Temperament and character profiles of medical students associated with tolerance of ambiguity and perfectionism

Association between tolerance for ambiguity specific to the clinical context and empathy in medical trainees: A multicenter cross-sectional study in Japan

PURPOSE

Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees.

METHODS

We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE).

RESULTS

Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy.

CONCLUSION

This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy.

Perfectionism in anorexia nervosa: Associations with clinical picture and personality traits

Although many researchers addressed the topics, no consistent data are currently available regarding the relationship between perfectionism and personality traits in anorexia nervosa (AN). The present study aimed to assess differences between high- and low-perfectionism groups of patients with AN and to identify which variables show the strongest association with perfectionism. A group of inpatients with AN (n = 193) was recruited and completed a battery of self-report questionnaires regarding eating-related and general psychopathology, perfectionism, and personality. On the basis of perfectionism scores, patients were divided into high- and low-perfectionism groups. High-perfectionist patients displayed higher eating-related and general psychopathology; higher depressive, cyclothymic, irritable and anxious temperament, and lower self-directedness, cooperativeness and self-esteem. Perfectionism was associated with the drive for thinness, cooperativeness, self-esteem and anxious temperament. On the basis of the two personality traits most strongly correlated with perfectionism (i.e., cooperativeness and anxious temperament), patients could be correctly assigned to the high- or low-perfectionism group by an algorithm. The study suggests that perfectionism in AN is related to eating psychopathology, especially of restrictive type, and personality features such as cooperativeness and anxious temperament. These findings confirm the important role of perfectionism in AN, not only concerning eating behaviour but personality as well.

The effects of becoming a physician on prescription drug use and mental health treatment

There is evidence that physicians disproportionately suffer from substance use disorder and mental health problems. It is not clear, however, whether these phenomena are causal. We use data on Dutch medical school applicants to examine the effects of becoming a physician on prescription drug use and the receipt of treatment from a mental health facility. Leveraging variation from lottery outcomes that determine admission into medical schools, we find that becoming a physician increases the use of antidepressants, anxiolytics, opioids, and sedatives. Increases in the use of antidepressants, anxiolytics, and sedatives are larger among female physicians than among their male counterparts.

The Almost Perfect Scale in medical students: factor analysis, measurement invariance, and profile analysis

Incoming medical students at a private midwestern medical school are routinely surveyed at the time of matriculation on wellness measures, one of which is the Almost Perfect Scale - Revised (APS-R). An 8-item subset of this 23-item scale has been suggested as an alternative perfectionism measure, called the Short Almost Perfect Scale (SAPS). To confirm the within-network and between-network construct validity of both scales in our population, responses in 592 matriculating medical students from the years 2020-2022 were analyzed using both versions of this scale. Confirmatory factor analysis found the items significantly measured the construct of perfectionism in the SAPS scale, but not the APS-R. The APS-R was not analyzed further. SAPS was analyzed for measurement invariance (MI) and was equivocal for gender at the scalar level; differential item functioning indicated that any MI effect was small. Latent profile analysis was inconclusive in our sample, possibly because our students' scores on the latent variable "standards" were consistently higher than previously reported. We recommend that the SAPS be used rather than the APS in medical students, that gender differences be analyzed with caution, and that profiles of types of perfectionists not be utilized in this population without further investigation. Finally, we suggest that the discrepancy scale alone may be a better indicator of perfectionism in this population of high achievers.

