Views & Reviews From the Frontline

All applicants to medical school should be interviewed

BMJ 2012; 344 doi: (Published 23 April 2012) Cite this as: BMJ 2012;344:e2889
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

I manipulate online self testing questionnaires for attention deficit hyperactivity disorder, bipolar 2, oppositional defiant disorder, and the rest. I guess the answers to get my diagnosis. I have never failed yet. Likewise, I pore over the Diagnostic and Statistical Manual (DSM) definitions of personality disorders—narcissistic, antisocial, histrionic, and paranoid—recognising all these traits in myself. Obviously these are to be expected in a columnist. These psychological and psychiatric descriptions are interesting and to some extent useful, but are in reality just inadequate cardboard cut-out caricatures, failing to encapsulate even a fraction of any individual. Defining human personality was once the responsibility of literature. In which case, the impossibly long DSM, with its unconvincing characterisation, lack of plot, pace, and action, surely is one of the worst novels ever written. No match for the free flowing insights on humanity offered by Shakespeare.

Increasingly, however, medical schools are using psychometric modelling and questionnaires in screening applicants, in addition to triple A academic rating. These test the soft skills of emotional quotient (EQ). A number crunched from an ability to read emotions, agreeableness, openness, extraversion, self awareness, and ability to cope—skills that blunt, direct, robust, older generations of doctors might describe as drug induced hippy 1970s nonsense. But these are real skills; evolutional tools that allowed disparate human tribes to live and work together. And mere education is no preparation for medicine; worse, academic ability can be a proxy for a lack of social skills and dullness. In the real world EQ is as every bit important as IQ. But should we rely on these questionnaires? Applicants would have to have the emotional and cognitive ability of a kitchen table not to see the patterns and loading in these questions. Test results are a guide but can easily be falsified. Especially by the adept middle class who specialise in playing any new testing game.

A few medical schools, however, rely only on these tick box tests, qualifications, and personal statements in selection. There is no interview. This is a bad idea. No employer would appoint a senior person without an interview. Interviews expose the dissonance between a sparkling résumé and the person; seeing is truly believing. And EQ is a two way street: the interviewers get an opportunity to read the candidate to see if they are genuine and plausible. Some universities use standardised structured multiple mini interviews in the name of fairness and consistency. But there is still a role for traditional, left field, free flowing interviews: EQ and IQ in motion. This allows candidates an opportunity to shine.


Cite this as: BMJ 2012;344:e2889