Future directions in personality, occupational and medical selection: myths, misunderstandings, measurement, and suggestions

Validity Evidence of a Screening Tool for Early Detection of Clinical Crisis-Related Anxiety Amongst Medical Students

Construct: Psychological distress among students is a growing concern in medical education, even more so with the advent of COVID-19 pandemic. Anxiety is among students' mental health issues. High and persistent anxiety has many negative impacts on students' academic and personal life. Early detection is essential for timely intervention. Background: Currently, medical student anxiety is assessed using tools primarily designed for psychiatric purposes. Despite their excellent validity evidence, these tools contain sensitive items and do not explore stressors related to clinical activities. There is a need for contextualized tools to better identify anxiety-provoking factors specific to the medical education environment. Approach: We previously developed the Crisis Experience Rating Scale (CERS-7), a short screening tool to identify early on anxious students participating in clinical activities during the first wave of the COVID-19 pandemic. The present study sought to produce further validity evidence for the CERS-7. Medical students in their clinical years at two Swiss and one French medical school, all involved in COVID-19 clinical activity during the second wave of the pandemic, completed the CERS-7 and the State Anxiety Inventory (STAI-A), the best known and widely used tool to measure for general anxiety. We evaluated internal structure using confirmatory factor analysis (CFA) and relation to other variables using linear regression (LR) and receiver operating characteristic (ROC) curves with thresholds defined using the Youden index. Findings: There were 372 participants. CFA confirmed the two-factor structure of the CERS-7 scale from first-wave dataset. The CERS-7 total scale and subscales demonstrated validity evidence in relationship to the STAI-A scores and categories. A CERS-7 total scale score < 27.5 identified 93% of severely anxious students. Conclusion: The CERS-7 produces reliable scores to use for monitoring anxiety status when assigning students to clinical settings as well as for improving training conditions during clinical crisis.

Effect of Attending Rheumatologists' Big 5 Personality Traits on Patient Trust in Patients With Systemic Lupus Erythematosus: The TRUMP2-SLE Project

OBJECTIVE

Differences in communication styles based on physicians' personality traits have been identified, particularly in primary care, and these physician-related factors can be important in building patient-physician trust. This study examined the effects of rheumatologists' personality traits on patients' trust in their attending rheumatologists.

METHODS

This cross-sectional study included adult Japanese patients with systemic lupus erythematosus (SLE) at 5 academic medical centers between June 2020 and August 2021. The exposures were the Big 5 personality traits (ie, extraversion, agreeableness, openness, conscientiousness, and emotional stability) of attending rheumatologists using the Japanese version of the 10-Item Personality Inventory scale (1-7 points each). The outcome was the patients' trust in their attending rheumatologist using the Japanese version of the 5-item Wake Forest Physician Trust Scale (0-100 points). A general linear model was fitted.

RESULTS

The study included 505 patients with a mean age of 46.8 years; 88.1% were women. Forty-three attending rheumatologists (mean age: 39.6 years; 23.3% female) were identified. After multivariable adjustment, higher extraversion and agreeableness were associated with higher trust (per 1-point increase, 3.76 points [95% CI 1.07-6.45] and 4.49 points [95% CI 1.74-7.24], respectively), and higher conscientiousness was associated with lower trust (per 1-point increase, -2.17 points [95% CI -3.31 to -1.03]).

CONCLUSION

Whereas higher extraversion and agreeableness of attending rheumatologists led to higher patient trust in their rheumatologist, overly high conscientiousness may lead to lower trust resulting from the physicians' demand of responsibility and adherence to instructions from patients with SLE.