Teaching the science of uncertainty

As we increasingly acknowledge the ubiquitous nature of uncertainty in clinical practice (Meyer AN, Giardina TD, Khawaja L, Singh H. Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions. Patient Educ Counsel 2021;104:2606-15; Han PK, Klein WM, Arora NK. Varieties of uncertainty in health care: a conceptual taxonomy. Med Decis Making 2011;31:828-38) and strive to better define this entity (Lee C, Hall K, Anakin M, Pinnock R. Towards a new understanding of uncertainty in medical education. J Eval Clin Pract 2020; Bhise V, Rajan SS, Sittig DF, Morgan RO, Chaudhary P, Singh H. Defining and measuring diagnostic uncertainty in medicine: a systematic review. J Gen Intern Med 2018;33:103-15), as educators we should also design, implement, and evaluate curricula addressing clinical uncertainty. Although frequently encountered, uncertainty is often implicitly referred to rather than explicitly discussed (Gärtner J, Berberat PO, Kadmon M, Harendza S. Implicit expression of uncertainty - suggestion of an empirically derived framework. BMC Med Educ 2020;20:83). Increasing explicit discussion of - and comfort with -uncertainty has the potential to improve diagnostic reasoning and accuracy and improve patient care (Dunlop M, Schwartzstein RM. Reducing diagnostic error in the intensive care unit. Engaging. Uncertainty when teaching clinical reasoning. Scholar;1:364-71). Discussion of both diagnostic and prognostic uncertainty with patients is central to shared decision-making in many contexts as well, (Simpkin AL, Armstrong KA. Communicating uncertainty: a narrative review and framework for future research. J Gen Intern Med 2019;34:2586-91) from the outpatient setting to the inpatient setting, and from undergraduate medical education (UME) trainees to graduate medical education (GME) trainees. In this article, we will explore the current status of how the science of uncertainty is taught from the UME curriculum to the GME curriculum, and describe strategies how uncertainty can be explicitly discussed for all levels of trainees.

Visualizing the Human Body Using an Artistic Approach

This chapter describes an innovative approach to the cross-disciplinary study of anatomy and art to facilitate visualization of the human body. We draw upon the literature, together with our own experience of designing, delivering and researching a cross-disciplinary art and anatomy course, to indicate the critical elements of the approach that foster students' visualization of the anatomy of the human body.Visual arts have been linked with anatomy for centuries, but typically biomedical science has existed in a utilitarian relationship with art only used as an aid. In this chapter, we discuss the rationale underpinning a cross-disciplinary anatomy and art course and describe our experience of devising activities and assessment that create a stimulating and mutually beneficial environment for visualizing the experience and physicality of the human body. We describe the structure of the course which integrates art and anatomy to train students in the language of anatomy and visual representation, by engaging them in a process of attempting their own visual communication. The cross-disciplinary nature of our approach creates a unique social environment that offers a supportive environment for exploration and experimentation without fear of failure. Students' personal growth in resilience, tolerance for uncertainty and creativity prepares them for the inclusion of these values in their career.

A longitudinal cohort study observed increasing perfectionism and declining resilience, ambiguity tolerance and calling during medical school which is not explained by student personality

BACKGROUND

The medical degree is a long and challenging program, not just academically, but regarding the expectations engrained in the culture of medical education. The recent proliferation of literature on the poor mental well-being among students suggests a dilemma that often lays the onus on students to improve their health. The link between personality and vulnerability to psychological distress is acknowledged. This longitudinal study looked at personality in 1^st-year and changes in levels of certain psychological traits, as proxy indicators of well-being, in 4^th-year. We aimed to determine to what extent changes in psychological traits over time may be attributed to personality.

METHODS

Medical students completed surveys at the start (1^st-year: baseline) and finish (4^th-year: follow-up) of their medical degree (N = 154). Temperament and character personality, Perfectionism-Concern over mistakes (CoM), Ambiguity Tolerance, Resilience, Calling to medicine, and demographic variables were measured. Paired t-tests compared changes in psychological traits from baseline to follow-up. Linear regression examined whether personality at baseline would predict levels of psychological traits at follow-up.

RESULTS

The temperament and character profile of the sample was as expected, and congruent with previous studies, which describe a mature personality. Over four years, levels of Perfectionism-CoM significantly increased, while Resilience, Ambiguity Tolerance and Calling to medicine decreased. Harm Avoidance, Persistence, Self-Directedness and Cooperativeness at baseline significantly predicted levels of these traits at follow-up, but effect sizes were weak. Correlations were in the expected direction and weak.

CONCLUSIONS

Most commencing medical students, including this cohort, have mature personalities with an industrious temperament and an adaptable character. Yet over four years of medicine, Ambiguity Tolerance, Resilience and Calling declined while Perfectionism-CoM, already elevated at baseline, continued to increase to the final year. Of concern is the increased perfectionism that is strongly associated with poor mental health and psychological distress. The findings suggest a closer look at the entirety of the education environment and how its culture, including secondary school and the medical school admissions processes may influence these trends in students. As medical educators we should question why the pathway to medicine places such unhealthy pressure on students who aspire to be doctors.

