The ‘Dark Side’ and ‘Bright Side’ of Personality: When Too Much Conscientiousness and Too Little Anxiety Are Detrimental with Respect to the Acquisition of Medical Knowledge and Skill

Abstract

Theory suggests that personality traits evolved to have costs and benefits, with the effectiveness of a trait dependent on how these costs and benefits relate to the present circumstances. This suggests that traits that are generally viewed as positive can have a ‘dark side’ and those generally viewed as negative can have a ‘bright side’ depending on changes in context. We test this in a sample of 220 UK medical students with respect to associations between the Big 5 personality traits and learning outcomes across the 5 years of a medical degree. The medical degree offers a changing learning context from pre-clinical years (where a more methodical approach to learning is needed) to the clinical years (where more flexible learning is needed, in a more stressful context). We argue that while trait conscientiousness should enhance pre-clinical learning, it has a ‘dark side’ reducing the acquisition of knowledge in the clinical years. We also suggest that anxiety has a ‘bright side’ enhancing the acquisition of skills in the clinical years. We also explore if intelligence enhances learning across the medical degree. Using confirmatory factor analysis and structural equation modelling we show that medical skills and knowledge assessed in the pre-clinical and clinical years are psychometrically distinguishable, forming a learning ‘backbone’, whereby subsequent learning outcomes are predicted by previous ones. Consistent with our predictions conscientiousness enhanced preclinical knowledge acquisition but reduced the acquisition of clinical knowledge and anxiety enhanced the acquisition of clinical skills. We also identified a curvilinear U shaped association between Surgency (extraversion) and pre-clinical knowledge acquisition. Intelligence predicted initial clinical knowledge, and had a positive total indirect effect on clinical knowledge and clinical skill acquisition. For medical selection, this suggests that selecting students high on conscientiousness may be problematic, as it may be excluding those with some degree of moderate anxiety.

Evaluating the complementary roles of an SJT and academic assessment for entry into clinical practice

“…Historically, medical selection has been based on academic attainment (Ferguson et al 2002), and a wealth of evidence offers consensus that this is an effective predictor of performance during medical education and training (Ferguson et al 2014;Puddey and Mercer 2014). However, current research shows that recruiting physicians solely on the basis of academic attainment is likely to neglect important non-academic attributes required for success during clinical practice (Patterson and Ferguson 2010;Patterson et al 2015a).…”

Situational judgement tests in medical education and training: Research, theory and practice: AMEE Guide No. 100

“…We propose that this is because during the classroom-based, didactic setting in which learning takes place during the early years of a medical degree, the focus is more on cognitive indicators and academic attainment. However, as students move into clinical practice and beyond, the necessity for interpersonal skills comes to the fore because the team-based working and patient contact are key measures of competence (Ferguson et al 2014). This proposition is supported by other researchers For example, applicants lacking prosocial ITPs are less likely to perform well on an SJT.…”

Selection methods in healthcare professions: where are we now and where next?

“…In addition to academic ability, it is vital that medical students also possess a range of other important skills and qualities (Ferguson et al 2014). There is increasing recognition that there is more to being a capable medical student or doctor than academic performance.…”