A Modest Proposal: Replace the Med School Interview With fMRI

A fashion faux pas almost prevented me from getting into my dream medical school. Midway through the interview there, the interviewer pointed to my left earlobe and said, “Do you really think we accept men who wear … those things?”

I had no idea what he was talking about at first, but then remembered the gold post I’d forgotten to remove. In a disdainful southern drawl the interviewer let me know how dark a shadow this stylistic error cast on my otherwise favorable application.

I left his office fairly sure I would not be admitted. I also doubted whether I wanted to be admitted to a school that selected physicians on the basis of their jewelry. Really?

Twenty years later, medical schools around the country still struggle to find the right way to decide who should be the physicians of the future, and who should not. Most have evolved past caring about male earrings, but what are the right criteria for admission – what makes a good proto-doctor?

Over forty thousand students apply to medical school each year. Each applicant spends thousand of dollars in fees and plane tickets, and institutions spend still more to screen, host, interview and pick among the hordes of black-suited applicants. Increasingly, medical schools are considering innovative and creative ways to distinguish the most promising applicants from the rest.

New approaches include:

1. Using a more holistic review rubric that de-emphasizes grades and MCAT scores, such as at Boston University;

2.  Suspending traditional pre-med requirements for humanities students, such as at the Icahn School of Medicine at Mt Sinai; and,

3. Creative admissions interviews that include problem solving, multiple mini-interviews and even observed standardized patient interactions.

Each of these innovative methods sounds great. Used in combination I suspect they will identify applicants with the necessary academic chops plus a great bedside manner.

Finding applicants with the potential to have great bedside manners is the real challenge of the admissions process. Many applicants are smart enough to know enough and think clearly enough to become full-fledged physicians. But those academic traits combined with the kind of compassionresilience and moral reasoning patients need is still rare.

Why not just MRI applicants instead? Brain metabolism is different in normal experimental subjects watching videos of people suffering compared to those who lack empathy. Isn’t that really what we’re seeking in a physician – empathy, or compassion?

Imagine the cost savings. Students could foot the bill for the MRI, skip all those unnecessary interviews, and still save money. Medical schools on the other hand would be spared the yearly search for a needle in a haystack of applications. A computer could plug and chug grades, MCAT scores, recommendations, and, newly, fMRI results. And, boom: you’re in. Or you should be imprisoned as a psychopath. Simple.

But wait, you say, surely an MRI misses something – isn’t an fMRI too blunt of an instrument? What about bedside manner? Couldn’t an applicant be smart, and non-psychopath, but still the wrong person to bring bad news or consolation?

There’s an app for that.

Or at least there could be.

Malcolm Gladwell of Blink fame popularized the work of Stanford psychologist Nalini Ambady who showed how quickly we discriminate good teachers from bad ones. She showed that students who viewed ten-second videotapes of a professor teaching gave the same ratings as students who took the professor’s whole course, suggesting that accurate impressions are made in an instant.

I bet we could apply these findings to the search for future physicians. We could pose a tough ethical puzzle to them, or ask them to engage a fictitious patient, and record their “doctoring” for two minutes. If Gladwell’s observations hold, we could easily discern the applicants with good natural bedside manners.

Here’s my proposal: take four years of grades, MCAT scores, the recommendations of close mentors, and instead of the unscientific, laborious, and not to mention expensive interview process, we snap a quick fMRI and film a two-minute video.

What could go wrong? I can hear the critics who will decry the fMRI and video approach as incapable of detecting the real core of what it means to be a great physician. But here’s my real argument: I don’t think a 30 minute interview can either. Nor a 45 minute psychotherapy session while the applicant juggles. There is only so much the application process can determine, and I think it makes sense to keep our eyes on that ball.

Ultimately, I got into my dream medical school despite the earring gaffe, and I loved it. I even joined its admissions committee, taking every opportunity to admit qualified applicants who wore earrings.

Tim Lahey, MD MMSc, is an HIV doctor, an associate professor at the Geisel School of Medicine at Dartmouth, and chair of the bioethics committee at the Dartmouth-Hitchcock Medical Center. You can follow him at this own blog, Murmurs. This post originally appeared in the Scientific American Blog Network on August 8, 2013.