Do students' personality traits change during medical training? A longitudinal cohort study

Many medical schools incorporate assessments of personal characteristics, including personality traits, in their selection process. However, little is known about whether changes in personality traits during medical training affect the predictive validity of personality assessments. The present study addressed this issue by examining the stability of personality traits and their predictive validity over a 6-year medical training course. Participants were two cohorts of Swiss medical students (N = 272, 72% of students admitted to Year 2) from whom we collected demographic data, Swiss medical studies aptitude test (EMS) scores, Big Five personality traits scores measured at three times and scores on the multiple-choice and objective structured clinical examination parts of the final medical examination. Our findings indicated that personality traits had medium-to-high rank-order stability (r > .60 over 3 years and r > .50 over 6 years). Mean-level changes were moderate for agreeableness (d = + 0.72) and small for neuroticism and conscientiousness (d = -0.29, d = -0.25, respectively). Individual reliable change indices ranged from 4.5% for openness to 23.8% for neuroticism. The predictive validity was similar to that of the first three years of follow-up. To the best of our knowledge, this is the first study to investigate changes in personality across undergraduate curriculum. Medical students' personality traits were mostly stable across medical school and retain their predictive validity. Consequently, this study supports the use of tools measuring constructs underlying personality traits in selection. In addition, this study confirms that examination formats could favor students with certain personality traits.

Do Pediatrician Interpersonal and Personality Characteristics Affect Patient Experience?

BACKGROUND AND OBJECTIVES

Previous studies have demonstrated associations between patient experience scores and physician's demographic characteristics such as gender and race. There is a paucity of data, however, on the effect of broader pediatrician characteristics on caregivers' experience of their children's care. This study assessed pediatric caregiver experience of care ratings within a children's hospital and examined the effects of pediatricians' interpersonal and personality traits on caregiver experience ratings.

METHODS

This cross-sectional study included caregivers of children under 18 years old (n = 26,703) and physicians within children's hospital system (n = 65). Caregivers of children who received care from 2017 to 2019 provided their rating (0-10) of care experience via the standardized National Research Corporation Health Survey. Top box provider ratings were used for analyses. Physician's interpersonal and personality data were collected. Multilevel logistic regression analyses were used to examine the effects of physician interpersonal characteristics (empathy, compassion) and personality (perfectionism, Big Five personality traits [openness, conscientiousness, extraversion, agreeableness, neuroticism]) on experience of care rating.

RESULTS

The odds of caregivers of Spanish-speaking children to provide a high physician rating were 75% higher than the odds for non-Spanish-speaking patients. At the physician level, lower agreeableness (odds ratio [OR] = 0.63, P = .002), and lower narcissistic perfectionism (OR = 0.98, P = .016) were associated with an increased likelihood of a high care experience rating. The odds of nonemergency medicine pediatricians receiving high ratings were approximately 4.17 times higher than that of EM pediatricians.

CONCLUSIONS

Current results may inform future interventions that address pediatrician personality characteristics associated with caregivers of children experience outcomes.

Exploring variation in surgical practice: does surgeon personality influence anastomotic decision-making?

BACKGROUND

Decision-making under uncertainty may be influenced by an individual's personality. The primary aim was to explore associations between surgeon personality traits and colorectal anastomotic decision-making.

METHODS

Colorectal surgeons worldwide participated in a two-part online survey. Part 1 evaluated surgeon characteristics using the Big Five Inventory to measure personality (five domains: agreeableness; conscientiousness; extraversion; emotional stability; openness) in response to scenarios presented in Part 2 involving anastomotic decisions (i.e. rejoining the bowel with/without temporary stomas, or permanent diversion with end colostomy). Anastomotic decisions were compared using repeated-measure ANOVA. Mean scores of traits domains were compared with normative data using two-tailed t tests.

RESULTS

In total, 186 surgeons participated, with 127 surgeons completing both parts of the survey (68.3 per cent). One hundred and thirty-one surgeons were male (70.4 per cent) and 144 were based in Europe (77.4 per cent). Forty-one per cent (77 surgeons) had begun independent practice within the last 5 years. Surgeon personality differed from the general population, with statistically significantly higher levels of emotional stability (3.25 versus 2.97 respectively), lower levels of agreeableness (3.03 versus 3.74), extraversion (2.81 versus 3.38) and openness (3.19 versus 3.67), and similar levels of conscientiousness (3.42 versus 3.40 (all P <0.001)). Female surgeons had significantly lower levels of openness (P <0.001) than males (3.06 versus 3.25). Personality was associated with anastomotic decision-making in specific scenarios.

