A comparison of personality traits, learning style, and perceived stress among surgical and nonsurgical residents in a tertiary care hospital in India.

INTRODUCTION: It is often perceived that the presence of a distinct surgical personality plays an important role in predicting success in their surgical career. This study compares the personality profiles, perceived stress, and learning styles of surgical and nonsurgical residents. AIM: The aim of this study is to examine the differences in personality traits, learning style preferences, and perceived stress among surgical and nonsurgical residents. SETTING AND
DESIGN: A cross-sectional study was conducted comparing surgical and non-surgical residents in a tertiary care teaching hospital.
MATERIALS AND METHODS: The 50-item International Personality Item Pool Big- Five Factor Marker questionnaire was used to score 5 personality domains. The 24-item Learning Style Inventory Questionnaire was used to determine the preferential learning styles (visual, auditory, or tactile). The Perceived Stress Scale was administered to assess the perception of stress in the residents. STATISTICAL ANALYSIS: t-test and chi-square test were done for statistical analysis.
RESULTS: A statistically significant difference was found in learning style preferences with visual (14.78 ± 3.73 vs. 7.4 ± 2.25) and kinesthetic styles being (13.84 ± 4.37 vs. 6.96 ± 1.47) preferred by surgical residents whereas auditory style was preferred by nonsurgical residents (P < 0.05). Surgical residents scored higher in extraversion (P = 0.00), conscientiousness (P = 0.00), and openness to experience (P = 0.00) which was statistically significant. Nonsurgical residents were found to have a higher perception of stress which was statistically significant (13.40 ± 7.10 vs. 21.12 ± 7.52) (P = 0.01).
CONCLUSION: The significant trait variance supports the concept of surgical personality. Copyright:

How personality traits fit the characteristics of an individual's chosen profession is one ofthe key factors for success in a professional career.[1] There has been growing research interest in determining personality traits in various professional fields with the aim to improve career counseling, selection processes, and training strategies.[2] Personality is the enduring set of traits and styles that the individual exhibits, which characteristically represents the dispositions of the individual and the ways in which this person differs from the standard normal person in his or her society.[3] Significant differences have been noted within the medical field in students depending on training under different specialties.[4] Personality can be comprehensively described using five higher-order factors, according to the five-factor model (FFM).[5]

Extraversion - Active, assertive, energetic, enthusiastic, outgoing, and talkative

Agreeableness - Appreciative, forgiving, generous, kind, sympathetic, and trusting

Conscientiousness - Efficient, organized, planning, reliable, responsible, and thorough

Neuroticism - Anxious, self-pitying, tense, touchy, unstable, and worrying

Openness to new experiences - Artistic, curious, imaginative, insightful, original, and wide interests.

Existing literature has supported the notion of “surgical personality,” however, clear-cut consensus has not yet been determined. Surgical personality is hypothesized to affect a patient's mortality and morbidity.[6] It is believed that low scores in openness and emotional stability may influence decision making in surgery and might affect the morbidity and mortality rate of patients.[6] A study, done in Ohio, with a sample size of 192 medical staff found that surgeons scored significantly higher on conscientiousness and extraversion but lower on agreeableness compared to nonsurgeons.[7]

Evidence from psychology literature suggests that there is an overlap that exists between personality attributes and preferred learning style.[8] An individual's learning style is referred to a characteristic mode of receiving, processing, and storing information.[9] Existing literature provides evidence that acquisition of knowledge is through four sensory modalities, visual, auditory, read/write and kinesthetic.[9] When compared to other specialties, surgeons not only need to master the complex anatomy, and physiology of the human body but also should have the ability to interpret and apply that knowledge in the operating room.[10]

Postgraduate trainees working in a tertiary care teaching hospital, experience stress daily in view of heavy workload, long working hours, night shift, brief vacation time, lesser time to sleep, eat, and study, and which is also compounded by the expectations of teachers and parents.[11] A certain amount of stress may be considered desirable for training and improved performance, but continuous chronic stress may predispose these young doctors to burnout syndrome which is detrimental for the residents themselves and also for the patient population they treat.[12] Burnout is “a persistent, negative, and work-related state of mind in individuals that are primarily characterized by exhaustion, accompanied by distress, a sense of reduced effectiveness, motivation, and the development of dysfunctional attitudes and behavior at work.”[13] Emotional exhaustion, depersonalization, and low personal accomplishment are the three elements that define the concept.[13]

In this study, we aim to find personality differences, learning styles, and perceived stress among surgical and nonsurgical residents and to compare compare these between genders.

