Personality assessments and outcomes in medical education and the practice of medicine: AMEE Guide No. 79

What makes us tick: Implications of personality differences among otolaryngology residents and faculty

OBJECTIVE

The rapid personal and professional growth experienced during medical training and practice is impacted by personality. The surgeon's personality is renowned in both medical lore and literature. However, it is now known that the personality characteristics of today's millennial trainees differ from older faculty. This study investigates the variability of different personality attributes among otolaryngology residents and faculty, as well as the practical implications of these findings.

METHODS

The opportunity to complete a series of web-based, commercially available, self-administered five factor-based personality assessments was given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups in the assessed metrics were evaluated using two-tailed t tests.

RESULTS

Seventy-eight otolaryngology faculty and 104 residents completed all three assessments. Of the assessed metrics, there were several significant differences between residents and faculty (all P < 0.05). Residents scored higher than faculty in the domains of interpersonal sensitivity, sociability, and inquisitiveness. With respect to potential challenges, faculty displayed higher levels of skepticism and reservation. In contrast, residents scored higher in the categories of mischievous and dutiful. As for motivators/values, although both groups were highly motivated by altruism, faculty valued tradition more than residents, whereas residents valued hedonism and affiliation more than faculty.

CONCLUSION

There are notable differences between residents and faculty in multiple domains, with implications for communication, education, and professional development.

LEVEL OF EVIDENCE

3 Laryngoscope, 129:2286-2290, 2019.

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.

Pharmacists opinions of the value of specific applicant attributes in hiring decisions for entry-level pharmacists

OBJECTIVE

The Hiring Intent Reasoning Examination (HIRE) was designed to (1) explore the relative value of applicant-specific attributes evaluated during the hiring of entry-level pharmacists; (2) examine how each of these attributes influences hiring decisions; and (3) identify which attributes practicing pharmacists perceive as most and least valuable.

METHODS

An electronic questionnaire was developed and sent to 36,817 pharmacists; 3723 (11%) responded representing a broad cross-section of practice settings and job roles. Forty-eight attributes were analyzed, 24 character traits and 24 markers of academic success. Respondents identified: 1) the relative importance the possession of each attribute would play in the decision to hire an applicant; 2) the relative importance the lack of possession of the attribute would play on the decision to hire an applicant; 3) the 10 most important attributes used when considering an applicant, and; 4) the 10 least important attributes used when considering an applicant. After investigating the relative importance of the 48 traits, a factor analysis to further group the traits was undertaken.

RESULTS

Character traits were consistently ranked higher than academic traits, both in importance and as more likely to effect the hiring decision. Additionally, "the top ten most important attributes" were dominated by character traits and "the top ten least important attributes" used in the hiring of an entry-level pharmacist were dominated by the academic traits. A factor analysis provided further evidence of the distinction of the character traits from the academic success markers.

CONCLUSION

When selecting employees from a pool of qualified applicants, the most important attributes used in hiring decision relate to the character of the pharmacist. The results are similar across all practice settings and types of respondents completing the survey.

Are parental rearing patterns and learning burnout correlated with empathy amongst undergraduate nursing students?

Objective

Empathy can help establish harmonious nurse-patient relationships. We aimed to assess the status of empathy, and explore the relationship between learning burnout, parental rearing patterns and empathy amongst nursing students.

Method

A questionnaire survey that employed the Learning Burnout Scale, the Short-Form Egna Minnenav Barndoms Uppfostran (s-EMBU) and the Jefferson Scale of Empathy was conducted amongst 562 nursing students. The data were analysed on the basis of descriptive statistic and correlation analysis was used.

Results

Empathy is negatively correlated with learning burnout, parental rejection and overprotection and showed no positive correlation with parental emotional warmth.

Conclusions

Educators should pay attention to nursing students' feelings and learning burnout status and take positive measures to improve the empathy level of the students. Positive parental rearing patterns also help cultivate empathy.

Different but similar: personality traits of​ surgeons and internists-results of a cross-sectional observational study

OBJECTIVES

Medical practice may attract and possibly enhance distinct personality profiles. We set out to describe the personality profiles of surgical and medical specialties focusing on board-certified physicians.

DESIGN

Prospective, observational.

