Medical School Interviews

Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity

Last week, The Wall Street Journal reported that the U.S. Education Department is requiring the Texas Tech University Health Sciences Center medical school to discontinue its practice of factoring race into its admissions decisions. The medical school agreed to a deal with the Education Department in order to end the long-running federal investigation into its use of affirmative action. In 2003, after the Supreme Court ruled that race was admissible as a factor in admissions decisions in Grutter v. Bollinger, the Texas Tech University Health Sciences Center resumed use of race as a criteria in admissions decisions. In 2004, the Center for Equal Opportunity filed a complaint against the school, and the next year the Education Department began the investigation, which this agreement concludes.

Texas Tech had previously ceased using its affirmative action policy for admissions in the pharmacy school in 2008 and for undergraduate programs in 2013. However, the medical school contended that, “It must continue weighing race in its admissions process because a cohort of doctors from different backgrounds could best serve Texas’ racially and ethnically diverse communities.” However, the recently signed agreement stipulated that the school was not providing an annual review of the necessity of race-based admissions and therefore could not rule out that other factors may provide similar diversity-levels. The agreement also suggested that the medical school use other “race-neutral factors” to meet diversity aims, “such as recruiting students from low-income areas and favoring bilingual or first-generation college students.”

Earlier this week and just following news of this agreement, Kaplan Test Prep released survey results showing that 80 percent of 245 pre-med students surveyed in January 2019 say that “It’s important for the American medical profession to be more demographically representative of the general patient population.” Among the students who agreed with this statement, one commented, “While it is certainly possible to be empathetic and ‘tuned in’ to your patients despite differences in language, culture, etc., it is important for patients to feel like they can relate to and trust their clinician…If American clinicians were more demographically representative of the population as a whole, patients would likely find it easier to connect with a care provider they are most comfortable with.” Those in the 20 percent who did not agree with the statement were more likely to focus on the importance of drive and technical ability in becoming an effective doctor.

Additionally, an earlier Kaplan study with medical school admissions officers showed that many felt competent with their school’s diversity efforts. When the admissions officers were asked to grade his/her medical school on diversity, the majority gave themselves a B (35 percent) or C (34 percent), while fewer rewarded themselves with an A (18 percent) and even fewer a D or F (5 percent).

While it is clear that prospective medical students and doctors see the value in diversity in medical school admissions, the process by which the schools will implement these diversity goals is changing based on the views of the current administration. And these changes should be noted, especially by prospective medical students.

For future applicants: Overall, it is wise to seek experiences that improve your ability to work with others, particularly those unlike yourself. And throughout your application, you will want to speak to these experiences in a manner that showcases your commitment to serving a diverse population of patients, highlights areas where you will bring diversity into the program, and show how you have thrived and what you have learned in diverse environments in the past.

As Physician Demand Will Continue to Outpace Supply, Medical School Admissions Committees are Particularly Interested in Applicants Committed to Practicing Primary Care in Underserved Locations

The AAMC recently published updated results of its physician workforce analysis, which modeled physician demand and supply to project the needs of the 2030 workforce. The analysis shows that physician demand will continue to outpace supply, which will lead to a physician shortage of between 42,600 and 121,300 full time equivalencies (FTEs) by 2030.

Within primary care, the shortage is projected to fall between 14,800 and 49,300 physicians, which incorporates various assumptions about the supply and partnership of Advanced Practice Registered Nurses and Physicians Assistants in the future, as well as the current estimated need for 13,800 physicians to reconcile the primary care shortage from currently designated shortage areas.

Projections for non-primary care specialties, including medical, surgical and other specialties, show an estimated shortage of between 33,800 and 72,700 physicians. The greatest projected gap is for surgeons, which is between 20,700 and 30,500 by 2030. While the supply of surgeons is projected to stay steady over time, the demand is expected to increase. “Other” specialties, which include emergency medicine, anesthesiology, psychiatry, radiology, and others, has a projected gap of between 18,600 and 31,800.

The main driver behind the increasing demand for physicians is the growing and aging U.S. population. Between 2016 and 2030, “the U.S. population is projected to grow about 11 percent, from about 324 million to 359 million. The population under age 18 is projected to grow by 3 percent; the population aged 65 and older is projected to grow by 50 percent; and the population aged 75 and older is projected to grow by 69 percent.”[i] Similarly, on the supply side, the aging population of physicians and their associated retirement decisions will impact the severity of the gap. “More than one-third of all currently active physicians will be 65 or older within the next decade. Physicians aged 65 and older account for 13.5 percent of the active workforce, and those between the ages of 55 and 64 make up nearly 27.2 percent of the active workforce.” [ii] Physicians’ weekly working hours are also currently trending downward across all physician age groups.

The report also modeled access to care, which is another factor that may impact demand in the future. There are currently inequities in access to care based on geographic, economic and sociodemographic factors. While projected physician shortages based on these factors was not included in the long-term projection estimates, the 2016 models show that if the country commits to improving access to care for disenfranchised groups, the demand for physicians will be drastically increased.

