Developing and evaluating the multiple mini interview in student midwife selection

The multiple mini interview (MMI) is an admissions instrument designed to replace the personal interview in health care student selection. Its effectiveness has been evaluated in medical student recruitment processes (Eva et al., 2004a, Roberts et al., 2014). At the commencement of this research no reliability, validity, or acceptability studies had been published specifically in relation to student midwife selection. Study objectives: to develop, pilot and evaluate the reliability, validity and acceptability of MMIs in student midwife selection in a Higher Education Institution (HEI) in the United Kingdom (UK). A dual paradigmatic dialectical enquiry was used in a multi-method case study. A literature review and qualitative work were conducted to identify the desirable personal qualities of a student midwife. This was followed by the systematic development of a customised eight station, five-minute MMI model. Sixty-two students from the BSc Midwifery Studies, September 2011 and 2012 cohorts, at the University of Surrey, volunteered to undertake ‘mock’ MMIs in the first week of their programme. Fifty-seven participants were followed up having completed their first year. Predictive validity was assessed using students’ end of year OSCE and mentor grading; station reliability, including inter-station and internal consistency, were also examined. Interviewers’ (n=9) and candidates’ (n=62) views of MMIs were obtained from a focus group and semi-structured questionnaires respectively. The literature review revealed that acknowledgement of the importance of ‘emotionality’ or an emotional dimension in the relationship between a woman and her midwife was missing from key professional, regulatory (Nursing and Midwifery Council, 2009, 2010, International Confederation of Midwives, 2011) and government documentation (Department of Health, DH,2012). According to the Department of Health (DH, 2013), selection to all National Health Service (NHS) funded training posts should incorporate recruitment for the NHS Constitution values (DH, 2012). In the absence of any mention of ‘emotionality’ it is suggested that this requires more specific recognition in considerations of what is important to appraise at selection. No statistically significant associations were found between students’ MMI score and their subsequent performance in clinical practice. The University Registrar would not consent to ‘live’ selection using MMIs in the absence of midwifery-specific evidence; participants were therefore students who had already been accepted onto an undergraduate midwifery programme. This has been addressed in an on-going longitudinal follow up-study. Reliability (internal consistency) was ‘excellent’ with Cronbach’s alpha scores between 0.91-0.97 across eight stations. Inter-station reliability findings suggested that each station measured different independent constructs with only a moderate positive correlation between two stations, kindness, compassion and respect for privacy and dignity (p<0.01). All other stations indicated little or no relationship offering additional support to the reliability of the scales. Candidates stated that undertaking MMIs would not discourage them from applying to the University as they felt they were a fair assessment instrument. They suggested that the multi- interview format was a positive feature which allowed them to recover from a poor performance at any one station. Overall, 23 participants (37%) reported a preference for MMIs compared to 22 (35%) who preferred a one-to-one personal interview format; 44 participants (71%) found the personal interview more daunting than MMIs. Interviewers appreciated the parity of opportunity afforded to candidates through the standardisation of the interview process. They were willing to adopt MMIs in future selection processes provided any anticipated complications were resolved. MMIs were shown to be reliable in the context and model defined. The insightful information obtained has informed a ‘roll out’ to MMIs across all health care student selection at the University of Surrey as well as being used by Health Education England as a case study example (HEE, 2014)