9 replies »

  1. A thought provoking piece. To be a successful doctor you need to be more than “book smart”, this article offers some great ways of finding such candidates and in a way that saves everyone money. Are fMRIs a bit outlandish? Maybe but it pushes the point that there are other ways, more cost effective ways to find even better applicants.

  2. Thanks for the great conversation. I agree there is nothing new under the sun, including the search for the perfect application process.

    Since there is no single model student type, no single system will work, and I suspect the differences in the various approaches are subtler than we admit.

    Perhaps the best approach is to be catholic in our selection process, to demand awesomeness and caring of some sort, and then not sweat the details.

    But definitely no Keb’s cycle!

  3. It seems that every couple of years, I see an article in a magazine or newspaper about how the requirements for admission to Med School should be changed to include greater emphasis on the humanities, literature, poetry, etc. Frankly, I could take the articles I saw in the 1980’s and 1990’s, update them slightly and submit them for publication today.
    These articles all proclaim how changing the emphasis of pre-medical education from Science to Poetry will make doctors more sympathetic, humanistic, patient centered, etc. and how their patients will benefit.

    So is it true that physicians that majored in Physics make worse doctors than those that majored in Poetry? Which extra-curricular activities make for better Physicians? Does majoring in English Literature reduce surgical complications? Does having taken a semester abroad in the Czech Republic make for a better Pediatrician? Of course, data to support any of these suppositions is never included since the conclusion is so self-evident.

    Having read so many of these articles, and having attained an age at which I am frequently mistakenly believed to have wisdom, I would like to propose an “alternate” model curriculum for those going to Medical School
    Requirements for admission to Medical School:
    1) Having had a serious illness.
    – There is nothing like being on the receiving end of medical care to give perspective.
    2) Long distance running (or other endurance sports like; swimming, bicycling, etc.) and all night poker games
    – Doctors need stamina for long days and long nights. The ability to think clearly, calculate odds and make rational decisions (despite the time of day or night) is crucial.
    3) The study of Latin and Greek
    – Memorization is the key ingredient of medical education – despite what many say. Plus, knowledge of Greek and Latin prefixes is very useful in learning medical terminology.

    You will note that I have not included anything about Sociology, Psychology, etc. You will also note that I have not included anything about having an interest in helping others. While I do believe that this is an important characteristic of being a physician, I also believe that it is the most easily “faked” qualification. I also believe that time changes all of us in unpredictable ways.

    Everything else would be optional. The skills needed by a neurosurgeon or anesthesiologist are different than those needed by a psychiatrist or family practitioner. Trying to fit square pegs into round holes is difficult.

    AND – I support Federal Legislation which would outlaw the teaching of the “Krebs Tricarboxylic Acid Cycle” to anyone. (tongue slightly in cheek)

  4. Just clarifying, Gabor: Do you mean commanding (ie arrogant) or do you mean astute, confident, and assertive?

    And out of curiosity, do you feel as though shifting mentalities (office vs operating room) is something which most surgeons–in your experience–make priority to do?

    Although–don’t we always want an astute physician? Your assessment of specialties makes it seem like we don’t, Heidi.

    On another note, if Abraham Verghese can use Google Glass to help improve and standardize appropriate bedside manner (http://www.youtube.com/watch?feature=player_embedded&v=_g4wNHIlaTY), the idea of an fMRI to objectively measure empathy doesn’t seem like a horrible idea…

  5. Surgeon’s behavior in the operating room is for the most part completely different as compared to the office environment.We HAVE to be commanding in the OR or nothing would get done in the proper manner!
    Your generalization that all sympathetic surgeons are poor surgeons is just wrong IMO . My OR experience spans 37 years from a surgical intern to a major University teaching staff surgeon….

  6. Perhaps that would be a great method for siphoning med students into specialties. As a nurse who has observed doctors for over 20 years, I’ll look for compassion and empathy in my primary physician. It’s certainly necessary for oncologists, HIV and geriatric specialties. If I need surgery, however, I’ll always choose the steely, charm-free, Spock-like type. The charming surgeon is usually the sloppiest. The one that ranks a 0 on the personality scale inevitably possesses the most enviable technical skills. OCD? Even better! Could it be that compassion and empathy are a negative in high stress situations calling for calculated judgement and impeccable hand-eye coordination?