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Female medical students: Who might make the cut?
Psychiatry Research 200 (2012) 457–463
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Female medical students: Who might make the cut? Carissa Coulston a,b, Ute Vollmer-Conna c, Gin Malhi a,b,n a b c
Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
a r t i c l e i n f o
abstract
Article history: Received 11 August 2011 Received in revised form 19 January 2012 Accepted 13 June 2012
Personality distinctions exist between male and female doctors, and between surgeons and nonsurgeons, but given the predominance of males in surgery, the personality profile of females interested in surgery is less clear. This study examined personality and other attributes of female medical students attracted to the surgical profession. A total of 580 second-year medical students in Australia completed questionnaires that measured their likelihood of considering various medical specialties, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the importance of several other parameters in directing career choice. Significantly fewer females than males rated surgery highly likely as a career. Females interested in surgery had higher Neuroticism and Agreeableness scores, and placed greater importance on ability to help people, and less importance on prestige and financial reward compared to males interested in surgery. Compared to males not interested in surgery, females interested in surgery had higher Openness scores, and placed greater importance on ability to help people, interesting and challenging work, and less importance on lifestyle. Lastly, females interested in surgery had lower Agreeableness scores, and placed greater importance on prestige and less importance on lifestyle compared to females not interested in surgery. Common findings that surgeons compared to nonsurgeons are more tough-minded, less patient-oriented and less empathic may be a function of the prevalence of males in surgery. In our sample, the females interested in surgery retained an overall similar personality profile to those less interested, with only few differences. & 2012 Elsevier Ireland Ltd. All rights reserved.
Keywords: Personality Medical students Surgery Females
1. Introduction Women are still under-represented in the field of surgery, despite increasing numbers of females enroling in medical school (Novielli et al., 2001; Hojat and Zuckerman, 2008; Goldacre et al., 2010). This male dominance in surgery is thought to relate to lifestyle issues including concerns about the feasibility of raising a family, alongside this demanding profession (Baxter et al., 1996; Wilson and Boulter, 1997; Riska, 2011). Recent Australian figures (Mahady, 2011) confirm that the field of surgery offers little workplace flexibility by way of adaptable full-time, job-share and part-time positions, thereby deterring women who have a desire to balance work with domestic commitments. Consequently, women who enter surgical careers are more likely to be unmarried and childless (Frank et al., 1998; Troppmann et al., 2009), and accepting of the notion that personal life should be sacrificed for work (Burnley and Burkett, 1986).
n Corresponding author at: Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Tel.: þ61 2 9926 7787; fax: þ 61 2 9926 7730. E-mail address: [email protected] (G. Malhi).
0165-1781/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2012.06.019
Whilst the drive to achieve a balanced lifestyle between career and family demands may be a strong factor in preventing women from entering the surgical field, other factors associated with personality also play a key role. A wealth of evidence suggests that personality profiles differ between male and female doctors (Meit et al., 2007), and between surgeons and non-surgeons (Baxter et al., 1996; Hojat and Zuckerman, 2008). The interplay between gender, personality factors and surgical versus non-surgical specialties was aptly demonstrated in two recent articles by a female psychiatrist and male neurosurgeon respectively (Coyne, 2011; McKay, 2011). The perceived rewards from helping people at their most vulnerable and unable to afford private care outweighed reduced remuneration and various stressors involved in working in the public hospital setting for the female psychiatrist (McKay, 2011), whilst unattractive financial gains, combating administration, and a lack of guaranteed indemnity in public health, were important contributors for the male neurosurgeon in his transition to full-time private practice (Coyne, 2011). The insights offered by these practitioners reflect the widely perceived personality distinctions between male and female doctors, and between surgeons and non-surgeons. Research of medical students and practitioners has shown that women tend
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to have a warmer personality and are more sensitive, empathic and self-doubting, and perhaps because of these traits, are more vulnerable to stress and emotional states, when compared to their male peers who are typically characterised as having greater emotional stability, self-assuredness, preference for facts, and a more forceful and assertive nature (Hojat et al., 2002; Meit et al., 2007). Female doctors therefore prioritise a more patient-oriented approach that emphasises interpersonal warmth, empathy and listening, whereas male practitioners favour a more instrumentoriented approach that focuses on analytical and technical skills (Batenburg et al., 1999; Hojat et al., 2002; Buddeberg-Fischer et al., 2003, 2006; van der Horst et al., 2010). Additionally, surgeons have been found to be more ‘toughminded’ and resolute, but at the same time are generally less empathic and patient-friendly than other specialists (Bruhn and Parsons, 1964; Borges and Osmon, 2001; Hojat et al., 2001, 2002). With such traits, surgeons may place greater importance on other factors such as prestige and financial reward (Bruhn and Parsons, 1964; Coombs et al., 1993; Lefevre et al., 2010). Consequently, surgery is perceived to be one of the most stressful medical specialties (Linn and Zeppa, 1984), and students who choose surgery are perhaps characterised by greater resilience and high self-esteem (Hojat and Zuckerman, 2008). Within the framework of the five-factor model of personality (Costa and McCrae, 1992), these distinctions between males and females, and between surgeons and non-surgeons are captured by the attributes of neuroticism (tendency to experience negative affects in response to stress), openness (attentiveness to feelings, intellectual curiosity, and independence of judgement), and agreeableness (modesty, tender-mindedness, altruism) (Borges and Savickas, 2002; Maron et al., 2007; Hojat and Zuckerman, 2008). Given the dominance of surgery by males, an important question that is seldom explored arises. Are surgeons less patient-oriented and characterised by emotional stability, reduced empathy and sensitivity (i.e., lower degrees of neuroticism, openness and agreeableness) as a function of gender, or does surgery per se require such traits for successful practise, irrespective of gender? Further, what types of women are cut out to be surgeons? Are they more resistant to stress and less agreeable than their non-surgical peers, or do they maintain an overall personality profile that is in keeping with female doctors in general? In this paper, we address these key questions by examining the personality profiles and specialty preferences of medical students in their early years of education, many years prior to determining career trajectory, and before influences such as family demands, for females in particular, can diminish their interest in surgery.
