Impact of personality temperaments and characters on academic performance and specialty selection among a group of Egyptian medical graduates

Abstract

Background:

The relationship between personality temperaments, academic achievement and specialty interest is important because of its implications in career counseling.

Aim:

To assess the effect of personality on academic performance and career selection and to study the impact of some sociodemographic factors on academic achievement and career choice of medical graduates.

Methodology:

A total of 436 medical graduates of Ain Shams medical school were approached, out of which 331 participated. They were given a sociodemographic questionnaire, and the Temperament and Character Inventory–Revised (TCI-R; 240) for personality construct; they had to answer questions about academic achievement, ranking, scores and choice of medical specialty.

Results:

Novelty seeking (NS1, NS2 and NS3) and self-transcendence (ST1 and ST2) were correlated with graduation ranking, (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively), that is, lower NS and ST had better academic outcome. Only high school score was associated with better achievement (p = .00). In specialty selection, females were significantly overrepresented in pediatrics and clinical pathology, whereas males were significantly predominating surgical specialties except for obstetrics and gynecology (p = .00). Students choosing patient-centered specialties had higher reward dependence (RD), persistence (PS) and cooperativeness (C); those choosing clinical pathology had highest harm avoidance (HA), whereas those choosing radiology had lowest HA and those choosing surgery had significantly higher self-directedness (SD3).

Conclusion:

Personality impacts academic achievement and specialty choice with other factors as gender and previous scholastic performance.

Keywords

Personality temperaments academic achievement medical students career specialty

Introduction

The personality of university students has been the subject of various investigations, which, however, is focused mainly on relationships between personality characteristics and academic performance; much less work has focused on the effect of personality on career options (Richter & Neumann, 2011).

Medicine is a heterogeneous profession in which a variety of clinical specialties are associated with differences in clinical environment, physician responsibility and patient exposure (Bergus, Randall, Winniford, Mueller, & Johnson, 2001). It follows intuitively that physicians practicing in certain disciplines may share distinctive personality characteristics that differ from those demonstrated by their colleagues in other specialties (Maron et al., 2007). Indeed, previous studies have reported that personality profiles identifiable at entry to or during medical school may be predictive of, or associated with, the specialty ultimately selected by students (Martini, Veloski, Barzansky, Xu, & Fields, 1994; Vaidya et al., 2004).

Other studies, however, have suggested that different variables as student academic standing and achievement in medical school, religious preference, family medical traditions, medical school curriculum, strong faculty mentors and lifestyle considerations may play important roles in determining the choice of specialty. Many of these factors may have altered the landscape sufficiently to make personality factors less important in the selection of a medical specialty (Maron et al., 2007; Nuthalapaty, Jackson, & Owen, 2004).

Cloninger, Przybeck, Svrakic, and Wetzel (1999) proposed a psychobiological model of personality based on the distinction between temperament and character, which are related to differences in major brain systems. The temperament dimensions are genetically homogenous and independently inherited: novelty seeking (NS), reward dependence (RD), harm avoidance (HA) and persistence (PS). According to this theory, HA reflects a heritable bias in the inhibition of behaviors. Subjects high in HA are pessimistic, worrying, fatigable and shy with strangers, and become tense in unfamiliar situations. NS is viewed as a tendency towards exhilaration in response to novel stimuli or cues. Subjects scoring high in NS are described as showing an increased frequency of explanatory behavior, impulsive decision-making, a quick loss of temper and active avoidance of frustration. RD reflects a tendency to maintain or pursue ongoing behaviors. People with high scores on RD are sentimental, socially attached and dependent on the approval of others. PS reflects the perseverance in behavior despite frustration and fatigue (Cloninger, Przybeck, Svrakic, & Wetzel, 1999; Richter & Neumann, 2011).

Character is defined as individual differences in self-concepts, which are acquired from the environment and are determined by socialization processes during the lifespan related to personal, social, moral and spiritual maturation. They represent the extent to which a person identifies himself as an autonomous individual (self-directedness (SD)), as an integrated part of the society (cooperativeness (C)), and as an integral part of the whole universe associated with conscience (self-transcendence (ST)). An individual, who is low in SD, could be described as irresponsible, aimless, undisciplined in behavior and of poor impulse control in general. Uncooperative individuals are characterized as hostile, aggressive, hateful and as revengeful opportunists. Individuals low in ST show conventional and materialistically oriented behavior with little or no concern for absolute ideas, such as goodness and universal harmony. The theory assumes that personality is determined by an interaction between social, environmental and genetic influences during the whole lifespan (Cloninger et al., 1999; Richter & Neumann, 2011).