SETTING

Online survey containing the Ten-Item Personality Inventory (TIPI), an internationally validated measure of the Five Factor Model of personality dimensions, distributed to board-certified physicians, residents and medical students in several European countries and Canada. Differences in personality profiles were analysed using multivariate analysis of variance and Canonical Linear Discriminant Analysis on age-standardised and sex-standardised z-scores of the personality traits. Single personality traits were analysed using robust t-tests.

PARTICIPANTS

The TIPI was completed by 2345 board-certified physicians, 1453 residents and 1350 medical students, who also provided demographic information.

RESULTS

Normal population and board-certified physicians' personality profiles differed (p<0.001). The latter scored higher on conscientiousness, extraversion and agreeableness, but lower on neuroticism (all p<0.001). There was no difference in openness to experience. Board-certified surgical and medical doctors' personality profiles were also different (p<0.001). Surgeons scored higher on extraversion (p=0.003) and openness to experience (p=0.002), but lower on neuroticism (p<0.001). There was no difference in agreeableness and conscientiousness. These differences in personality profiles were reproduced at other levels of training, that is, in students and training physicians engaging in surgical versus medical practice.

CONCLUSION

These results indicate the existence of a distinct and consistent average 'physician personality'. Despite high variability within disciplines, there are moderate but solid and reproducible differences between surgical and medical specialties.

Dr. Congeniality: Understanding the Importance of Surgeons' Nontechnical Skills Through 360° Feedback

OBJECTIVE

Physician performance is a complex construct that is broadly defined by technical and nontechnical components. The primary aim of this study was to identify which Big Five personality traits (openness, conscientiousness, extraversion, agreeableness, and emotional stability) in surgeons were related to patient satisfaction and teamwork performance in a surgical setting. A secondary aim of this study was to examine the specific perceptions of physician behavior related to patient satisfaction and teamwork performance.

DESIGN

Orthopedic surgeons received anonymous multisource 360° feedback from managers, colleagues, nurses, technicians, and trainees. Personality traits were categorized with a modified Delphi Consensus technique using the Big Five framework. Patient satisfaction was measured using retrospective Clinician & Group-Consumer Assessment of Healthcare Providers and System (CG-CAHPS) data. Teamwork performance was measured using the Quality PULSE 360 Teamwork Index.

SETTING

Research was performed at a large academic medical center in the northeastern United States.

PARTICIPANTS

Participants in this study included a sample of 24 orthopedic surgeons.

RESULTS

Backward stepwise regressions were used to determine which model with the most variance used the fewest explanatory variables. Personality traits acted as predictor variables in the regression models and patient satisfaction and teamwork performance were utilized as outcome variables. The higher the physicians' emotional stability, the higher patients' overall satisfaction (β = 0.41, p = 0.04) and willingness to recommend them to other patients (β = 0.45, p = 0.03). Furthermore, high emotional stability was related to effective surgical teams as rated by team members (β = -0.75, p = 0.00) such that the more emotionally stable physicians were, the higher their teamwork rating by colleagues.

CONCLUSIONS

Both physicians-in-training and in-practice physicians may benefit from engaging in empathic and constructive behaviors with patients and team members.

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.

Identifying the Emergency Medicine Personality: A Multisite Exploratory Pilot Study

OBJECTIVES

This study aimed to understand the personality characteristics of emergency medicine (EM) residents and assess consistency and variations among residency programs.

METHODS

In this cross-sectional study, a convenience sample of residents (N = 140) at five EM residency programs in the United States completed three personality assessments: the Hogan Personality Inventory (HPI)-describing usual tendencies; the Hogan Development Survey (HDS)-describing tendencies under stress or fatigue; and the Motives, Values, and Preferences Inventory (MVPI)-describing motivators. Differences between EM residents and a normative population of U.S. physicians were examined with one-sample t-tests. Differences between EM residents by program were analyzed using one-way analysis of variance tests.

RESULTS

One-hundred forty (100%), 124 (88.6%), and 121 (86.4%) residents completed the HPI, HDS, and MVPI, respectively. For the HPI, residents scored lower than the norms on the adjustment, ambition, learning approach, inquisitive, and prudence scales. For the HDS, residents scored higher than the norms on the cautious, excitable, reserved, and leisurely scales, but lower on bold, diligent, and imaginative scales. For the MVPI, residents scored higher than the physician population norms on altruistic, hedonistic, and aesthetics scales, although lower on the security and tradition scales. Residents at the five programs were similar on 22 of 28 scales, differing on one of 11 scales of the HPI (interpersonal sensitivity), two of 11 scales of the HDS (leisurely, bold), and three of 10 scales of the MVPI (aesthetics, commerce, and recognition).