2. Methods 2.1. Participants and materials Over three successive years, 580 students in the second year of a six-year undergraduate medical programme at the University of New South Wales, Australia, were administered a questionnaire based on that developed for a North American study (Feifel et al., 1999). The questionnaire was administered at the beginning of the first semester as part of an introductory lecture, and had a near 100% response rate. Participation was voluntary and respondents remained anonymous. Permission to administer the questionnaire was obtained from the appropriate institutional authority. The questionnaire collected demographic information (age entering medical school, gender), and data that focused on specialty choice. Specifically, students were asked to rate for each of the specialties of Surgery, Internal Medicine, Psychiatry, Paediatrics, General Practice and Obstetrics/Gynaecology the likelihood of choosing it as a career on a five-point rating scale (1¼‘Chosen career’, 2¼ ‘Strong possibility’, 3¼ ‘No strong opinion yet’, 4¼ ‘Unlikely’, 5¼ ‘No way’). Generic factors that students considered important, namely, ‘Prestige’, ‘Financial reward’, ‘Ability to help people’, ‘Lifestyle’, and ‘Interesting & challenging work’
were also rated using a five-point scale (1¼‘Very important’, 2¼ ‘Important’, 3¼ ‘Somewhat important’, 4¼ ‘Of very little importance’, 5¼ ‘Not important’). In addition, the questionnaire incorporated the 60-item NEO Five-Factor Inventory (NEO-FFI) (Costa and McCrae, 1992), which measured each student’s scores on the five personality factors of Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A) and Conscientiousness (C). 2.2. Data analysis The collated data were entered into SPSS Windows Version 16 (SPSS Inc., Chicago, IL, USA) and analysed in several ways. Scores derived from the NEO-FFI were screened for normality, homoscedasticity and linearity of the residuals, multicollinearity, independence of errors, and univariate and multivariate outliers. Data from any students identified as univariate or multivariate outliers were deleted from subsequent analyses. Parametric tests (e.g., One-Way Analysis of Variance and Multivariate Analysis of Variance: ANOVA and MANOVA) were performed when the dependent variable consisted of continuous scores (i.e., the five personality factors), and non-parametric tests (e.g., Mann–Whitney U-test) were performed when the dependent variable consisted of categorical scores (i.e., choice of medical specialty, ratings of importance on the five generic factors pertaining to ‘Prestige’, ‘Financial reward’, ‘Ability to help people’, ‘Lifestyle’, and ‘Interesting & challenging work’). Differences between males and females were examined with respect to choice of medical specialty, the five personality factors and importance on the five generic factors. Medical specialty choice (irrespective of gender) was examined with respect to the five personality and five generic factors. Lastly, females interested in surgery were compared against males interested in surgery, as well as both males and females not interested in surgery in terms of personality and importance on the five generic factors.
3. Results 3.1. Characteristics of the sample Of the 580 students who completed the questionnaire, seven (1.2%) were identified as univariate and multivariate outliers based on their NEO-FFI scores, and their data were excluded from subsequent analyses, leaving 573 participants. The group comprised 267 males (46.6%) and 304 females (53.1%). Two students (0.3%) did not indicate their gender. The mean age of entry into medical school was 18.57 years (S.D.¼2.09), and the proportions of males and females were similar. There was no significant difference in age of entry into medical school between males (M¼18.68 years, S.D.¼2.09) and females (M¼18.45 years, S.D.¼2.09) (p40.05). 3.2. Gender Differences between males and females with respect to choice of medical specialty, personality and importance on the five generic factors is summarised in Table 1. 3.2.1. Choice of medical specialty The order of preference (and ratio of males to females) for the different specialties were Internal Medicine (n¼289; M:F 134:155), Surgery (n¼277; M:F 168:109), Paediatrics (n¼260; M:F 108:152), General Practice (n¼212; M:F 83:129), Obstetrics/Gynaecology (n¼107; M:F 28:79), and Psychiatry (n¼86; M:F 35:51). Males rated a career in Surgery as significantly more likely than did females (U ¼26,859.00, po0.001, r ¼ 0.31). Females indicated significantly higher preferences than males for a career in Obstetrics/Gynaecology (U¼ 28,496.5, po0.001, r ¼ 0.26), Paediatrics (U¼ 35,512.00, p¼0.021, r¼ 0.10), and General Practice (U¼33,650.50, p ¼0.001, r ¼ 0.14). There were no significant differences between males and females in preference ratings for Internal Medicine and Psychiatry (p40.05). 3.2.2. Personality scores Females had significantly higher scores than males on the factors of Neuroticism [Females (M¼21.53, S.D.¼7.34), Males (M¼19.46, S.D.¼7.69); F(1,569) ¼10.79, p¼0.001], Openness [Females (M¼30.68,
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Table 1 Differences between males and females with respect to choice of medical specialty, personality, and importance on the generic factors.
Medical specialty Internal Medicine
Surgery
Psychiatry
Paediatrics
Obstetrics/ Gynaecology
General Practice
Males Females
Personality Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness
Ability to help people
Lifestyle
Interesting & Challenging work
Males Females
Importance on generic factors Prestige
Financial Reward
Males Females
Indicates significantly higher scores on this factor for males.
Indicates significantly higher scores on this factor for females.
S.D.¼5.56), Males (M¼29.60, S.D.¼5.74); F(1,569) ¼5.26, p¼ 0.02] and Agreeableness [Females (M¼ 33.08, S.D.¼5.12), Males (M¼30.68, S.D.¼5.47); F(1,569) ¼29.34, po0.001]. There were no significant differences between males and females on scores for Extraversion and Conscientiousness (p40.05).
3.2.3. Importance on generic factors Males rated ‘Prestige’ (U¼31,038.00, p o0.001, r ¼ 0.20) and ‘Financial reward’ (U ¼32,584.00, p o0.001, r ¼ 0.17) as significantly more important than did females in directing their choice of specialty. Compared to males, females rated ‘Ability to help people’ as significantly more important in choosing a specialty (U¼35,088.00, p ¼0.002, r ¼ 0.13). There were no significant differences between males and females in ratings of the importance of ‘Lifestyle’ and ‘Interesting/challenging work’ in directing future specialty choice (p40.05).
3.3. Medical specialty The degree of likelihood of making a particular specialty choice was originally rated across five categories, but because of small numbers in some categories, the data were collapsed into three categories and renamed for clarity. ‘Highly likely’ combined responses for ‘Chosen career’ and ‘Strong possibility’, ‘Undecided’ represented responses for ‘No strong opinion yet’, and ‘Not likely’ combined responses for ‘Unlikely’ and ‘No way’.
Table 2 summarises the personality profiles and degree of importance placed on the five generic factors for each of the six medical specialties. 3.3.1. Personality factors 3.3.1.1. Surgery. There was an overall significant difference across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Surgery (Wilks l ¼0.97; F(10,1126) ¼ 2.03, p¼0.028). Tests of between-subjects effects showed a significant main effect for Agreeableness (F(2,567) ¼4.30, p¼0.014). Post-hoc tests showed that those who rated Surgery ‘Highly likely’ had significantly lower Agreeableness scores (M¼31.39, S.D.¼5.62) than those who indicated ‘Not likely’ to Surgery (M¼33.04, S.D.¼5.64) (t(411) ¼2.79, p¼ 0.005). There were no significant differences between students indicating ‘Highly likely’, ‘Undecided’, and ‘Not likely’ on the factors of Neuroticism, Extraversion, Openness and Conscientiousness (p40.05). 3.3.1.2. Other specialties. There was an overall significant difference across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Psychiatry (Wilks l ¼0.90; F(10,1118) ¼5.83, po0.001) and Paediatrics (Wilks l ¼0.95; F(10,1118) ¼2.89, p¼0.001). Those who rated Psychiatry ‘Highly likely’ had significantly higher Openness scores (M¼33.66, S.D. ¼5.35) than those who rated Psychiatry ‘Not likely’ (M¼28.91, S.D. ¼ 5.41) (t(399) ¼7.25, po0.001). Those who rated Paediatrics ‘Highly likely’ had
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Table 2 Personality profiles and importance on generic factors associated with choice of medical specialty.
