Surgeon and Nonsurgeon Personalities at Different Career Points

journal of surgical research 196 (2015) 60e66

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Surgeon and nonsurgeon personalities at different career points

Joseph M. Drosdeck, MD,a,* Sylvester N. Osayi, MD,a Laura A. Peterson, MD,a Lianbo Yu, PhD,b Edwin Christopher Ellison, MD,a and Peter Muscarella, MDa a Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio b Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio article info abstract

Article history: Background: Previous studies have demonstrated correlations between personality traits and Received 11 June 2014 job performance and satisfaction. Evidence suggests that personality differences exist be- Received in revised form tween surgeons and nonsurgeons, some of which may develop during medical training. Un- 20 January 2015 derstanding these personality differences may help optimize job performance and satisfaction Accepted 11 February 2015 among surgical trainees and be used to identify individuals at risk of burnout. This study aims Available online 18 February 2015 to identify personality traits of surgeons and nonsurgeons at different career points. Materials and methods: We used The Big Five Inventory, a 44-item measure of the ﬁve factor Keywords: model. Personality data and demographics were collected from responses to an electronic Personality survey sent to all faculty and house staff in the Departments of Surgery, Medicine, and Surgical personality Family Medicine at The Ohio State University College of Medicine. Data were analyzed to Specialty choice identify differences in personality traits between surgical and nonsurgical specialties ac- Physician burnout cording to level of training and to compare surgeons to the general population. Results: One hundred ninety-two house staff and faculty in surgery and medicine completed the survey. Surgeons scored signiﬁcantly higher on conscientiousness and extraversion but lower on agreeableness compared to nonsurgeons (all P < 0.05). Surgery faculty scored lower in agreeableness compared with that of surgery house staff (P ¼ 0.001), whereas nonsurgeon faculty scored higher on extraversion compared with that of nonsurgeon house staff (P ¼ 0.04). Conclusions: There appears to be inherent personality differences between surgical and nonsurgical specialties. The use of personality testing may be a useful adjunct in the residency selection process for applicants deciding between surgical and nonsurgical specialties. It may also facilitate early intervention for individuals at high risk for burnout and job dissatisfaction. ª 2015 Elsevier Inc. All rights reserved.

1. Introduction for comparative studies. Personality researchers rely on a descriptive model of these traitsdthe ﬁve factor model (FFM). The development of the Big Five factor structure of personality This system categorizes personality into ﬁve traits as follows: [1] has standardized personality measurement and allows openness, conscientiousness, extraversion, agreeableness,

* Corresponding author. Department of Surgery, The Ohio State University Wexner Medical Center, N711 Doan Hall, 410 West 10th Avenue, Columbus, OH 43210. Tel.: þ1 414 688 8769; fax: þ1 614 293 7852. E-mail address: [email protected] (J.M. Drosdeck). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.02.021 journal of surgical research 196 (2015) 60e66 61 and neuroticism (Fig. 1). Although prior studies have investi- gated personality differences between medical specialties 2. Methods [2,3], few have examined surgery house staff personality 2.1. Study sample profiles [4]; fewer still have evaluated personality traits across different career points. To date, no study has examined differences in personality traits across generations in the surgi- The study was approved by the Institutional Review Board. cal workforce. An electronic link to an anonymous personality survey was Among the biggest threats to the surgical workforce are emailed to all faculty and house staff in the Departments of ¼ stress and burnout. High levels of stress can adversely affect Medicine and Family Medicine (nonsurgeons, n 586) and ¼ performance, career longevity, and job satisfaction [5]. This in the Department of Surgery (surgeons, n 150) at The is particularly important among newer generations of sur- Ohio State University Wexner Medical Center. Faculty geons who may not have developed advanced coping stra- members included all clinicians in a department, and tegies [6] and tend to place more importance on lifeework house staff included all physicians-in-training (interns, balance [7]. Although the causes of burnout are multifac- residents, and fellows) in a department. Surveys were torial, individual characteristics play an important role. completed online via surveymonkey.com.Participants Ironically, the traits that define a good surgeon are often were informed that no personal identifying information associated with a greater risk of burnout. These include was collected. attention to detail, commitment to patients, and desire for perfection [5]. Personality testing may help identify in- 2.2. Measures dividuals at risk for burnout so that early intervention can be undertaken. We used the Big Five Inventory (BFI) to assess personality Prior investigations [2,3] have sought differences between traits according to the FFM [8]. This 44-item inventory re- surgeons and nonsurgeons, and our group believes that in- quires participants to rate self-descriptive phrases on a 5- dividuals with certain personality characteristics may gravi- point Likert scale from “agree strongly” to “disagree tate toward surgical careers. We believe these personality strongly” (e.g., “I see myself as someone who is a reliable characteristics are refined throughout residency training by worker”). The BFI questionnaire is shown in Figure 2. This numerous factors, including acquisition of skills and knowl- measurement tool is widely used and noted for its simplicity edge, interactions with colleagues and other healthcare pro- and brevity. Additionally, it achieves a high degree of reli- fessionals, and emulation of role models. We hypothesize that ability and acceptable level of discriminant correlations [8]. there are inherent personality differences between surgeons Each of the five personality traits on the FFM are quantified and nonsurgeons and that personality traits vary based on by averaging participants’ numerical responses to state- stage in career. The purpose of this study was to determine ments pertaining to the corresponding personality trait. the distribution of personality traits among surgical and Forward and reverse scoring were used according to the nonsurgical faculty and house staff according to the FFM. standard scoring technique [8].