CONCLUSIONS

Our findings suggest that the personality characteristics of EM residents differ considerably from the norm for physicians, which may have implications for medical students' choice of specialty. Additionally, results indicated that EM residents at different programs are comparable in many areas, but moderate variation in personality characteristics exists. These results may help to inform future research incorporating personality assessment into the resident selection process and the training environment.

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.

Noncognitive Attributes in Physician Assistant Education

Physician assistant (PA) admissions processes have typically given more weight to cognitive attributes than to noncognitive ones, both because a high level of cognitive ability is needed for a career in medicine and because cognitive factors are easier to measure. However, there is a growing consensus across the health professions that noncognitive attributes such as emotional intelligence, empathy, and professionalism are important for success in clinical practice and optimal care of patients. There is also some evidence that a move toward more holistic admissions practices, including evaluation of noncognitive attributes, can have a positive effect on diversity. The need for these noncognitive attributes in clinicians is being reinforced by changes in the US health care system, including shifting patient demographics and a growing emphasis on team-based care and patient satisfaction, and the need for clinicians to help patients interpret complex medical information. The 2016 Physician Assistant Education Association Stakeholder Summit revealed certain behavioral and affective qualities that employers of PAs value and sometimes find lacking in new graduates. Although there are still gaps in the evidence base, some tools and technologies currently exist to more accurately measure noncognitive variables. We propose some possible strategies and tools that PA programs can use to formalize the way they select for noncognitive attributes. Since PA programs have, on average, only 27 months to educate students, programs may need to focus more resources on selecting for these attributes than teaching them.

Energetic Modalities as a Self-Care Technique to Reduce Stress in Nursing Students

This article describes the outcomes of nursing students taking a course in complementary and alternative therapies focusing on energetic modalities that were used as a means of self-care. Students kept journal logs and did a formal presentation for the class. Nursing students reported decreased stress and improved concentration, academic performance, productivity, and problem-solving while experiencing a greater appreciation of their clinical experiences. Using Therapeutic Touch and other subtle energy interactions, the students also cited improved interpersonal relationships, increased feelings of calmness, a higher degree of self-awareness and self-care, reduced physical pain, increased energy, and greater appreciation of the world around them. The theoretical framework was Margret Neuman's theory of health as expanding consciousness. While this is an elective nursing course, the nursing students were primarily juniors and seniors already taking clinical courses. A research study with a wide sample of student participants, especially freshmen, and using quantitative as well as qualitative measures would be beneficial to determine if such a course should be part of the standard nursing curriculum to not only expand nurses' understanding of complementary and alternative therapies but also to help students with their own self-care and influence their practice as clinicians.

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.

Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia® )

AIMS

To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes.

METHODS

As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia^® ), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy).

RESULTS

A total of 6753 of 9247 eligible physicians completed the IntroDia^® survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations.

CONCLUSIONS

Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation.

A new admission method may select applicants with a distinct personality profile

BACKGROUND

There is little data to suggest that a specific admission method can select students with a distinct personality profile. We have recently introduced a new admission process that combines a computerized personality test, with a single interview. The purpose of the current study was to find whether the new method selects applicants with a different personality profile and attitudes compared with the previous method.

METHOD

Using a validated personality questionnaire (HEXACO) and attitudes questionnair, that were filled anonymously between November 2014 and May 2015, the authors compared two groups of students: group A comprising students accepted with the new method (first and second year) with group B comprising students accepted with the previous method (third to sixth year).

RESULTS

In group A, 157 responded out of 250 (63%), while in group B 194 out of 352 (55%). Group A students ranked significantly higher in honesty-humility, extraversion, agreeableness and openness to experience, and lower in emotionality. Physicians' role in society was perceived to be more meaningful among Group A students (M = 4.19, SD = 0.50, N = 152) compared to Group B students (M = 3.86, SD = 0.57, N = 184).

CONCLUSIONS

The new method may select applicants with a distinct personality profile and different attitudes toward the physicians' role in the society.