CONCLUSION

Colorectal surgeons have different personality traits from the general population. Certain traits seem to be associated with anastomotic decision-making but only in specific scenarios. Further exploration of the association of personality, risk-taking, and decision-making in surgery is necessary.

The big five: Studying the surgical personality

BACKGROUND

The challenging nature of performing surgery on a personal and professional level demands specific characteristics. Personality traits play an important role in the nature and behavior of humans, which are studied using the five-factor model. Therefore, we investigated the personality of 3 surgical generations.

METHODS

Three distinct surgical populations were approached. The Dutch Big Five Inventory-2 was sent out online to 126 surgical residents (response: n = 69) and 104 surgeons (response: n = 60) in a teaching region in the Netherlands. Moreover, medical students interested in surgery were approached via the students' surgical society (response: n = 54). To obtain a normative Dutch population sample, the Longitudinal Internet studies for the Social Sciences panel was used, creating groups of the following age categories: 18 to 25 (n = 84), 26 to 35 (n = 101), 36 to 67 (n = 432). One-way analysis of variance with Bonferroni correction was used to assess differences in personality scores.

RESULTS

Individuals interested in surgery (ie, surgically-oriented medical students, surgical residents, and surgeons) generally scored significantly higher on extraversion, conscientiousness, agreeableness, open-mindedness, and lower on negative emotionality compared with the normative population sample. Across the surgical generations, surgical residents scored significantly lower on open-mindedness (3.60) compared with surgeons (3.92) and surgically-oriented medical students (3.82). Surgically-oriented medical students scored significantly higher in negative emotionality (2.44) compared with surgical residents (2.12) and surgeons (2.07).

CONCLUSION

Being a surgeon demands particular levels of determination and emotional stability. The surgical population shows a distinct personality pattern compared with the normative population, and more modest differences exist between persons in different stages of their surgical career.

Does Personality Matter? Perceptions and Experiences of Introverts and Extraverts as General Surgeons

PHENOMENON

Medical educators increasingly recognize both the challenges introverts, compared to extraverts, may face in medical training and the unique strengths they bring to practice. However, few researchers have examined in-depth how introverts and extraverts truly experience training and practice, particularly in specialties like surgery that tend to value qualities (e.g., dominance and assertiveness) typically associated with extraverts. This study aimed to explore the perceptions and experiences of individuals with both personalities within the field of general surgery.

APPROACH

Using a constructivist grounded theory approach, six general surgeons and 10 general surgery residents who identified as introverted, extraverted, or ambiverted were recruited from two Canadian tertiary care hospitals to participate in semi-structured interviews. Data collection and analysis occurred iteratively, and data were analyzed using open, selective, and thematic coding. Constant comparison allowed us to make sense of the similar and dissimilar views that emerged from each interview.

FINDINGS

Irrespective of their personalities, participants voiced two general patterns of responses. Some participants believed that "personality doesn't matter": that both introverted and extraverted practice styles were equally viable and neither introverts nor extraverts would find surgical training more challenging than the other (culture of equality). However, others believed that "personality matters," emphasizing that surgeons should be dominant and aggressive leaders. Only those who believed "personality matters" felt that introverts sometimes needed to act more extraverted in order to succeed in surgical training (culture of hierarchy). Similar numbers of introverts and extraverts adhered to each viewpoint.

INSIGHTS

Our qualitative approach allowed us to draw meaning from the complex subjective experiences of our research participants. Our findings suggest that two competing cultures (equality and hierarchy) co-exist within the field of surgery and that trainees, depending on which culture they adhere most to, will or will not "adapt" their personalities to the workplace. These findings deepen our understanding of the nuances of surgical culture and have important implications for how we select candidates based on personality.

