Personality and Interest in General Practice: Results from an Online Survey among Medical Students.

doi:10.21203/rs.3.rs-3156398/v1

Background

The growing shortage of General Practitioners (GPs) is a European-wide challenge, especially in rural areas. Facing this problem in Germany, funding programmes and voluntary courses during medical studies aim to enhance students’ interest in general practice. To further increase the number of GPs, medical training should support students in making career choices that suit them as a person. Can taking students’ personality traits into account add value to this?

Objectives

We hypothesise that students pursuing a career in general practice show outlined manifestations of personality traits that influence their interest.

Methods

In March 2021, we started an ongoing online survey among medical students at the University of Würzburg aiming to collect longitudinal data about the ‘Big Five’ personality traits and aspects of career choice. Until December 2022, we invited three cohorts of first-year beginners and one cohort each of third-, fifth- and sixth-year students via email to participate in line with data protection guidelines. We performed partial correlation and ANCOVA analyses to examine the relationship between students’ interests in general practice and their personality traits, controlling for gender and age as possible confounding factors.

Results

According to our research, the personality traits of agreeablenessand conscientiousness were the most significant factors that impacted students' decision to pursue general practice as a specialty. There was a significant positive correlation for agreeableness (r=.18, p<.001) and a negative correlation with conscientiousness (r=-.11, p=.03), while the results for openness(r=-.05, p=.35), extraversion(r=.076, p=.14), and neuroticism (r=.077, p=.059) were not significant. High extents of agreeablenessand low extents of conscientiousnesscould predict a greater interest in General Practice. Female students scored higher than males on all personality traits. Most interest in choosing General Practice as a specialty was stated by female students with high extents of agreeableness.

Conclusion

This study shows a link between students’ interest in becoming a GP and their personality. The curriculum ought to offer opportunities for students to develop their personalities and prepare for their professional careers. Considering personality can also help to support students in their career choices and to identify promising students for programs promoting the next generation of GPs.

Medical studies

students

personality

General Practice/Family Medicine

‘Big Five’

career choice

The shortage of General Practitioners (GPs) is a well-known problem that remains a challenge. The rapidly growing ageing population worldwide continues to increase the demand for primary care, but the supply of medical graduates embarking on a GP career is not keeping up. The proportion of elderly GPs is also increasing, with one-third of currently employed GPs in Germany being 60 years and older (1, 2). Projections by the National Association of Statutory Health Insurance Physicians (KBV) in Germany indicate a shortage of over 10,500 primary care doctors by 2030 (3).

To address this challenge in the long term, it’s essential to encourage more students to specialise in General Practice and prioritise their training as future GPs. Some German federal states introduced a rural doctor quota (‘Landarztquote’) for medical studies to motivate more students who will pursue a GP career (4, 5). A preferential selection of rural students and immersion in the rural environment at different stages of their medical studies and for a longer period has proven to be an effective tool (6, 7). In addition, support or scholarship programmes aim to promote students with an interest in General practice from early on in their studies. The project ‘Beste Landpartie Allgemeinmedizin’ (BeLA; ‘Best Rural Outing – General Practice’) is funded by the Bavarian State Ministry of Health and Care (8). It includes financial aid and a custom-made curriculum for students that will practice in rural regions. To customise future GP training, it is essential to clearly understand their personalities to support their specialty choices and improve the matching between students and medical specialties. Assessing personality using the five-factor model, which focuses on openness (to experience), conscientiousness, extraversion, agreeableness, and neuroticism, is a well-researched approach (9). Some studies emphasise the importance of professional education and coaching of personality aspects in both physicians and students (10). Shaping certain personality traits can not only enhance students’ skills for empathic communication with future patients (11) and their openness to patient diversity (12) but can also improve patients’ safety through better inter-professional relationships among healthcare providers (13). Looking at a professional’s contentment and health, there is evidence for the positive effects of coaching programmes, e.g., leading to reduced job-related stress experience and increased resilience (14, 15, 16).

In this study, we explored the connection between personality traits in medical students and their interest in becoming a GP. We hypothesised that students who pursue a GP career show outlined manifestations of personality traits that influence their interest.

Study design and setting

This study was part of a longitudinal monitoring of medical students at Julius-Maximilians-University Würzburg, Germany, regarding interrelationships between students’ study admission, study success, and specialty choice.