Due to the absence of research involving medical graduates in Egypt and other Arab countries and due to the importance of the relationship between personality characteristics and specialty selection with its vast implications on student career counseling and in forecasting future specialty distribution, the authors of this research aimed to examine the association of certain personality variables with academic performance and career options and study the impact of various sociodemographic factors as gender, parental occupation and so on, on academic achievement and career choice of medical graduates. Our main hypotheses were that graduates choosing a stressful or surgical specialty would have different personality traits (e.g. more risk taking) than those choosing less stressful specialties and that those who choose specialties having direct involvement with patients would have different traits than those choosing specialties with minimal patient involvement. This would be the first Egyptian research tackling this issue according to the authors’ best knowledge.

Methodology

Sample

All medical graduates of Ain Shams Medical School, Cairo, Egypt, who have finished their sixth year of medical education and are in their internship year were approached to participate in the study; the total number of students approached was 436, of whom 42 students expressed their unwillingness to participate and 27 students dropped out of the study after giving an initial consent and taking the study tools but did not return them and 36 students completed either the demographic questionnaire or the Temperament and Character Inventory–Revised (TCI-R) only. Therefore, the remaining 331 participated completely in the study and were enrolled; the mean age of the enrolled students was 23.9 ± 0.81 years, and their gender distribution was 150 males and 181 females.

Measurements

This is a cross-sectional cohort study, which employed qualitative and quantitative measurements. Subjects were given a demographic survey to identify the various social and educational characteristics of the students, including age, gender, high school graduating score, occupation of parents, clinical years evaluation grade (fourth, fifth and sixth years of medical school), overall graduating score and rank, whether receiving private medical tuition and selected medical specialty.

All participants were asked to fill out the temperament and character inventory-revised (TCI-R, Cloninger et al., 1999): a self-administered dimensional questionnaire constructed to assess the seven basic dimensions of personality, namely, the genetically determined temperaments as harm avoidance (HA), novelty seeking (NS), persistence (PS) and reward dependence (RD) and the characters self-transcendence, cooperativeness and self-directedness; each dimension consists of several subdimensions, which are added up to form the final temperament or character dimension. It constitutes 240 questions (30–45 minutes administration time) scored on a 5-point Likert scale (1 = definitely false to 5 = definitely true) with 110 inversely scored questions and 5 validity questions for more reliability. The internal consistency (Cronbach’s α) of the dimensions ranged from .86 to .89 for character and from .69 to .91 for temperament scales. (Eley, Young, & Przybeck, 2009). Three bilingual psychiatrists did the Arabic translation of the TCI-R. All three were native Arabic speakers with excellent proficiency in English. Discrepancies between the translations were resolved. A fourth psychiatrist, who was unaware of the original English language document, back translated the final Arabic version; it has been validated through its use in previous research (El Sheikh, Sadek, Omar, & El Nahass, 2003).

Statistical analysis

The collected data were analyzed to obtain results by using the computerized version of the Statistical Package for Social Sciences, 17th version (SPSS 17). Quantitative variables were described in mean ± standard deviation (SD), or numbers and percentages, if qualitative. Pearson’s chi square test (χ²) was used to detect presence or absence of significant association between two categorical variables. Correlations (two-tailed) were calculated using Pearson coefficient, and partial correlations were used when controlling for gender. To compare the mean scores between the Student’s t-tests for independent groups (two-tailed), one-way analysis of variance (ANOVA) was used to compare more than two means. Multivariate analysis of variance (MANOVA) controlling for gender was conducted with TCI-R dimensions and subscales as dependent variables and students’ specialty choice and clinical years’ evaluation. Regression analysis was used to correlate variables together in order of their significance. p value was used to indicate the level of significance (p ≤ .05 is considered significant, p ≤ .01 is highly significant and p ≤ .001 is very highly significant).

