Personality testing in the context of selecting health professionals

Abstract

It is a topic that has been debated for years: Is it useful to include assessment of personal qualities in the selection procedure for future health professionals? It is widely acknowledged, indeed axiomatic, that doctors and other health care workers need attributes additional to academic ability to perform competently and professionally. However, there has been a great reluctance to include serious assessment of anything other than academic scores or cognitive skills into selection procedures either at undergraduate level for entry to medical school, or when graduates are being chosen for specialist training positions. Even assessment of communication skills, a fundamental requirement of all potential health care professionals, is typically not included as part of the selection procedure for health professional programmes other than medicine. And even interviews, which are perhaps the best way to measure communication skills, are not universally conducted. At least one medical school in very recent years has abandoned the interview as a component of its student selection procedure (Wilkinson et al. 2008). What are the reasons? There appear to be many. Firstly, it is suggested that the necessary personal qualities can be taught during the course of studies – indeed this is a primary purpose of undergraduate education. It may be true that some skills in the interpersonal domain can be taught. However, it must be acknowledged that an individual’s basic personality and value system must have an important bearing on the success of such educational interventions. The study published in the current issue of Medical Teacher gives considerable insight. Matveevskii and Merlo (2009) showed that residents in an anaesthesiology training programme rated by their mentors as high achieving could be differentiated on the basis of the presence of desirable personal qualities, such as cooperation, self-efficacy and adventurousness. They also had lower scores – compared to their lesser rated peers – on measures of neuroticism, anger and vulnerability. Interestingly, according to an earlier report, anaesthesiology trainees identified as more competent did not differ from their peers on test scores, grade point average or class rank (Baker et al. 1993), and the present study reports no difference between the high- and low-achieving residents in terms of their fine motor dexterity, executive functioning, processing speed or sustained attention, i.e. their cognitive and psychomotor skills; the difference lies in the non-cognitive domain. The authors of the study provide a compelling argument in favour of measuring a spectrum of personal qualities to reduce the presence of unsuitable individuals who ‘may ... be more likely to contribute to critical incidents during clinical care or to cause other problems within the training programme’. The second reason often given, particularly by medical schools, for non-adoption of measures other than academic scores at the point of selection is centred on the proposition that ‘medicine is a broad church’ and that there is a potential niche for anyone who has the academic ability to graduate from a medical school programme. It is true that there is a very wide range of specialties in the health care domain, but most would acknowledge that all health professionals must possess a basic, generic range of personal qualities that includes good communication and interpersonal skills, personal reliability and conscientiousness, emotional stability, robust mental health and high ethical standards. Accordingly it would seem reasonable to measure these qualities at the point of selection and use the information for making admissions decisions.