Medical specialty Personality
Surgery
Internal Medicine
Psychiatry
Paediatrics
Obstetrics/ Gynaecology
General Practice
Neuroticism Extraversion Openness Agreeableness Conscientiousness Generic factors Prestige Financial reward Ability to help people Lifestyle Interesting & challenging
Indicates significantly higher scores on this factor.
Indicates significantly lower scores on this factor.
significantly higher Extraversion scores (M¼31.22, S.D. ¼6.05) than those who rated Paediatrics ‘Not likely’ (M¼28.75, S.D. ¼5.81) (t(3 6 1) ¼3.55, po0.001), and those who rated Paediatrics ‘Highly likely’ had significantly higher Agreeableness scores (M¼32.80, S.D.¼ 5.06) than those who rated Paediatrics ‘Not likely’ (M¼30.92, S.D.¼5.85) (t(3 6 1) ¼3.04, p¼0.003). There were no significant differences in scores across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Internal Medicine, Obstetrics/ Gynaecology and General Practice (p 40.05). 3.3.2. Importance on generic factors 3.3.2.1. Surgery. Compared to those who indicated ‘Not likely’ to Surgery, those who indicated ‘Highly likely’ placed significantly greater importance on ‘Prestige’ (U¼12,977.00, po0.001, r¼ 0.25), ‘Financial reward’ (U¼14,837.00, p¼0.001, r¼ 0.17), and lesser importance on ‘Lifestyle’ (U¼ 14,563.00, po0.001, r¼ 0.18). 3.3.2.2. Other specialties. Those who indicated ‘Highly likely’ to Internal Medicine placed significantly greater importance on ‘Interesting and challenging work’ than those who indicated ‘Not likely’ (U¼ 5320.50, p ¼0.003, r ¼ 0.16). Those who indicated ‘Highly likely’ to Paediatrics placed significantly greater importance on ‘Ability to help people’ than those who indicated ‘Not likely’ (U ¼10,126.00, p o0.001, r ¼ 0.22). Those who indicated ‘Highly likely’ to Obstetrics and Gynaecology placed significantly less importance on ‘Interesting and challenging work’ (U ¼11,859.00.00, p ¼0.033, r ¼ 0.11) and ‘Ability to help
people’ (U¼11,713.50, p¼0.016, r¼ 0.13) than those who indicated ‘Not likely’. Finally, those who indicated ‘Highly likely’ to General Practice placed significantly greater importance on ‘Lifestyle’ (U¼16,609.50, p¼ 0.047, r ¼ 0.10), and significantly less importance on ‘Interesting and challenging work’ (U ¼ 14,713.50, p o0.001, r ¼ 0.21) and ‘Prestige’ (U¼14,555.50, po0.001, r ¼ 0.19) than those who indicated ‘Not likely’. 3.4. Gender by interest vs. non-interest in surgery 3.4.1. Personality factors There was an overall significant difference across the five personality factors between females who indicated ‘Highly likely’ to Surgery, ‘Unlikely’ to Surgery, and males who indicated ‘Highly likely’ to Surgery and ‘Unlikely’ to Surgery (Wilks l ¼ 0.84; F(15,1115.67) ¼5.02, po0.001). Tests of between-group effects showed a significant main effect for Neuroticism (F(3,408) ¼6.37, po0.001), Openness (F(3.408) ¼ 4.48, p ¼0.004) and Agreeableness (F(3,408) ¼8.05, p o0.001). 3.4.2. Importance on generic factors Compared to males who indicated ‘Highly likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Ability to help people’ (U¼7941.50, p¼0.047, r ¼ 0.12), and significantly lesser importance on ‘Prestige’ (U¼7258.50, p ¼0.007, r¼ 0.16) and ‘Financial reward’ (U ¼6496.00, p o0.001, r ¼ 0.25). Table 3 summarises the differences between females interested in surgery compared to males interested in surgery, and
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Table 3 Personality profiles and importance on generic factors for females interested in surgery versus males interested in surgery, and males and females not interested in surgery.
Females interested in Surgery (n=109) VERSUS: Personality
Males interested in Surgery (n=168)
Males not interested in Surgery (n=37)
Females not interested in Surgery (n=98)
Neuroticism Extraversion Openness Agreeableness Conscientiousness Generic factors
Prestige Financial reward Ability to help people Lifestyle Interesting & challenging work
Indicates higher scores on this variable for Females interested in Surgery.
Indicates lower scores on this variable for Females interested in Surgery.
both males and females not interested in surgery in terms of the five personality factors and importance on the five generic factors. With respect to Neuroticism, females who rated Surgery ‘Highly likely’ had significantly higher scores (M¼22.34, S.D.¼7.55) than males who rated Surgery ‘Highly likely’ (M¼18.70, S.D.¼5.62) (t(275) ¼3.78, po0.001), but there were no differences between females who rated ‘Highly likely’ to Surgery and both males and females who rated ‘Not likely’ to Surgery (p40.05). With respect to Openness, females who rated Surgery ‘Highly likely’ had significantly higher scores (M¼30.59, S.D. ¼5.59) than males who rated Surgery ‘Not likely’ (M ¼27.46, S.D. ¼6.23) (t(144) ¼ 2.86, p ¼0.005), but there were no differences between females who rated ‘Highly likely’ to Surgery and males who rated ‘Highly likely’ to Surgery and females who rated ‘Not likely’ to Surgery (p40.05). With respect to Agreeableness, females who rated Surgery ‘Highly likely’ had significantly higher scores (M ¼32.45, S.D. ¼ 5.27) than males who rated Surgery ‘Highly likely’ (M ¼30.71, S.D. ¼5.76) (t(275) ¼2.53, p¼0.012), and significantly lower scores than females who rated ‘Not likely’ to Surgery (M¼33.95, S.D. ¼5.54) (t(205) ¼2.00, p ¼0.047), but there were no differences between females who rated ‘Highly likely’ to Surgery and males who rated ‘Not likely’ to Surgery (p 40.05). Compared to males who indicated ‘Not likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Ability to help people’ (U ¼1601.50, p ¼0.05, r ¼ 0.16), ‘Interesting and challenging work’ (U¼
1457.00, p ¼0.007, r ¼ 0.22), and significantly lesser importance on ‘Lifestyle’ (U ¼1529.50, p ¼0.04, r ¼ 0.17). Compared to females who indicated ‘Not likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Prestige’ (U¼3874.50, p¼ 0.001, r ¼ 0.23) and significantly less importance on ‘Lifestyle’ (U ¼3813.50, p o0.001, r¼ 0.26).