Results

Personality characteristics and academic performance of medical students

Before starting to analyze the data, it was expected that gender is a significant covariate that may affect TCI-R findings. Independent Student’s t-test was done to explore the differences in TCI-R dimensions between male and female students of the sample. As could be expected, there were significant differences between both sexes. Females showed higher mean scores of harm avoidance and all its subscales (103.8 ± 17.1 vs 97.8 ± 18.4, t = −3, p = .03), RD1 (28.9 ± 4.4 vs 27.6, t = −2.4, p = .02), C4 (26.1 ± 5.3 vs 24.3 ± 5.7, t = −3.1, p = .002) and C5 (31.9 ± 4.3 vs 30.1 ± 4.7, t = −3.6, p = .000). Males showed higher mean scores of of NS4 ( 18.6±4.4 vs 17.1±1.5, t = 3.1, p = .002), PS3 (37.9 ± 6 vs 36.4 ± 5.9, t = 2.3, p = .02), SD2 (22.3 ± 4.5 vs 20.9 ± 4.4, t = 2.6, p = .009), SD3 (17.2 ± 3.7 vs 16.1 ± 3.5, t = 2.7, p = .006), C1 (28.6 ± 4.3 vs 26.8 ± 4.8, t = 2.3, p = .02) and ST2 (23.0 ± 4.9 vs 21.7 ± 4.8, t = 2.4, p = .02). Therefore, partial correlations between TCI-R dimensions and the overall graduation ranking controlled for gender were conducted to explore the relation between academic performance and personality traits. NS, ST and most of their subscales (NS1 exploratory excitability vs rigidity, NS2 impulsiveness vs reflection, NS3 extravagance vs reserve, ST1 creative self-forgetfulness vs self-conscious experience and ST2 transpersonal identification vs personal identification) were positively correlated to the overall ranking (r = .2, p = .00; r = .15, p = .009; r = .16, p = .005; r = .12, p = .003; r = .14, p = .02; r = .17, p = .004; r = .13, p = .03, respectively). This means that students of late ranking have higher NS and ST and most of their subscales. Stepwise linear regression analysis (Table 1) was done using overall graduation ranking as dependent variable and personality traits, which were significantly correlated to ranking (NS, NS1, NS2, NS3, ST, ST1 and ST2), as independent variables. The most important personality traits predicting medical students’ graduation ranking were NS followed by ST1.

Table 1.

Stepwise linear regression analysis showing the most important personality traits predicting graduation ranking among medical students.

Personality trait	Beta coefficient	t	p
NS	.18	3	.003**
ST1	.13	2.2	.02*
NS1	−.02	−0.21	.83
NS2	.06	0.75	.45
NS3	.003	0.04	.97
ST2	.05	0.84	.40
ST	−.02	0.50	.62

NS: novelty seeking; NS1: exploratory excitability vs rigidity; NS2: impulsiveness vs reflection; NS3: extravagance vs reserve; ST: self-transcendence; ST1: creative self-forgetfulness vs self-conscious experience; ST2: transpersonal identification vs personal identification.

*p < .05, **p ≤ .01, ***p ≤ .001.

Other factors affecting academic performance of medical students

The researchers of the study expected that other factors that may affect students’ performance include gender, receiving private tuitions, having one or both parents working as a doctor and high school graduation score. Student’s t-test revealed that there were no mean differences between male and female students’ overall graduation scores (5,738 ± 361, 5,263 ± 602, respectively, t = 1.3, p = .19). Also, there was no difference between overall mean scores of students who received private tuitions and those who did not (5,312 ± 529, 5,307 ± 382 respectively, t = 0.07, p = .9). One-way ANOVA revealed that although students who have both parent working as doctors had higher overall graduation mean score (5,648.9 ± 292) compared to those who have one doctor parent (5,488.2 ± 296) and those with both parents working in other occupation (5,271.3 ± 541.8), this finding did not reach the level of statistical significance (F = 2.9, p = .058). Pearson correlations revealed that there was positive correlation between high school graduation scores and overall medical school graduation scores (r = .3, p = .00).