MATERIALS AND METHODS

Ethics

Ethical clearance was obtained from the Ethical Research Committee.

Study design

Selection and description of participants

A cross-sectional study was conducted comparing 50 surgical and 50 nonsurgical residents in a tertiary care teaching hospital in Kerala. In both groups, 20 were females and 30 were males. Among the participants, non surgical residents were from dermatology, pathology, and pharmacology. Surgical residents were from general surgery, gastrosurgery, orthopedics, obstetrics and gynecology, and plastic surgery departments.

Technical information

The 50-item International Personality Item Pool Big-Five Factor Marker questionnaire was used to score 5 personality domains (extraversion, conscientiousness, agreeableness, neuroticism, and openness to experience).[14] This questionnaire, by assessing responses to 50 statements, measures the 5 domains. Each of the 5 domains is measured by 10 items and scored from 0 to 5, with 5 indicating a higher disposition for that trait.[14]

Learning styles have previously been described as predominantly clustering into three modalities of learning; visual, auditory, and tactile styles.[15] This study utilized a freely available 24-item self-reported Learning Style Inventory (LSI) Questionnaire to determine the preferential learning styles of students and trainees.[15] A score of 21 points or more in a modality indicates strength in that area. The highest of the 3 scores indicates the most efficient method of information intake. The second highest score indicates the modality which boosts the primary strength.

The Perceived Stress Scale (PSS), 10-item scale was administered to assess the perception of stress in the residents. It is a measure of the degree to which situations in one's life are appraised as stressful. The questions in the PSS ask about feelings and thoughts during the last month. The respondents answer each PSS question on a Likert scale (never, almost never, sometimes, fairly often, or very often). We scored the answers to the questions 1, 2, 3, 6, 9, and 10 by giving a score of “0” to the “never” answers and 4 to the “very often responses.” Questions 4, 5, 7, and 8 were scored by scoring “never” as 4 and “very often” as 0. The PSS score was calculated by summing up the score of all individual questions. Scores ranging from 0 to 13 would be considered low stress, scores ranging from 14 to 26 would be considered moderate stress, and scores ranging from 27 to 40 would be considered high perceived stress.[16]

Statistics

Assuming alpha error at 0.5%, power at 80%, the minimum sample size estimated is 60, but for our study, we enrolled 100 participants (50 from surgical and nonsurgical specialties). Statistical analysis was done using SPSS 20 (IBM Corp., Armonk, NY) software. Pearson's chi-square test and t-test were applied for analysis.

RESULTS

The 50-item International Personality Item Pool Big-Five Factor Marker questionnaire, LSI and PSS was filled by 50 surgical (females-20, males-30) and 50 nonsurgical (female-20, males-30) residents. Surgical residents scored higher in extraversion (41.42 ± 6.79 vs. 25.72 ± 2.73) (P = 0.00), conscientiousness (43.12 ± 4.82 vs. 37.80 ± 6.22) (P = 0.00), and openness to experience (43.94 ± 3.32 vs. 31.10 ± 5.12) (P = 0.00) than nonsurgical residents, which was statistically significant whereas nonsurgical residents scored higher in neuroticism, which was statistically significant (25.02 ± 3.88 vs. 44.92 ± 2.14) (P < 0.05) [Table 1]. Statistically significant differences were found in learning style preferences with visual (14.78 ± 3.73 vs. 7.4 ± 2.25) and kinesthetic styles being (13.84 ± 4.37 vs. 6.96 ± 1.47) preferred by surgical residents whereas auditory style (9.72 ± 2.1 vs. 15.54 ± 2.39) was preferred by nonsurgical residents (P < 0.05) [Table 2]. Nonsurgical residents were found to have higher perception of stress than surgical residents which was statistically significant (13.40 ± 7.10 vs. 21.12 ± 7.52) (P = 0.01).

Table 1

Mean scores of surgical and nonsurgical residents on each personality domain

Group	Mean±SD
	Extroversion	Agreeableness	Conscientiousness	Neuroticism	Openness to experience
	Surgical residents	41.42±6.71	37.6±6.57	43.12±4.82	25.02±3.88	43.94±3.37
Nonsurgical residents	25.72±2.73	36.74±4.07	37.8±6.22	44.92±2.14	31.1±5.12

SD – Standard deviation

Table 2

Mean scores of surgical and nonsurgical residents of learning style inventory and perceived stress

Group	Mean±SD
	Auditory style	Visual style	Kinesthetic style	Perceived stress
Surgical residents	9.72±2.13	14.78±3.73	13.84±4.37	13.4±7.1
Nonsurgical residents	15.54±2.39	7.4±2.25	6.96±1.47	21.12±7.52

SD – Standard deviation

Among surgical residents, females scored higher for conscientiousness (P = 0.01) whereas males scored higher for extraversion (P = 0.01) which was statistically significant [Table 3]. Among nonsurgical residents, females and males scored highest for neuroticism with mean of (46.1 ± 1.99)and (44.13 ± 1.88), respectively which was statistically significant [Table 3].