Fig. 1 e Description of the FFM of personality traits, adapted from John et al. [8]. 62 journal of surgical research 196 (2015) 60e66

Fig. 2 e BFI questionnaire, adapted from John et al. [8].

2.3. Statistical analyses faculty and 60% house staff) and 39.5% of nonsurgeon responders (34.7% of faculty and 39.5% of house staff; Table 1). We used nonpaired, two-tailed Student t-tests to identify Compared with a representative population sample, surgeons significant differences in personality scores between surgeons scored significantly higher on conscientiousness and and nonsurgeons. A one-sample t-test was used to compare the physician groups to a population sample of 71,867 adults between the ages of 21 and 60 who completed the BFI online Table 1 e Participant demographics. [9]. A predetermined significance level (P value) was set at 0.05. Minitab 16 (Minitab, Inc., State College, PA) and R 3.0.1 (R Demographics Surgeons Nonsurgeons Total (%)

Foundation for Statistical Computing, Vienna, Austria) soft- Faculty 38 72 110 (57) ware were used for statistical analyses. House staff 30 52 82 (43) Men 44 75 119 (62) Women 24 49 73 (38) 3. Results Age 25e34 33 66 99 (52) e Sixty-eight of 150 surgeons (45%) and 124 of 586 nonsurgeons 35 44 17 28 45 (23) 45þ 18 30 48 (25) (21%) provided data for ﬁnal analysis (overall response rate Total (%) 68 (35) 124 (65) 192 37%). Women represented 35.3% of surgeon responders (15.5% journal of surgical research 196 (2015) 60e66 63

Table 2 e BFI, surgeons versus nonsurgeons, and general population. Measure Surgeons Nonsurgeons Mean P value (n ¼ 68) (n ¼ 124) difference

Openness 3.75 (0.48) 3.74 (0.55) 0.01 0.89 Conscientiousness 4.30 (0.41) 4.12 (0.49) 0.18 0.01* Extraversion 3.74 (0.68) 3.32 (0.88) 0.42 0.001* Agreeableness 3.76 (0.48) 4.03 (0.58) 0.27 0.002* Neuroticism 2.46 (0.75) 2.49 (0.73) 0.03 0.75

Surgeons (n ¼ 68) Population Mean difference P value

Openness 3.75 (0.48) 3.90 0.15 0.013* Conscientiousness 4.30 (0.41) 3.73 0.57 <0.001* Extraversion 3.74 (0.68) 3.25 0.49 <0.001* Agreeableness 3.76 (0.48) 3.82 0.06 0.307 Neuroticism 2.46 (0.75) 3.13 0.67 <0.001*