Factors affecting specialty choice of medical students

On analyzing the data, specialty choices were classified once according to the way of dealing with patients during practice into patient-centered and non-patient-centered specialties. Patient-centered specialties included specialties dealing directly with patients: internal medicine, general surgery, anesthesia, pediatric, gynecology and obstetrics, ophthalmology, ENT, cardiology, dermatology, oncology, orthopedics and urology. Non-patient-centered specialties do not directly deal with patients and included clinical pathology, radiology and academic (preclinical) subjects, such as anatomy and physiology.

Further classification was done by grouping specialty choices into surgical specialties (including general surgery, anesthesia, gynecology and obstetrics, ophthalmology, ENT, orthopedics and urology) and nonsurgical specialties (including internal medicine, pediatric, cardiology, dermatology, oncology, clinical pathology, radiology and academic (preclinical) subjects). Anesthesia was grouped with surgical specialties as it involves the same risks and stress levels as surgical ones (Mitra, Sinha, Gombar, & Basu, 2003).

Table 2 shows gender differences in relation to specialty choice. There were no significant differences between male and female students on choosing patient-centered or non-patient-centered specialties (50.7% (n = 110) of students who chose patient-centered specialties were males, 49.3% (n = 107) were females, χ² = 0.57, p = .45). Similarly, there were no significant gender difference between students choosing surgical and nonsurgical specialties: 56.4% (n = 62) of students who chose surgical specialties were males and 43.6% (n = 48) were females (χ² = 3.36, p = .07). However, 77.5% (n = 31) of students who chose general surgery and 87.5% (n = 7) of those who chose anesthesia were males. However, 70% (n = 28) of those who chose gynecology and obstetrics, 64.7% (n = 33) of those who chose pediatrics and all of those who chose clinical pathology (n = 8) were females (χ² = 49.5, p = .00).

Table 2.

Gender differences in relation to specialty choice.

Specialty	Male (117)	Female (117)	χ²	p
Internal medicine (44)	26 (59.1%)	18 (49.9%)	49.08	.000***
General surgery (40)	31 (77.5%)	9 (22.5%)
Pediatric (51)	18 (35.3%)	33 (64.7%)
Gynecology and obstetrics (40)	12 (30%)	28 (70%)
Clinical pathology (8)	0 (0%)	8 (100%)
Radiology (5)	4 (80%)	1 (20%)
Ophthalmology (13)	6 (46.2%)	7 (53.8%)
ENT (5)	2 (40%)	3 (60%)
Anesthesia (8)	7 (87.5%)	1 (12.5)
Cardiology (7)	4 (57.1%)	3 (42.9)
Dermatology (4)	0 (0%)	4 (100%)
Oncology (1)	0 (0%)	1 (100%)
Orthopedics (3)	3 (100%)	0 (0%)
Urology (1)	1 (100%)	0 (0%)
Academic (4)	3 (75%)	1 (25%)
Patient-centered specialty (217)	110 (50.7%)	107 (49.3%)	0.57	.45
Non-patient-centered specialty (17)	7 (41.2%)	10(58.8%)	0.57	.45
Surgical specialty (124)	62(56.4%)	48 (43.6%)	3.36	.07
Nonsurgical specialty (110)	55(44.4%)	69 (55.6%)	3.36	.07

Data of students who did not mention their gender or specialty choice were excluded from the analysis (n = 97).

*p < .05, **p ≤ .01, ***p ≤ .001.

Further analysis was done to explore the relation between academic performance of students and their specialty choice. Student’s t-test revealed no significant differences between means of overall graduation score of students choosing patient-centered specialties (5,305.9 ± 397.2) compared to those choosing non-patient-centered specialties (5,520.5 ± 235.2) (t = −1.7, p = .09), and students who chose surgical specialties (5,356.8 ± 392.4) compared to those who chose nonsurgical specialties (5,292.2.3 ± 386.8) (t = 0.87, p = .38).

Cross-tabulation revealed that there was no significant relation between clinical years’ evaluation grades and type of students’ specialty choice whether patient-centered or non-patient-centered (χ² = 2.5, p = .5). Similarly, it was not significantly related to the choice students on choosing surgical and nonsurgical specialties (χ² = 1.6, p = .7).

