Personality and medical education

This issue of Medical Education includes a fascinating paper by psychologist Jean Twenge, entitled, ‘Generational changes and their impact in the classroom: teaching Generation Me.’1 In it, Twenge outlines her ongoing attempts to describe and understand the nature of the current generation of university students. Her research techniques include what she describes as ‘cross-temporal meta-analysis’, which consists of comparing the results of studies conducted on student-age populations carried out at different time-points. Her principle findings are that today’s generation of university students appears to differ systematically to those of previous years on a number of measures; measures that include personality, character, self-perception, expectations and values, and probably some mix of the above. These findings seem to express with some certainty the observations of a number of educators (although such discussions occur more commonly in corridors than in academic journals). More specifically, Twenge describes the current crop of university-age students as having higher levels of expectation, entitlement, self-esteem and even narcissism than students in previous decades. She also describes differences in learning, such as a tendency to prefer educational approaches that stress multimedia content, demand less reading, and allow greater flexibility on the part of the student. Although Twenge cautions that such generalisations will not apply to all members of the current generation, she argues that these trends are definitely present, at least in Western students, and that educators should consider how to address such realities in their day-to-day teaching. Such advice would seem both appropriate and worthy of consideration. Medical education, in general, lags far behind other fields in understanding how personality impacts on workplace behaviour As a social and personality psychologist who spent many years away from medicine and medical education before returning to the fold, I had a couple of thoughts while reading this paper that I’d like to share. The first concerns both the extent to which personality is shaped by one’s environment and what Twenge’s research tells us about who we are. The second refers to the degree to which medical education, in general, seems to lag so far behind other fields in understanding how personality impacts on workplace behaviour. Most reasonable people think that both what we inherit from our parents and the experiences we have in life shape us into who we are The debate about whether personality is inborn or learned dates back many years, and the Blank Slate camp and the Inherited Characteristics camp have both had their supporters and detractors over the years. Outside of academic circles, however, most reasonable people think that both what we inherit from our parents and the experiences we have in life shape us into who we are. The current model of personality used by most trait researchers is that of the ‘Big Five’ (the relatively independent constructs of Neuroticism, Extraversion, Openness to New Experience, Agreeableness and Conscientiousness) or some variant thereof. For comprehensive discussions of these models, see Goldberg2 or John et al.3 Mounting evidence suggests at least some inherited component of the Big Five in humans, which in turn supports biological models of personality structure.4 The systematic changes in mean population scores of personality characteristics over time identified by Twenge’s work strongly support the notion that, despite genetic influences, how we raise our children has much to say about who they will become as adults. It will indeed be interesting to see to what extent these findings replicate in other cultures, but the increasing homogenisation of the world’s cultures would suggest that this may be (or will become) a global phenomenon. The broad construct of Conscientiousness has been found to predict job performance across occupational groups The second issue that I feel bears mention concerns the discrepancy between how educators (here, specifically medical ones) and employers see the relationship between personality and performance. The correlation between personality characteristics and job performance seems obvious to most people outside of education. Most of us generally don’t want rude waiters, sloppy painters, dishonest car salesmen, uncaring teachers, aggressive policemen or panicky airline pilots. We do, however, like attentive waiters, precise painters, honest salesmen, caring teachers, friendly policemen and calm airline pilots. For most high-risk, high-performance and error-intolerant jobs there exist selection procedures that attempt to identify the best candidates for that field. In my previous work in the aerospace industry, much effort was expended to identify candidates with high degrees of conscientiousness, reliability and calmness in emergencies; namely, team-oriented individuals, who, everyone agreed, typified the ideal pilot or astronaut. Indeed, the use of standardised psychological selection batteries, detailed background checks and interviews (sometimes multiple) by trained psychologists were commonplace. Mount and Barrick’s 1991 meta-analysis5 reviewed 117 studies covering more than 20 000 participants and found the broad construct of Conscientiousness to predict job performance in all occupational groups. When I returned to medicine after so many years in another field, I was struck by both the lack of awareness of personality as a predictor of performance, and the ubiquitous discussions of professionalism and teamwork (usually the lack thereof), although usually at postgraduate level. Indeed, in casually broaching the subject, I was surprised to come across beliefs ranging from (a) personality is unmeasurable and unscientific, to (b) even if real, personality predicts little, if anything, of significance. Some of these beliefs can be traced to the somewhat bizarre debates of the 1960s and 1970s, where psychologists such as Walter Mischel6 argued that personality was both unstable and poorly predictive. Some psychologists of the era went even further, stating that personality is a perceptual illusion and that no such constructs really exist. Such views have long since been overturned, but the impact of that thinking certainly persists in some circles. Reliance on interviews conducted by untrained personnel may favour those applicants who simply self-present well in interview settings Regardless of its origin, however, the lack of formal psychological assessment of candidates for medical careers is striking. Typically, letters of intent submitted by applicants are read by untrained readers and scored on dubious criteria. Even more questionable is whether candidates themselves even write many of those letters. Most medical schools also require some sort of face-to-face interview, in which candidates are often interviewed by multiple interviewers, but, again, few if any of those interviewers are typically trained in psychological assessment and little empirical research has been conducted to validate whether the criteria assessed actually predict clinical or professional behaviours. Reliance on interviews conducted by untrained personnel may favour those applicants who simply self-present well in interview settings, which may predict nothing other than how well they portray themselves in subsequent interviews during their careers, which is of questionable importance. Firm data on the ideal traits of doctors are lacking, however, and, without those data, more sophisticated selection strategies are challenging. Ironically, much current discussion in academic medicine seems to revolve around non-cognitive aspects of being a doctor, such as empathy, professionalism and communication. The issues raised by Twenge add further grist to this discussion. It is worth remembering that there is an entire field out there that looks at personality and job performance.