Data presented as mean (standard deviation). * P < 0.05. extraversion (P < 0.001) and lower on neuroticism (P < 0.001) house staff, though this failed to reach statistical significance and openness (P ¼ 0.013; Table 2). (P ¼ 0.06; Table 4). No significant differences were found Surgeons scored significantly higher on conscientiousness between male and female nonsurgeon faculty. (P ¼ 0.01) and extraversion (P ¼ 0.001) but significantly lower on agreeableness (P ¼ 0.002) compared with those of nonsurgeons (Table 2). Subgroup analysis comparing surgeon 4. Discussion faculty to house staff revealed significantly higher scores for agreeableness among house staff compared with that of fac- The aim of this study was to investigate the distribution of ulty (P ¼ 0.001; Table 3). Nonsurgeon faculty scored signifi- personality traits among surgical and nonsurgical faculty and cantly higher on extraversion compared with that of house staff, according to the FFM. We showed that surgeons nonsurgeon house staff (P ¼ 0.04; Table 3). were significantly more conscientious and extraverted, and A comparison of male to female surgeons yielded no sig- significantly less agreeable, compared with nonsurgeon col- nificant differences in personality scores. This observation held leagues. We also showed that surgery house staff were true when male surgery faculty was compared with female significantly more agreeable compared with surgery faculty, surgery faculty and male surgery house staff compared with but no significant differences were found between these two female surgery house staff. In contrast, male nonsurgeons groups in the domains of openness and neuroticism. (faculty and house staff) scored significantly higher on extra- Although literature on surgeon personalities is subject to version (P ¼ 0.01) but significantly lower on neuroticism heterogeneity of results and personality measurement tools, (P ¼ 0.003) when compared with female nonsurgeons (faculty the observation that surgeons score higher on extraversion and house staff; Table 4). Likewise, male nonsurgeon house and conscientiousness is an established finding. McGreevy staff scored significantly lower on neuroticism compared with et al. [10] compared personality traits of surgical residents to female nonsurgeon house staff (P ¼ 0.01), and there was a trend the general population. They observed that surgery residents toward higher extraversion scores among male nonsurgeon scored significantly higher on extraversion, openness, and

Table 3 e Personality traits of surgeons and nonsurgeons at different career points. Measure Surgery faculty (n ¼ 38) Surgery house staff (n ¼ 30) Mean difference P value

Openness 3.75 (0.38) 3.75 (0.58) 0.0 0.98 Conscientiousness 4.34 (0.39) 4.24 (0.42) 0.10 0.31 Extraversion 3.71 (0.70) 3.78 (0.66) 0.07 0.68 Agreeableness 3.60 (0.49) 3.98 (0.37) 0.38 0.001* Neuroticism 2.43 (0.77) 2.50 (0.72) 0.07 0.71

Nonsurgeon faculty (n ¼ 72) Nonsurgeon house staff (n ¼ 54) Mean difference P value

Openness 3.76 (0.57) 3.71 (0.53) 0.05 0.64 Conscientiousness 4.18 (0.47) 4.02 (0.51) 0.16 0.07 Extraversion 3.45 (0.81) 3.13 (0.94) 0.32 0.04* Agreeableness 4.02 (0.60) 4.04 (0.57) 0.02 0.80 Neuroticism 2.43 (0.74) 2.58 (0.73) 0.15 0.26

Data presented as mean (standard deviation). * P < 0.05. 64 journal of surgical research 196 (2015) 60e66

Table 4 e BFI, personality differences by gender. Measure Male Female Mean P Male Female Mean P surgeons surgeons difference value surgery surgery difference value (n ¼ 44) (n ¼ 24) (M F) house staff house staff (M F) (n ¼ 12) (n ¼ 18)

