title: The fairness, predictive validity and acceptability of multiple mini interview in an internationally diverse student population--a mixed methods study.
abstract: BACKGROUND
  International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population.
  
  
  METHODS
  This was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students.
  
  
  RESULTS
  109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates.
  
  
  CONCLUSIONS
  MMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.
authors.affiliation: The Medical School, National University of Ireland Galway, (NUI Galway), Galway, Ireland. maureen.kelly@nuigalway.ie.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Kelly
authors.affiliation: School of Medicine, University of Dundee, Dundee, Scotland. j.s.dowell@dundee.ac.uk.
authors.forename: Jon
authors.initials: J
authors.lastname: Dowell
authors.affiliation: School of Medicine, University of Dundee, Dundee, Scotland. a.husbands@dundee.ac.uk.
authors.forename: Adrian
authors.initials: A
authors.lastname: Husbands
authors.affiliation: Health Research Board (HRB) Clinical Research Facility, National University of Ireland, Galway (NUI Galway), Galway, Ireland. john.newell@nuigalway.ie.
authors.forename: John
authors.initials: J
authors.lastname: Newell
authors.affiliation: The Medical School, University College Cork (UCC), Cork, Ireland. siun.oflynn@ucc.ie.
authors.forename: Siun
authors.initials: S
authors.lastname: O'Flynn
authors.affiliation: The Medical School, National University of Ireland Galway, (NUI Galway), Galway, Ireland. thomas.kropmans@nuigalway.ie.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kropmans
authors.affiliation: The Medical School, National University of Ireland Galway, (NUI Galway), Galway, Ireland. fidelma.dunne@nuigalway.ie.
authors.forename: Fidelma P
authors.initials: FP
authors.lastname: Dunne
authors.affiliation: The Medical School, National University of Ireland Galway, (NUI Galway), Galway, Ireland. andrew.murphy@nuigalway.ie.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Murphy
mesh_terms: D003099:College Admission Test; D003142:Communication; D003469:Culture; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000592:standards*; D007494:Ireland; D007802:Language; D008297:Male; D015203:Reproducibility of Results; D012923:Social Class; D055815:Young Adult