Recruitment and selection of study subjects

The survey was designed to capture crucial points in time during medical school, which comprises six years in total in Germany. We addressed the first year, representing the very beginning of all studies. After the first state examination (end of 2^nd year), medical students in Germany start their clinical section, so we chose this period to address students’ characteristics at the beginning of their clinical education. In Germany, the fifth year ends with a second state examination, followed by a year of internship. Therefore, we chose this year to address students’ characteristics before experiencing education outside the university, working in a hospital, or ambulatory care. Addressing sixth-year students, we wanted to assess final characteristics at the end of the entire study programme. All students were contacted via email containing a link to the survey conducted with the platform EvaSys® (version 8.0, Electric Paper Evaluationssysteme GmbH, Lüneburg, Germany), which is hosted by the university. We used reminder emails to increase the return rate and offered free mugs with the logo of the faculty for each participant.

Survey

The survey comprised items concerning students’ demography, study permission, influences on choosing medical studies, and aspects of the study process. A test trial running from 22.03.2021 to 15.04.2021 led to minor adjustments of some items, e.g., linguistic issues or the number of response categories. The first wave of the survey started in May 2021 and continued (see Table 1 for an overview of surveys).

Study variables

Interest in General Practice: Students were asked to estimate the likelihood of choosing General Practice as their field of specialty after finishing medical school on a five-point Likert scale (‘not likely at all’ – ‘very likely’).

Personality traits: We used the German short version of the Big Five Inventory (BFI-K) to assess different personality traits in medical students by self-evaluation (17). It consists of 21 items rated on a five-point Likert scale to measure the ‘Big Five’ personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism (18). We used this short version of the personality questionnaire to limit the extent of items in the survey. More detailed information on personality assessment is provided in the supplement of this article (see Supplement 1).

Data analysis

We conducted statistical analyses on our sample using SPSS (Version 26.0, IBM, Armonk NY). We analysed the characteristics in our sample by studying the absolute frequency, mean, and standard deviation. To explore relationships between variables in the first step, we used Pearson correlation for metric variables and Spearman’s rho for non-parametric data (gender). Age and gender were estimated to be interference variables, so partial correlation and analysis of covariance (ANCOVA) were conducted to control interference effects in a second step.

To assess different extents of students’ manifestations of the five personality traits, we transformed new variables to define ‘low’ and ‘high’ extent of the personality traits by a median split. This was necessary, as the BFI-K used various items whose average values define the total scores of the personality traits, leading to many levels that were not appropriate for ANOVA testing. During the median split, endpoints of the group with lower extents were included for all personality traits except conscientiousness, where exclusion was more effective in creating similarly sized groups. We used R² (coefficient of determination) and η² (for AN[C]OVA) as measures of effect size. Because the research question constituted an exploratory approach, we waived alpha adjustment. P-values of equal to or less than 0.05 were considered significant for all tests. All tests were two-tailed.

Data management and data protection

In the preparation of the study, the data protection officer of the University of Würzburg was consulted. In compliance with the General Data Protection Regulation (GDPR), written informed consent was obtained. All data were collected and processed anonymously. To ensure anonymity, only the year of birth was inquired. The collected data are retained by the Office of Student Affairs and will be deleted 10 years after finishing the overall study in which the survey was conducted.

Ethics

The study was approved by the Ethics Committee at the University of Würzburg, Germany (ref. no 2021011803).

Sample characteristics

Out of the 1284 students who were invited to participate in the survey, 628 responded, resulting in a response rate of 48.9% (for more details, see Table 1).

Table 1: Characteristics of the survey and sample.

Year	Data collection period	Invited (N)	Response (n)	Age (M, SD)	Gender (n m/f)
1 (begin)	22.03.-15.04.2021	170	83	21.5 (2.8)	25/57
1 (begin)	17.05.-16.06.2021	167	76	22.0 (4.0)	18/58
1 (begin)	02.11.-25.11.2021	177	90	20.5 (2.5)	20/70
1 (begin)	14.11.-13.12.2022	164	84	20.9 (3.0)	30/54
3 (begin)	06.05.-31.05.2021	157	69	23.3 (3.5)	25/43⁺
5 (end)	26.05.-28.06.2021	143	66	26.0 (3.2)	24/41*
6 (end)	13.09.-18.10.2021	153	84	27.3 (2.3)	25/58⁺
6 (end)	01.03.-15.04.2022	153	80	28.0 (2.8)	21/59
	Total	1284	628	23.4 (4.2)	188/440

Legend Table 1: *1 student refers to divers; ⁺1 student refers to nothing (‘not specified’)

In this sample, the average age was 23.4 years old and the gender distribution was 70.1% female and 29.9% male. One diverse person was excluded from data analysis, as gender effects needed to be addressed and the cell population was too small here. Regarding specialty, 46.6% of the students indicated an interest in choosing General Practice (by answering ‘likely’ or ‘very likely’ when asked how likely they would choose General Practice as a specialty). Out of the entire sample, 13.9% quoted General Practice as their current first choice for specialty, including students who already committed themselves to become a GP due to study permission or sponsorship.