4. Discussion The analysis conducted in this paper profiles the personality of female medical students interested in pursuing surgery as a career, and other attributes deemed influential in directing their career choice. This was considered an important issue, as it is unclear whether the typical personality profiles of surgeons are a function of the over-riding representation of males in this field, or whether women who are attracted to surgery would have similar profiles. Compared to students interested in non-surgical specialties, would they similarly show resilience to stress, less patientoriented approaches and less empathy, or would females interested in surgery retain the characteristics typically observed in females across medicine? Many of the results from our study are concordant with the findings from previous research. First, a greater proportion of males compared to females expressed a strong likelihood of pursuing surgery (Novielli et al., 2001; Goldacre et al., 2010),
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whilst a significantly greater proportion of women compared to men were attracted to the fields of paediatrics, obstetrics/gynaecology and general practice (Batenburg et al., 1999; Hojat and Zuckerman, 2008). Second, the males compared to females were characterised by lower neuroticism, openness and agreeableness traits, and they placed greater importance on prestige and financial reward, with less importance on ability to help people (Buddeberg-Fischer et al., 2003, 2006; Maron et al., 2007; Meit et al., 2007). Third, irrespective of gender, most of these personality traits and attributes found in males were apparent in students interested in surgery. That is, students attracted to surgery, irrespective of gender, had lower agreeableness traits, placed greater importance on prestige and financial reward, and less importance on lifestyle than those not interested in surgery (Bruhn and Parsons, 1964; Burnley and Burkett, 1986; Hojat et al., 2001, 2002; Lefevre et al., 2010). Conversely, non-surgical specialties attracted students who had higher openness and agreeableness traits, and who placed greater importance on lifestyle and ability to help people (Hojat et al., 2001, 2002; Borges and Savickas, 2002; Maron et al., 2007; Lefevre et al., 2010). Of particular interest here is that females attracted to surgery were different from their male counterparts in several regards. The females maintained higher neuroticism and agreeableness scores, and placed greater importance on ability to help people, and lesser importance on prestige and financial reward, in keeping with the characteristics of the female sample in general. In contrast to female medical students not interested in surgery, the females interested in surgery assigned greater importance to prestige and lesser importance to lifestyle. The latter is especially in keeping with studies showing that women interested in surgery are more likely to perceive that personal life should be sacrificed for work (Burnley and Burkett, 1986). In comparison to the males who expressed no likelihood of pursuing surgery, females interested in surgery had higher openness scores and placed greater importance on helping people, and also interesting and challenging work. However, the fact that the females interested in surgery did not differ from their male counterparts on neuroticism and agreeableness scores, suggests the possibility that a less ‘tough-mind’ and more person-oriented disposition may dissuade these males from surgery. Similarly, lifestyle may play a role as this was also of greater importance to the males not interested in surgery.
5. Limitations A primary limitation of this study concerns the target population which comprised medical students in their early years of training, and therefore, the results may not hold when extrapolated to female surgical graduates and practitioners. A larger proportion of women than men who plan to pursue surgery at the beginning of medical school lose interest in surgery and pursue non-surgical specialties (Novielli et al., 2001). Reasons that drive this change in interest for women are still not clear, however, two main factors that have been identified relate to lifestyle and exposure to the specialty through the course of medical training. In terms of lifestyle factors, younger women in their earlier years of medical school may have an intrinsically lower interest in having children, which may develop in later years of training when the realities of the pressures of the surgical specialty become realised (Troppmann et al., 2009). In terms of increasing exposure to the surgical specialty, there may be a lack of female role models, and women are confronted by the male culture in surgery that becomes a significant deterrent (Park et al., 2005). Specifically, studies have reported that a large proportion of women perceive sex discrimination in surgery, view surgeons as having a distinctive ‘macho-type’ personality, and are discouraged by
the perception of surgery as an ‘old boys’ club’ (Gargiulo et al., 2006; Stabile, 2008). The role of such factors in conjunction with personality traits would be important to examine in a prospective study, to determine more specifically what differentially influences women to retain their interest in surgery, or choose another specialty.
6. Conclusions Our finding that women attracted to the field of surgery early in their medical training did not show the traits and attitudes popularly attributed to surgeons (i.e., more tough-minded, resolute, less patient friendly and less empathic than other specialists) (Bruhn and Parsons, 1964; Borges and Osmon, 2001; Hojat et al., 2001, 2002) suggests that these traits and attributes may not be required for women to choose the surgical profession. The most remarkable difference between the young women interested in surgery and their non-surgery-oriented peers was the degree of importance placed on lifestyle and prestige, and perhaps the perception that the field of surgery is more interesting and challenging. In all other respects, the women interested in surgery remained focused on ability to help people and had overall higher ‘open’ and ‘agreeable’ traits compared to the men. However, given that the participants in this study were in their early years of medical training, it is important to replicate this study in surgical graduates and practitioners to determine more precisely what types of women might ultimately make the cut for surgery.
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Hojat, M., Gonnella, J.S., Nasca, T.J., Mangione, S., Vergare, M., Magee, M., 2002. Physician empathy: definition, components, measurement, and relationship to gender and specialty. American Journal of Psychiatry 159, 1563–1569. Hojat, M., Mangione, S., Gonnella, J.S., Nasca, T., Veloski, J.J., Kane, G., 2001. Empathy in medical education and patient care. Academic Medicine 76, 669. Hojat, M., Zuckerman, M., 2008. Personality and specialty interest in medical students. Medical Teacher 30, 400–406. Lefevre, J.H., Roupret, M., Kerneis, S., Karila, L., 2010. Career choices of medical students: a national survey of 1780 students. Medical Education 44, 603–612. Linn, B.S., Zeppa, R., 1984. Does surgery attract students who are more resistant to stress? Annals of Surgery 200, 638–643. Mahady, S.E., 2011. Adding flexibility to physician training. Medical Journal of Australia 194, 460–462. Maron, B.A., Fein, S., Maron, B.J., Hillel, A.T., El Baghdadi, M.M., Rodenhauser, P., 2007. Ability of prospective assessment of personality profiles to predict the practice specialty of medical students. Proceedings (Baylor University Medical Center) 20, 22–26. McKay, D.R., 2011. Public or private: where would you choose to work? Medical Journal of Australia 194, 458.
