Personality Factors Associated With Resident Performance: Results From 12 Accreditation Council for Graduate Medical Education Accredited Orthopaedic Surgery Programs

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

PHENOMENON

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

APPROACH

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

FINDINGS

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

INSIGHTS

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

Personality in anaesthesiologists, a systematic review of the literature

BACKGROUND

As a central part of their job, anaesthesiologists often have to perform demanding tasks under high-stakes conditions. Yet, some anaesthesiologists seem better able to deal with the demands of the profession than others.

OBJECTIVES

This review aims to answer the following questions. What are the necessary or desirable qualities of an anaesthesiologist? Which personality traits or characteristics have been found in anaesthesiologists? How does personality relate to job performance and work stress among anaesthesiologists?

DESIGN

Systematic review of studies that examined anaesthesiologists' personality or personality characteristics. We performed our synthesis in terms of the five-factor model of personality.

DATA SOURCES

The search was conducted in the PubMed, EMBASE and Web of Science databases. Literature was included until December 2020.

ELIGIBILITY CRITERIA

We included qualitative and quantitative studies that examined anaesthesiologists' personality; also, we included studies that focused on anaesthesiologists' stress, performance or mental health but only if these topics were examined from the perspective of personality.

RESULTS

We included 6 qualitative and 25 quantitative articles. Synthesis of the qualitative articles revealed two classes of desirable technical and nontechnical personality characteristics. Synthesis of the quantitative articles suggested that anaesthesiologists do not essentially differ from other medical specialists. Moreover, our synthesis revealed several personality traits that predict good performance, low stress and good mental health among anaesthesiologists: lower Neuroticism, higher Extraversion, higher Openness and higher Conscientiousness.

CONCLUSION

Those personality traits that predict performance, stress or mental health in anaesthesiologists, also predict performance, stress or mental health in other high demand/high stakes environments (both medical and nonmedical). The ideal anaesthesiologist would be lower on Neuroticism, higher on Extraversion and higher on Conscientiousness.

Can Orthopaedic Residents Beat a Personality Assessment?

BACKGROUND

Selection of residents is a challenging process. The use of personality inventories to evaluate applicants has been validated in professions outside of healthcare. It has been shown that job applicants could not game the personality evaluation.

OBJECTIVE

The purpose of this study was to determine if orthopaedic surgery residents could game the personality assessment to make themselves seem like a better fit for orthopaedic surgery residencies.

METHODS

In 2017, 20 orthopaedic surgery residents at a single program were administered a validated personality assessment twice. On one occasion, they were instructed to answer honestly. On the other, they were instructed to shade their answers in a way that they would want a program to see them. Assessments were scored on 9 scales to determine how many were modified to a more desirable result based on previously determined results for desirability of orthopaedic residents.

RESULTS

Nineteen of 20 subjects had at least one of the nine scales that was "undesirable" when taking the test honestly. The average was 2.1. Forty-two out of a possible 180 results were "undesirable" when the test was taken honestly. 41 of the 42 became desirable when the subjects were instructed to shade their answers.

CONCLUSIONS

Orthopaedic surgery residents were able to modify their answers to a personality assessment enough to hide most "red flag" findings when they were instructed to shade questions toward answers they thought would be desirable by a program. This limits the utility of personality assessments as screening tools for residency applications.

The Orthopaedic Resident Selection Process: Proposed Reforms and Lessons From Other Specialties

INTRODUCTION

Proposals for substantive reforms to the orthopaedic resident selection process are growing, given increasing applicant competitiveness, burgeoning inefficiencies and inequities of the current system, and impending transition of Step 1 to pass/fail. The COVID-19 pandemic has further catalyzed the need for reforms, offering unprecedented opportunities to pilot novel changes. However, a comprehensive collation of all proposed and implemented orthopaedic reforms is currently lacking. Thus, we aimed to characterize proposed orthopaedic-specific resident selection reforms in the context of reforms implemented by other specialties.

METHODS

EMBASE, MEDLINE, Scopus, and Web of Science databases were searched for references proposing reforms to the orthopaedic resident selection process published from 2005 to 2020. An inductive approach to qualitative content analysis was used to categorize reforms.