Benchmarking in Academic Physical Therapy Using the PT-GQ Survey: Wave 2 Update With Application to Accreditation Reporting

OBJECTIVE

The Benchmarking in Academic Physical Therapy study uses the Physical Therapist-Graduation Questionnaire (PT-GQ) survey to develop comprehensive performance benchmarks for physical therapist education. These benchmarks facilitate interprofessional comparisons and have application to accreditation self-study reporting. The purpose of this study is to report updated benchmarks from enrollment Wave 2 of the study, with an emphasis on curricular areas that align with accreditation standards.

METHODS

Seventy doctor of physical therapy (DPT) programs (26.5% national sample) administered the survey to graduates during 2020-2021. Where possible, respondent data were contextualized by statistical comparison with published medical student data (Welch t test, Hedges g).

RESULTS

There were 1894 respondents who participated in the study (response rate: 63.9%). The average survey duration was 32.9 minutes. White-only, non-Hispanic/Latino/a/x individuals (78.8%) exceeded the 2020 US Census prevalence (60.1%), and only one-half of respondents perceived a benefit to their training from the diversity present in their programs. Over 94% of respondents indicated that their curricula were characterized by "problem solving/critical thinking" and "clinical reasoning," but nearly one-half indicated "busywork" was prevalent. High curricular satisfaction ratings clustered in content areas relating to profession-specific technical skills and low ratings clustered in foundational sciences. DPT respondents reported significantly lower tolerance for ambiguity, significantly more exhaustion, and significantly less disengagement than medical students. Respondents endorsed higher levels of "adaptive" perfectionism (striving for high performance) than "maladaptive" perfectionism (concern over negative evaluations). Respondents with loans (27.7%) had debt exceeding $150,000, the benchmark above which the DPT degree loses economic power.

CONCLUSION

PT-GQ benchmarks revealed strengths (eg, curricula emphasizing problem solving/critical thinking and clinical reasoning) and challenges (eg, low diversity, problematic student debt) in physical therapist education.

IMPACT

Programs can use benchmarking for quality-improvement efforts and as a data source for accreditation self-study reports. The ongoing study will refine national benchmarks and pilot items to address new research questions.

Externalizing personality characteristics define clinically relevant subgroups of alcohol use disorder

AIMS

Higher levels of externalizing characteristics, i.e. impulsivity, novelty seeking and aggression, could contribute to the development, progression and severity of alcohol use disorder (AUD). The present study aims to explore whether these externalizing characteristics together have a potential group-forming role in AUD using latent profile analysis (LPA).

METHODS

Externalizing characteristics of 102 AUD patients were analyzed using LPA to explore the group-forming role of externalizing symptoms; groups were compared in terms of demographic and alcohol-related variables, indices of psychopathological, depressive and anxiety symptom severity.

RESULTS

LPA revealed and supported a two-group model based on externalizing symptoms. The group with higher levels of externalizing symptoms showed significantly elevated levels of alcohol-related and anxio-depressive symptoms.

CONCLUSIONS

Externalizing characteristics converge and have a group-forming role in chronic AUD, and are associated with a more severe form of AUD. By making the diagnostic category less heterogeneous, these different subtypes within AUD may provide aid in tailoring treatments to patients' specific needs.

Does medical school cause depression or do medical students already begin their studies depressed? A longitudinal study over the first semester about depression and influencing factors

OBJECTIVE

In the past, medical students have been found to be at increased risk for depressive symptoms compared to the general population. This study addresses the question, whether medical students already show these elevated depression scores at the beginning of medical school or whether it is the studies of medicine that leads to symptoms of depression.

METHODS

In the winter semester 2018/2019, 148 medical students at a middle-sized German university answered a questionnaire during the first (T0) and last week (T1) of their first semester that examined various risk and resilience factors for initial depressive symptoms and their course. The severity of symptoms was assessed with the Beck´s Depression Inventory II (BDI-II). A subscale of the NEO-FFI was used to investigate the personality factor neuroticism.