Correlations between personality traits and interest in General Practice controlled for age and gender effects

In line with our previous assumption, there was a significant effect of gender (male/female) on personality traits but not age (also see discussion). Detailed non-parametric correlations (Spearman’s rho) between gender and personality traits were: conscientiousness: r=.244, p<.001, agreeableness: r=.145, p<.001; neuroticism: r=.271, p<.001, openness: r=-.086, p=.032, extraversion: r=.051, p=.201. To assess the relationship between the ‘Big Five’ and the interest in GP, we used partial correlation and still found highly significant correlations between the extents of the personality traits and the interest in General Practice when controlling for the gender effect (see Figure 1). In detail, there was a positive correlation for agreeableness (r=.150, p<.001) and a negative correlation with conscientiousness (r= -.139, p <.001), while the results for openness (r=-.050, p=.217) and extraversion (r=.055, p=.169) did not reach significance. For neuroticism, the correlation was r=.069, missing the level of significance (p=.085).

Prediction of interest in GP by low vs. high manifestation of the personality traits and effects of gender

Looking at the mean manifestation ranking of the personality traits, conscientiousness had the highest mean score (M=4.107, SD=.558), followed by openness (M=3.801, SD=.729), extraversion (M=3.723, SD=.826), and agreeableness (M=3.531, SD=.756). The lowest mean score was found for neuroticism (M=2.813, SD=.819). Levels of interest in General Practice were different depending on the personality traits. Controlling for possible effects of age and gender by using ANCOVA, we found that high extents of agreeableness (p=.010, η²=.011) and low extents of conscientiousness (p=.006, η²=.012) predicted high interest in General Practice (see Figure 2).

Looking for gender in detail, there were significant differences between male and female students in their manifestation of most personality traits (conscientiousness: p<.001; agreeableness: p<.001; neuroticism: p<.001; openness: p<.048), except for extraversion (p=.254). Female students displayed higher mean scores on all personality traits (see Figure 3).

Although no interaction with gender was found by ANCOVA to be significant, we present the interest in GP by subgrouping gender and high/low extent of personality traits in Figure 4 (for detailed statistical values, see Supplement 2). Mean values for interest in GP are higher for female students (statically not significant; p=.327), whereas the effects of conscientiousness and agreeableness were consistently significant (p<.05 and p<.01, respectively; see also Figure 2).

Our study analysed the 'Big Five' personality traits of medical students and their interest in General Practice as a specialty. We found that students with higher extents of agreeableness and lower extents of conscientiousness were more likely to choose General Practice. Other studies have also explored the link between personality traits and specialty choices: Borges and Savickas suggested a rather loose association between a few personality traits and particular medical specialties (19). The extent of this association between personality traits and medical specialty choice aligns with our results, indicating quite small effect sizes. Nevertheless, our findings demonstrate a stable influence of personality traits that can not be attributed to gender or age.

The ‘Big Five’

Agreeableness describes interpersonal behaviour: People with higher scores tend to behave in an altruistic, supporting, and compassionate manner. In the GP context, this translates into the ability to establish trustful relationships and guide patients in a supportive and motivating manner over a long period of time. Consistently, other studies found higher scores of agreeableness in primary care physicians compared to, e.g., surgeons (20, 21).

Conscientiousness refers to one’s extent of thoughtfulness, goal orientation, and self-control. Individuals with higher scores tend to be more self-disciplined and persistent, while lower scores are associated with preferring spontaneity. In our study, we found lower extents of conscientiousness in students with an interest in general practice. Other studies reported contradictory results on this factor that might reflect the different composition of the reference group (22). Another explanation for the lower scores could be the need for GPs to quickly and flexibly adapt to new situations, requiring a broad and diverse knowledge base.

Neuroticism refers to relatively stable tendencies to respond with negative emotions to threat, frustration, or loss. Those with low scores tend to exhibit emotional stability and resilience, while those with higher scores are more prone to anxious, stressed, and emotionally driven behaviour (23). In our study, students with an interest in becoming a GP showed a tendency towards higher scores of neuroticism. This goes in the same direction as Mc Collough et al., who reported higher scores in GPs than in surgeons (24). Higher extents of neuroticism were associated with more concerns about the future (25). Being cautious is beneficial for GPs, as they must carefully evaluate symptoms and determine if a referral to a specialist is necessary.