Social Dominance Orientation, Dispositional Empathy, and Need for Cognitive Closure Moderate the Impact of Empathy-Skills Training, but Not Patient Contact, on Medical Students' Negative Attitudes toward Higher-Weight Patients

Anti-fat bias in healthcare providers and medical students has serious implications for quality of care of higher-weight patients. Studies of interventions aimed at reducing anti-fat attitudes in medical students have generally been disappointing, with little enduring effect. It is possible that some students may be more receptive to prejudice-reducing influences than others, due to underlying differences in their personal characteristics. It is also possible that attitudes toward patients, specifically, may differ from anti-fat attitudes in general, and prejudice-reduction effectiveness on patient-specific attitudes has not yet been evaluated. The present study explored the effect on general and patient-specific anti-fat attitudes of (1) contact with higher-weight individuals prior to and during medical school; and (2) training designed to increase medical students' empathy toward patients by encouraging them to take the patient's perspective during clinical encounters. The moderating role of individual difference factors on effectiveness of contact and student-reported hours of empathy training on patient-specific attitudes was assessed. A total of 3,576 students enrolled across 49 US medical schools completed an online survey at the start of their first year of medical school and at the end of their fourth year. Favorable contact experience with higher-weight patients predicted improved attitudes toward heavier patients after 4 years of medical school, and appeared sufficient to partially offset the effects of dislike of higher-weight individuals at baseline. The impact of favorable contact on general anti-fat attitudes was less strong, highlighting the importance of using target-specific outcome measures. The positive effects of favorable contact on attitudes toward higher-weight patients did not differ based on students' baseline levels of social dominance orientation, dispositional empathy, or need for cognitive closure. In contrast, the effectiveness of training did vary by student characteristics, generally being more effective in students who were more egalitarian and empathic at baseline, with little effect, or even adverse effects in students low in these traits. Overall, however, perspective-taking training produced only small improvements in attitudes toward higher-weight patients.

Improving Otolaryngology Residency Selection Using Principles from Personnel Psychology

There has been a heightened focus on improving the resident selection process, particularly within highly competitive specialties. Previous research, however, has generally lacked a theoretical background, leading to inconsistent and biased results. Our recently published systematic review examining applicant characteristics and performance in residency can provide historical insight into the predictors (ie, constructs) and outcomes (ie, criteria) previously deemed pertinent by the otolaryngology community. Personnel psychology uses evidence-based practices to identify the most qualified candidates for employment using a variety of selection methods. Extensive research in this discipline has shown that integrity tests, structured interviews, work samples, and conscientiousness offer the greatest increase in validity when combined with general cognitive ability. Blending past research knowledge with the principles of personnel selection can provide the necessary foundation with which to engage in theory-driven, longitudinal studies on otolaryngology resident selection moving forward.

The State of the Otolaryngology Match: A Review of Applicant Trends, "Impossible" Qualifications, and Implications

Objective This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency. Data Sources Electronic Residency Application Service, National Residency Matching Program, PubMed, Ovid, and GoogleScholar. Review Methods Electronic Residency Application Service and National Residency Matching Program data were analyzed to evaluate trends in applicant numbers and qualifications. Additionally, a literature search was performed with the aforementioned databases to identify relevant articles published in the past 5 years that examined USMLE Step 1 scores, AOA status, and research/publications. Conclusions Compared with other highly competitive fields over the past 3 years, the only specialty with decreasing applicant numbers is otolaryngology, with the rest remaining relatively stable or slightly increased. Additionally, USMLE Step 1 scores, AOA status, and research/publications do not reliably correlate with performance in residency. Implications for Practice The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the "ideal" otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not "impossible" but rather a feasible and worthwhile endeavor.

International study of medical school learning environments and their relationship with student well-being and empathy

OBJECTIVE

To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China.

METHODS

Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank.

RESULTS

Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12).

CONCLUSIONS

Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest.

Simulation Testing for Selection of Critical Care Medicine Trainees. A Pilot Feasibility Study

RATIONALE

Selection of physicians into anesthesiology, intensive care, and emergency medicine training has traditionally relied on evaluation of curriculum vitae, letters of recommendation, and interviews, despite these methods being poor predictors of subsequent workplace performance.

OBJECTIVES

In this study, we evaluated the feasibility and face validity of incorporating assessment of nontechnical skills in simulation and personality traits into an existing junior doctor selection framework.