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Meit, S.S., Borges, N.J., Early, L.A., 2007. Personality profiles of incoming male and female medical students: results of a multi-site 9-year study. Medical Education 12, 1–6. Novielli, K., Hojat, M., Park, P.K., Gonnella, J.S., Veloski, J.J., 2001. Change of interest in surgery during medical school: a comparison of men and women. Academic Medicine 76, S58–61. Park, J., Minor, S., Taylor, R.A., Vikis, E., Poenaru, D., 2005. Why are women deterred from general surgery training? American Journal of Surgery 190, 141–146. Riska, E., 2011. Gender and medical careers. Maturitas 68, 264–267. Stabile, B.E., 2008. The surgeon: a changing profile. Archives of Surgery 143, 827–831. Troppmann, K.M., Palis, B.E., Goodnight Jr., J.E., Ho, H.S., Troppmann, C., 2009. Women surgeons in the new millennium. Archives of Surgery 144, 635–642. van der Horst, K., Siegrist, M., Orlow, P., Giger, M., 2010. Residents’ reasons for specialty choice: influence of gender, time, patient and career. Medical Education 44, 595–602. Wilson, J.A., Boulter, P.S., 1997. Targeting medical students to promote women in surgery. Journal of the Royal College of Surgeons of Edinburgh 42, 217–218.
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Psychiatry Research journal homepage: www.elsevier.com/locate/psychres
Female medical students: Who might make the cut? Carissa Coulston a,b, Ute Vollmer-Conna c, Gin Malhi a,b,n a b c
Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
a r t i c l e i n f o
abstract
Article history: Received 11 August 2011 Received in revised form 19 January 2012 Accepted 13 June 2012
Personality distinctions exist between male and female doctors, and between surgeons and nonsurgeons, but given the predominance of males in surgery, the personality profile of females interested in surgery is less clear. This study examined personality and other attributes of female medical students attracted to the surgical profession. A total of 580 second-year medical students in Australia completed questionnaires that measured their likelihood of considering various medical specialties, personality traits using the NEO Five-Factor Inventory (NEO-FFI), and the importance of several other parameters in directing career choice. Significantly fewer females than males rated surgery highly likely as a career. Females interested in surgery had higher Neuroticism and Agreeableness scores, and placed greater importance on ability to help people, and less importance on prestige and financial reward compared to males interested in surgery. Compared to males not interested in surgery, females interested in surgery had higher Openness scores, and placed greater importance on ability to help people, interesting and challenging work, and less importance on lifestyle. Lastly, females interested in surgery had lower Agreeableness scores, and placed greater importance on prestige and less importance on lifestyle compared to females not interested in surgery. Common findings that surgeons compared to nonsurgeons are more tough-minded, less patient-oriented and less empathic may be a function of the prevalence of males in surgery. In our sample, the females interested in surgery retained an overall similar personality profile to those less interested, with only few differences. & 2012 Elsevier Ireland Ltd. All rights reserved.
Keywords: Personality Medical students Surgery Females
1. Introduction Women are still under-represented in the field of surgery, despite increasing numbers of females enroling in medical school (Novielli et al., 2001; Hojat and Zuckerman, 2008; Goldacre et al., 2010). This male dominance in surgery is thought to relate to lifestyle issues including concerns about the feasibility of raising a family, alongside this demanding profession (Baxter et al., 1996; Wilson and Boulter, 1997; Riska, 2011). Recent Australian figures (Mahady, 2011) confirm that the field of surgery offers little workplace flexibility by way of adaptable full-time, job-share and part-time positions, thereby deterring women who have a desire to balance work with domestic commitments. Consequently, women who enter surgical careers are more likely to be unmarried and childless (Frank et al., 1998; Troppmann et al., 2009), and accepting of the notion that personal life should be sacrificed for work (Burnley and Burkett, 1986).
n Corresponding author at: Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Tel.: þ61 2 9926 7787; fax: þ 61 2 9926 7730. E-mail address: [email protected] (G. Malhi).
0165-1781/$ - see front matter & 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.psychres.2012.06.019
Whilst the drive to achieve a balanced lifestyle between career and family demands may be a strong factor in preventing women from entering the surgical field, other factors associated with personality also play a key role. A wealth of evidence suggests that personality profiles differ between male and female doctors (Meit et al., 2007), and between surgeons and non-surgeons (Baxter et al., 1996; Hojat and Zuckerman, 2008). The interplay between gender, personality factors and surgical versus non-surgical specialties was aptly demonstrated in two recent articles by a female psychiatrist and male neurosurgeon respectively (Coyne, 2011; McKay, 2011). The perceived rewards from helping people at their most vulnerable and unable to afford private care outweighed reduced remuneration and various stressors involved in working in the public hospital setting for the female psychiatrist (McKay, 2011), whilst unattractive financial gains, combating administration, and a lack of guaranteed indemnity in public health, were important contributors for the male neurosurgeon in his transition to full-time private practice (Coyne, 2011). The insights offered by these practitioners reflect the widely perceived personality distinctions between male and female doctors, and between surgeons and non-surgeons. Research of medical students and practitioners has shown that women tend
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to have a warmer personality and are more sensitive, empathic and self-doubting, and perhaps because of these traits, are more vulnerable to stress and emotional states, when compared to their male peers who are typically characterised as having greater emotional stability, self-assuredness, preference for facts, and a more forceful and assertive nature (Hojat et al., 2002; Meit et al., 2007). Female doctors therefore prioritise a more patient-oriented approach that emphasises interpersonal warmth, empathy and listening, whereas male practitioners favour a more instrumentoriented approach that focuses on analytical and technical skills (Batenburg et al., 1999; Hojat et al., 2002; Buddeberg-Fischer et al., 2003, 2006; van der Horst et al., 2010). Additionally, surgeons have been found to be more ‘toughminded’ and resolute, but at the same time are generally less empathic and patient-friendly than other specialists (Bruhn and Parsons, 1964; Borges and Osmon, 2001; Hojat et al., 2001, 2002). With such traits, surgeons may place greater importance on other factors such as prestige and financial reward (Bruhn and Parsons, 1964; Coombs et al., 1993; Lefevre et al., 2010). Consequently, surgery is perceived to be one of the most stressful medical specialties (Linn and Zeppa, 1984), and students who choose surgery are perhaps characterised by greater resilience and high self-esteem (Hojat and Zuckerman, 2008). Within the framework of the five-factor model of personality (Costa and McCrae, 1992), these distinctions between males and females, and between surgeons and non-surgeons are captured by the attributes of neuroticism (tendency to experience negative affects in response to stress), openness (attentiveness to feelings, intellectual curiosity, and independence of judgement), and agreeableness (modesty, tender-mindedness, altruism) (Borges and Savickas, 2002; Maron et al., 2007; Hojat and Zuckerman, 2008). Given the dominance of surgery by males, an important question that is seldom explored arises. Are surgeons less patient-oriented and characterised by emotional stability, reduced empathy and sensitivity (i.e., lower degrees of neuroticism, openness and agreeableness) as a function of gender, or does surgery per se require such traits for successful practise, irrespective of gender? Further, what types of women are cut out to be surgeons? Are they more resistant to stress and less agreeable than their non-surgical peers, or do they maintain an overall personality profile that is in keeping with female doctors in general? In this paper, we address these key questions by examining the personality profiles and specialty preferences of medical students in their early years of education, many years prior to determining career trajectory, and before influences such as family demands, for females in particular, can diminish their interest in surgery.