Pathways to performance in undergraduate medical students: role of conscientiousness and the perceived educational environment

This study examined conscientiousness and the perceived educational environment as independent and interactive predictors of medical students' performance within Biggs' theoretical model of learning. Conscientiousness, the perceived educational environment, and learning approaches were assessed at the beginning of the third year in 268 medical students at the University of Geneva, Switzerland. Performance was examined at the end of the third year via a computer-based assessment (CBA) and the Objective Structured Clinical Examination (OSCE). Path analysis was used to test the proposed model, whereby conscientiousness and the perceived educational environment predicted performance directly and indirectly via students' learning approaches. A second model included interaction effects. The proposed model provided the best fit and explained 45% of the variance in CBA performance, and 23% of the variance in OSCE performance. Conscientiousness positively predicted CBA performance directly (β = 0.19, p < 0.001) and indirectly via a deep learning approach (β = 0.05, p = 0.012). The perceived educational environment positively predicted CBA performance indirectly only (β = 0.02, p = 0.011). Neither conscientiousness nor the perceived educational environment predicted OSCE performance. Model 2 had acceptable, but less optimal fit. In this model, there was a significant cross-over interaction effect (β = 0.16, p < 0.01): conscientiousness positively predicted OSCE performance when perceptions of the educational environment were the most positive, but negatively predicted performance when perceptions were the least positive. The findings suggest that both conscientiousness and perceptions of the educational environment predict CBA performance. Research should further examine interactions between personality traits and the medical school environment to inform strategies aimed at improving OSCE performance.

Resilience and vulnerability factors influence the cortisol awakening response in individuals vulnerable to suicide

Suicide is a global health issue. Dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, has been identified as one potential risk factor. Evidence is emerging to suggest that different psychological factors may be associated with increased resilience and vulnerability in this context. The current study investigated whether trait resilience, social support, socially prescribed perfectionism, trait worry and trait impulsivity influenced the cortisol awakening response (CAR) over a 7-day study in individuals vulnerable to suicide. 142 participants with a history of suicidal attempt or ideation (suicide vulnerability group; n = 95) and with no suicide risk history (control group; n = 47) were recruited. Participants completed baseline questionnaires before commencing a 7-day study where they provided cortisol samples immediately upon waking, at 15 min, 30 min and 45 min on 7 consecutive days. Higher worry, socially prescribed perfectionism and impulsivity, lower resilience and social support were found in the suicide vulnerability group compared to the control group. Lower levels of resilience, higher levels of socially prescribed perfectionism, worry and impulsivity were associated with significantly lower total CAR. Suicide group membership was also found to have an indirect effect on total CAR via trait worry. The current findings show for the first time, that these well-known psychological risk factors for suicide are associated with smaller total cortisol awakening responses. Researchers ought to elucidate the precise causal mechanisms linking these traits, CAR and suicide risk in order to develop interventions to help build resilience in vulnerable populations.

The Long-Term Effectiveness of Empathic Interventions in Medical Education: A Systematic Review

The Association of American Medical Colleges recognizes that empathy is an important part of providing excellent patient care and lists empathy as a Core Entrustable Professional Attribute for physicians. This study is a review of the literature focusing on studies with an educational intervention to promote empathy and at least one year follow-up data. After reviewing the 4910 abstracts retrieved from PubMed, PsycInfo, Cochrane, Web of Science, CINAHL, and Embase; the coauthors selected 61 articles for full-text review and completed a medical education research study quality instrument (MERSQI) to ensure all selected studies scored at least 7 or above. Five studies from the US and seven international studies met our inclusion criteria and formed the basis for the study. Few longitudinal studies with a post-intervention follow-up exist to confirm or disprove the effectiveness and durability of empathy training. Of the published studies that do conduct long-term follow-up, study design and measures used to test empathy are inconsistent. Despite the high degree of heterogeneity, the overwhelming majority demonstrated declining empathy over time. Little evidence was identified to support the ability to augment the empathy of physician trainees in sustained fashion. A model is presented which explains the observed changes. Alternative solutions are proposed, including the selection of more prosocial candidates.