RESULTS

Twenty-six articles proposing 13 unique reforms to the orthopaedic resident selection process were identified. The most commonly proposed reforms included noncognitive assessments (n = 8), application caps (n = 7), standardized letters of recommendation (n = 5), program-specific supplemental applications (n = 5), creation of a centralized database of standardized program information (n = 4), use of a standardized applicant composite score (n = 4), and a moratorium on postinterview communication (n = 4). Importantly, nearly all of these reforms have also been proposed or implemented by other specialties.

DISCUSSION

Numerous reforms to the orthopaedic resident selection process have been suggested over the past 15 years, several of which have been implemented on a program-specific basis, including noncognitive assessments, supplemental applications, and standardized letters of recommendation. Careful examination of applicant and program experiences and Match outcomes after these reforms is imperative to inform future directions.

Evaluating the Whole Applicant: Use of Situational Judgment Testing and Personality Testing to Address Disparities in Resident Selection

PURPOSE OF REVIEW

Urology program directors are faced with increasing numbers of applications annually, making holistic review of each candidate progressively more difficult. Efforts to streamline evaluation using traditional cognitive metrics have fallen short as these do not predict overall resident performance. Situational judgment tests (SJTs) and personality assessment tools (PATs) have been used in business and industry for decades to evaluate candidates and measure non-cognitive attributes that better predict subsequent performance. The purpose of this review is to describe what these assessments are and the current literature on the use of these metrics in medical education.

RECENT FINDINGS

SJTs relative to PATs have more original research. Data suggests that SJTs decrease bias, increase diversity, and may be predictive of performance in residency. PATs are also emerging with data to support use with ability to assess fit to program and certain traits identified more consistently among high-performing residents and correlation to performance on ACGME milestones. PATs may be more coachable than SJTs. SJTs and PATs are emerging as techniques to supplement the current resident application review process. Early evidence supports their use in undergraduate medical education as does some early preliminary results in graduate medical education.

Data-Based Self-awareness as the Foundation for Effective Leadership

The AONL Nurse Executive Fellowship supports nurses who are new to an executive role in developing critical executive competencies. Participants engage in an in-depth specialized assessment process to help them understand themselves and the impact on their leadership. Learnings from the 1st 2 cohorts of fellowship participants provide insight into challenges faced by new executives and how self-awareness can improve performance to address those challenges.

The Use of Personality Assessment in Mentoring and to Aid in Self-reflection in Orthopaedic Surgery Residency Programs

Personality plays an important role in performance in medical education and mentorship. Personality assessment can aid in the ability to identify strengths and areas for development by understanding how one's personality influences their learning and interpersonal relationships. We sought to evaluate personality assessment as an effective tool in mentoring during orthopaedic residency in this prospective, cross-sectional study from two orthopaedic surgery residency programs using the Hogan Personality Inventory (HPI). Participants completed a survey regarding their experience with the assessment. Descriptive statistics were calculated, and two-sample t-tests were used to examine differences between groups. In total, thirty-four individuals completed the survey. Our results showed 82.4% reported that the HPI very accurately represented them and 58.8% reported better understanding potentially perceived strengths and weaknesses. In total, 75.7% and 72.7% were satisfied with their mentorship about development as a clinician and researcher, respectively. Significant differences were seen between participants who did and did not re-review their results, and participants who did and did-not believe their results profile was accurate. We conclude that personality assessments can be valuable in promoting introspection and strengthening relationships within orthopaedic surgery, particularly when they are valued and emphasized by the user. Our results suggest that use of the HPI provided participants with a better understanding of their perceived strengths and weaknesses as they progress through their orthopaedic residency training.

Predictors of Success in an Orthopaedic Residency

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Orthopaedic surgery is one of the most competitive residencies to match into. Meanwhile, the average applicant's United States Medical Licensing Examination (USMLE) test scores, research involvement, and number of clinical honors increase every year.

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Measures such as USMLE scores, productivity in research, Alpha Omega Alpha (AΩA) honor society status, number of clinical honors, and performance on away rotations have all been cited as factors contributing to program directors choosing applicants for interviews and ranking them for their program. However, questions remain as to whether these measures translate to success on board examinations, high faculty evaluations, and designation as chief resident during orthopaedic residency.