The relation between personality characteristics and specialty choice

MANOVA was conducted with TCI-R dimensions and subscales as dependent variables controlling for gender and students specialty choice whether patient-centered or non-patient-centered as a fixed factor (Table 3). Students who chose patient-centered specialty had higher RD, PS and C dimensional scores. On the subscale level, they showed higher scores on RD4 (dependence vs independence), PS1 (eagerness of effort vs laziness), C1 (social acceptance vs social intolerance), C3 (helpfulness vs unhelpfulness), C4 (compassion vs revengefulness), ST3 (spiritual acceptance vs rational materialism) and lower NS4 (disorderliness vs regimentation).

Table 3.

Multivariate analysis of variance showing the means and standard deviations of TCI-R dimensions of students choosing patient-centered or non-patient-centered specialty choice after controlling for gender.

TCI-R dimensions	Patient-centered specialty choice (n = 220)	Non-patient-centered specialty choice (n = 17)	F	p
NS1	31.1 ± 5.1	29.4 ± 4.8	1.9	.2
NS2	22.3 ± 5.3	22.8 ± 6.2	0.09	.8
NS3	28.2 ± 6.1	28.6 ± 4.8	0.03	.9
NS4	17.6 ± 4.2	20.6 ± 4.4	9.2	.003**
NS	99.1 ± 13.1	101.3 ± 14.4	0.4	.5
HA1	33.3 ± 6	33.4 ± 7	0.0	.9
HA2	23.8 ± 5.9	22.1 ± 7.7	2.1	.2
HA3	19.9 ± 5.6	22.1 ± 7,4	2.0	.2
HA4	23.9 ± 5.7	24.9 ± 5.6	0.5	.5
HA	100.9 ± 17.7	102.5 ± 24.5	0.1	.8
RD1	28.4 ± 4.6	28.3 ± 4.9	0.6	.8
RD2	35.1 ± 5.4	32.6 ± 5.3	3.5	.1
RD3	18.9 ± 4.9	17.2 ± 3.9	2.1	.2
RD4	21.5 ± 3.6	19.2 ± 4.2	6.3	.01**
RD	103.8 ± 12.7	97.3 ± 10.8	4.9	.03*
PS1	32.8 ± 5.5	29.8 ± 6.2	5.4	.02*
PS2	27.8 ± 4.8	26.8 ± 3.8	0.6	.5
PS3	37.6 ± 5.9	34.8 ± 5.3	3.2	.08
PS4	26.9 ± 4.6	25 ± 4.2	2.7	.1
PS	125.1 ± 17.6	116.4 ± 16.5	3.8	.05*
SD1	27.4 ± 5.3	26.2 ± 3.8	0.6	.4
SD2	22 ± 4.5	20.5 ± 3.3	1.7	.2
SD3	16.8 ± 3.8	15.4 ± 3	2	.2
SD4	28 ± 5.6	29.5 ± 6.2	0.9	.3
SD5	38.1 ± 5.2	36.2 ± 4.3	2.4	.1
SD	132.4 ± 17.1	127.9 ± 11.1	1.1	.3
C1	27.7 ± 4.8	24.4 ± 4.9	7.3	.007**
C2	17.9 ± 3.2	16.4 ± 3.9	3.2	.07
C3	29.2 ± 4	27.1 ± 3.2	4.5	.04*
C4	25.6 ± 5.7	22.2 ± 5.3	6.6	.01**
C5	31.1 ± 4.6	29.7 ± 5.2	1.8	.2
C	131.5 ± 16	119.8 ± 14.2	9	.003**
ST1	30.4 ± 5.4	30.5 ± 6.2	0.002	.9
ST2	22.5 ± 4.7	22.1 ± 6	0.06	.8
ST3	28.6 ± 4.4	26.3 ± 3.7	4.8	.03*
ST	81.6 ± 10.9	78.9 ± 9.8	0.9	.3