METHODS

Candidates short-listed for a critical care residency position were invited to participate in the study. On the interview day, consenting candidates participated in a simulation scenario and debriefing and completed a personality test (16 Personality Factor Questionnaire) and a survey. Timing of participants' progression through the stations and faculty staff numbers were evaluated. Nontechnical skills were evaluated and candidates ranked using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Nontechnical skills ranking and traditional selection method ranking were compared using the concordance correlation coefficient. Interrater reliability was assessed using the concordance correlation coefficient.

MEASUREMENTS AND MAIN RESULTS

Thirteen of 20 eligible participants consented to study inclusion. All participants completed the necessary stations without significant time delays. Eighteen staff members were required to conduct interviews, simulation, debriefing, and personality testing. Participants rated the simulation station to be acceptable, fair, and relevant and as providing an opportunity to demonstrate abilities. Personality testing was rated less fair, less relevant, and less acceptable, and as giving less opportunity to demonstrate abilities. Participants reported that simulation was equally as stressful as the interview, whereas personality testing was rated less stressful. Assessors rated both personality testing and simulation as acceptable and able to provide additional information about candidates. The Ottawa GRS showed moderate interrater concordance. There was moderate concordance between rankings based on traditional selection methods and Ottawa GRS rankings (ρ = 0.52; 95% confidence interval, -0.02 to 0.82; P = 0.06).

CONCLUSIONS

A multistation selection process involving interviews, simulation, and personality testing is feasible and has face validity. A potential barrier to adoption is the high number of faculty required to conduct the process.

The Correlation Between Personality Dimensions and Young People's Choice of a Medical Career

Objective: The research assumes that there is a correlation between personality dimensions Extraversion and Conscientiousness which mean autonomy, ambition and consistency of purpose, self-efficacy and determination for young people who want to aspire to a medical career.

Methods: In this study’s target group were included 130 students aspiring to a medical career, that participated in the summer school organized by UMF Tirgu-Mures in 2016, of which 25 (19%) male and 106 (81%) female, average overall age group being 17.23.

Results: Within the female group, the Pearson cross-correlation coefficient of Openness and Conscientiousness is r. Pearson (105) = − .20, p <0.05. The Pearson coefficient of cross-correlation between Extraversion and Conscientiousness is = − .20, p <0.05. The Pearson coefficient of cross-correlation between emotional stability and conscientiousness is r. Pearson (105) = .36, p <.001. In the male group, the Pearson cross-correlation coefficient between the Extraversion and Conscientiousness personality dimensions is r. Pearson (N = 25) = −.39 where p <0.05.

Conclusions: The Extraversion dimension of personality is a dynamic factor and motivator only when it is correlated with the Conscientiousness personality dimension. This indicates dynamism and autonomy, persistence in achieving goals, ambition, high motivation, interpersonal social intelligence and emotional stability, resulting a personality profile that matches one of the aspirants to a medical career.

Medical Humanities Coursework Is Associated with Greater Measured Empathy in Medical Students

PURPOSE

The primary focus of the study was to determine whether coursework in the medical humanities would ameliorate students' loss of and failure to develop empathy, a problem known to be common during medical education.

METHODS

Students were offered an elective course in the Medical Humanities for academic credit. The Jefferson Scale of Empathy Student Version (JSE-S) was administered at the beginning and end of an academic year in which humanities courses were offered. Changes in JSE-S scores among students who studied Medical Humanities were compared with changes in student who did not take any humanities coursework.

RESULTS

Medical humanities coursework correlated with superior empathy outcomes among the medical students. Of students not enrolled in humanities courses, 71% declined or failed to increase in JSE-S score over the academic year. Of those who took humanities coursework, 46% declined or failed to increase in JSE-S scores. The difference was statistically significant (P = .03). The medical humanities curriculum correlated with favorable empathy outcomes as measured by the JSE-S.

CONCLUSIONS

Elective medical humanities coursework correlated with improved empathy score outcomes in a group of US medical students. This may reflect a direct effect of the humanities coursework. Alternately, students' elective choice to take medical humanities coursework may be a marker for students with a propensity to favorable empathy outcomes.

How personality traits affect clinician-supervisors' work engagement and subsequently their teaching performance in residency training

PURPOSE

Clinician-supervisors often work simultaneously as doctors and teachers. Supervisors who are more engaged for their teacher work are evaluated as better supervisors. Work engagement is affected by the work environment, yet the role of supervisors' personality traits is unclear. This study examined (i) the impact of supervisors' personality traits on work engagement in their doctors' and teachers' roles and (ii) how work engagement in both roles affects their teaching performance.