Openness 3.70 (0.47) 3.84 (0.48) 0.14 0.26 3.53 (0.60) 3.89 (0.54) 0.36 0.10 Conscientiousness 4.25 (0.44) 4.39 (0.31) 0.14 0.17 4.09 (0.51) 4.34 (0.32) 0.25 0.12 Extraversion 3.68 (0.68) 3.85 (0.67) 0.17 0.33 3.71 (0.64) 3.83 (0.69) 0.12 0.62 Agreeableness 3.73 (0.42) 3.83 (0.58) 0.10 0.41 3.95 (0.34) 3.99 (0.40) 0.04 0.75 Neuroticism 2.41 (0.74) 2.54 (0.77) 0.13 0.50 2.45 (0.78) 2.53 (0.70) 0.08 0.77

Male Female Mean P Male Female Mean P nonsurgeons nonsurgeon difference value nonsurgeon nonsurgeon difference value (n ¼ 75) (n ¼ 49) (M F) house staff house staff (M F) (n ¼ 28) (n ¼ 24)

Openness 3.75 (0.55) 3.71 (0.55) 0.04 0.71 3.70 (0.50) 3.72 (0.56) 0.02 0.93 Conscientiousness 4.08 (0.52) 4.17 (0.44) 0.09 0.37 3.96 (0.52) 4.10 (0.50) 0.14 0.31 Extraversion 3.47 (0.83) 3.08 (0.90) 0.39 0.01* 3.36 (0.94) 2.86 (0.89) 0.50 0.06 Agreeableness 4.07 (0.61) 3.96 (0.54) 0.11 0.28 4.16 (0.54) 3.91 (0.59) 0.25 0.11 Neuroticism 2.34 (0.72) 2.73 (0.69) 0.39 0.003* 2.34 (0.69) 2.86 (0.69) 0.52 0.01*

Data presented as mean (standard deviation). * P < 0.05. conscientiousness, whereas male surgery residents scored Compared with the surgeon response rate of 45%, only 21% of significantly lower on neuroticism compared with the general nonsurgeons responded. Nonsurgeon responders include inter- population. Hoffman et al. [4] also observed that surgery resi- nal medicine and family medicine physicians who are more dents obtained greater scores on conscientiousness and ex- likely to emphasize a community-oriented mind-set, an impor- traversion compared with those of community norms. tant component of the agreeableness domain. The disparate Comparisons between surgeons and nonsurgeon physi- response rate between surgeons and nonsurgeons must be cians have led credence to the popular belief that there exists considered when interpreting the observed difference in agree- a set of personality traits common to surgeonsdthe “surgical ableness between these two groups. Among surgeons in our personality.” In the aforementioned study by Hoffman et al. study, agreeableness scores were significantly higher for house [4], conscientiousness and extraversion scores were higher staff compared with those of faculty. Because of their increased among surgery residents when compared with those of medical knowledge and clinical experience, faculty may be medical students and pediatric residents. Similarly, other more confident with their decisions and may be less likely to studies have shown that surgeons score higher on extraver- compromise. Alternatively, it is possible that increased time sion compared with that of nonsurgeon physicians [3,11].We demands on surgery faculty lead to more rapid and firm decision observed that surgeons scored higher on extraversion and making. Although there is conflicting evidence, a study of Asian conscientiousness, and lower on agreeableness, as compared military unit leaders showed that agreeableness correlated with those of nonsurgeons. negatively with transformational leadership skills [13]. To our knowledge, the observation of lower agreeableness Although some evidence suggests that personality traits scores among surgeons has not been previously reported in may evolve throughout residency [2], the homogeneity of the literature using the BFI to compare personalities of sur- personality traits within each of these physician groups sup- geons and nonsurgeons. Gilligan et al. [12] identified differ- ports the notion that trainees gravitate toward specialties ences between surgeons and geriatricians in decision-making where members display similar personality characteristics. preferences according to the MyerseBriggs Type Indicator This may be the result of selection bias on the part of trainees, (MBTI). Although 85% of surgeons expressed a preference for faculty physicians, or both. In addition, the absence of any making decisions in detached, logical, and objective manner significant difference in personality traits between male and (“thinking” domain), only 43% of geriatricians exhibited this female surgeons supports the notion of a surgical personality preference. The remaining 57% of geriatricians expressed a that may supersede commonly encountered personality dif- preference for making decisions using subjective assessments ferences between genders. as well as personal and value-oriented beliefs (“feeling” Observations about personality have potentially important domain). Although the MBTI does not directly measure the implications on career satisfaction and physician burnout. In a personality domains of the FFM, differences in decision- meta-analysis, Judge et al. [14] found the Big Five personality making preferences according to the MBTI may overlap with traits with the highest correlation to job satisfaction were one’s agreeableness as defined by the FFM. This may explain, neuroticism (0.29), conscientiousness (0.26), and extraversion in part, the differences in agreeableness observed between (0.25). This is consistent with the results from a national survey surgeons and nonsurgeons in the present investigation. of trauma surgeons that found extraversion and emotional Alternatively, the difference in agreeableness between sur- stability (inverse of neuroticism) to have the highest correlation geons and nonsurgeons may be influenced by selection bias. with job satisfaction, both 0.20, respectively [15]. journal of surgical research 196 (2015) 60e66 65