TCI-R: Temperament and Character Inventory–Revised; NS: novelty seeking, NS1: exploratory excitability vs rigidity; NS2: impulsiveness vs reflection; NS3: extravagance vs reserve; NS4: disorderliness vs regimentation; HA: harm avoidance; HA1: anticipatory worry vs optimism; HA2: fear of uncertainty vs confidence; HA3: shyness vs gregariousness; HA4: fatigability and asthenia vs vigor; RD: reward dependence; RD1: sentimentality vs insensitiveness; RD3: attachment vs detachment; RD4: dependence vs independence; PS: persistence; PS1: eagerness of effort vs laziness; PS2: work hardness vs spoiled; PS3: ambitious vs underachieving; PS4: perfectionistic vs pragmatist; SD1: responsibility vs blaming; SD2: purposefulness vs lack of goal direction; SD3: resourcefulness vs inertia; SD4: self-acceptance vs self-striving; SD5: impulse control vs bad habits; C: cooperativeness; C1: social acceptance vs social intolerance; C2: empathy vs social disinterest; C3: helpfulness vs unhelpfulness; C4: compassion vs revengefulness; C5: pure hearted principles vs self-serving advantage; ST1: creative self-forgetfulness vs self-conscious experience; ST2: transpersonal identification vs personal identification; ST3: spiritual acceptance vs rational materialism.

Data of students who did not mention specialty choice were excluded from the analysis (n = 94).

*p < .05, **p ≤ .01, ***p ≤ .001.

Multivariate analysis showed no significant differences in TCI-R dimensions and subscales of students who chose surgical specialties from those who chose nonsurgical specialties except that students who chose surgical specialties had significantly higher SD3 score even after controlling for gender (17.3 ± 3.3 vs 16.2 ± 4, F = 4.5, p = .03).

We tried to explore the variation of personality traits among different specialties individually. Multiple univariate ANOVA was conducted using TCI-R dimensions and subscale-dependent variables and different specialties as fixed factor controlled for gender. Students choosing clinical pathology (n = 8) had the highest scores in HA (116.4 ± 15.4) and all of its subscales, while those choosing radiology (n = 4) had the least score in HA (74.6 ± 21.2) (F = 2.5, p = .02).

Discussion

The aim of our study was to establish preliminary data on the personality traits and other factors affecting high academic achievement and medical specialty selection in a group of medical graduates based on Cloninger’s seven-factor theory of personality using the TCI-R questionnaire, and a demographic data sheet.

When analyzing the effect of personality temperaments and character on academic excellence detected by having higher graduating scores and lower overall graduating class ranking where lower ranks reflected better academic performance, there was a strong positive correlation between higher ranking and higher novelty seeking and self-transcendence in most of their subdimensions, namely, NS1 exploratory excitability, NS2 impulsiveness, NS3 extravagance, and similarly, ST1 creative self-forgetfulness and ST2 transpersonal identification, and no correlation was found between the other personality dimensions assessed. This meant that higher academic achievement was correlated with individuals who have little need for novel stimulation, do not derive satisfaction from exploration, are slow to engage in new ideas, are conventional and rarely bored (low scorers NS1), are reflective, are analytical and require detailed information, rarely break the rules and stay focused for long periods (low scorers NS2), are reserved, are controlled and are restrained (low scorers NS3); they were low ST1 scorers, indicating being aware of their individuality, unimaginative and self-conscious, and low scorers in ST2, which reflects a weak connection to nature and viewing nature as an external object to be manipulated instrumentally. This finding was further confirmed by regression analysis showing that novelty seeking and self-transcendence were significant independent factors affecting overall graduation ranking. This was done after controlling for the gender differences in TCI as females generally scored higher in reward dependence and harm avoidance. There were no gender differences in novelty seeking or in persistence (Rizzo, 2013).

Few researchers have conducted comparisons with the seven-factor model on academic achievement in medical students, but one such study reported that harm avoidance was positively associated with fatigue scores and SD was negatively associated with chronic fatigue, they subsequently related high fatigue scores to poor academic attainment and impaired academic performance in Japanese medical students (Tanaka, Mizuno, Fukuda, & Watanabe, 2010). In an earlier study, by the same researchers investigating the personality temperaments in relation to intrinsic academic motivation and better academic achievement in medical students in 119, second-year medical students at Osaka City School of Medicine, they reported that persistence, self-directedness and self-transcendence were positively associated with intrinsic academic motivation and higher academic achievement even when controlling for age and gender (Tanaka, Mizuno, Fukuda, Tajima, & Watanabe, 2009). Another study on 220 Korean first-year medical students reported that both male and female subjects with a higher grade point average (GPA) had higher persistence and lower novelty seeking traits. In addition, male subjects with high GPA had higher scores in SD and female subjects with a higher GPA may be characterized as having higher scores in harm avoidance (Ham et al., 2006); our results agreed with prior studies in the impact of lower novelty seeking only, a possible explanation might be cultural effects as ST is a culturally determined variable. We agree with the explanation provided by Kluger, Laidlaw, Kruger, and Harrison (2002) that