METHODS

Residents evaluated supervisors' teaching performance, using the validated System for Evaluation of Teaching Qualities. Supervisors' reported work engagement in doctor and teacher roles separately using the validated Utrecht Work Engagement Scale. Supervisors' personality traits were measured using the Big Five Inventory's five factor model covering conscientiousness, agreeableness, extraversion, emotional stability and openness.

RESULTS

Overall, 549 (68%) residents and 636 (78%) supervisors participated. Conscientiousness, extraversion and agreeableness were positively associated with supervisors' engagement in their teacher work, which was subsequently positively associated with teaching performance.

CONCLUSIONS

Conscientious, extraverted, and agreeable supervisors showed more engagement with their teacher work, which made them more likely to deliver adequate residency training. In addition to optimizing the work environment, faculty development and career planning could be tailor-made to fit supervisors' personality traits.

Recruiting for values in healthcare: a preliminary review of the evidence

Displaying compassion, benevolence and respect, and preserving the dignity of patients are important for any healthcare professional to ensure the provision of high quality care and patient outcomes. This paper presents a structured search and thematic review of the research evidence relating to values-based recruitment within healthcare. Several different databases, journals and government reports were searched to retrieve studies relating to values-based recruitment published between 1998 and 2013, both in healthcare settings and other occupational contexts. There is limited published research related to values-based recruitment directly, so the available theoretical context of values is explored alongside an analysis of the impact of value congruence. The implications for the design of selection methods to measure values is explored beyond the scope of the initial literature search. Research suggests some selection methods may be appropriate for values-based recruitment, such as situational judgment tests (SJTs), structured interviews and multiple-mini interviews (MMIs). Personality tests were also identified as having the potential to compliment other methods (e.g. structured interviews), as part of a values-based recruitment agenda. Methods including personal statements, references and unstructured/'traditional' interviews were identified as inappropriate for values-based recruitment. Practical implications are discussed in the context of values-based recruitment in the healthcare context. Theoretical implications of our findings imply that prosocial implicit trait policies, which could be measured by selection tools such as SJTs and MMIs, may be linked to individuals' values via the behaviours individuals consider to be effective in given situations. Further research is required to state this conclusively however, and methods for values-based recruitment represent an exciting and relatively unchartered territory for further research.

How Different Medical School Selection Processes Call upon Different Personality Characteristics

Background

Research indicates that certain personality traits relate to performance in the medical profession. Yet, personality testing during selection seems ineffective. In this study, we examine the extent to which different medical school selection processes call upon desirable personality characteristics in applicants.

Methods

1019 of all 1055 students who entered the Dutch Bachelor of Medicine at University of Groningen, the Netherlands in 2009, 2010 and 2011 were included in this study. Students were admitted based on either top pre-university grades (n = 139), acceptance in a voluntary multifaceted selection process (n = 286), or lottery weighted for pre-university GPA. Within the lottery group, we distinguished between students who had not participated (n = 284) and students who were initially rejected (n = 310) in the voluntary selection process. Two months after admission, personality was assessed with the NEO-FFI, a measure of the five factor model of personality. We performed ANCOVA modelling with gender as a covariate to examine personality differences between the four groups.

Results

The multifaceted selection group scored higher on extraversion than all other groups(p<0.01), higher on conscientiousness than both lottery-admitted groups(p<0.01), and lower on neuroticism than the lottery-admitted group that had not participated in the voluntary selection process. The latter group scored lower on conscientiousness than all other groups(p<0.05) and lower on agreeableness than the multifaceted selection group and the top pre-university group(p<0.01).

Conclusions

Differences between the four admission groups, though statistically significant, were relatively small. Personality scores in the group admitted through the voluntary multifaceted selection process seemed most fit for the medical profession. Personality scores in the lottery-admitted group that had not participated in this process seemed least fit for the medical profession. It seems that in order to select applicants with suitable personalities, an admission process that calls upon desirable personality characteristics is beneficial.

How effective are selection methods in medical education? A systematic review

CONTEXT

Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years.

METHODS

A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design.

RESULTS

Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness.

