Medical practitioners require more than academic abilities to be competent in their line of work; hence assessments of non-cognitive qualities such as empathy and interpersonal skills have been viewed as equally important 1. Evidence of Multiple Mini Interview (MMI), a series of stationed whereby candidates being interviewed on a different subject, has been stated as “a non-biased, practical, feasible, reliable, and content-valid admission tool” 2, and the utilization of Multiple Mini Interview (MMI) as a means to assess non-cognitive characteristics have been supported by several validity tests 3. One such way of assessing the non-cognitive characteristics of the candidates is the Multiple Mini Interview (MMI) 4, where candidates are interviewed in a series of stations, each with a different interviewer.
Eligibility tests and Grade Performance Average (GPA) have been reported to be good pre-admission indicators and authentic medical student selection formats 5. In the past decade, the demand for assessing complex skills and performances at the time of medical school admission has caused the emergence of MMI as a preferred mode of access in most medical schools globally. The abundance of literature vouches for MMI as a precise method of admittances to evaluate the non-cognitive traits of candidates in medical science fields when compared to traditional interviewing. Furthermore, MMI has been related to good scores obtained from the respective clerkship directors and to the theoretical exams along with the objective structured clinical examinations (OSCE) across different study groups of additional years 6. Numerous studies advocated the consistency and reliability of the MMI 7 however, there is a dearth of evidence to support the predictive power of MMIs with regards to academic success in the initial years of medical school6, 8, 9. Appraising critical thinking, presentation skill, professionalism, and communication skill during MMI may be essential aspects of predicting academic achievements, especially in performance-based subjects.
MMI provides a valid indication of a candidate's non-cognitive characteristics than traditional admissions tools 9. A strong relationship between practical interpersonal communication skills and healthcare outcomes has been well established. A moderate positive correlation between the average MMI interpersonal score and the communication score on the OSCE was observed 10. Meanwhile, MMI scores correlated positively with performance-based exams during the first and second years4, 6. In particular, critical thinking, presentation, professionalism, and communication skills might be essential competencies in performance-based academic achievement, as well as significant predictors for evaluating post-graduation performances 4.
Critical thinking skills predict academic success during the medical education field's preclinical years11. In assessing individual station and student outcomes, Lee et al. (2016) demonstrated the following findings from their MMI results; first, critical thinking and presentation skills assessment stations showed that the score could predict the results of written and performance-based exam in the second year, but not results of written test in first year 4. This might be because first-year tests are highly focused on basic medicine skills, not medical reasoning. In the second year, knowledge and reasoning-oriented clinical medicine courses were assessed, and findings showed that this particular station’s scores could predict both written and performance-based results.
Second, scores from stations assessing professionalism, including communication skills, self-understanding and motivation, were most highly correlated with performance-based exams, especially in Doctoring Medical Humanities, which is about developing medical professionalism such as self-awareness, self-confidence, self-regulation, motivation and career choice.
Evidence has clearly shown that MMI is a valuable tool for medical student selection, especially in the areas of critical thinking, professionalism, presentation and communication skills 4. It predicts medical student performance in clinical clerkships, OSCE and licensing examinations ,10. Hence, our proposed study would evaluate the relationship between individual MMI station scores with results or performances in each module (HS, PC, OCPPD and SSM 1,2,3) to see if specific themes testing a particular skill can be tested to predict student performances in any of the modules.
Amid social distancing, conducting MMI online has become the norm 12. Online MMI has enabled social distance and eliminated the necessity for travel. Nevertheless, online MMI has been used at the University of Sydney since 2006 for graduate medical and dental programmes 13. Zoom (Zoom Video Communications, 2011), a digital cloud-based video platform, has been utilised by three reported universities so far 12, 14, 15. Online MMI has brought about easy access and less expense for applicants but also eliminates unstructured interactions between applicants and interviewers15. Online MMI is feasible and acceptable, requiring proficient coordination among team members and a reliable high-speed internet 12. This ease of access and low-cost expenditure for applicants of online MMI may be the norm alongside face-to-face when social distancing eased up.
Traditional face-to-face MMI usually consists of between 5 and 12 stations in a circuit. As changeover between station to station requires more coordination time, such as leaving a room and then joining another room, four stations were implemented in each circuit12. Online MMI enables an interviewer to have real-time interaction at two physical locations to measure various non-cognitive attributes such as problem evaluation, oral communication or ethical reasoning 16.
In Universiti Brunei Darussalam (UBD), the Institute of Health Sciences has offered undergraduate medical education since 2005, where students spend the first three years in the local faculty followed by three years at one of UBD’s partner medical schools in the United Kingdom, Ireland, Australia and Hong Kong. Students in the medical programme in UBD are required to undertake core modules in the following areas: ‘Health Sciences’ (HS) – consisting of basic and clinical sciences; ‘Patient Care’ (PC) – equipping students with clinical as well as communication skills and ‘Our Community, Personal & Professional Development’ (OCPPD) – comprising of community and population medicine. They also undertake Special Study Modules (SSM 1,2,3) in a project of interest to develop their self-critical approach to medicine as well as insight in scientific method, research discipline and presentation of data. All students successful in the six semesters of the programme will graduate with a Bachelor of Health Science degree and proceed to overseas partner medical schools to pursue the remaining three years of the medical degree. The academic success of the students is measured by the GPA, which is the average of grade points or marks obtained for the modules sat in a particular semester (GPA) but even more so by the cumulative grade point average (cGPA), the average of grade points of all six semesters completed. With this setting, the objectives of our study were to compare the MMI results of students who attended onsite and online MMI, compare the academic performance of the first-year result (first 2 semesters) of the students who passed the MMI, evaluate the effectiveness of the two MMI modes based on the academic performance of year one medical student. Furthermore, we also aimed to determine the effectiveness of onsite MMI in the evaluation of specific skills sets based on medical students’ performance across the first three years of medical school (as the students leave for partner medical schools for completion of the degree).