We did not find significant associations between interest in General Practice and openness or extraversion. This finding could reflect less variance among medical students on these personality traits, as gender differences were less pronounced on both factors. Furthermore, students’ extents of openness and extraversion could likely play a subordinate role in the performance of medical studies, so a tendency towards the middle during the processing of the personality questionnaire might influence the (lack of) significant differences between students.

Interpretation of results

When interpreting our findings on the personalities of students, it is important to exercise caution and take into account the comparison to other students in our sample. For instance, lower scores of conscientiousness in students with an interest in general practice do not indicate that these students tend to behave carelessly. More likely, there were many students in our sample preferring a more detail-oriented specialty than general practice. More importantly, assessing personality alone is not enough to predict specialty choices. Other factors, such as age, gender, culture, or regional background, influence medical specialty choice (26, 27).

Strengths and limitations

A self-selection bias among medical students can be assumed, as student success is already associated with higher extents of conscientiousness (28). Another bias addresses students’ voluntary participation in this survey due to personality traits. For instance, Saßenroth found that the chance for ‘eager responding’ in a survey increases with higher extents of neuroticism (29). Furthermore, we could only assess the current interest in general practice that might be different from the later choice of specialty. This limitation is compensated by our collected data being representative of the whole cohort of medical students in our faculty according to age and gender, as a comparison of data from the beginners to the 6^th year and official data from our Students Deanery shows. Our cohorts will undergo surveys for the next six years, providing ample time to evaluate the medical fields our alumni ultimately pursue. This longitudinal approach may also allow us to address the influences of age and major life events during medical work. In the long term, we might even address the effect of practising as a GP on a GP’s personality. The BFI-K does not specifically address concepts such as resilience or a sense of coherence. However, we were convinced to use the BFI-K to add strength to our study by working with a personality model that has been internationally and widely used to produce well-validated findings on personality (30). Finally, we could only assess the year of birth regarding age due to data protection requirements. This might contribute to the lack of age effects.

Implications for voluntary courses and funding programmes

An overriding goal of our study was to look at the practical implications of creating course offerings for medical students to support their professional development. Our findings indicate that a voluntary course for self-reflection can help to identify personality strengths or accentuations that can either qualify for certain specialties or increase conflicts with patients and other people. For example, the reflection of high extents of neuroticism can help to reflect a diminished willingness to communicate with patients (25). Moreover, educational compact interventions with trainees in primary care have been shown to have positive effects on trainees’ self-care behaviour, which is an important skill to maintain personal well-being and professional work behaviour (31). Inspired by this, we included a voluntary course for individual stress management and group sessions of case supervision in the BeLA programme at Würzburg University. The in-house evaluation showed high contentment with these offers. Finally, entrance interviews in the BeLA programme revealed students’ strong interest and demand for voluntary courses addressing self-improvement in individual social skills.

This study shows a correlation between student's interest in pursuing a career as a general practitioner and their personality traits. However, further research is necessary to confirm these findings across other universities and countries. These insights may prove useful in supporting students in making informed decisions about their medical specialisations and career paths, ultimately contributing to greater job satisfaction and overall well-being among physicians.

Ethics approval and consent to participate

The study protocol was approved by the local institutional review and ethics board, and the registration number was 20210118 03. Participation in the study was voluntary, and participants provided informed consent upon submitting the questionnaire. Data collection and retrieval were performed anonymously via EvaSys®.

Consent for publication

Not applicable.

Availability of data and materials

The raw data supporting the contents of this article are provided on request by the corresponding author.

Competing interests

The authors declare that they have no competing interests.

Funding

The research project known as 'Best Rural Outing' received partial funding from the Bavarian State Ministry of Health and Care to conduct this study.

Authors' contributions

MK contributed to conceptualisation, methodology, formal analysis, data curation, writing - original drafts, review & editing, and visualisation. TL contributed to conceptualisation, software, validation, formal analysis, investigation, resources, data curation, writing - original drafts, and visualisation. PEH focused on writing - original draft, review & editing. SK contributed to conceptualisation, resources, review and editing of the manuscript, and funding acquisition. AS was responsible for the conceptualisation, review and editing of the manuscript, supervision, and funding acquisition.

Acknowledgements

We would like to thank the students for their participation. We also thank Dr Yvonne Kaußner and Joy Backhaus for providing support with the data analysis and Antonia Ganz for assistance with figure design.

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No competing interests reported.

Personality and Interest in General Practice: Results from an Online Survey among Medical Students.

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Abstract

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Introduction

Methods and Material

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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