This article covers dealing with difficult MMI stations. Specifically, handling rude, angry and hostile MMI actors or interviewers. The actors used in MMI stations tend to be very well trained and convincing. They will have a brief that they follow but generally they tailor their reactions depending on how you behave towards them. If you can calm them down, they will become calmer, if you do something to aggravate them they will become aggravated.

In certain MMI stations, actors may become angry, annoyed or frustrated. They may become upset and even start crying. MMI stations where this could happen include stations where you have to break some bad news to an actor. For example, you have lost something valuable that they entrusted you with; or you have run over and killed their beloved pet. In other stations, for example, in information gathering stations; actors may be sarcastic, rude or difficult. In some MMI stations, candidates are asked to talk over scenarios to interviewers rather than act them out, and interviewers may similarly behave like this.

Tip 1 – Look forward to difficult stations; they strengthen your advantage

It is crucial to realise that nobody is behaving in the manner described above to be horrible to you. These stations are designed to bring out the best in you and assess specific skills such as your ability to communicate in stressful situations, to be empathetic, to defend your arguments etc. By handling these stations well, they become a chance for you to showcase your skills. If everyone was delightful than you would not get the chance to show these skills.

For these reasons, tough stations are something to look forward to rather than fear. This simple change in mindset will give you an advantage over other candidates who are likely nervous about these stations coming up and more likely to panic. Remember, if a station is difficult for you, it is likely difficult for others too. If you are a candidate who has strong interview techniques for these challenging stations and a positive mindset you are at an advantage having difficult stations rather than easy stations. This is because easy stations are easy for everyone and it is harder to stand out. Difficult stations are difficult for everyone but even more so for candidates who are ill-prepared or very nervous, so it is easier for you to do better than those candidates. This means your advantage for being well prepared and having a good mindset versus other less prepared candidates is in fact greatest in harder stations, not easy ones.

Tip 2 – Do not be provoked

Do not be provoked into saying something or doing something inappropriate. If an actor or interviewer is being sarcastic, abrupt or difficult with you, then do not respond back in a likewise manner. Not only will this reflect poorly on you it will likely make the situation worse. Actors in MMI stations are typically very responsive to you. If you respond to their anger by giving them space to vent and listening, they likely will calm down. If you say aggravating things, then they will become aggravated!

Remember, in real life doctors occasionally come across patients behaving poorly. Doctors need strong communication skills to handle these situations and will usually be able to steer a negative interaction towards a more fruitful one. If a doctor cannot have a constructive interaction or a patient’s behaviour is entirely unacceptable, then a doctor may end a consultation or even a patient-doctor relationship if they think it is irreparable. However, what doctors are not supposed to do is react rudely, angrily or sarcastically to patients just because that is how a patient has behaved towards them.

Tip 3 – Use the power of silence to your advantage

Silence is a tool in the skillset of good communicators. Often, particularly when people are angry or upset, the most appropriate thing to do is let them talk or cry etc. You should not be tempted to fill every moment of silence with a question or comment as this could stop them from continuing. Not everything an actor says needs a direct response. You can occasionally say things like “gosh, that sounds tough”, “I can see your upset”, “oh dear” or simply “mmh hmm” and let people speak. You can also just paraphrase the last sentence that they said e.g. “so they didn’t give you an answer straight away?” Other phrases which can be useful include “so what happened next?” or “what are you hoping to will happen now?” All these examples show that you do not need to have the perfect response at the tip of your tongue to deal with upset or angry people.

Pauses are also useful when being asked a question. A momentary pause will give you time to gather your thoughts and has the added benefit of making your answers sound less rehearsed. Moments of silence will usually appear longer to you than they are in reality, so do not feel like you have to fill them all. If you need more than a momentary pause than you can say “that’s an interesting question” or something to that effect and then take some more time.

Tip 4 – Stay neutral and non-judgemental when hearing people complain

If an actor is complaining about someone or something or is angry or upset, it is possible to have empathy and sympathy for them without taking sides or judging either party. The first thing you must do before empathy can even be shown is allow them to speak. When someone is angry or upset, often they simply want to be heard. Interrupting them with questions and comments can frustrate people and not allow them to finish what they are saying. Make sure you are “actively listening” – which means you are being seen to be listening. This involves making eye contact, nodding your head, leaning in etc. otherwise the person may get the impression you are not interested.

Do not take sides, especially early on in a conversation when you do not know all the facts and after all, you are only hearing one side of an account. You can say things like “gosh that must have been very frustrating” “I’m so sorry you had to experience that” instead of “wow those nurses sound so incompetent, I can’t believe they did that. Perhaps they aren’t trained properly?”. The first two statements show sympathy without being judgmental while the last one takes a side without knowing all the facts and sides of the story. Also, do not be afraid to say sorry. It is not an admission of guilt.

Tip 5 – Do not mistake follow-up questions or a little challenge to your responses as being hostile.

Some stations do not involve actors, but instead, a scenario is presented, and you will talk through it to an interviewer. Interviewers fall on a spectrum, and most are very nice or at least neutral. Some can appear to be very tough and even hostile, scrutinising everything you say or questioning your achievements, grades, personal statement etc. If Medicine interviewers act in these ways, they are not doing so to upset you. They are doing this to test you and bring out the best in you. And remember, some inquisition is healthy. Often interviewers are just playing devil’s advocate or trying to facilitate your final answer so that you can give them your best last answer. It is their job to scrutinise the finer details of something you said you did in your personal statement. Don’t take it personally. Be ready to defend your views and arguments and do not fold just because you receive a little resistance. Do not do this in a dogmatic or bigoted way and remain open and aware of differing opinions. If the interviewer’s comments make you realise that you were indeed wrong than just admit it and move on.

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