Assessment of Diversity Outcomes in American Medical School Admissions: Applying the Grutter Legitimacy Principles

In the last 30 years, except for female participation, the enrollment of Latinx, African Americans, Native Americans, Alaskan natives, and disadvantaged students in medical school has been constant; however, increasing enrollment of these minority populations is feasible, if admissions committees make two changes in approach. First, the traditional belief that matriculation merit is a linear function of past academic performance must be rejected. Second, once the threshold needed to complete medical school in four years and to pass licensing examinations at the first attempt has been met, all candidates are equally qualified, and matriculation decisions must be based, in part, on societal interests. In Grutter vs. Bollinger, the United States Supreme Court determined that graduate admission committees can and should consider societal interests. Each admission decision represents a substantial government investment in each student, as the Medicare Act directly subsidizes much of the cost of medical education. As Grutter explained, there is a societal interest in the public having confidence in, and access to, the medical school training that will prepare tomorrow’s medical, professional, and political leaders. Our analysis suggests that medical school admissions are biased towards academic achievement in matriculants, beyond acceptable thresholds for graduation and licensure. We believe medical schools must shift their admissions strategies and consider noncognitive factors in all candidates as determinative once minimum acceptable academic standards have been met.

The dynamics of poverty, educational attainment, and the children of the disadvantaged entering medical school

Approximately one-third of the US population lives at or near the poverty line; however, this group makes up less than 7% of the incoming medical students. In the United Kingdom, the ratio of those of the highest social stratum is 30 times greater than those of the lowest to receive admission to medical school. In an effort to address health disparities and improve patient care, the authors argue that significant barriers must be overcome for the children of the disadvantaged to gain admission to medical school. Poverty is intergenerational and multidimensional. Familial wealth affects opportunities and educational attainment, starting when children are young and compounding as they get older. In addition, structural and other barriers exist to these students pursuing higher education, such as the realities of financial aid and the shadow of debt. Yet the medical education community can take steps to better support the children of the disadvantaged throughout their education, so they are able to reach medical school. If educators value the viewpoints and life experiences of diverse students enriching the learning environment, they must acknowledge the unique contributions that the children of the disadvantaged bring and work to increase their representation in medical schools and the physician workforce. We describe who the disadvantaged are contrasted with the metrics used by medical school admissions to identify them. The consequences of multiple facets of poverty on educational attainment are explored, including its interaction with other social identities, inter-generational impacts, and the importance of wealth versus annual income. Structural barriers to admission are reviewed. Given the multi-dimensional and cumulative nature of poverty, we conclude that absent significant and sustained intervention, medical school applicants from disadvantaged backgrounds will remain few and workforce issues affecting the care patients receive will not be resolved. The role of physicians and medical schools and advocating for necessary societal changes to alleviate this dynamic are highlighted.

Discrete Trajectories of Resolving and Persistent Pain in People With Rheumatoid Arthritis Despite Undergoing Treatment for Inflammation: Results From Three UK Cohorts

Rheumatoid arthritis (RA) is an example of human chronic inflammatory pain. Modern treatments suppress inflammation, yet pain remains a major problem for many people with RA. We hypothesized that discrete RA subgroups might display favorable or unfavorable pain trajectories when receiving treatment, and that baseline characteristics will predict trajectory allocation. Growth mixture modelling was used to identify discrete trajectories of Short Form-36 bodily pain scores during 3 years in 3 RA cohorts (Early RA Network (n = 683), British Society for Rheumatology Biologics Register Biologics (n = 7,090) and nonbiologics (n = 1,720) cohorts. Logistic regression compared baseline predictor variables between trajectories. The role of inflammation was examined in a subgroup analysis of people with normal levels of inflammatory markers after 3 years. The mean Short Form-36 bodily pain scores in each cohort improved but remained throughout 3 years of follow-up of >1 standard deviation worse than the UK general population average. Discrete persistent pain (59-79% of cohort participants) and resolving pain (19-27%) trajectories were identified in each cohort. In Early RA Network, a third trajectory displaying persistently low pain (23%) was also identified. In people with normal levels of inflammatory markers after 3 years, 65% were found to follow a persistent pain trajectory. When trajectories were compared, greater disability (adjusted odds ratio = 2.3-2.5 per unit baseline Health Assessment Questionnaire score) and smoking history (adjusted odds ratio = 1.6-1.8) were risk factors for persistent pain trajectories in each cohort. In conclusion, distinct trajectories indicate patient subgroups with very different pain prognosis during treatment for RA. Inflammation does not fully explain the pain trajectories, and noninflammatory factors as well as acute phase response predict which trajectory an individual will follow. Targeted treatments additional to those which suppress inflammation might reduce the long-term burden of arthritis pain. PERSPECTIVE: Immunosuppression decreases inflammation in RA, but pain outcomes are less favorable. Discrete persistent and resolving pain trajectories were identified after treatment, both in early and established RA. Smoking and greater disability at baseline predicted persistent pain. Identifying patient subgroups with a poor pain prognosis could enable adjunctive treatment to improve outcomes.