RESULTS

Over the study period, the percentage of students suffering from at least mild depressive symptoms increased from 16.3% in the first week of their studies (T0) to 21.4% at the end of the first semester (T1). The use of drugs or medication, loneliness, mental overload, performance pressure and financial burden show the strongest influence on the development of depressive symptoms. Concerning surveyed resilience factors, in particular emotional support, physical workout and sufficient time for social contact appear to be protective. The more risk factors are concentrated on an individual, the higher its increase of depressive symptoms. The opposite is prevailing for the investigated resilience factors. Except for the use of drugs or medication, no other criterion than the BDI-II value at T0 was able to predict the BDI-II score at T1. This underlines that especially the interplay of factors is decisive.

CONCLUSION

The findings of this study could indicate a worsening tendency of the BDI-II score in the further course of medical school. Ultimately, we emphasize the importance of offering preventive measures to medical students as early as possible.

Maladaptive Perfectionism, Impostor Phenomenon, and Suicidal Ideation Among Medical Students

OBJECTIVE

Suicide is a leading cause of death for young adults, and medical students experience elevated rates of suicide and suicidal ideation. The present study uses mediation analysis to explore relationships between suicidal ideation and two dysfunctional mindsets common among medical students: maladaptive perfectionism, high standards accompanied by excessive self-criticism, and impostor phenomenon, pervasive feelings of inadequacy despite evidence of competence and success.

METHODS

Two hundred and twenty-six medical students at a single institution completed an online survey which assessed maladaptive perfectionism, impostor phenomenon, and suicidal ideation. After calculating measures of association between all study variables, linear regression was conducted to establish the relationship between maladaptive perfectionism and suicidal ideation. To evaluate whether impostor phenomenon mediated the relationship between maladaptive perfectionism and suicidal ideation as hypothesized, a series of regression models were constructed and the regression coefficients were examined. The statistical significance of the indirect effect, representing the mediated relationship, was tested using bootstrapping.

RESULTS

Significant positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation were observed. Impostor phenomenon score was found to mediate the relationship between maladaptive perfectionism and suicidal ideation.

CONCLUSIONS

Medical students who exhibit maladaptive perfectionism are at increased risk for feelings of impostor phenomenon, which translates into increased risk for suicide. These results suggest that an intervention targeted at reducing feelings of impostor phenomenon among maladaptive perfectionists may be effective in reducing their higher risk for suicide. However, interventions promoting individual resilience are not sufficient; systemic change is needed to address medicine's "culture of perfection."

Towards a medical school curriculum for uncertainty in clinical practice

Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale (IUS). Items asked students to rate preparedness, confidence, and comfort with uncertainty in clinical practice. Items on curricular programs asked students to identify training that prepared them for uncertainty in clerkships, and examined correlations with specific clinical practice uncertainty domains (CPUDs). Spearman's rank-order correlation, Chi-Square, and ANOVA were used to analyze quantitative data. Open responses were analyzed using Braun and Clarke's Framework. Response rate was 98.9% (287/290). GSE was inversely correlated with IUS (p < 0.001). GSE was positively correlated with all CPUDs (p < 0.005). IUS had an inverse correlation with all CPUDs (p < 0.005). Pedagogies with statistically-significant relationships with preparing students for uncertainty, communicating and building relationships with patients during times of uncertainty, and overall well-being included: team debriefs, role plays, case- and team-based learning, story slams, and sharing narratives with peers and faculty (p < 0.05). Qualitatively, students appreciated storytelling, role-modeling of communication strategies, debriefing, and simulations. Strategically immersing specific educational formats into formal curriculum may help cultivate skills needed to prepare students for uncertainty. Clinical debriefs, interprofessional role plays, simulations, communications skills training, instructor emotional vulnerability, storytelling, and peer-to-peer conversations may have the most impact. Further study is required to evaluate their longitudinal impact.

Tolerance for Uncertainty, Personality Traits and Specialty Choice Among Medical Students

OBJECTIVE

The objective was to explore the tolerance for uncertainty in its different aspects (risk, ambiguity and complexity) in medical students at different times of their careers, and to relate these tolerance levels with their predominant personality traits and specialty choices. A secondary objective was to build a hypothetical model aimed at explaining the potential relationships of dependency between gender, personality traits, tolerance for uncertainty and specialty choice using a structural equation modeling (SEM) analysis.

