Multiple Mini Interviews (MMI)

What are the common themes covered during role play scenarios?

For those universities using MMI, the following are common themes:

• Breaking bad news
• Dealing with an angry patient
• Consoling a patient or friend
• Challenging a co-worker or friend about alcohol or drugs

Your role
You will be given a particular role to play, often that of a doctor or medical student. It can be quite difficult given that you are very unlikely to have undertaken such role play previously. It does require a degree of maturity, but advance preparation certainly helps. It is a good idea, if you have time, to practise the character role several times before the actual MMI station. Although some things are out of your control, others can be controlled:

• Always stay within the limit of the role you have been given. Not only does this give you a focus, but it also demonstrates that you’ve understood the role you’ve been asked to act.
• Generally the actors will also have limits to their roles. But they may also have been briefed to try and lead you away from your own, in whatever way, do be careful not to allow yourself be led down blind alleys.
• You should always be kind in your tone.
• Give your ‘patient’ opportunities for reflection.
• Be enthusiastic.

Empathy
Showing empathy can be difficult, particularly in a staged MMI scenario. When the actor shows concern or demonstrates sadness, however, it is insufficient simply to sympathise with their situation. Instead, you are expected to empathise: to ‘feel’ the actor’s feelings and react to them dynamically is really important. Good techniques/words are:

• Acknowledgement of their situation
• “I know it must be hard for you to find out………”
• “I understand why you are upset………..”
• “I may have reacted the same way given the circumstances………..”

Reflection:

• “So, how did that make you feel?”
• Use silence appropriately. A silent voice doesn’t mean a silent body! A slight pause can show that you are listening and that you are caring. Too much hesitation, however, may indicate a lack of comprehension or a lack of confidence.
• Even though you’re obviously not saying anything during a short period of silence, good body language, good eye contact, good posture and sympathetic facial gestures can ‘speak’ volumes. This is considered as active body language.
• Acknowledging the other person by nodding and smiling also demonstrates that you are listening and interacting.

If you’re asked to take a history from a patient or gain knowledge about scenario you must have a strategy.

We recommend using the ICE technique.

What is the ICE method of consultation?
ICE (Ideas, Concerns and Expectations) is a concept in consultation skills training to elicit the patient’s agenda. It has been shown to reduce overdiagnosis and overtreatment.

Ideas
Find out what your patient is thinking:

• “Tell me about what you think may be of concern to you .”
• “Do you have any ideas about what might be occurring at the moment with you?”
• “It’ll be nice to know what you think.”

Concerns
And find out exactly what their concerns are (which may be different to yours):

• “What’s your biggest concern at the moment?”
• “Are you concerned about this today?”
• “What’s your number one issue regarding this condition today?”

Expectations
Find out where your patient expects the consultation to go:

• “What would you like to happen today?”
• “What are you aiming to get from today?”
• “What is the best plan of action for you?”

Remember never get angry, look fed up, or be rude.
Remember again, never get angry, look fed up, or be rude, however much your ‘patient’ might push you.

Preparation is key!