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USMLE scores have been shown to correlate with Orthopaedic In-Training Examination (OITE) and American Board of Orthopaedic Surgery (ABOS) scores, while clinical grades and AΩA status correlate with faculty evaluations. Participating in research as a medical student was predictive of research productivity in residency but did not correlate with standardized testing scores or faculty evaluations.

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The literature has suggested ways in which measures such as personality and grit may be used in the application process and how these factors may contribute to predictors of success. However, additional research is needed to measure and define personality and grit during the application evaluation process.

Systems-Level Reforms to the US Resident Selection Process: A Scoping Review

BACKGROUND

Calls to reform the US resident selection process are growing, given increasing competition and inefficiencies of the current system. Though numerous reforms have been proposed, they have not been comprehensively cataloged.

OBJECTIVE

This scoping review was conducted to characterize and categorize literature proposing systems-level reforms to the resident selection process.

METHODS

Following Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, searches of Embase, MEDLINE, Scopus, and Web of Science databases were performed for references published from January 2005 to February 2020. Articles were included if they proposed reforms that were applicable or generalizable to all applicants, medical schools, or residency programs. An inductive approach to qualitative content analysis was used to generate codes and higher-order categories.

RESULTS

Of 10 407 unique references screened, 116 met our inclusion criteria. Qualitative analysis generated 34 codes that were grouped into 14 categories according to the broad stages of resident selection: application submission, application review, interviews, and the Match. The most commonly proposed reforms were implementation of an application cap (n = 28), creation of a standardized program database (n = 21), utilization of standardized letters of evaluation (n = 20), and pre-interview screening (n = 13).

CONCLUSIONS

This scoping review collated and categorized proposed reforms to the resident selection process, developing a common language and framework to facilitate national conversations and change.

The Impact of Away Rotations on the Ophthalmology Residency Match

Background The ophthalmology residency match is highly competitive, and fourth-year medical students frequently complete away rotations at other institutions hoping to increase their chances of matching.

Objective The study aimed to determine the impact of away rotations on the ophthalmology residency selection process and to provide recommendations to faculty for counseling fourth-year medical students as they prepare for the ophthalmology match.

Methods A survey was sent in June 2020 to program directors (PDs), medical student educators (MSEs), and residents at 119 accredited ophthalmology residency programs via the Association of University Professors of Ophthalmology e-mail listserv. The 43 PDs and 38 MSEs who responded were asked questions about their views regarding away rotations and visiting students during the residency selection process. The 83 resident respondents were asked about their interview and match success after completing away rotations. Categorical variables were analyzed by Chi-square test.

Results The majority of PDs and MSEs typically recommend that fourth-year medical students complete away rotations (p = 0.022 and p = 0.194, respectively). The majority believe that an away rotation will increase the chance of the applicant matching with the host institution (p = 0.004 and p = 0.001, respectively). The vast majority of PDs were more likely to offer an interview to a visiting student compared with another equally qualified applicant (p < 0.001). However, only one-third of PDs were typically more likely to rank an away rotator higher on their rank list (p = 0.047). Two-thirds of residents completed at least one away rotation in medical school (mean = 1.7 rotations). The majority received interview invitations from at least some of their host institutions (p < 0.001). Approximately one-fifth ultimately matched at a host residency program (p < 0.001).

Conclusion The majority of ophthalmology PDs and MSEs surveyed recommend that fourth-year medical students complete away rotations and believe that these rotations will increase the chance of the applicant matching at a host institution. The PDs are more likely to offer an interview to a visiting student compared with another equally qualified applicant. For some programs, visiting students may also receive special consideration by being ranked higher on a program's rank list and being more likely to match.

How personality affects teamwork: a study in multidisciplinary obstetrical simulation

BACKGROUND

Multidisciplinary simulation has been shown to improve teamwork in the obstetrical literature by providing a safe, but realistic, environment for participants to learn. However, the impact of team members' personality traits on how the team performs during an obstetrical emergency has not been studied in medicine.

OBJECTIVE

Our objective was to evaluate teamwork and communication of simulation participants in association with personality traits within a multidisciplinary obstetrical simulation program.

