Interviews are deemed an essential part of the medical school selection process as they assess a range of interpersonal skills (e.g., communication, empathy, and so forth) that cannot be gathered from other sources [1,2]. Medical school interviews can take various forms, including traditional one-on-one interviews, multiple miniinterviews, panel interviews, and group interviews [1].

Despite the popularity of medical selection interviews, their validity is debatable because interviewers form subjective judgments based on personal preferences, stereotypes, or biases [3]. Due to time constraints and limited information, interviewers often rely on heuristics or mental shortcuts to simplify decision-making [4]. These heuristics commonly involve initial impressions (anchoring bias or halo/horn effect) and discrepancies between verbal and non-verbal communication. Research on nonverbal cues suggests that dynamic vocalics, eye contact, head movement, and professional appearance significantly influence interview outcomes, whereas posture and smiling do not [5]. Notably, interviewers can only make accurate personality judgments through non-verbal cues when valid cues are available, observable, and align with their validity for specific personality traits. Despite the importance of this topic, no previous research has examined how interviewers’ heuristics influence evaluations in medical school selection interviews, which this study aims to address.

The main objective is to identify how interviewers perceive interviewees’ non-verbal behaviors in two medical schools in different cultural contexts, one in Taiwan and the other in Australia. The study will also explore whether interviewers’ impressions of non-verbal behaviors differ between the two countries.

Among interviewees’ NoVOC, we identified three factors related to their perception of non-verbal behaviors: “charming,” “disengaged,” and “Anxious.” The validity and reliability of the first two factors are confirmed across the two countries, whereas interviewers did not consistently interpret or perceive “anxious” between the two countries.

A key finding is interviewers’ similar perceptions of “charming” and “disengaged” non-verbal behaviors across the two countries. “Charming” was characterized by happiness, smiling, and concise responses, while “disengaged” exhibited mostly opposite behaviors. The “charming” NoVOC aligns with valid non-verbal cues used to assess extraversion, agreeableness, and intelligence traits [13]. Despite reflecting the opposite, “disengagement” might represent a relevant medical profession trait, whereas “charming” might indicate bias [14]. Given that doctors need to demonstrate effective patient engagement, identifying disengagement expressions is important for medical selection. Conversely, while being charming is not inherently negative, it has not been identified as an important medical profession trait, and therefore interviewers should be aware of charm’s impact on their judgment. Moreover, expressing charm has been associated with narcissism, along with “flashy and neat dress,” “self-assured body movements,” and “humorous verbal expression” [15]. Adding the impact of oral fluency, dominant facial expression, and gestures on popularity such as zero acquiescence suggests that charm is an important bias that might lead to interviewers favoring narcissist interviewees who prioritize their own needs above those of others [16].

Two main implications are derived from this research. First, interviewers need to be aware that a “charming” interviewee should be considered more carefully than a less charming person due to the association between personal charm and narcissism, which not be strongly appreciated in the medicine profession. Second, once these factors are formalized and placed in the public domain as selection criteria (engagement and charm) or explicitly not (anxiety), they might influence applicants’ interview preparation. While it is difficult to predict the outcome of such unintended consequences, it is not recommended to ignore these two important factors that affect the results of medical selection interviews. Accordingly, further research into this topic is warranted.

Although no country differences were identified regarding the impact of “charm” and “disengagement,” the non-verbal behaviors of being “anxious” (showing sadness, moving on the chair, and speaking with a stammer) differ across the two countries, potentially due to cultural differences. Interviewers in Taiwan rated “anxious” as unfavorable, while those in Australia perceived it as less negative. The high/low context difference might partly explain the inconsistent perception of “anxious” behaviors, as high context cultures such as China and Taiwan strongly rely on non-verbal cues and indirect communication, while low context cultures such as the United States and Australia prioritize direct and explicit communication [17-19]. Interviewers are widely used to selecting among culturally diverse students for medical and health profession education programs (e.g., Asian students comprise up to 50% of some medical school cohorts in Australia). Therefore, interviewers should be trained to understand cultural differences and their impact on their impressions of interviewees to enhance the validity and trustworthiness of the interview process.

Most previous studies have explored non-verbal behaviors in job application interviews, identifying a positive link between recruiter evaluations and applicant non-verbal behaviors, particularly eye contact, smiling, and speech modulation [5]. Such research has mostly been conducted through a direct comparison of the listed non-verbal behaviors in relation to selection outcomes. By contrast, our study has followed a scale development methodology, including item development through a qualitative Delphi-like process, EFA to identify factors, CFA for model fit, multiple-group invariance analysis across populations, and reliability tests for internal consistency. This careful approach enhances confidence that the factors identified truly represent interviewers’ biases.

The main limitation is the sample size, as typically a larger sample size is required for such a study. The sample size in this study was smaller than expected (N=125), although the results of both EFA and CFA yielded an acceptable model fit. Replication of this study with a much larger sample size might be necessary to ensure that the findings are not incidental but rather representative. Our study identified a difference between the two countries in the factor of “anxious,” while “disengaged” and “charming” remained relatively stable in the invariance analysis. The latter two factors might have broader generalizability, although further studies are warranted for generalizability.

Future research can further explore the influence of non-verbal factors on selection outcomes and investigate strategies for effectively training interviewers to interpret and evaluate these cues, taking cultural differences into account. Additionally, if the use of the questionnaire becomes publicly known, it might affect how applicants prepare for interviews, necessitating further investigation.

In conclusion, the three distinct factors revealed in this study—“charming,” “disengaged,” and “anxious”—provide valuable insights into the NoVOC that interviewers perceive and evaluate during the interview process. The findings highlight the importance of considering nonverbal communication in selecting medical students and emphasize the need for training and awareness among interviewers. By understanding cultural differences and their impact on non-verbal behaviors, selection processes can be improved to mitigate bias and enhance the fairness and reliability of medical student selection.