DESIGN/SETTING/PARTICIPANTS

A prospective cross-sectional study including two cohorts of second-year (n = 155) and sixth-year (n = 157) medical students was performed during 2017 at the Buenos Aires University School of Medicine. Both student cohorts completed instruments assessing tolerance for different types of uncertainty: (1) complexity (Tolerance for Ambiguity scale); (2) risk (Pearson Risk Attitude scale); and (3) ambiguity (Ambiguity Aversion in Medicine scale). Information on age, gender and specialty choice in sixth-year medical students was included, plus the Big Five Inventory-10 (BFI-10) personality test.

RESULTS

Sixth-year students showed significantly lower scores than second-year students at tolerance for complexity (p = 0.0003) and ambiguity (p = 0.008). Sixth-year students choosing a surgical specialty were associated with low tolerance for risk and ambiguity, and moderate for complexity. Conversely, students choosing a clinical specialty were related with high tolerance for risk, moderate for ambiguity, and low for complexity. Logistic regression analysis including the uncertainty questionnaires plus BFI-10 categories demonstrated that only the "neuroticism" personality trait was independently associated with a surgical specialty choice (OR: 1.31, 95%CI: 1.03-1.67). The final SEM that best represented the data showed good fit statistics: chi-square (p = 0.108), and RMSEA (p = 0.047).

CONCLUSIONS

Tolerance for uncertainty in its different dimensions was associated with personality traits and specialty choice among medical students. A SEM analysis could satisfactorily explain the hypothetical relationships of dependency between gender, personality traits, tolerance for uncertainty, and specialty choice.

Case Report: The Gold Standard: The Case for Inclusion of a Medical Student-Specific Counseling Center and Wellness Programming in Early Medical Education

Medical student's mental health and wellness is a multifactorial discussion that requires a multidimensional and comprehensive approach. The high prevalence of burnout and its recent recognition by the World Health Organization as a work-related syndrome has scholars questioning if experiences in early medical education have an impact. The Herbert Wertheim College of Medicine at Florida International University in 2009 created an in-house counseling and wellness center. In assessing programming and services, approximately 55% of the medical student body has sought out individualized services from the Medical Student Counseling and Wellness Center. Moreover, the Association of American Medical Colleges Graduate Questionnaire results regarding the satisfaction of students in personal counseling, mental health services, and wellness programming have been 20% or higher than the national average. This is a call to action highly encouraging other medical schools to emulate and consider implementing a detailed and comprehensive program to be offered early in medical education.

Contributions of Affective Temperament Traits to Professional Choice: Evidence from the Study of Firefighters, Musicians, Athletes, Bank Managers, Nurses and Paramedics

Purpose

The purpose of this study was to expand knowledge about the relationship between temperament and choice of profession by comparing temperaments among representatives of various professional groups.

Subjects and Methods

A total of 759 subjects aged 18-71, representatives of six professional groups: firefighters, musicians, athletes, bank managers, nurses and paramedics, were included in the study. Temperament was assessed using the TEMPS-A autoquestionnaire.

Results

Musicians showed higher levels of depressive and anxious temperaments whereas firefighters were lower on cyclothymic dimension. Athletes, bank managers and paramedics showed higher intensity of hyperthymic temperament compared to firefighters, musicians and nurses. Athletes showed lower of depressive temperament compared to bankers, musicians and nurses. Bankers obtained lower results of irritable temperament compared to musicians, athletes and nurses. Nurses showed a higher intensity of anxious temperament compared to firefighters, athletes and paramedics.

Conclusion

The results obtained support the concept of adaptive and socially useful role of affective temperaments. The studied professional groups show different individual temperamental profiles, which is justified in such aspects of the profession, as the level of stimulation, stress encountered, the necessity of making important decisions, or entering into relationship with the patient.