2. Methods 2.1. Participants and materials Over three successive years, 580 students in the second year of a six-year undergraduate medical programme at the University of New South Wales, Australia, were administered a questionnaire based on that developed for a North American study (Feifel et al., 1999). The questionnaire was administered at the beginning of the first semester as part of an introductory lecture, and had a near 100% response rate. Participation was voluntary and respondents remained anonymous. Permission to administer the questionnaire was obtained from the appropriate institutional authority. The questionnaire collected demographic information (age entering medical school, gender), and data that focused on specialty choice. Specifically, students were asked to rate for each of the specialties of Surgery, Internal Medicine, Psychiatry, Paediatrics, General Practice and Obstetrics/Gynaecology the likelihood of choosing it as a career on a five-point rating scale (1¼‘Chosen career’, 2¼ ‘Strong possibility’, 3¼ ‘No strong opinion yet’, 4¼ ‘Unlikely’, 5¼ ‘No way’). Generic factors that students considered important, namely, ‘Prestige’, ‘Financial reward’, ‘Ability to help people’, ‘Lifestyle’, and ‘Interesting & challenging work’
were also rated using a five-point scale (1¼‘Very important’, 2¼ ‘Important’, 3¼ ‘Somewhat important’, 4¼ ‘Of very little importance’, 5¼ ‘Not important’). In addition, the questionnaire incorporated the 60-item NEO Five-Factor Inventory (NEO-FFI) (Costa and McCrae, 1992), which measured each student’s scores on the five personality factors of Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A) and Conscientiousness (C). 2.2. Data analysis The collated data were entered into SPSS Windows Version 16 (SPSS Inc., Chicago, IL, USA) and analysed in several ways. Scores derived from the NEO-FFI were screened for normality, homoscedasticity and linearity of the residuals, multicollinearity, independence of errors, and univariate and multivariate outliers. Data from any students identified as univariate or multivariate outliers were deleted from subsequent analyses. Parametric tests (e.g., One-Way Analysis of Variance and Multivariate Analysis of Variance: ANOVA and MANOVA) were performed when the dependent variable consisted of continuous scores (i.e., the five personality factors), and non-parametric tests (e.g., Mann–Whitney U-test) were performed when the dependent variable consisted of categorical scores (i.e., choice of medical specialty, ratings of importance on the five generic factors pertaining to ‘Prestige’, ‘Financial reward’, ‘Ability to help people’, ‘Lifestyle’, and ‘Interesting & challenging work’). Differences between males and females were examined with respect to choice of medical specialty, the five personality factors and importance on the five generic factors. Medical specialty choice (irrespective of gender) was examined with respect to the five personality and five generic factors. Lastly, females interested in surgery were compared against males interested in surgery, as well as both males and females not interested in surgery in terms of personality and importance on the five generic factors.
3. Results 3.1. Characteristics of the sample Of the 580 students who completed the questionnaire, seven (1.2%) were identified as univariate and multivariate outliers based on their NEO-FFI scores, and their data were excluded from subsequent analyses, leaving 573 participants. The group comprised 267 males (46.6%) and 304 females (53.1%). Two students (0.3%) did not indicate their gender. The mean age of entry into medical school was 18.57 years (S.D.¼2.09), and the proportions of males and females were similar. There was no significant difference in age of entry into medical school between males (M¼18.68 years, S.D.¼2.09) and females (M¼18.45 years, S.D.¼2.09) (p40.05). 3.2. Gender Differences between males and females with respect to choice of medical specialty, personality and importance on the five generic factors is summarised in Table 1. 3.2.1. Choice of medical specialty The order of preference (and ratio of males to females) for the different specialties were Internal Medicine (n¼289; M:F 134:155), Surgery (n¼277; M:F 168:109), Paediatrics (n¼260; M:F 108:152), General Practice (n¼212; M:F 83:129), Obstetrics/Gynaecology (n¼107; M:F 28:79), and Psychiatry (n¼86; M:F 35:51). Males rated a career in Surgery as significantly more likely than did females (U ¼26,859.00, po0.001, r ¼ 0.31). Females indicated significantly higher preferences than males for a career in Obstetrics/Gynaecology (U¼ 28,496.5, po0.001, r ¼ 0.26), Paediatrics (U¼ 35,512.00, p¼0.021, r¼ 0.10), and General Practice (U¼33,650.50, p ¼0.001, r ¼ 0.14). There were no significant differences between males and females in preference ratings for Internal Medicine and Psychiatry (p40.05). 3.2.2. Personality scores Females had significantly higher scores than males on the factors of Neuroticism [Females (M¼21.53, S.D.¼7.34), Males (M¼19.46, S.D.¼7.69); F(1,569) ¼10.79, p¼0.001], Openness [Females (M¼30.68,
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Table 1 Differences between males and females with respect to choice of medical specialty, personality, and importance on the generic factors.
Medical specialty Internal Medicine
Surgery
Psychiatry
Paediatrics
Obstetrics/ Gynaecology
General Practice
Males Females
Personality Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness
Ability to help people
Lifestyle
Interesting & Challenging work
Males Females
Importance on generic factors Prestige
Financial Reward
Males Females
Indicates significantly higher scores on this factor for males.
Indicates significantly higher scores on this factor for females.
S.D.¼5.56), Males (M¼29.60, S.D.¼5.74); F(1,569) ¼5.26, p¼ 0.02] and Agreeableness [Females (M¼ 33.08, S.D.¼5.12), Males (M¼30.68, S.D.¼5.47); F(1,569) ¼29.34, po0.001]. There were no significant differences between males and females on scores for Extraversion and Conscientiousness (p40.05).
3.2.3. Importance on generic factors Males rated ‘Prestige’ (U¼31,038.00, p o0.001, r ¼ 0.20) and ‘Financial reward’ (U ¼32,584.00, p o0.001, r ¼ 0.17) as significantly more important than did females in directing their choice of specialty. Compared to males, females rated ‘Ability to help people’ as significantly more important in choosing a specialty (U¼35,088.00, p ¼0.002, r ¼ 0.13). There were no significant differences between males and females in ratings of the importance of ‘Lifestyle’ and ‘Interesting/challenging work’ in directing future specialty choice (p40.05).