Physician stress and burnout continues to be an area of Surgeons appear to score higher than their nonsurgical col- concern across all medical specialties and levels of training. leagues in the areas of conscientiousness and extraversion Personality assessment may provide insight into those at but lower in agreeableness. Agreeableness may decrease over greatest risk. Surgeons’ burnout has been estimated at 30%e time. Although this finding may be related to personality 38% [5] and is the single greatest predictor of surgeons’ satis- change during surgical training or generational differences, faction with career and specialty choice [16]. Thomas et al. [17] the cross-sectional nature of this study precludes definitive concluded that there is currently insufficient evidence to use conclusions about this finding. These differences have po- demographic or personality screening tools to identify house tential implications for physician trainees and surgical edu- staff at risk for burnout. However, Foster et al. [18] assessed the cators who wish to attract and train successful, competent psychological profile of surgery faculty and house staff and physicians. Given the complex nature of personality, howev- concluded that the World of Work Inventory assessment tool er, it is currently impractical to use personality to predict provides a stable profile of successful surgeons and demon- clinical performance. strates differences in personality profiles between high and low performing surgery house staff. A literature review conducted by Doherty et al. [19] identified two publications implicating high neuroticism scores as a risk factor for stress Acknowledgment among medical students [20,21]. Additional personality traits identified as potential risk factors include low extraversion Authors’ contributions: J.M.D., S.N.O., L.A.P., E.C.E., and P.M. and either high or low conscientiousness [20e23]. These re- provided significant contributions to the study design and sults highlight the need for further investigation as undue data acquisition. J.M.D., S.N.O., L.A.P., E.C.E., P.M., and L.M. did levels of stress impair judgment, decision making, and the data interpretation. L.Y. contributed to the statistical communication among surgeons [6]. analysis. Additionally, all authors contributed to the article The present study is subject to several limitations. Our preparation. response rate is less than the reported physician response rate of up to 61% in the literature [24], and the higher response rate Disclosure of surgeons (45%) compared with that of nonsurgeons (21%) may reflect a desire among surgeons to comply with a survey The authors reported no proprietary or commercial interest in conducted by peers. Therefore, the possibility of self-selection any product mentioned or concept discussed in the article. bias must be considered. However, previously published studies using surveys of US surgeons have reported response rates comparable, or even lower, than the current investiga- references tion [25]. Additionally, Kellerman et al. [26] found that nonre- sponse bias in cross-sectional studies of physicians may exert less influence on results than surveys of the general public, as [1] Goldberg LR. An alternative “description of personality”: the physicians comprise a more homogeneous group. Women big-five factor structure. J Pers Soc Psychol 1990;59:1216. represented 35.3% of surgeon responders (15.5% faculty and [2] Borges NJ, Savickas ML. Personality and medical specialty choice: a literature review and integration. J Career Assess 60% house staff) and 39.5% of nonsurgeon responders (34.7% 2002;10:362. of faculty and 39.5% of house staff). The difference in women [3] McCulloch P, Kaul A, Wagstaff GF, Wheatcroft J. 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