Personality, Resilience, and Calling in Students Undertaking a Medical Degree Across Two Continents: Disparate Pathways to the Healing Profession

Background: An educational partnership between The University of Queensland (UQ) in Australia and Ochsner Health in the United States developed the UQ-Ochsner medical program that trains American citizens to practice medicine in the United States. This program provides the opportunity to explore and compare the personal characteristics of UQ-Ochsner students with their domestic (Australian citizen) and international classmates not enrolled in the Ochsner program. Findings may offer some insights into the types of students who choose to study medicine across multiple countries. Methods: We used a quantitative cross-sectional design for our study. A first-year cohort of domestic, international, and UQ-Ochsner students completed a survey comprising demographic questions and measures of temperament and character personality, resilience, and calling to medicine. Univariate statistics were used to compare groups for all variables. Results: The whole sample response rate was 72.1% (375/520). Domestic students represented the greatest proportion of students <25 years, and UQ-Ochsner students represented the greatest proportion of students of ≥26 years. Gender did not differ significantly between groups. The majority first degree for all students was science, although 23% of UQ-Ochsner students reported arts/law/humanities degrees. In comparison to all other students (domestic and international combined), UQ-Ochsner students scored significantly lower in levels of harm avoidance (P=0.039) and higher in self-directedness and self-transcendence, resilience, and calling with medium to strong effect sizes (d>0.3). Conclusion: UQ-Ochsner students have a personality profile similar to their classmates but with levels of certain traits-higher self-directedness and lower harm avoidance-that in combination contribute to higher resilience and a strong sense of calling to medicine. Being slightly older may allow for more development of self-directedness, but low harm avoidance suggests an innate degree of confidence in and acceptance of risk to achieving goals.

Students' Confidence and Interest in Palliative and Bereavement Care: A European Study

As part of a European Erasmus Plus project entitled Death Education for Palliative Psychology, this study assessed the ways in which Master's Degree students in psychology and the creative arts therapies self-rated their confidence and interest in death education and palliative and bereavement care. In five countries (Austria, Israel, Italy, Poland, Romania), 344 students completed an online questionnaire, and 37 students were interviewed to better understand their views, interest, and confidence. The results revealed some significant differences between countries, and showed that older respondents with previous experience as formal caregivers for end-of-life clients showed greater interest in obtaining practical clinical competence in these fields. A mediation analysis indicated that students' previous care experiences and past loss experiences were related to students' current interest in death education and palliative and bereavement care through the mediation of their sense of confidence in this field. The qualitative findings identified five shared themes: life and death, learning about death, the psychological burden, personal experience and robust training, and four key training needs. Overall, students' interest in studying and working with terminal illness and death are rooted in internal resources, a preliminary sense of confidence, but also external requirements.

Ambiguity tolerance among medical students and its relationship with personality and participation in the mentoring program: A cross-sectional study

Background

Low ambiguity tolerance (AT) can lead to burnout and impact medical students' quality of life. Interventions are effective in increasing tolerance in ambiguous situations. Mentors can be facilitators in ambiguous situations. We aimed to determine the AT among Tehran University of medical sciences (TUMS) medical students and assess its relation with personality traits and mentor-seeking behavior.

Methods

A cross-sectional study was designed. We used Budner AT questionnaire and the Ten Item Personality Inventory in our study. Questionnaires were sent to 350 randomly selected TUMS medical students in different years of education. Two hundred six students completed the questionnaires. The response rate was 58.85%.

Results

The mean AT score was 59.77 among TUMS medical students. No significant difference was seen between different genders and students with different marital statuses. Also, AT was constant among students at different years at medical school and at different education levels (P > 0.05). Students who had participated in the mentoring program were significantly more intolerant of novel situations (P = 0.01). However, they did not have significantly different scores in other subscales of AT scale and its total score than those who had not participated in the mentoring program (P > 0.05).

Conclusion

Medical students are more intolerant of ambiguity at TUMS than medical students abroad, and there should be interventions to help them cope in ambiguous situations. Mentoring programs may also be considered for future interventions as participants who participate in the program are less tolerant of ambiguity in novel situations.

The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate medical training: results from multiple samplings of a single cohort

BACKGROUND

Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees' tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.

METHODS

This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests.

RESULTS

From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.

CONCLUSION

Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.

Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students

OBJECTIVE

Medical students have personalities that are often shown to be perfectionistic. Perfectionism can manifest as maladaptive and lead to psychological distress. This study examined the mediating role of perfectionism on the association between personality trait profiles and levels of psychological distress.

METHODS

First-year medical students completed a questionnaire containing measures of personality, perfectionism (Concern over Mistakes: CoM), stress, anxiety and depression. Latent profile analysis classified students based on their personality traits and identified a profile vulnerable to psychological distress. Structural equation models examined the mediation effects of perfectionism on the relationship between the vulnerable personality profile and distress.

RESULTS

The sample totalled 376 (84% response). The vulnerable personality profile was highest in Harm Avoidance, lowest in Self-Directedness, and significantly correlated with the highest Perfectionism-CoM. High Perfectionism-CoM was associated with the highest levels of stress, anxiety and depression. Perfectionism-CoM was a significant mediator for the relationship between personality and higher levels of psychological distress.

CONCLUSION

Certain personality profiles are predisposed to psychological distress such as anxiety, stress and depression. Perfectionism, as a mediator between personality and psychological distress, may be a target strategy to help increase students' self-acceptance, and self-awareness of their perfectionistic tendencies and lower their vulnerability to poor mental health.

Study of the Correlation Between Multiple Chemical Sensitivity and Personality Using the Quick Environmental Exposure Sensitivity Inventory Questionnaire and the Temperament and Character Inventory

OBJECTIVE

We conducted an analysis using the Quick Environmental Exposure Sensitivity Inventory to examine the correlation between multiple chemical sensitivity (MCS) and personality traits by using temperament and character inventory, and environmental exposures.

METHODS

An anonymous questionnaire was distributed to 667 employees working at an IT manufacturing plant in Japan. Variables including chemically sensitive population (CSP), personality, and environmental chemical exposure were individually evaluated using U-test, chi-squared test, and correlation analyses. We also did covariance structure analysis to build a structural equation model.

RESULTS

There was little direct impact of temperament on the CSP, while there was a significant impact of character on the CSP. Women were more likely to exhibit symptoms of CSP.

CONCLUSION

MCS is correlated with personality, impacted more by character acquired later in life than innate temperament. There were sex differences in the incidence of MCS.

Need for cognitive closure, tolerance for ambiguity, and perfectionism in medical school applicants

BACKGROUND

Physicians have to deal with uncertainty on a daily basis, which requires high tolerance for ambiguity. When medical decisions have to be made in ambiguous situations, low levels of need for cognitive closure and high levels of adaptive perfectionism are beneficial. It might be useful to measure such personality traits during medical school selection processes. In our study, we explored the expression of need for cognitive closure, tolerance for ambiguity, and perfectionism in medical school applicants who participated in a multiple mini-interview selection process with respect to the final decision of admission or rejection.

METHODS

After participating in the multiple mini-interview procedure (HAM-Int) at Hamburg Medical School in August 2019, 189 medical school applicants filled out a questionnaire including the Multidimensional Perfectionism Scale by Hewitt and Flett (MPS-H), the Multidimensional Perfectionism Scale by Frost (MPS-F), the Tolerance for Ambiguity Scale (TAS), the 16-Need for Cognitive Closure Scale (16-NCCS), and sociodemographic data. After the final admission decision, the scores of need for cognitive closure, tolerance for ambiguity, and perfectionism of admitted and rejected applicants were compared. We also assessed the predictive power of need for cognitive closure and age for the admission decision in a binary logistic regression model.

RESULTS

Compared to the admitted applicants, the rejected applicants showed a significantly higher need for cognitive closure (p = .009). A high need for cognitive closure correlated significantly positively with maladaptive perfectionism (p < .001) and significantly negatively with tolerance for ambiguity (p < .001). Low need for cognitive closure and older age were associated with a positive admission decision.

CONCLUSIONS

Regarding the personality traits need for cognitive closure, tolerance for ambiguity, and perfectionism we identified interesting differences and correlations of relevance for physicians' daily work in medical school applicants who were admitted or rejected after participating in a multiple mini-interview selection procedure. Further studies are needed to investigate these characteristics and their development longitudinally in medical students and to correlate them with students' medical performance.