There appears to be a different interpretation of Self-Transcendence between the East and the West. Whereas Eastern society considers individuals with high scores on Self-Transcendence to be enlightened and wise, Western society admires low scorers on this characteristic. These individuals are seen as rational, scientifically objective and materialistically successful.

On exploration of the other factors that might contribute to higher academic achievement among medical graduates, we found that better academic achievement was NOT related to the gender of students or to whether they received private tuition in any medical subject. Parental occupation exerted an impact, as medical graduates whose parents were doctors achieved higher scores than graduates coming from nonmedical families, most of the studies that tackled this issue have focused on the parental occupation as a reflection of the socioeconomic status of the family and have reached similar results (Dhalla et al., 2002; Fan et al., 2007); others have focused on parental occupation as a motivation to study medicine (McManus, Livingston, & Katona, 2006). We also report a statistically significant positive correlation between academic success in medical studies and precollege high school scores, and this concurs with findings of previous investigators who reported that the preadmission academic profile is highly predictive of success in the preclinical year, and extend it further than just the preclinical years which were the focus of the mentioned study, as our research involved the overall medical performance (Afolabi, Mabayoje, Togun, & Oyadeyi, 2007).

McManus et al. (2006) commented that medicine provides a varied range of career specialties, differing in the types of patient and the types of clinical problem dealt with. The immediate job characteristics of a neurosurgeon differ remarkably from that of a histopathologist. Specialties differ in where work occurs (hospital or community), the organ involved, patient involvement (conscious, anesthetized or a blood or tissue specimen) and the time-scale of the doctor–patient interaction (minutes for a histopathologist, days for a neurosurgeon or months to years for a psychiatrist). Therefore, when analyzing the factors that might influence the choice of medical specialty among the studied sample and to avoid fragmentation of the results, we grouped the specialties regarding involvement with patients (patient-centered vs non-patient-centered) and dealing with surgery (surgical vs nonsurgical specialties), as we hypothesized that graduates choosing to deal with patients might have different personality traits than those avoiding them, and those choosing surgical specialties might have more risk taking traits than those who prefer less stressful specialties. Although we found no overall gender difference in both groups regarding specialty selection, some specialties were significantly chosen by males as general surgery and anesthesia (77.5% and 87.5%, respectively), whereas others were predominated by females as clinical pathology, obstetrics and gynecology and pediatrics (100%, 70% and 65%), the significance of this fact lies in its future implications on health service planning, as further research is needed on why certain specialties are avoided by a certain gender of medical graduates. Our results agree with Fischer, Klaghofer, and Buddeberg (2003) studied career choices among 439 Swiss medical students and reported female doctors were overrepresented in specialties like gynecology and obstetrics (27%), pediatrics (33%) and anesthesiology (27%) and male doctors in surgical specialties (55%); Vaidya et al. (2004) found that women are underrepresented in procedure-oriented specialties and Hojat and Zuckerman (2008) found that males constituted 64% and women 36% of those interested in the ‘surgical’ category. In contrast, women comprised a significantly larger proportion (65%) than men (35%) of those interested in ‘primary care’ specialties in their study of 1,076 medical graduates. We agree with the explanation provided by previous investigators that women are interested in surgical specialties, but often experience gender-relevant exclusion mechanisms in other surgical fields, that the marked gender shift in gynecology and obstetrics is due to the growing attitude that women should be treated by female physicians and that pediatrics is also a specialty in which gender schemas play a role (Fischer et al., 2003; Gargiulo, Hyman, & Hebert, 2006; Wendel, Godellas, & Prinz, 2003). Nevertheless, the reasons for the decisive role of gender on specialty choice cannot be distinguished by this study.