STUDY DESIGN

This was a prospective observational study of postpartum hemorrhage simulations involving participants from Obstetrics, Nursing, Midwifery, and Anesthesia. Before simulation, individual personality testing was performed on participants using the Big Five Inventory. Each team was scored using the Clinical Teamwork Scale after simulation. Communication and teamwork scores were evaluated for association, and personality traits were analyzed for association with teamwork and communication. For each personality trait, an interaction model was tested for 3 of the team scores: teamwork, communication, and situational awareness. Analysis of variance with 2 level interactions was used in this effort.

RESULTS

From July 2018 to June 2019, 22 obstetrical simulations were performed with a total of 270 staff. Overall, teamwork was significantly associated with communication for each team. When examining individual personality scores, neuroticism was negatively associated with teamwork when coupled with communication. That is, increased neuroticism was significantly associated with increased communication that was detrimental to the overall teamwork. Other personality traits were not significantly associated with teamwork and communication (P=.03).

CONCLUSION

In a multidisciplinary simulation, communication was positively associated with teamwork, and specific personality traits negatively affected team performance.

Reimagining Residency Selection: Part 3-A Practical Guide to Ranking Applicants in the Post-COVID-19 Era

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Personality Assessment and Emotional Intelligence in Orthopaedic Surgery Residency Selection and Training

Orthopaedic surgery has increasingly emerged as one of the most popular and competitive of all medical specialties. The selection of the best applicants has become a more difficult process because the number of qualified medical students has concomitantly grown. Although there are standardized guidelines in residency selection, there are several intangible factors that determine an applicant's fit into a program. Personality assessments, such as the Neuroticism-Extraversion-Openness Personality Inventory and the Myers-Briggs Type Indicator, are proficiencies that have garnered significant interest to help fill this void. Understanding and measuring empirically supported measures of personality traits and styles of medical students and residents may be valuable to medical educators and program directors in a variety of applications such as residency selection, mentoring, and education. Similar to personality identification, emotional intelligence assessments, such as the Mayer-Salovey-Caruso Emotional Intelligence Test, can prove to be pivotal tools in residency education and training. Emotional intelligence has shown to align with current Accreditation Council for Graduate Medical Education residency standardized core competencies that emphasize aptitude in noncognitive characteristics.

Personality Predictors of Communication Skills Among Orthopedic Surgery Residents

INTRODUCTION

This study examined the relationship between personality traits and interpersonal communication skills among first-year orthopedic surgery residents.

METHOD

This study performed a retrospective analysis on the data collected in the 2 phases among the 6 cohorts of first-year orthopedic surgery residents (n = 73) during a 6-year period at an urban academic medical hospital. Resident personality was assessed through self-report prior to entry into the program and included a total of 7 personality traits. These traits were broken down into 2 categories, day to day, or usual, tendencies, which measured personality traits when no stress was present and stress tendencies, which measured personality traits when stressed or fatigued. The "day to day" tendencies measured were Emotional Stability, Agreeableness, Conscientiousness and Openness) and "stress" tendencies measured were Excitable, Skeptical and Imaginative. Communication skills were measured across 4 specific dimensions of patient communication (Engage, Empathy, Educate, Enlist) in an Objective Structured Clinical Examination (OSCE).

RESULTS

Multiple regression analyses showed that the personality traits identified as "stress" tendencies predicted performance on 2 of the 4 communication skills dimensions measured by the OSCE and accounted for up to 34.8% of the total variance in the ratings of empathic communication and up to 67.2% of the total variance in education-related communication.

CONCLUSIONS

Our research identifies specific personality traits that affect resident communication skills related to patient education and empathy in simulated encounters. Three stress-related personality traits (Excitable, Skeptical, Imaginative) had a strong negative influence on communication skills, while day to day personality traits (Emotional Stability, Agreeableness, Conscientiousness) positively influenced communication skills.

Perceived lack of training moderates relationship between healthcare providers' personality and sense of efficacy in trauma-informed care

Background and Objectives: Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers' personality traits in relation to their sense of TIC efficacy, taking into account perceived barriers to TIC and professional quality of life. Study Design: The study used cross-sectional survey methods to examine our central hypothesis that provider personality traits and perceived barriers to TIC would be associated with TIC-efficacy, and to explore interactions among study variables. Methods: Survey data were collected from 172 healthcare providers examining TIC knowledge, TIC-efficacy, perceived barriers to TIC, personality traits, and professional quality of life. Results: TIC-efficacy was positively correlated with "intellectence/openness" and inversely correlated with "neuroticism" and perceived lack of training as a barrier. "Intellectence/openness" interacted with perceived lack of training to predict TIC-efficacy, suggesting that providers with lower "intellectence/openness" report greater TIC-efficacy when lack of training is not perceived as a barrier. Conclusions: Provider personality traits and perceived barriers to TIC appear related to providers' TIC-efficacy. Implications for overcoming barriers to TIC through training and implementation are discussed.

