شخصیت و ارزش به عنوان پیش بینی کننده هایی در انتخاب تخصص پزشکی

Research rarely considers the combined influence of personality traits and values in predicting behavioral outcomes. We aimed to advance a germinal line of inquiry that addresses this gap by separately and simultaneously examining personality traits and physician work values to predict medical specialty choice. First-year medical students (125 women and 119 men) responded to measures of personality and physician work values. After graduation, participants' residency choices were identified. Results indicated that personality traits predict person- or technique-oriented medical specialty choice. Physician work values, whether used alone or in tandem with personality traits, however, did not significantly predict specialty choice. Implications for practice and research are discussed.

Work values have long been considered as a trait variable suitable for matching people to jobs in individual difference tradition (Lofquist and Dawis, 1978, Holland, 1997, Rounds, 1990 and Super, 1970). As such, theorists and researchers have advanced work values, much like personality traits, as useful for predicting and promoting a range of behavioral outcomes. Such outcomes include occupational choice, work adjustment, and job satisfaction (Dawis, 1991, Dawis, 2001, Holland, 1997, Super, 1995 and Zytowski, 1994). Both work values and personality traits are widely thought to affect work motivation (Dawis, 2001 and Furnham et al., 1999) and research generally supports links between personality and vocational choice (Phillips & Jome, 2005). The utility of values alone as an individual difference variable for predicting vocational choice, while receiving some support (e.g., Judge & Bretz, 1992), has not, however, been as well studied and consequently not as well supported by the literature (Dawis, 2001 and Hirschi, 2008). Some research suggests that examining the combined influence of values and other variables, such as personality and vocational interests, may be a more useful approach to using values for predicting behavioral outcomes like vocational choice (Duffy et al., 2009, Hirschi, 2008, Parks and Guay, 2009 and Rounds, 1990). The present study aimed to further test this possibility by examining the combined influence of personality traits and values in predicting medical specialty choice. Distinct lines of inquiry have investigated the particular and separate influences of values and personality on human behavior. Seldom have researchers examined the potential joint influences of these variables on behavioral outcomes. To address this problem, Parks and Guay (2009) developed a model that simultaneously considers values and personality in motivational processes related, respectively, to goal content such as achieving good grades and goal striving such as persisting in a behavior despite obstacles. Within this framework, personality traits reflect what people tend to do naturally and values reflect what people believe they ought to do. When combined, personality traits and values may increase predictability of behavioral outcomes because they represent distinct yet complementary variables (Parks, 2007). Recent work in vocational psychology (Berings et al., 2004, Hirschi, 2008 and Duffy et al., 2009) has begun to examine personality and values, both in tandem and along with other constructs. This work aims to gain a more complete and holistic understanding of how these variables influence vocational behavior. Notably, Hirschi (2008) examined personality complexes comprising traits, vocational interests, work values, and self-evaluations. Results of his study supported using these variables in combination to better comprehend career choice and development. Similarly, Berings et al. (2004) found that a majority of work values relate moderately to personality traits. We aimed to further test relationships between personality traits and work values by examining their potential joint influence in predicting career specialty choice among medical students. Previous research has established that significant differences in personality traits and values exist among physicians with regard to their medical specialty (e.g., Borges and Gibson, 2005, Borges and Osmon, 2001, Hojat et al., 1998, Smith et al., 2007, Wasserman et al., 1969 and Xu et al., 1996–1997). Differences in personality traits and values have also been observed in relation to medical students' self-reported specialty preferences (Hojat and Zuckerman, 2008, Leong et al., 2005, McFarland and Rhoades, 1998 and Rogers and Searle, 2009). However, these studies have investigated personality traits and values with cross-sectional research designs and have examined personality traits and values separately. The complementary nature of personality traits and values (Parks, 2007 and Parks and Guay, 2009) may in fact prove to be particularly useful in predicting differences related to specialty choice. Using a longitudinal design, the present study investigated separately and conjointly the variables of personality traits and physician work values as predictors of medical specialty choice within a sample of first-year medical students. Previous research has demonstrated that personality and value differences exist among practicing physicians in relation to chosen specialty and among medical students in relation to specialty preference. We hypothesized that personality traits and values will separately predict specialty choice. Additionally, we hypothesized that using personality traits and values in tandem will increase the accuracy in predicting medical specialty choice.

