Kanter, Steven L. MD
Those of us who work and learn in medical schools and teaching hospitals frequently interview people: an applicant for medical school or residency, a candidate for a key staff opening, or a recruit for a faculty position.
And while we use interviews to inform important decisions, we continue to question the purpose, value, structure, length, validity, and reliability of these interviews. A quick search for relevant articles will reveal that these issues have been argued in the literature for decades.
In this issue, Eddins-Folensbee et al. continue the discussion by focusing attention on whether it makes sense for medical students (in addition to one or more faculty members) to interview applicants to medical school. And, among the references they cite, you will find important articles about interviewing that have been published in this journal over the last 40 years.
With decades of practice, experience, and data, one might think that acquiring and using information from an interview would be straightforward and easy. But it's not. And one reason it's not, is because interviewers are trying to understand interviewees' thought processes, attitudes, behaviors, and decisions as they have played out over a number of years by talking with them for just a few minutes. In a sense, you want to come to a conclusion based on a video, but all you have is the ability to take a snapshot.
This is why interviewing is much more art than science. If we accept that past behavior, taken over a long period of time, is the strongest predictor of future behavior, how do we, as interviewers, get a good sense of that past behavior in just a few minutes? What questions can an interviewer ask that provide the most revealing sense of how someone thinks and acts and makes decisions over time?
All who interview have their own favorite approaches, techniques, and questions. Over the years, I have had many conversations with colleagues about their own styles, and I always ask, “What are your most revealing questions?”
In general, the most revealing questions are simple and to the point, yet provide an opportunity for applicants to show their creativity, their curiosity, and the depth and quality of their thinking. Good questions allow, maybe even encourage, applicants to explain what inspires them and how they have responded to such inspiration. Good questions elicit responses that provide insight into applicants' past behaviors, tendencies, and trends, how they deal with adversity, and the nature of their decisions over time. Ideally, such questions will illuminate future goals and aspirations by revealing previous patterns and trends.
Of all the “revealing questions” that colleagues have shared with me, three, in particular, deserve mention.
The first question is, What are you going to do to change the world?
The late Peter Safar, a physician who pioneered cardiopulmonary resuscitation, established the first intensive care unit in the United States, and is responsible for many other “firsts” in medicine, would begin interviews with prospective faculty candidates by asking them some version of this question. Of course, such a question can be interpreted on several levels and in many ways, which makes it a question that has the potential to reveal much about the interviewee.
A question like this gives interviewees broad license to show whether they are original thinkers and intellectual leaders, whether they have thought deeply about problems in their fields, and whether they can situate those problems in a broader context.
The second question is, Tell me about a book you have read recently and how it has changed you?
One day, I was conversing with the director of a college honors program. I said, “With all the wonderful, talented, and overqualified applicants to your program, it must be quite difficult to select the ones to admit.” He replied, “Oh, no, it's not difficult. It's really quite easy. I ask each applicant one simple question.” I said with obvious surprise, “One simple question? That's it? What do you ask?”
He said, “I ask, ‘Have you ever read a book?’ If an applicant says yes, I admit him or her; if no, I don't.” Of course, he was being facetious about relying solely on whether or not the applicant had read a book to make a decision about admission, but at the same time, he was expressing concern that it is important for students to read books from cover to cover. When he posed this question to interviewees, he wanted to know whether they understood a story or an issue or an idea from start to finish. He felt that this question gave interviewees the opportunity to reveal whether they were critical thinkers and whether they had the ability to develop a deep and sophisticated understanding of a problem or topic. And, as we discussed this question further, we agreed that a question like this can elicit from interviewees whether they read only to fill themselves with new facts or whether they read also because reading transforms them. Sometimes, he would ask, “What did you learn about yourself from the last book you read?”
The third question is, Do you enjoy your own mind? And, if so, how?
A physics professor who has won many teaching awards shared this question with me. He used it to try to understand whether interviewees enjoyed thinking. As we discussed its value, we agreed that it is an intentionally broad question that does not convey clues about how to structure an answer. This gives interviewees free rein to reveal themselves to the interviewer—for better or worse—in a way that might not occur otherwise. Also, the question allows interviewees to reveal interests they cultivate in addition to professional pursuits. Essentially, it asks them to discuss what they think and feel about what they think and feel. And it allows them to convey the extent to which they value intellectual pursuit, curiosity, and the development of one's own mind.
A common thread through all of these questions is the notion of transformation. The questions ask interviewees to reveal how they plan to act on the world around them to make it a better place and, in a complementary vein, how the world around them causes them to grow and develop. These questions give interviewees significant latitude to disclose the depth of their insights, the breadth of their perspectives, and how they respond to and process knowledge. And the questions provide fertile ground for an applicant competing for a faculty position, a residency slot, or a seat in a medical school class to reveal his or her sources of inspiration and capability to think creatively and independently.
So, as we continue to study the predictive potential of grades, test scores, and other quantifiable factors, we also should study the qualitative aspects of interviewing. If we do, we will begin to understand what kinds of questions, asked by astute interviewers, elicit evidence of creativity, insight, and previous patterns of accomplishment that reveal the true potential of interviewees.