Table 3

Gender differences in personality traits among surgical and nonsurgical residents

Variable	Surgical residents (mean±SD)		P	Nonsurgical residents (mean±SD)		P
	Females (n=20)	Males (n=30)		Females (n=20)	Males (n=30)
	Extroversion	33.6±1.39		46.63±2.14	0.01*		23.4±1.69	27.27±2.13	0*
Agreeableness	43.8±4.09	33.47±4.23	0*	33.05±2.28	39.2±2.99	0.02*
Conscientiousness	45.7±1.62	41.4±5.46	0.01*	44.3±2.92	33.47±3.36	0.01*
Neuroticism	27.8±1.1	23.17±3.98	0*	46.1±1.99	44.13±1.88	0*
Openness to experience	44.2±2.04	43.77±4.04	0.66	25.3±1.92	34.77±1.75	0.01*

*P≤0.05 is considered statistically significant. SD – Standard deviation

Kinesthetic learning style was the most preferred by female surgical residents (17.8 ± 0.61) (P = 0.00) whereas male surgical residents preferred visual style the most (17.2 ± 1.93) (P = 0.01) which was statistically significant [Table 4]. Among nonsurgical residents, auditory learning style was the most preferred by both females (14.05 ± 2.7) and males (16.53 ± 1.45) which was statistically significant (P = 0.01) [Table 5].

Table 4

Learning style preference among surgical residents

Learning style preferences	Surgical residents (mean±SD)		P
	Females (n=20)	Males (n=30)
Auditory style	11.6±1.66	8.47±1.35	0*
Visual style	11.15±2.66	17.2±1.93	0.01*
Kinesthetic style	17.8±0.61	11.2±3.75	0*

*P≤0.05 is considered statistically significant. SD – Standard deviation

Table 5

Learning style preferences among nonsurgical residents

Learning style preferences	Nonsurgical residents (mean±SD)		P
	Females (n=20)	Males (n=30)
Auditory style	14.05±2.7	16.53±1.45	0.01*
Visual style	8±3.02	7±1.46	0.125
Kinesthetic style	7.3±1.96	6.73±0.98	0.185

*P≤0.05 is considered statistically significant. SD – Standard deviation

About 76.7% of male surgical residents had low perceived stress scores whereas 40% of female surgical residents had moderate perceived stress scores, which was statistically significant (P = 0.01). Among nonsurgical residents, 83.3% males and 40% females had moderate perceived stress levels and was statistically significant (P < 0.00) [Table 6].

Table 6

Gender differences in perceived stress among surgical and nonsurgical residents

Group	Perceived stress
	Low grade, n (%)	Moderate grade, n (%)	High grade, n (%)	P
Surgical residents
Females (n=20)	6 (30)	8 (40)	6 (30)	0.01*
Males (n=30)	23 (76.7)	7 (23.31)	0
Nonsurgical residents
Females (n=20)	6 (30)	8 (40)	6 (30)	0*
Males (n=30)	5 (16.7)	25 (83.3)	0

*P≤0.05 is considered statistically significant

DISCUSSION

Conscientiousness

During surgery, every phase of the procedure is important from prepping the patient to the final closure of the surgical site. Having conscientiousness as a trait in a surgeon makes him/her well organized and able to prioritize necessary steps to be taken if anything unexpected happens.[17]

In our study, surgical residents were found to score more on conscientiousness, with females found to be more conscientious than male surgical residents (P < 0.01). High conscientiousness also has been associated with superior academic outcomes and better job performance, not only in the medical field but also in various other professions.[18]

Extraversion

Extraversion is characterized by sociability, assertiveness, and activity. Extraverted individuals tend to be upbeat, energetic, and optimistic. Such traits may help them to bring together all their junior staff and work as a team.[19]

In this study, surgical residents scored higher on “extraversion” than nonsurgical residents which is consistent with some of the previously conducted studies.[20] On the contrary; Swanson et al.[21] demonstrated how introversion dominates the personality types of modern surgical residents, instead of the extroverted persona typically displayed by the previous generations of surgeons.