3.3. Medical specialty The degree of likelihood of making a particular specialty choice was originally rated across five categories, but because of small numbers in some categories, the data were collapsed into three categories and renamed for clarity. ‘Highly likely’ combined responses for ‘Chosen career’ and ‘Strong possibility’, ‘Undecided’ represented responses for ‘No strong opinion yet’, and ‘Not likely’ combined responses for ‘Unlikely’ and ‘No way’.
Table 2 summarises the personality profiles and degree of importance placed on the five generic factors for each of the six medical specialties. 3.3.1. Personality factors 3.3.1.1. Surgery. There was an overall significant difference across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Surgery (Wilks l ¼0.97; F(10,1126) ¼ 2.03, p¼0.028). Tests of between-subjects effects showed a significant main effect for Agreeableness (F(2,567) ¼4.30, p¼0.014). Post-hoc tests showed that those who rated Surgery ‘Highly likely’ had significantly lower Agreeableness scores (M¼31.39, S.D.¼5.62) than those who indicated ‘Not likely’ to Surgery (M¼33.04, S.D.¼5.64) (t(411) ¼2.79, p¼ 0.005). There were no significant differences between students indicating ‘Highly likely’, ‘Undecided’, and ‘Not likely’ on the factors of Neuroticism, Extraversion, Openness and Conscientiousness (p40.05). 3.3.1.2. Other specialties. There was an overall significant difference across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Psychiatry (Wilks l ¼0.90; F(10,1118) ¼5.83, po0.001) and Paediatrics (Wilks l ¼0.95; F(10,1118) ¼2.89, p¼0.001). Those who rated Psychiatry ‘Highly likely’ had significantly higher Openness scores (M¼33.66, S.D. ¼5.35) than those who rated Psychiatry ‘Not likely’ (M¼28.91, S.D. ¼ 5.41) (t(399) ¼7.25, po0.001). Those who rated Paediatrics ‘Highly likely’ had
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Table 2 Personality profiles and importance on generic factors associated with choice of medical specialty.
Medical specialty Personality
Surgery
Internal Medicine
Psychiatry
Paediatrics
Obstetrics/ Gynaecology
General Practice
Neuroticism Extraversion Openness Agreeableness Conscientiousness Generic factors Prestige Financial reward Ability to help people Lifestyle Interesting & challenging
Indicates significantly higher scores on this factor.
Indicates significantly lower scores on this factor.
significantly higher Extraversion scores (M¼31.22, S.D. ¼6.05) than those who rated Paediatrics ‘Not likely’ (M¼28.75, S.D. ¼5.81) (t(3 6 1) ¼3.55, po0.001), and those who rated Paediatrics ‘Highly likely’ had significantly higher Agreeableness scores (M¼32.80, S.D.¼ 5.06) than those who rated Paediatrics ‘Not likely’ (M¼30.92, S.D.¼5.85) (t(3 6 1) ¼3.04, p¼0.003). There were no significant differences in scores across the five personality factors between those who indicated ‘Highly likely’, ‘Undecided’ and ‘Not likely’ for Internal Medicine, Obstetrics/ Gynaecology and General Practice (p 40.05). 3.3.2. Importance on generic factors 3.3.2.1. Surgery. Compared to those who indicated ‘Not likely’ to Surgery, those who indicated ‘Highly likely’ placed significantly greater importance on ‘Prestige’ (U¼12,977.00, po0.001, r¼ 0.25), ‘Financial reward’ (U¼14,837.00, p¼0.001, r¼ 0.17), and lesser importance on ‘Lifestyle’ (U¼ 14,563.00, po0.001, r¼ 0.18). 3.3.2.2. Other specialties. Those who indicated ‘Highly likely’ to Internal Medicine placed significantly greater importance on ‘Interesting and challenging work’ than those who indicated ‘Not likely’ (U¼ 5320.50, p ¼0.003, r ¼ 0.16). Those who indicated ‘Highly likely’ to Paediatrics placed significantly greater importance on ‘Ability to help people’ than those who indicated ‘Not likely’ (U ¼10,126.00, p o0.001, r ¼ 0.22). Those who indicated ‘Highly likely’ to Obstetrics and Gynaecology placed significantly less importance on ‘Interesting and challenging work’ (U ¼11,859.00.00, p ¼0.033, r ¼ 0.11) and ‘Ability to help
people’ (U¼11,713.50, p¼0.016, r¼ 0.13) than those who indicated ‘Not likely’. Finally, those who indicated ‘Highly likely’ to General Practice placed significantly greater importance on ‘Lifestyle’ (U¼16,609.50, p¼ 0.047, r ¼ 0.10), and significantly less importance on ‘Interesting and challenging work’ (U ¼ 14,713.50, p o0.001, r ¼ 0.21) and ‘Prestige’ (U¼14,555.50, po0.001, r ¼ 0.19) than those who indicated ‘Not likely’. 3.4. Gender by interest vs. non-interest in surgery 3.4.1. Personality factors There was an overall significant difference across the five personality factors between females who indicated ‘Highly likely’ to Surgery, ‘Unlikely’ to Surgery, and males who indicated ‘Highly likely’ to Surgery and ‘Unlikely’ to Surgery (Wilks l ¼ 0.84; F(15,1115.67) ¼5.02, po0.001). Tests of between-group effects showed a significant main effect for Neuroticism (F(3,408) ¼6.37, po0.001), Openness (F(3.408) ¼ 4.48, p ¼0.004) and Agreeableness (F(3,408) ¼8.05, p o0.001). 3.4.2. Importance on generic factors Compared to males who indicated ‘Highly likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Ability to help people’ (U¼7941.50, p¼0.047, r ¼ 0.12), and significantly lesser importance on ‘Prestige’ (U¼7258.50, p ¼0.007, r¼ 0.16) and ‘Financial reward’ (U ¼6496.00, p o0.001, r ¼ 0.25). Table 3 summarises the differences between females interested in surgery compared to males interested in surgery, and
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Table 3 Personality profiles and importance on generic factors for females interested in surgery versus males interested in surgery, and males and females not interested in surgery.
Females interested in Surgery (n=109) VERSUS: Personality
Males interested in Surgery (n=168)
Males not interested in Surgery (n=37)
Females not interested in Surgery (n=98)
Neuroticism Extraversion Openness Agreeableness Conscientiousness Generic factors
Prestige Financial reward Ability to help people Lifestyle Interesting & challenging work
Indicates higher scores on this variable for Females interested in Surgery.
