Introduction

This blog is about medical education in the US and around the world. My interest is in education research and the process of medical education.



The lawyers have asked that I add a disclaimer that makes it clear that these are my personal opinions and do not represent any position of any University that I am affiliated with including the American University of the Caribbean, the University of Kansas, the KU School of Medicine, Florida International University, or the FIU School of Medicine. Nor does any of this represent any position of the Northeast Georgia Medical Center or Northeast Georgia Health System.



Wednesday, May 16, 2018

I recently saw this really interesting article (1) in Medical Teacher, the official journal of AMEE.  The authors, Renee A. Scheepers and colleagues from the Center for Evidence Based Education at the University of Amsterdam, asked a great question: which personality traits affect a supervising physician’s doctor role and teacher role engagement? They were also trying to determine if engagement in work would have an affect on the association between teaching performance and a faculty member’s personality.  Of secondary importance to this study, but arguably as important overall as the engagement question was the idea that engaged physicians may experience less burnout.

The authors started out with the Five Factor model of personality traits (2) which has five separate domains, including conscientiousness, agreeableness, extraversion, emotional stability, and openness. Prior work had identified that conscientiousness is associated with engagement and dedication to work and may lead to improvement in teaching engagement. (3) 

As physician burnout continues to make headlines in the US, there has been precious little progress in helping the physician community to adequately respond.  Physician suicide is disproportionately higher than the general population. (4) Gonzalez-Roma and colleagues (5), noted that work engagement is the opposite of burnout, it’s a positive and active state of mind. Feedback, particularly on your performance as a teacher, may stimulate engagement, and interestingly be protective against burnout. 

This study took place in 61 residency programs that were located in 18 different hospitals (2 academic, 16 community) in the Netherlands. The authors invited 815 resident physicians to participate.  By the end of the study period, 67% of the residents completed evaluations on 805 / 819 supervising physicians. 78 percent of the supervising physicians self-reported personality traits using the BFI-10 (Big Five Inventory). The authors used the validated Utrecht Work Engagement Scale (UWES-9) to measure overall work engagement, but the measure also was able to separate engagement in their role as a physician from their role as a teacher.

The authors found that conscientiousness, extraversion, and emotional stability were all positively associated being engaged as a physician, while conscientiousness, extraversion, and agreeableness were associated with engagement as a teacher. They didn’t find any direct association between personality traits and teaching performance as evaluated by the residents. It seems that the physicians’ engagement explained more of the residents’ positive evaluations than any individual personality characteristic. But since having the characteristics of extraversion, agreeableness, and conscientiousness led to more engagement as a teacher, the residents liked their teaching style better.

So, some of this is a no-brainer! If you are more engaged, the residents will see you in a more positive light as a teacher. When students identify their best teachers, they often mention things like passion and excitement for the topic. That would also fit in the extraversion model.  Agreeableness may be a proxy measure of the atmosphere of a safe, non-toxic teaching environment that is promoted by great teachers.

The authors also made the observation that conscientiousness, while seen as a positive teaching characteristic may lead to increased stress on the physician work side of the equation because it also includes goal-directed and achievement-oriented behaviors. This can lead to overly high standards and higher stress levels in physicians. 

The bottom line is that engaged teachers receive better evaluations from residents for their teaching performance than do engaged physicians. Unfortunately, supervising physicians were more engaged in the physician work than they were for their teaching work. We need to work to identify ways to help supervising physicians build engagement with their teaching role, while continuing to support and build engagement in their physician role.

References
1. Scheepers RA, Araha OA, Heinemana MJ, Lombarts KM.  How personality traits affect clinician-supervisors’ work engagement and subsequently their teaching performance in residency training.  Medical Teacher  2016; 38 (11): 1105–1111.
2. McCrae RR, Costa PT. Validation of the five-factor model of personality across instruments and observers. J Pers Soc Psychol. 1987; 52: 81.
3. Akhtar R, et al. The engageable personality: personality and trait as predictors of work engagement. Pers Individ Differ 2015; 73: 44–49.
4. Schernhammer ES, Colditz GA. Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). Am J of Psychiatry  2004; 161(12): 2295-2302.
5. Gonzalez-Roma V, et al.  Burnout and work engagement: independent factors or opposite poles? J Vocat Behav 2006; 68: 165–174.

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