CONCLUSIONS

Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

The transferability of Western concepts to other cultures: validation of the Zuckerman-Kuhlman Personality Questionnaire in a Saudi Arabic context

BACKGROUND

The importance of medical education research in Saudi Arabia has been acknowledged increasingly and a lot of concepts used have been derived from the Western world. The question arises, however, whether Western concepts and questionnaires are transferable to societies with different cultures. The aim of this study was to investigate the instrument structure and the reliability of the Arabic version of the Zuckerman-Kuhlman Personality Questionnaire-medium (ZKPQ-m).

METHODS

Three statistical methods with decreased amount of strictness were used to analyse our data: Confirmatory Factor Analysis, Procrustes rotation and Principal Component Analysis.

RESULTS

Our outcomes did not confirm the original instrument structure. Instead, we found four interpretable components: Emotional Instability, Impulse-seeking, Activeness and Self-Control. However, the amount of explained variance was not very high and the internal consistencies ranged from unsatisfactory to only moderate. The data showed a high percentage of respondents agreeing with more than three items of the Infrequency scale, which may be attributable to the collectivistic culture in Saudi Arabia.

CONCLUSION

We did not succeed in replicating the ZKPQ structure in the Arabic context. Social desirability, a common characteristic in collectivistic cultures, may have reduced the replicability of the internal structure of the ZKPQ-m. Different methods to measure concepts in collectivistic cultures may help to get round social desirability.

Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine?

PURPOSE

To test the hypotheses that medical students recognized by peers as the most positive social influencers would score (1) high on measures of engaging personality attributes that are conducive to relationship building (empathy, sociability, activity, self-esteem), and (2) low on disengaging personality attributes that are detrimental to interpersonal relationships (loneliness, neuroticism, aggression-hostility, impulsive sensation seeking).

METHOD

The study included 666 Jefferson Medical College students who graduated in 2011-2013. Students used a peer nomination instrument to identify classmates who had a positive influence on their professional and personal development. At matriculation, these students had completed a survey that included the Jefferson Scale of Empathy and Zuckerman-Kuhlman Personality Questionnaire short form and abridged versions of the Rosenberg Self-Esteem Scale and UCLA Loneliness Scale. In multivariate analyses of variance, the method of contrasted groups was used to compare the personality attributes of students nominated most frequently by their peers as positive influencers (top influencers [top 25% in their class distribution], n = 176) with those of students nominated least frequently (bottom influencers [bottom 25%], n = 171).

RESULTS

The top influencers scored significantly higher on empathy, sociability, and activity and significantly lower on loneliness compared with the bottom influencers. However, the effect size estimates of the differences were moderate at best.

CONCLUSIONS

The research hypotheses were partially confirmed. Positive social influencers appear to possess personality attributes conducive to relationship building, which is an important feature of effective leadership. The findings have implications for identifying and training potential leaders in medicine.

Underlying construct of empathy, optimism, and burnout in medical students

OBJECTIVE

This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students.

METHODS

Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model.

RESULTS

Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization).

CONCLUSIONS

Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.

Eleven Years of Data on the Jefferson Scale of Empathy-Medical Student Version (JSE-S): Proxy Norm Data and Tentative Cutoff Scores

OBJECTIVE

This study was designed to provide typical descriptive statistics, score distributions and percentile ranks of the Jefferson Scale of Empathy-Medical Student version (JSE-S) of male and female medical school matriculants to serve as proxy norm data and tentative cutoff scores.

SUBJECTS AND METHODS

The participants were 2,637 students (1,336 women and 1,301 men) who matriculated at Sidney Kimmel (formerly Jefferson) Medical College between 2002 and 2012, and completed the JSE at the beginning of medical school. Information extracted from descriptive statistics, score distributions and percentile ranks for male and female matriculants were used to develop proxy norm data and tentative cutoff scores.

RESULTS

The score distributions of the JSE tended to be moderately skewed and platykurtic. Women obtained a significantly higher mean score (116.2 ± 9.7) than men (112.3 ± 10.8) on the JSE-S (t2,635 = 9.9, p < 0.01). It was suggested that percentile ranks can be used as proxy norm data. The tentative cutoff score to identify low scorers was ≤ 95 for men and ≤ 100 for women.

CONCLUSIONS

Our findings provide norm data and cutoff scores for admission decisions under certain conditions and for identifying students in need of enhancing their empathy.