Do different curriculum aligned selection procedures admit students with different personality profiles to medical school?

BACKGROUND

Medical schools aim to contribute to a pool of doctors who are ready for a future practice that will be ever-changing requiring collaboration skills and lifelong learning. They adapt their curricula and selection procedures to fulfil this responsibility. This study aims to determine whether two different selection procedures in one medical school, both matching the key characteristics of the subsequent curricula (one traditional, knowledge-based, and one recently designed for self directed learning and focusing on practice), select students with different personality traits as a side-effect. This perspective was chosen as personality has been related to the CanMeds competencies, innovation capacities, medical school performance and medical professional success.

METHODS

A total of 621 students admitted through the new or the traditional selection procedure were invited to complete a Big Five Inventory questionnaire at the start of their Bachelor's programme. Using ANCOVA, we compared Big Five traits of students admitted through the new selection procedure (n = 196) and the traditional selection procedure (n = 425).

RESULTS

The group of students admitted through the procedure matching the newly designed curriculum had a lower mean score on neuroticism (p < .01) and higher mean scores on conscientiousness, extraversion, agreeableness and openness (p < .001) than the other group.

CONCLUSIONS

The findings of the current study indicate that the medical school population is influenced in terms of personality traits as a side-effect of a changing selection procedure. We recommend studying this mechanism and its implications further and using it more consciously in selection procedure design.

2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions

Selection and recruitment into healthcare education and practice is a key area of interest for educators with significant developments in research, policy, and practice in recent years. This updated consensus statement, developed through a multi-stage process, examines future opportunities and challenges in selection and recruitment. There is both a gap in the literature around and a compelling case for further theoretical and empirical literature to underpin the development of overall selection philosophes and policies and their enactment. More consistent evidence has emerged regarding the quality of different selection methods. Approaches to selection are context-dependent, requiring the consideration of an institution's philosophy regarding what they are trying to achieve, the communities it purports to serve, along with the system within which they are used. Diversity and globalization issues continue to be critically important topics. Further research is required to explore differential attainment and explain why there are substantial differences in culturally acceptable ways of approaching diversity and widening access. More sophisticated evaluation approaches using multi-disciplinary theoretical frameworks are required to address the issues. Following a discussion of these areas, 10 recommendations are presented to guide future research and practice and to encourage debate between colleagues across the globe.

The colorectal surgeon's personality may influence the rectal anastomotic decision

AIM

Colorectal surgeons regularly make the decision to anastomose, defunction or form an end colostomy when performing rectal surgery. This study aimed to define personality traits of colorectal surgeons and explore any influence of such traits on the decision to perform a rectal anastomosis.

METHOD

Fifty attendees of The Association of Coloproctology of Great Britain and Ireland 2016 Conference participated. After written consent, all underwent personality testing: alexithymia (inability to understand emotions), type of thinking process (intuitive versus rational) and personality traits (extraversion, agreeableness, openness, emotional stability, conscientiousness). Questions were answered regarding anastomotic decisions in various clinical scenarios and results analysed to reveal any influence of the surgeon's personality on anastomotic decision.

RESULTS

Participants were: male (86%), consultants (84%) and based in England (68%). Alexithymia was low (4%) with 81% displaying intuitive thinking (reflex, fast). Participants scored higher in emotional stability (ability to remain calm) and conscientiousness (organized, methodical) compared with population norms. Personality traits influenced the next anastomotic decision if: surgeons had recently received criticism at a departmental audit meeting; were operating with an anaesthetist that was not their regular one; or there had been no anastomotic leaks in their patients for over 1 year.

CONCLUSION

Colorectal surgeons have speciality relevant personalities that potentially influence the important decision to anastomose and could explain the variation in surgical practice across the UK. Future work should explore these findings in other countries and any link of personality traits to patient-related outcomes.