On analyzing other factors that might have contributed to medical specialty choice such as better overall academic performance or better academic performance during the clinical years (fourth, fifth and sixth years of medical school), no significant correlation was detected, which yields that better academic achievement is not related to certain specialties; however, a noteworthy finding was that medical graduates who chose non-patient-centered specialties as clinical pathology, radiology and academic studies tended to have higher overall graduating score, which although did not reach statistical significance, represented a statistical trend (p = .09), which should be explored further using a larger sample before drawing conclusions.

When exploring the impact of personality traits on specialty selection, we found that medical graduates who chose to deal with patients had significantly lower NS4, denoting being orderly, being methodical, preferring rules and regulations, being able to delay gratification when frustrated and being slower in outward expression of anger. They also showed significantly higher total RD and the subdimension RD4, which implies dependency on others approval with high sensitivity to social cues and responsiveness to social pressure (RD4), and additionally being tender hearted, sensitive, dedicated and sociable (RD). They had significantly higher persistence, that is, industrious and hard working, but the most significant character trait detected was higher scores in cooperativeness and most of its subdimensions, denoting that graduates choosing to deal directly with patients are more compassionate, tolerant and enjoy being of service to others. Our finding are in line with findings of other investigators who compared students of medicine, economics and verbal communication, and they reported significantly higher persistence, cooperativeness, reward dependence and self-transcendence among medical students, we are extrapolating their findings that among the medical students those choosing to deal directly with patients have those higher personality traits (Richter & Neumann, 2011). Hojat and Zuckerman (2008) reported similar findings, and they elaborated further that specialties requiring minimal interaction between the doctor and patient seem to attract those with lower empathy than others in specialties where a more prolonged and direct contact with patients is required, which could be regarded as lower cooperativeness according to the TCI-R.

Students choosing surgical specialties reported higher SD3 scores than those choosing nonsurgical ones, which implies that future surgeons reported themselves as being more resourceful, competent and innovative and tending to look at difficult situations as a challenge. Our findings partially agree with the work of previous investigators who found surgeons to be especially cooperative and self-directed (Coombs, Fawzy, & Daniels, 1993; Schwartz et al., 1994), and the later work of Vaidya et al. (2004), who reported that students choosing surgery were as cooperative as the other students, and contradict the work of Hojat and Zuckerman (2008) who reported that students who were interested in the ‘surgical’ specialties scored significantly higher on the ‘impulsive sensation seeking’. As we found students choosing surgery to be more self-directed, but as cooperative as students choosing nonsurgical specialties, the contradiction might be due to the difference in assessment tools used.

When analyzing each medical specialty alone, we found that those choosing clinical pathology had the highest harm avoidance scores in all of its dimensions and those choosing radiology had the lowest. Considering that high HA individuals would be timid, fearful, discouraged, cautious, socially inhibited and pessimistic, whereas low HA individuals would be carefree, composed, courageous, optimistic, socially confident and daring, it seems as if the personality trait describes the job characteristics. Our results corroborate the results of other researchers as Hojat and Zuckerman (2008) who reported that students interested in the ‘hospital-based’ specialties scored lower than other specialty categories on the ‘sociability’ scale as ‘hospital-based’ physicians have the minimum contact with patients, and this low level of patient contact may be attractive to students who are social introverts. However, the small number of students in each specialty warrants caution in interpreting those findings.

In conclusion, academic achievement has specific predictors and personality traits that enable students to perform better. Similarly, the choice of career specialty has specific genetic temperaments and gender determinants that affect this choice. Therefore, it is only logical that personality assessment be done for all college students, based on which proper career counseling programs should be initiated to help medical students to the choice that enables that to have best performance options.

Strengths and limitations

The strengths of this study lie in it being the first study to assess a group of Egyptian medical graduates, and the findings shed light on some universal findings that were proven in spite of being in a different culture and others that need further cultural exploration. The sample consisted of interns after finishing the sixth year of medical school that draws a more valid picture (compared to other studies that assessed first-year students). However, the main limitations of the study are that the sample was drawn from one medical school in Cairo limited number of students in each specialty. Therefore, this study provided preliminary data, and it is strongly recommended to replicate the study with samples drawn from many Egyptian universities, with special focus on urban and rural areas, before solid conclusions are drawn.

Footnotes

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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