Selecting Residents for Predetermined Factors Identified and Thought to be Important for Work Performance and Satisfaction: A Methodology

OBJECTIVE

The medical profession seeks to hire and train individuals who consistently meet and/or exceed both job and cultural expectations. Resident selection is often not structured to meet this goal. The objective of this quality improvement project was to evaluate a classic unscripted interview process (OI) in conjunction with a structured, scripted interview process (SI) developed using an established hiring methodology from industry not yet utilized in health care. Qualitative questions we sought to answer: (1) Can SI be practically applied to the selection of residents? (2) Is there a significant difference in the relative position of applicants between the OI and SI rank lists? (3) Qualitatively, does SI help the evaluation/discussion of the affective domain?

METHODS

Design: Prospective qualitative comparison of OI versus SI.

SETTING

Dartmouth Hitchcock Medical Center, Lebanon, NH.

PARTICIPANTS

Applicants were assessed by OI and SI. SI factors were selected based on a job profile. Interview scripts were created from validated behavioral and attitudinal questions. Online assessments assessed 2 important attributes - adaptability and values. Rank lists were compared for relative rank position of applicants. Feedback from faculty was obtained.

RESULTS

Fifty-two applicants. Critical attributes were self-management, integrator-synthesizer, versatility, communication, and achievement. Absolute mean difference in rank/applicant was 9.8 (standard deviation 8.9, Range 0-36) positions. Comparing the top 20 candidates of each rank list, 40% of those applicants were only on one list. Faculty felt that applicants were given a greater opportunity to show "who they are."

CONCLUSIONS

In conjunction with OI, an industry proven methodology was practically applied to define and select for high performance for the authors' specific institution. Comparing OI and SI resulted in substantial differences in rank lists. This initiative seemed to provide a structure to evaluate values and motivations that are inherently difficult to assess. Faculty felt SI in conjunction with OI gave a greater chance for applicants to show "who they are."

Medical students' empathy and attitudes towards professionalism: Relationship with personality, specialty preference and medical programme

Background

Existing research has suggested that self-reported empathy in medical students is moderated by personality traits and diverse demographic and educational factors including age, gender, nationality, career aspirations, as well as year of curriculum. It is unclear how empathy, personality, and background factors might impact on students’ attitudes towards professionalism in medicine.

Methods

A cross-sectional questionnaire-based study was conducted in first and final year medical students at an Irish medical school. The following instruments were administered: (a) Jefferson Scale of Empathy; (b) NEO Five-Factor Inventory (NEO-FFI-3); (c) Attitudes towards Professionalism Scale. Demographic and educational variables were also measured. Descriptive and correlational analysis was conducted to examine the association between empathy, personality, professionalism-related attitudes and additional measures. Regression analysis was used to examine determinants of attitudes towards professional behaviour.

Results

Both selected NEO-FFI personality traits and empathy were independently associated with distinct categories of professional behaviour. Specifically, Openness to Experience was associated with higher empathy scores, and higher ‘Social responsibility’. Extraversion was linked with higher scores on the “Personal characteristics” and “Interactions with team” categories, while Conscientiousness was also positively associated with “Personal characteristics”. In agreement with previous studies, the personality traits most associated empathy were Agreeableness and Openness to Experience. Empathy did not vary according to programme year or career specialty preference.

Conclusions

This study is the first to show that empathy and personality factors may act as determinants of students’ attitudes towards medical professionalism in a manner which is dependent upon category of professional behaviour.

Identification of Warning Signs During Selection of Surgical Trainees

OBJECTIVE

The aim was to document empirical observations about antecedents to and practices of unsuitable behaviours amongst surgical trainees and develop an interview guide that could be used for the selection process.

DESIGN

A mixed methods design was adopted combining a survey distributed to senior surgeons and heads of departments, followed by semi-structured interviews with experienced surgeons.