The AAMC is currently advocating for a multipronged approach to address the physician shortage including the improved use of technology, team-based care, and delivery innovations, as well as the increase of federal funding for additional residency positions. The AAMC is clear that the U.S. government needs to act in the short-term to expand graduate medical education to address the long-term physician demand identified in the report, as physician training is a ten-year process. Federal funding for residency positions has not been expanded since the 1997 Balanced Budget Act. While there have been two pieces of legislation recently introduced (explained below), which would provide funding for additional residency spots,[iii] neither have gained much traction since introduction.

  • The Resident Physician Shortage Reduction Act of 2017 provides comprehensive reform to federal funding for graduate medical education.
  • Lifts the funding cap placed on the number of residents and fellows funded by Medicare
  • Adds an additional 3,000 federally-supported residency positions each year for the next five years
  • The Opioid Workforce Act of 2018 specifically targets and funds residency training for areas of critical need.
  • Adds an additional 1,000 federally-supported resident positions over the next five years in hospitals that have, or are establishing, programs in addiction medicine, addiction psychiatry, or pain management

Prospective and current medical students should familiarize themselves with this report, especially when considering their future fields of study.  Many medical schools are echoing the demand for students interested in primary care, as well as those committed to working in rural or otherwise underserved locations; In 2017, the AAMC reports that nearly 30% of those entering medical school plan to work in an underserved area. Additionally, these topics are likely to come up in interviews and at networking events.  

The AAMC has committed to updating the projections on an annual basis and makes the report available online.

The final report for 2018 created by IHS Markit Ltd for the AAMC is available here: https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

 

[i] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[ii] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[iii] https://www.forbes.com/sites/brucejapsen/2018/05/17/congressional-bill-would-add-1000-doctors-to-fight-opioid-addiction/#60926102684a

 

The Multiple Mini Interview: Preparation and Day-of Tips for Success

Each year, an increasing number of U.S. medical schools are using the Multiple Mini Interview, an interview type focused on obtaining a deeper understanding of how a student processes information under pressure and uses critical thinking skills to derive an answer. The unique format allows prospective students multiple opportunities to make a “first impression” and reduces interviewer bias because of the recurrence of opportunities for a student to think through and address various types of questions.   

Multiple Mini Interviews typically consist of between four and ten interview stations, some with rest stations included in between. At the stations, interviewees are provided with a question prompt and a couple of minutes to think through the situation, then they’re asked to respond within a five to eight-minute period. The requested response could take various forms including collaborating with other prospective students, acting out a scenario, responding to an ethical or policy scenario, writing an essay, or providing a behavioral interview response. Whatever the format, applicants’ responses must showcase critical thinking skills, strong sense of ethics, and ability to see multiple viewpoints.

Preparation for the MMI should be focused on increasing your comfort level in reading a prompt and analyzing the question quickly so that you can articulate a thorough and comprehensive response. The MMI does not aim to assess your knowledge of specific topic areas, but rather is a format designed to extract a more genuine version of you.

We recommend you consider the following as you prepare for the interview:

  • Don’t forget the goal. As you practice your MMI responses, be sure that you’re integrating qualities into your answers that demonstrate intellectual curiosity, empathy, humility, professionalism, commitment to medicine and research, and tenacity. MMI questions are designed to reveal an authentic version of you, so as you prepare, make sure that you’re highlighting those qualities that will make you an excellent medical student and doctor.
  • Get current. Familiarize yourself with policy and ethical issues in healthcare by reading about current events. Write down key topic areas you encounter frequently and take informed positions. Practice describing your position, out loud, with an eight-minute time limit.
  • Practice your pace. If possible, participate in mock MMI interviews to get a more realistic interview experience and gather candid feedback. If you do not have someone to provide a mock interview, review sample MMI questions and record and time your responses. Critique your responses, focusing on how well you verbalized your thought process and supported your viewpoint, as well as, how adequately you made use of the time available. While this exercise may feel uncomfortable at first, it will be helpful to get used to working within the time constraints of the interview.  And viewing a recording will help you to hear/see what improvements you need to make.

On the day of the interview:

  • Read each prompt carefully and think through all aspects of the response. If the question allows you to make a counter-argument, do so, and share why you opted for the conclusion you did. If it is an ethical or values-based question, be sure to point out areas of nuance.
  • Make eye contact, look friendly, speak clearly and use every station as an opportunity to showcase your professionalism. If you start to stumble or get frustrated, take a deep breath or sip of water and compose yourself before continuing.
  • Use your time carefully; during the two minutes of preparatory time, outline your response and the general timing you’d like to abide by to make each of your key points.
  • Start fresh at each station; regardless of how well or poorly you did in the last mini interview, leave it behind and focus entirely on the prompt at hand.
  • For introverts, the MMI can be particularly challenging. Be sure to give yourself some quiet time prior to the MMI to gather your energy.