursing, midwifery and paramedic science undergraduate programmes during 2021-2022. PRIMARY, SECONDARY OUTCOME MEASURES: Psychometric properties (internal consistency, construct validity, dimensionality) were assessed using Cronbach's alpha (α), parallel analysis (PA), Schmid-Leiman transformation and ordinal confirmatory factor analysis (CFA). Usability and acceptability were evaluated using descriptive statistics and conventional content analysis. METHODS: The system was configured in a seven question 4 min MMI. Applicants' videorecorded their answers which were later assessed by interviewers and scores summed. Applicants and interviewers completed online evaluation questionnaires. RESULTS: Performance data from 712 applicants determined good-excellent reliability for the asynchronous MMI (mean α 0.72) with similar results across subgroups (gender, age, disability/support needs, UK/non-UK). PA and factor analysis results suggested there were seven factors relating to the MMI questions with an underlying general factor that explained the variance in observed candidate responses. A CFA testing a seven-factor hierarchical model showed an excellent fit to the data (Confirmatory Fit Index=0.99), Tucker Lewis Index=0.99, root mean square error (RMSE) =0.034). Applicants (n=210) viewed the flexibility, relaxed environment and cost savings advantageous. Interviewers (n=65) reported the system to be intuitive, flexible with >70% time saved compared with face-to-face interviews. Reduced personal communication was cited as the principal disadvantage. CONCLUSIONS: We found that the asynchronous MMI was reliable, time-efficient, fair and acceptable and building fairness in was lost-cost. These novel, insights are applicable across health professions selection internationally informing the future configuration of online interviews to ensure workforces represent the societies they serve.

Can a virtual learning module foster empathy in dental undergraduate students?

BACKGROUND: Empathy is an essential part of patient-centred health care, which positively benefits both patients and clinicians. There is little agreement regarding how best to design and deliver training for healthcare trainees to impart the skills and behaviours of clinical empathy. The study aimed to inform the field by sharing an educational intervention where we aimed to improve empathy amongst dental undergraduate students in Trinity College Dublin using a virtual learning module. METHODS: Adopting pre-post-repeat pre-experimental design, dental professional students completed the Jefferson Scale of Empathy (JSE) for Health Professional Students immediately prior to and after a three-week virtual programme designed to increase clinical empathy. Using a three-factor model described for the JSE in the literature, scores were evaluated for internal consistency and paired tests were performed on scores appropriate to their distributions. Seven-point Likert scales were scored to record student experience of training and technology, which are reported descriptively. RESULTS: Most of the 37 participants were female (76%) and represented dental science (N = 27) and dental hygiene roles (N = 7). Results revealed a mean JSE-HPS scale score rise from 110.0 (SD = 10.4) to 116.4 (SD = 11.1), which represented a rise of 5.8% (t (36) = 3.6, p = 0.001). The three factors associated with cognitive empathy, namely perspective-taking (T(36) = 3.931, p < 0.001; walking in the patient's shoes T(36) = 2.093, p = 0.043); and compassionate care (Z = 2.469, p = 0.014) were all found to have increased after the intervention. Students reported a positive experience of discipline-specific and generic videos as part of the module. CONCLUSION: The study demonstrated that a virtual educational module was associated with an increase in empathy amongst dental undergraduate students. The design of a blended module incorporating the Massive Open Online Course (MOOC) and virtual learning are beneficial and have a promising future.

Feasibility of an automated interview grounded in multiple mini interview (MMI) methodology for selection into the health professions: an international multimethod evaluation.

OBJECTIVES: Global, COVID-driven restrictions around face-to-face interviews for healthcare student selection have forced admission staff to rapidly adopt adapted online systems before supporting evidence is available. We have developed, what we believe is, the first automated interview grounded in multiple mini-interview (MMI) methodology. This study aimed to explore test-retest reliability, acceptability and usability of the system. DESIGN, SETTING AND PARTICIPANTS: Multimethod feasibility study in Physician Associate programmes from two UK and one US university during 2019-2020. PRIMARY, SECONDARY OUTCOMES: Feasibility measures (test-retest reliability, acceptability and usability) were assessed using intraclass correlation (ICC), descriptive statistics, thematic and content analysis. METHODS: Volunteers took (T1), then repeated (T2), the automated MMI, with a 7-day interval (±2) then completed an evaluation questionnaire. Admission staff participated in focus group discussions. RESULTS: Sixty-two students and seven admission staff participated; 34 students and 4 staff from UK and 28 students and 3 staff from US universities. Good-excellent test-retest reliability was observed at two sites (US and UK2) with T1 and T2 ICC between 0.65 and 0.81 (p<0.001) when assessed by individual total scores (range 80.6-119), station total scores 0.6-0.91, p<0.005 and individual site (≥0.79 p<0.001). Mean test re-test ICC across all three sites was 0.82 p<0.001 (95% CI 0.7 to 0.9). Admission staff reported potential to reduce resource costs and bias through a more objective screening tool for preselection or to replace some MMI stations in a 'hybrid model'. Maintaining human interaction through 'touch points' was considered essential. Users positively evaluated the system, stating it was intuitive with an accessible interface. Concepts chosen for dynamic probing needed to be appropriately tailored. CONCLUSION: These preliminary findings suggest that the system is reliable, generating consistent scores for candidates and is acceptable to end users provided human touchpoints are maintained. Thus, there is evidence for the potential of such an automated system to augment healthcare student selection.