An exploratory study on the contribution of graduate entry students personality to the diversity of medical student populations

Studies conducted in medical education show that personality influences undergraduate medical students academic and clinical performances and also their career interests. Our aims with this exploratory study were: to assess the contribution of graduate entry students to the diversity of personality in medical student populations; to assess whether eventual differences may be explained by programme structure or student age and sex. We performed a cross-sectional study underpinned by the five-factor model of personality, with students attending three medical schools in Portugal. The five personality dimensions were assessed with the Portuguese version of the NEO-Five Factor Inventory. MANOVA and MANCOVA analyses were performed to clarify the contributions of school, programme structure, age and sex. Student personality dimensions were significantly different between the three medical schools [F (10,1026)  = 3.159, p < .001, [Formula: see text] = 0.03, π = 0.987]. However, taking sex and age into account the differences became non-significant. There were institutional differences in personality dimensions. However, those were primarily accounted for by sex and age effects and not by the medical school attended. Diversifying age and sex of the admitted students will diversify the personality of the medical student population.

Psychosocial predictors of attitudes toward physician empathy in clinical encounters among 4732 1st year medical students: a report from the CHANGES study

OBJECTIVE

Medical school curricula intended to promote empathy varies widely. Even the most effective curricula leave a significant group of students untouched. Pre-existing student factors influence their response to learning experiences. We examined the individual predictors of first semester medical students' attitudes toward the value of physician empathy in clinical encounters.

METHODS

First year students (n=4732) attending a stratified random sample of 49 US medical schools completed an online questionnaire that included measures of dispositional characteristics, attitudes and beliefs, self-concept and well-being.

RESULTS

Discomfort with uncertainty, close-mindedness, dispositional empathy, elitism, medical authoritarianism, egalitarianism, self-concept and well-being all independently predicted first year medical students' attitudes toward the benefit of physician empathy in clinical encounters.

CONCLUSION

Students vary on their attitude toward the value of physician empathy when they start medical school. The individual factors that predict their attitudes toward empathy may also influence their response to curricula promoting empathic care.

PRACTICE IMPLICATIONS

Curricula in medical school promoting empathic care may be more universally effective if students' preexisting attitudes are taken into account. Messages about the importance of physician empathy may need to be framed in ways that are consistent with the beliefs and prior world-views of medical students.

Personality traits affect teaching performance of attending physicians: results of a multi-center observational study

Background

Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties.

Method

We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness.

Results

Overall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: −0.10, 95% CI: −0.15 to −0.05, P<0.001) and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01).

Conclusions

Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of openness were evaluated as less adequate feedback-givers. Non-surgical attending physicians who were conscientious seem to be good at evaluating residents. These insights could contribute to future work on development paths of attending physicians in medical education.

Associations between medical student empathy and personality: a multi-institutional study

BACKGROUND

More empathetic physicians are more likely to achieve higher patient satisfaction, adherence to treatments, and health outcomes. In the context of medical education, it is thus important to understand how personality might condition the empathetic development of medical students. Single institutional evidence shows associations between students' personality and empathy. This multi-institutional study aimed to assess such associations across institutions, looking for personality differences between students with high empathy and low empathy levels.

METHODS

Participants were 472 students from three medical schools in Portugal. They completed validated adaptations to Portuguese of self-report measures of the NEO-Five Factor Inventory(NEO-FFI) and the Jefferson Scale of Physician Empathy(JSPE-spv). Students were categorized into two groups: "Bottom" (low empathy, N = 165) and "Top" (high empathy, N = 169) according to their empathy JSPE-spv total score terciles. Correlation analysis, binary logistic regression analysis and ROC curve analysis were conducted.

RESULTS

A regression model with gender, age and university had a predictive power (pseudo R2) for belonging to the top or bottom group of 6.4%. The addition of personality dimensions improved the predictive power to 16.8%. Openness to experience and Agreeableness were important to predict top or bottom empathy scores when gender, age and university were considered." Based on the considered predictors the model correctly classified 69.3% of all students.

CONCLUSIONS

The present multi-institutional cross-sectional study in Portugal revealed across-school associations between the Big5 dimensions Agreeableness and Openness to experience and the empathy of medical students and that personality made a significant contribution to identify the more empathic students. Therefore, medical schools may need to pay attention to the personality of medical students to understand how to enhance the empathy of medical students.