Indicates lower scores on this variable for Females interested in Surgery.
both males and females not interested in surgery in terms of the five personality factors and importance on the five generic factors. With respect to Neuroticism, females who rated Surgery ‘Highly likely’ had significantly higher scores (M¼22.34, S.D.¼7.55) than males who rated Surgery ‘Highly likely’ (M¼18.70, S.D.¼5.62) (t(275) ¼3.78, po0.001), but there were no differences between females who rated ‘Highly likely’ to Surgery and both males and females who rated ‘Not likely’ to Surgery (p40.05). With respect to Openness, females who rated Surgery ‘Highly likely’ had significantly higher scores (M¼30.59, S.D. ¼5.59) than males who rated Surgery ‘Not likely’ (M ¼27.46, S.D. ¼6.23) (t(144) ¼ 2.86, p ¼0.005), but there were no differences between females who rated ‘Highly likely’ to Surgery and males who rated ‘Highly likely’ to Surgery and females who rated ‘Not likely’ to Surgery (p40.05). With respect to Agreeableness, females who rated Surgery ‘Highly likely’ had significantly higher scores (M ¼32.45, S.D. ¼ 5.27) than males who rated Surgery ‘Highly likely’ (M ¼30.71, S.D. ¼5.76) (t(275) ¼2.53, p¼0.012), and significantly lower scores than females who rated ‘Not likely’ to Surgery (M¼33.95, S.D. ¼5.54) (t(205) ¼2.00, p ¼0.047), but there were no differences between females who rated ‘Highly likely’ to Surgery and males who rated ‘Not likely’ to Surgery (p 40.05). Compared to males who indicated ‘Not likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Ability to help people’ (U ¼1601.50, p ¼0.05, r ¼ 0.16), ‘Interesting and challenging work’ (U¼
1457.00, p ¼0.007, r ¼ 0.22), and significantly lesser importance on ‘Lifestyle’ (U ¼1529.50, p ¼0.04, r ¼ 0.17). Compared to females who indicated ‘Not likely’ to Surgery, females who indicated ‘Highly likely’ to Surgery placed significantly greater importance on ‘Prestige’ (U¼3874.50, p¼ 0.001, r ¼ 0.23) and significantly less importance on ‘Lifestyle’ (U ¼3813.50, p o0.001, r¼ 0.26).
4. Discussion The analysis conducted in this paper profiles the personality of female medical students interested in pursuing surgery as a career, and other attributes deemed influential in directing their career choice. This was considered an important issue, as it is unclear whether the typical personality profiles of surgeons are a function of the over-riding representation of males in this field, or whether women who are attracted to surgery would have similar profiles. Compared to students interested in non-surgical specialties, would they similarly show resilience to stress, less patientoriented approaches and less empathy, or would females interested in surgery retain the characteristics typically observed in females across medicine? Many of the results from our study are concordant with the findings from previous research. First, a greater proportion of males compared to females expressed a strong likelihood of pursuing surgery (Novielli et al., 2001; Goldacre et al., 2010),
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whilst a significantly greater proportion of women compared to men were attracted to the fields of paediatrics, obstetrics/gynaecology and general practice (Batenburg et al., 1999; Hojat and Zuckerman, 2008). Second, the males compared to females were characterised by lower neuroticism, openness and agreeableness traits, and they placed greater importance on prestige and financial reward, with less importance on ability to help people (Buddeberg-Fischer et al., 2003, 2006; Maron et al., 2007; Meit et al., 2007). Third, irrespective of gender, most of these personality traits and attributes found in males were apparent in students interested in surgery. That is, students attracted to surgery, irrespective of gender, had lower agreeableness traits, placed greater importance on prestige and financial reward, and less importance on lifestyle than those not interested in surgery (Bruhn and Parsons, 1964; Burnley and Burkett, 1986; Hojat et al., 2001, 2002; Lefevre et al., 2010). Conversely, non-surgical specialties attracted students who had higher openness and agreeableness traits, and who placed greater importance on lifestyle and ability to help people (Hojat et al., 2001, 2002; Borges and Savickas, 2002; Maron et al., 2007; Lefevre et al., 2010). Of particular interest here is that females attracted to surgery were different from their male counterparts in several regards. The females maintained higher neuroticism and agreeableness scores, and placed greater importance on ability to help people, and lesser importance on prestige and financial reward, in keeping with the characteristics of the female sample in general. In contrast to female medical students not interested in surgery, the females interested in surgery assigned greater importance to prestige and lesser importance to lifestyle. The latter is especially in keeping with studies showing that women interested in surgery are more likely to perceive that personal life should be sacrificed for work (Burnley and Burkett, 1986). In comparison to the males who expressed no likelihood of pursuing surgery, females interested in surgery had higher openness scores and placed greater importance on helping people, and also interesting and challenging work. However, the fact that the females interested in surgery did not differ from their male counterparts on neuroticism and agreeableness scores, suggests the possibility that a less ‘tough-mind’ and more person-oriented disposition may dissuade these males from surgery. Similarly, lifestyle may play a role as this was also of greater importance to the males not interested in surgery.
5. Limitations A primary limitation of this study concerns the target population which comprised medical students in their early years of training, and therefore, the results may not hold when extrapolated to female surgical graduates and practitioners. A larger proportion of women than men who plan to pursue surgery at the beginning of medical school lose interest in surgery and pursue non-surgical specialties (Novielli et al., 2001). Reasons that drive this change in interest for women are still not clear, however, two main factors that have been identified relate to lifestyle and exposure to the specialty through the course of medical training. In terms of lifestyle factors, younger women in their earlier years of medical school may have an intrinsically lower interest in having children, which may develop in later years of training when the realities of the pressures of the surgical specialty become realised (Troppmann et al., 2009). In terms of increasing exposure to the surgical specialty, there may be a lack of female role models, and women are confronted by the male culture in surgery that becomes a significant deterrent (Park et al., 2005). Specifically, studies have reported that a large proportion of women perceive sex discrimination in surgery, view surgeons as having a distinctive ‘macho-type’ personality, and are discouraged by
the perception of surgery as an ‘old boys’ club’ (Gargiulo et al., 2006; Stabile, 2008). The role of such factors in conjunction with personality traits would be important to examine in a prospective study, to determine more specifically what differentially influences women to retain their interest in surgery, or choose another specialty.
6. Conclusions Our finding that women attracted to the field of surgery early in their medical training did not show the traits and attitudes popularly attributed to surgeons (i.e., more tough-minded, resolute, less patient friendly and less empathic than other specialists) (Bruhn and Parsons, 1964; Borges and Osmon, 2001; Hojat et al., 2001, 2002) suggests that these traits and attributes may not be required for women to choose the surgical profession. The most remarkable difference between the young women interested in surgery and their non-surgery-oriented peers was the degree of importance placed on lifestyle and prestige, and perhaps the perception that the field of surgery is more interesting and challenging. In all other respects, the women interested in surgery remained focused on ability to help people and had overall higher ‘open’ and ‘agreeable’ traits compared to the men. However, given that the participants in this study were in their early years of medical training, it is important to replicate this study in surgical graduates and practitioners to determine more precisely what types of women might ultimately make the cut for surgery.
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