Concept of distinct surgical personality revisited. Personality traits and personal values as surgical specialty choice predictors
Purpose: The Distinct Surgical Personality (DSP) concept continues to arouse avid interest for two reasons, namely social prestige of the surgery and on going development of personality diagnostic methods. The aim of the study is to verify the authors' own proposition concerning the revision of the concept of a DSP. We postulate that the declared choice of surgery depends more on personal values (as defined in the Schwartz model) than on personality traits (as defined in the Five Factor Model) Material/Methods: Conducted on 223 students from the Medical University in Lublin, the study employed the Polish versions of the Personality Inventory NEO FFI and of the instrument to measure values by Schwartz. Results: The results indicate the following predictors for the choice of the surgical specialty: conscientiousness and self enhancement (positive predictor) as well as agreeableness (negative predictor) With an increase in conscientiousness European Journal of Medical Technologies 2016; 1(10) 54 59 Copyright (c) 2016 by ISASDMT All rights reserved www. medical technologies.eu Published online 22.03.2016 7.00 scores MNiSW European Journal of Medical Technology 1(10) 2016 55 Copyright (c) 2016 by ISASDMT and self enhancement by 1 SD, the declared choice of the surgical specialty is up by 40% and 86% respectively. A similar rise in agreeableness translates into a drop in making this choice by 37% Conclusions: The present study justifies the inclusion of personality traits and personal values in the concept of Distinct Surgical Personality. The relations between personality and specialty choice in the medical profession have long been the object of empirical studies. It is assumed that "fitting" one's personality traits and specific characteristics of a job is key to one's professional career [1] Such an approach is best manifested in the concept of the Distinct Surgical Personality (DSP) An evergrowing interest in testing the DSP concept empirically is attributed to two factors. Social prestige associated with the surgery across cultures is one, and this is so irrespective of culture [2] Also in Poland surgeons are held in the highest esteem among all kinds of physicians, which, in turn, is reflected in the level of trust [3] The second reason is the continuous development of personality diagnostic methods. Early studies conducted since the 1970s utilised research techniques grounded in various theoretical standpoints. Their results led to the development of an additive juxtaposition of surgical personality traits: in the emotional sphere immunity to stress and a general mental "toughness" [4] in the cognitive sphere a realistic approach, the ability to make decisions quickly [5] and in the interpersonal sphere low empathy, a general inclination towards domination as well as attention to one's own social standing [6] As modern research into the surgical personality intensified, a standardized theoretical framework was introduced in the early 1990s based on the five factor personality model (FFM) A key concept adopted in the FFM is that of a personality trait, understood as a predisposition towards certain consistent patterns of feeling and action. The five factor model has been operationalised as the Five Factor Inventory (FFI) a research tool evaluating the intensity of the following personality traits: neuroticism refers to emotional stability versus instability, extraversion denotes intensity of inter personal relations, a need for stimulation, and a level of activity; openness to experience encompasses search for activity and new experience; agreeableness refers to the quality of interpersonal relations ranging from sympathy to animosity and conscientiousness defines a tendency to organise oneself, his/her determination and motivation [7] With an increased use of the FFI, it is possible to compare the results obtained using unambiguous personality trait categories. Such comparative studies are carried out largely along two schemes. In the first one, the control group for surgeons or students who declare the choice of the surgery is made up of non surgeons or students declaring other career options [8] In the other, comparisons are made with the findings determined for the general population [9] Scholars report in unison a higher degree of extraversion and conscientiousness, and a lower degree of agreeableness of surgeons relative to the general population as well as to a more homogenous group of physicians, residents, and medical students. In conclusion, it seems justified to claim that the data obtained by means of the FFI employed as a research tool support the concept of DSP. This specificity manifests itself already at the stage of choosing the surgical specialty and, as Drosdeck et al. [10] contend, it increases on subsequent stages of the professional career. Despite the high social standing of the surgical specialty and its perfect positioning as a potential career choice for medical school graduates, the only analysis pertaining to the concept of DSP available in Polish literature is our own research presented in a previous paper [11] which analysed the correlation between the personality of medical school students declaring the intention to specialise in surgery and the style of their future medical practice. The object of the present study is to revisit the concept of DSP. We propose that the research on surgical personality conducted to date, and limited to a diagnosis of personality traits, has been hampered by the fact that although personality traits describe fairly accurately what people are like, they fail to explain why European Journal of Medical Technology 1(10) 2016 56 Copyright (c) 2016 by ISASDMT people do what they do [12] We postulate adopting a broader definition of personality that would also account for its motivational aspects manifested in the individual preference for particular values. Similarly to the FFM, which describes the universality of personality traits, there exists a theory of values that describes the universality of motives that is the Schwartz model of values [13] This theory defines ten basic values, i.e. self direction, stimulation, hedonism, power, security, conformity, tradition, benevolence, universalism, and achievement. Basic values constitute four higher level value types, brought together under two dimensions. The first one covers 'openness to change' (self direction, stimulation) versus 'conservation' (conformity, tradition, security) The other dimension contrasts 'self transcendence' (benevolence, universalism) and 'self enhancement' (achievement, power) Despite their diversity, these traits and personal values affect one another. It follows that traits and values are key in predicting human choices. Moreover, the relative strength of the effect they have on such choices depends on whether they are made spontaneously or under intentional control. A particular effect of traits is manifested in habitual patterns of perception of reality. Where a decision falls under intentional control, it seems that values come to the fore [14] In our past article [11] we postulated that the DSP concept include personality traits and personal values. We further assumed that considering the personality variables of a comparable level of universality, the choice of surgery as a preferred specialty is determined more by values than by personality traits. The assumptions were verified with regard to students declaring the choice of the surgical specialty, who constituted the study group in our previous research. Such a decision can be justified by referring to the reports indicating the stability of early declarations of the choice of surgery as well as the availability and distribution of resident positions specific to Poland. The results of many studies converge in showing surgery as one of the most stable career options declared by medical students, which tends to remain unchanged throughout university years [15] The second reason for the decision with regard to the study group is a clear result of the centralised resident position distribution system in Poland where the availability of resident positions determines to a large degree the choice of future specialty. Vocational training in an area of one's interest is hard to come by [3] In turn, the control group was composed of students declaring the choice of specialties that involve working with the patient, historically these include family medicine, paediatrics, internal medicine, and psychiatry. The applied criteria were defined in accordance with the dichotomous taxonomy of medical specialties: technique oriented vs person oriented specialities [16] In light of our earlier observations, the choice of surgery (relative to the declared preference for person oriented specialties) is determined by a specific intensity of the higherlevel value type: self enhancement (positive predictor) and personality traits (agreeableness, neuroticism negative predictors) [11] In approaching the revisited DSP concept in the present article, we decided to modify our control group to include, for the purposes of this analysis, all students declaring the choice of a specialty other than surgery, rather than a was the case in our earlier research [11] exclusively students planning to choose one of the 'people oriented' specialties. With this revision of the control group composition we aimed to impact the influence of the deliberate selection of respondents on our results. Materials and methods There were 223 fourth year students from the Medical University of Lublin who volunteered in the study (127 females and 96 males) aged 22 27 (M=23.19, SD=1.38) Individualised studies were conducted during the academic years 2012/2013 and 2013/2014. General surgery was the most frequently indicated preference (41.7% of the respondents, N=93) For the purposes of the presently reported study, the control gr