Challenges In Widening Participation Outreach: Is Enough Being Done To Tackle The Under-Representation Of Low-Income Students In Medicine?

Widening Participation (WP) in medicine refers to all theory, activities and policy concerned with removing barriers to entering medical school for students from lower income and under-represented backgrounds. Medical schools and other institutions including; the Medical Schools Council, the Office for Fair Access, the Higher Education Funding Council for England, have been committed to improving Widening Participation for more than a decade. As senior medical students and academics, we have been actively involved with WP work at our respective medical schools and in conjunction with the British Medical Association (BMA) and the Medical Schools Council (MSC). Yet, we have observed over the years that the pace of change seems sometimes stuttering and stagnated. Here, we have investigated the reasons why there is still such a significant under-representation of students from lower income backgrounds in medicine. In order to make the medical student intake representative of the general population, the number of applications from lower income students would need to increase five-fold. This would require a great scaling up of WP outreach work. Critical analysis demonstrates that medical schools and the other key institutions in medical education have made many nominal commitments to WP, but have yet to make any commitments that are truly binding. This may be due to the institutions lack of belief in their own capacity to scale up WP Outreach sufficiently to achieve success. Ultimately binding commitments will be needed to secure a representative intake of medical students. In order for institutions to be willing to move towards such commitments, evidence-based success in WP must first be demonstrated through collaboration on specific projects that are scalable, sustainable and impactful.

An exploration of applicant perceptions of asynchronous video MMIs in medical selection.

This article was migrated. The article was marked as recommended. Over the last two decades, technological advancements internationally have meant that the Internet has become an important medium for recruitment and selection. Consequently, there is an increased need for research that examines the effectiveness of newer technology-mediated selection methods. This exploratory research study qualitatively explored applicant perceptions of fairness of asynchronous video interviews used in medical selection. Ten undergraduate medical students participated in a pilot asynchronous multiple-mini interview and were invited to share their experiences and perceptions in a follow-up interview. The data was transcribed verbatim and analysed using template analysis, with Gilliland's (1993) organisational justice theory guiding the original template. Many of the original themes from Gilliland's model were uncovered during analysis. Additionally, some significant themes were identified that did not form part of the original template and were therefore added to the final coding template - these were specifically relating to technology, including acceptability in a medical context; technical issues and adverse impact. Overall, results suggested that participants perceived asynchronous video interviews to be a fair method of selection. However, participants thought asynchronous interviews should only be used as part of an extensive selection process and furthermore, should not replace face-to-face interviews. Findings are discussed in line with existing research of fairness perceptions and justice theory in selection ( Gilliland, 1993) and implications for research and practice are presented.

Does the inclusion of 'professional development' teaching improve medical students' communication skills?

BACKGROUND: This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations. METHODS: Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported. RESULTS: Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination. CONCLUSIONS: Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.

The effect of professional skills training on patient-centredness and confidence in communicating with patients.

OBJECTIVES: The effect of introducing professional skills training on students' patient-centred attitudes and perceptions of ability to communicate was examined. The professional skills training included weekly training in communication skills, ethics and law, and clinical skills. METHODS: Consecutive cohorts of medical students receiving a traditional pre-clinical curriculum (n = 199) and a new curriculum including professional skills training (n = 255) were compared. Students completed the Doctor-Patient Scale to assess patient-centred attitudes and an 11-item scale to assess confidence in their ability to communicate with patients. Students completed the measures at the start of Year 1 and the end of Year 2. RESULTS: Students receiving the professional skills training showed increased confidence in communicating with patients and increases in 2 dimensions of patient-centredness ('holistic care' and 'patient decision making'). Students receiving the traditional curriculum showed increased nervousness in talking to patients. Gender and ethnic differences were found in patient-centredness and confidence in communicating, which were maintained over time. CONCLUSIONS: The introduction of professional skills training was successful in improving students' confidence in their ability to perform specific communicative behaviours and increasing patient-centredness relative to a traditional curriculum.