Medical specialty choice and well-being at work: Physician's personality as a moderator

We examined whether physicians' personality traits moderate the association between medical specialty and well-being at work. Nationally representative sample of Finnish physicians (n = 2,815; 65% women; aged 25-72 years in 2015) was used. Personality was assessed with the shortened Big Five Inventory. Indicators of well-being at work were measured with scales from Work Ability Index, General Health Questionnaire, Jenkins' Sleep Problems Scale and Suicidal Ideation. Higher extraversion, openness to experience and agreeableness showed as personality traits beneficial for higher well-being at work among person-oriented specialties whereas higher conscientiousness but lower openness and agreeableness showed as personality traits beneficial for higher well-being at work among technique-oriented specialties. The role of neuroticism remains minor in general. Physicians' personality traits may moderate the association between medical specialty and well-being at work.

Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty

BACKGROUND

Personality influences an individual's adaptation to a specific job or organization. Little is known about personality trait differences between medical career and specialty choices after graduating from medical school when actually practicing different medical specialties. Moreover, whether personality traits contribute to important career choices such as choosing to work in the private or public sector or with clinical patient contact, as well as change of specialty, have remained largely unexplored. In a nationally representative sample of Finnish physicians (N = 2837) we examined how personality traits are associated with medical career choices after graduating from medical school, in terms of employment sector, patient contact, medical specialty and change of specialty.

METHODS

Personality was assessed using the shortened version of the Big Five Inventory (S-BFI). An analysis of covariance with posthoc tests for pairwise comparisons was conducted, adjusted for gender and age with confounders (employment sector, clinical patient contact and medical specialty).

RESULTS

Higher openness was associated with working in the private sector, specializing in psychiatry, changing specialty and not practicing with patients. Lower openness was associated with a high amount of patient contact and specializing in general practice as well as ophthalmology and otorhinolaryngology. Higher conscientiousness was associated with a high amount of patient contact and specializing in surgery and other internal medicine specialties. Lower conscientiousness was associated with specializing in psychiatry and hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice and occupational health. Lower agreeableness and neuroticism were associated with specializing in surgery. Higher extraversion was associated with specializing in pediatrics and change of specialty. Lower extraversion was associated with not practicing with patients.

CONCLUSIONS

The results showed distinctive personality traits to be associated with physicians' career and specialty choices after medical school independent of known confounding factors. Openness was the most consistent personality trait associated with physicians' career choices in terms of employment sector, amount of clinical patient contact, specialty choice and change of specialty. Personality-conscious medical career counseling and career guidance during and after medical education might enhance the person-job fit among physicians.

Personality and achievement along medical training: Evidence from a cross-lagged analysis

INTRODUCTION

Evidence on personality traits change implies it should be studied as an outcome and not only as an explanatory effect. Therefore, we aimed to assess how personality and academic achievement sway each other. Three cohorts of medical students (n = 181) comprised of school leavers and graduates, completed NEO-FFI when admitted (baseline) and later on medical training (follow-up). Previous achievement was measured as mean scores on national school examinations, and academic achievement as medical course average. Causal relations were studied by cross-lagged analysis.

RESULTS

Cross-sectional analysis at baseline showed differences between graduates and school leavers on personality, with graduates scoring lower on neuroticism (β = -12.344, p<0.001), and higher on openness to experience (β = 5.257, p<0.001), conscientiousness (β = 2.345, p = 0.004,) and agreeableness (β = 6.993, p<0.001). Longitudinal analyses indicated that personality traits and achievement tracked over time. Cross-lagged analysis found a positive significant association between academic achievement and neuroticism at baseline (β = 0.031, p = 0.014) and with being a graduate student (β = 0.766, p = 0.006). After adjusting, no association was found between previous achievement and personality at follow-up.

CONCLUSIONS

Some neuroticism may enhance medical academic achievement. The blurring of the initial differences between graduates and school leavers suggests a reasonable possibility of personality traits change along the medical course. Future research on medical selection processes cannot afford to ignore the influence of the medical school environment on personality traits change.