Neuroticism

During every surgery, there is a risk of unforeseen complications at every step. Surgeons should be able to remain calm and composed when something unexpected happens.

In this study, nonsurgical residents scored higher on neuroticism than surgical residents with females scoring higher than male residents. The low scores in this facet mean that surgical residents are calm, able to relax, and able to face stressful situations without becoming upset or rattled.[22] However, in a study in the UK done among 261 cardiac surgeons it was found that neuroticism does not have any influence on surgical outcomes. Since medical profession is an emotionally demanding field; this trait might have repercussions on physicians' well-being indicators such as perceived stress and job satisfaction.[23]

Agreeableness

Agreeableness is a trait which may help to gain the trust of the patients easily. It also may help in becoming a good team leader. In this study, surgical residents scored higher on agreeableness with females scoring higher than male surgical residents (P < 0.05). This finding is in line with a study by Warschkow et al. who also revealed higher agreeableness scores in surgeons.[20]

Openness to experience

Surgical field is constantly evolving. Doctors should have the ability to educate themselves on new techniques and adapt to new technologies. In this study, we found surgical residents scored higher in openness than nonsurgical residents. The gender differences were significant only in nonsurgical group with males scoring higher than females (P < 0.05). Openness always facilitates acceptance, flexibility, and adequate adjustment to situational changes. It has been more beneficial particularly in the medical clinical setting than in academic achievement during medical education.[24]

Learning style

In view of the current curriculum, long work shifts, brief relaxation period, and increased workload in postgraduate training, it has become extremely vital to manage time and utilize it carefully in effective learning. Learning style can be defined as an individual's preferred way of gathering, organizing, and thinking about information.[9] In this study, visual learning style was slightly more prevalent than kinesthetic style among surgical residents. Female surgical residents preferred kinesthetic learning style male surgical residents preferred visual learning style and the differences were statistically significant. Kim et al.[25] showed that more than 50% of surgical residents had a multimodal learning style preference. A study among surgical trainees demonstrated that tactile learning style preference increased over time which can be attributed to the greater involvement of trainees in practical surgical procedures compared with students.[26] The predominance of visual learning styles in this study supports the previous research findings suggesting that candidates with higher visuospatial ability perform better during surgical procedures. The results of this study show the importance of incorporating multimedia in surgical procedures.[27]

It is also important that students adapt to the real environment and refrain from adhering to their own preferred styles. Self-directed learning should be encouraged in residents where the learner identifies his own learning needs and actively implements certain learning strategies with or without the help of others.[10]

Perceived stress

In this study, we found that nonsurgical residents perceived more stress than surgical residents. Female surgical residents scored a higher grade of perceived stress than male surgical residents (P < 0.05). Scarce existing literature attributes high perceived stress to neuroticism trait.[28] Persons scoring high on neuroticism suffer more from emotional instability, have lower levels of self-esteem, and experience higher levels of stress.[29] A study which assessed the personality traits of 172 doctors across six general hospitals observed that stress immunity was the leading personality trait among surgeons.[30] This study is in keeping up with their findings that surgical residents perceived lesser stress than nonsurgical residents.

The major limitation of this study is a small sample size and inclusion of participants from a single institution. Hence, the results cannot be generalized. This being a cross-sectional study, does not take into account the personality traits, learning styles, and perception of stress before joining the surgical course. Residents from multiple institutions should be included to form a larger sample to generalize the results.

CONCLUSION

This is one of the few studies investigating personality traits among surgical and nonsurgical residents in India. Significant personality trait differences between male and female residents in surgical and nonsurgical groups highlights the importance of including gender in surgical personality descriptions. The findings of the study, on the whole, fit the public perception of the surgical personality: that surgeon is among other things, intellectually curious, highly disciplined, organized, and assertive.[7] Given the scarce research and variability in results, the evidence for a surgical personality is far from robust.

This study also highlights how learning style preferences and perceived stress vary with specialty and gender. Neuroticism was significantly lower in surgical residents which may explain significantly lower levels of perceived stress. Teaching stress management techniques, for example, mindfulness and other relaxation techniques may be useful to help the residents cope with their higher levels of neuroticism. Finally, knowing one's personality traits and learning styles may have implications on deciding whether they are suitable for the chosen field during postgraduate counseling. Whether these traits and learning styles were present before they chose residency or developed over the course of training, still remains obscure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.