SETTING

All surgical departments and hospitals in The South Swedish Health Care Region.

PARTICIPANTS

The survey was completed by 54 of 83 eligible surgeons above 50years of age, and 4 of 7 heads of surgical departments. Semi-structured interviews with 13 surgeons representing local, regional, and university hospitals from the same cohort.

RESULTS

Forty-six (85%) surgeons and four of seven heads of departments responded that they had come across surgical trainees deemed unsuitable to train and work as a surgeon. All heads of department and 31 of 54 of the surgeons believed tendencies towards unsuitability are evident early during training. From the survey, 107 statements described reasons for finding a trainee unsuitable. Qualitative analysis of the interviews and free-text answers of the survey led to identification of 11 problem domains with associated "warning signs". An interview guide to help detect unsuitability tendencies in candidates during selection procedures was constructed.

CONCLUSIONS

Experienced surgeons have quite consistent views on what makes a person unsuitable as a surgeon. Their views have been systematized into 11 problem domains, and a set of 'warning signs' for unsuitable behaviours and traits has been developed. Early detection of these signs and traits is important for the individual, the work environment, and patient safety. A recommendation for a minimum framework for selection including the constructed interview guide is presented.

Adding Long-term Value to the Residency Selection and Assessment Process

The residency selection process is challenging for both applicants and programs. This is particularly true in competitive specialties such as otolaryngology. The importance of noncognitive competencies in successful residents has been well demonstrated in both medicine and surgery. Unfortunately, there is no streamlined or uniform process for incorporating this information into the selection and training of residents. This review provides a summary of innovative approaches in the selection of residents in otolaryngology and the important role these methods and associated data can play in resident selection and training. The goal of these processes is to create a holistic view of potential residents so programs can enhance the development of current residents and boost long-term success in our specialty. Laryngoscope, 130:65-68, 2020.

One Small Step for Step 1

Step 1 of the United States Medical Licensing Examination (USMLE) is a multiple-choice exam primarily measuring knowledge about foundational sciences and organ systems. The test was psychometrically designed as pass/fail for licensing boards to decide whether physician candidates meet minimum standards they deem necessary to obtain the medical licensure necessary to practice. With an increasing number of applicants to review, Step 1 scores are commonly used by residency program directors to screen applicants, even though the exam was not intended for this purpose. Elsewhere in this issue, Chen and colleagues describe the "Step 1 climate" that has evolved in undergraduate medical education, affecting learning, diversity, and well-being.Addressing issues related to Step 1 is a challenge. Various stakeholders frequently spend more time demonizing one another rather than listening, addressing what lies under their respective control, and working collaboratively toward better long-term solutions. In this Invited Commentary, the author suggests how different constituencies can act now to improve this situation while aspirational future solutions are developed.One suggestion is to report Step 1 and Step 2 Clinical Knowledge scores as pass/fail and Step 2 Clinical Skills scores numerically. Any changes must be carefully implemented in a way that is mindful of the kind of unintended consequences that have befallen Step 1. The upcoming invitational conference on USMLE scoring (InCUS) will bring together representatives from all stakeholders. Until there is large-scale reform, all stakeholders should commit to taking (at least) one small step toward fixing Step 1 today.

Personality Assessment in Orthopaedic Surgery: AOA Critical Issues

Personality assessment tools are used effectively in many arenas of business, but they have not been embraced by the medical profession. There is increasing evidence that these tools have promise for helping to match resident candidates to specific fields of medicine, for mentoring residents, and for developing improved leadership in our field. This paper reviews many aspects of personality assessment tools and their use in orthopaedic surgery.

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.

Non-cognitive factors predicting success in orthopedic surgery residency

Admissions to orthopedic surgery is a highly competitive process. Traditionally measures such as United States Medical Licensing Examination (USMLE) Step 1, class rank, AOA status have been major determinants in the ranking process. However, these traditional objective measures show mixed correlation to clinical success in orthopedic surgery residency. There have been several studies on the cognitive factors and their correlation with success in residency. However, it is clear that residency requires more than objective cognition, emphasizing complex social interactions that are influenced by non-cognitive variables including personality, work ethic, etc. This review aims to summarize the current understanding of non-cognitive factors influencing performance in orthopaedic surgical residency.