E = T x P: New for Aspiring Doctors, the People Skills Test

One of the time-tested concepts that I’ve always included in any training session is the concept E = T x P. This isn’t a new equation from the world of particle physics, but rather a catchy way of expressing a profound truth: Effectiveness is the product of the Technical solution times the People aspect. We would stress that even if the technical solution was a perfect 100, if the people side was zero the end effectiveness was also zero.

One sees this principle at work in so many areas, especially, in my opinion, the world of medicine. This story from The New York Times (“New for Aspiring Doctors, the People Skills Test”, July 10, 2011) is merely the most recent example of the struggle to balance the technical focus of many physicians with the human factors.

Writes Gardiner Harris in the article:

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 new process has enormous consequences not only for the lives of the applicants but, its backers hope, also for the entire health care system. It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.

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.

The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.

Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.

Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

“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.

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.

The system grew out of research that found that interviewers rarely change their scores after the first five minutes, that using multiple interviewers removes random bias and that situational interviews rather than personal ones are more likely to reveal character flaws, said Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, who developed the system.

In fact, candidate scores on multiple mini interviews have proved highly predictive of scores on medical licensing exams three to five years later that test doctors’ decision-making, patient interactions and cultural competency, Dr. Reiter said.

A pleasant bedside manner and an attentive ear have always been desirable traits in doctors, of course, but two trends have led school administrators to make the hunt for these qualities a priority. The first is a growing catalog of studies that pin the blame for an appalling share of preventable deaths on poor communication among doctors, patients and nurses that often results because some doctors, while technically competent, are socially inept.

The full article is found at:

http://www.nytimes.com/2011/07/11/health/policy/11docs.html?pagewanted=1&_r=1&hp

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