The present study examined whether or not combining physician work values with personality traits would add to the predictive validity in differentiating first-year medical students who enter person- or technique-oriented specialties. We hypothesized that personality traits and values when used separately would predict medical specialty choice and that when used in tandem would increase predictive accuracy. The results of the study only found partial support for our hypotheses. Only personality traits demonstrated any predictive utility in differentiating those that entered person- or technique-oriented specializations. Specifically, our findings indicate that the personality traits of Sensitivity, Dominance, Warmth, Rule-consciousness, Tension, Vigilance, and Apprehension differentiate those who enter person- or technique-oriented specialties. Physician work values do not make such differential predictions when used alone. Further, combining physician work values with personality traits slightly decreases the predictive efficiency of personality traits alone in differentiating person- vs. technique-oriented specialty choices among first-year medical students. Therefore, the assessment of physician work values early in medical education does not appear to have any predictive utility in specialty choice at the time of residency selection. The results of the present study support findings from previous research that personality differences exert some influence on medical specialty choice (Borges & Savickas, 2002). The present findings indicate that first-year medical students who tend to be more attentive to others, tender minded, worrisome, and conscientious are more likely to enter person-oriented specialties. Conversely, our findings indicate that first-year medical students who tend to be more skeptical, socially dominant, and impatient are more likely to enter technique-oriented specialties. Physician work values on the other hand did not demonstrate such predictive utility when used alone or in tandem with personality traits. This result contradicts a cross-sectional study that examined physician work values in relation to specialty preference. In a sample of Australian first and final-year medical students, Rogers and Searle (2009) reported that physician work values as measured by the PVIPS predicted choice for primary care and non-primary care specialties. Results indicated that medical students who had a preference for non-primary care specialties placed a higher value on prestige and scholarly pursuits whereas those who preferred primary care specializations tended to value autonomy to a greater degree. However, given the cross-sectional nature of the study, a major limitation is that students indicated their specialty preference and not their actual choice as in the case of the current study. A potential reason why physician work values did not differentially predict specialty choice may be attributed to the nature of the PVIPS and the participant pool in this study. The PVIPS was designed to assess work values in the context of medical practice (Hartung et al., 2005). The context-specific content of the PVIPS may not be suitable in assisting first-year medical students' discernment of physician work values since they have not yet been exposed to medical practice as part of their training. The assessment of such context-specific values may not lend itself to differential prediction of specialty choice until medical students have some direct contact with various specialties. Recent longitudinal research indicates that the clinical experiences gained during the clerkship phase of medical education significantly influence specialty preference (Maiorova, Stevens, Scherpbier, & van der Zee, 2008). It may not be until students have a sufficient frame of reference regarding medical practice that physician work values can be meaningfully assessed and thereby become useful in predicting specialty choice. Alternatively, it may be the case that as guideposts of vocational behavior, values influence how an individual practices an occupational choice rather than predict what occupation an individual chooses. For example, one person makes the occupational choice of physician primarily to realize altruistic values, whereas another person does so primarily to realize lifestyle values. If so, values may be more useful for understanding how one practices within a given occupation rather than what occupation one selects. Given the results of the current study, future longitudinal research investigating the combined predictive validity of personality traits and values in medical specialty choice may want to consider both the type of values measure used and the nature of the sample. Research involving medical students prior to clerkship experiences might do well to consider personal values assessment (e.g. Rokeach Value Survey; Rokeach, 1973) or generic work values assessment (e.g. The Values Scale; Nevill & Super, 1989) to investigate whether these more general values assessments add incremental validity in the prediction of specialty choice. Research involving medical students' clerkship experiences should consider using more context-specific values measures such as the PVIPS to examine whether a context-specific measure of values has greater utility once a student has acquired a frame of reference for medical practice. Results of the current investigation also have implications for practice. Students struggling with specialty choice can benefit from career counseling interventions (Leong et al., 2005). Results from the current study indicate that personality traits differentiate first-year medical students entering person- or technique-oriented specialties. These personality differences can be observed early in medical education and therefore may be useful in facilitating early exploration of medical specialties. Specialty exploration with first-year medical students should initially focus on these trait differences in order to facilitate broad-based exploration of person or technique-oriented specialties. This initial guidance in specialty exploration can help medical students to systematically explore specialties that are complementary to their personality without having to consider the myriad possibilities for specialization. Using personality assessments may be particularly helpful with first-year medical students because structured career exploration via field experiences in clinical settings does not seem to help students to identify a specialty preference at that point in their medical education (Borges, 2007). Although the current study examined the separate and conjoint influence of personality traits and values to prospectively predict medical specialty choice, it did, of course, have some limitations. First, results are limited to first-year medical students and may not be generalizable to medical students at more advanced levels of their medical education. A different pattern of results may have emerged had we used samples of participants across the continuum of medical school training rather than just students in their first year. Additionally, data were collected from a single medical school. Therefore, results may not generalize to other types of medical school where different admission criteria and training experiences may affect residency choices. Future research regarding personality traits and physician work values could examine how these domains contribute to predicting specialty choice and physician satisfaction and retention. First, future research should investigate the predictive utility of personality traits and physician work values combined with interest assessment contextualized for medical practice (Richard, 2005). As suggested previously, such research may yield significant results after medical students have completed their clerkships thereby giving them a frame of reference for medical practice. Additionally, future research examining the role of personality and physician work values in specialty choice should also consider whether individual differences in these domains relate to satisfaction with specialty choice. Physicians experiencing job dissatisfaction are likely to leave the field of medicine (Landon, Reschovsky, Pham & Blumenthal, 2006). Recent research suggests that job satisfaction for physicians may vary as a function of specialty area (Duffy & Richard, 2006). Research examining the role of personality and value incongruence with specialty choice may shed some additional light on the causes of job dissatisfaction among practicing physicians in similar fashion as interest incongruence has demonstrated (Borges, Gibson, & Karnani, 2005).