Does personal character affect the results of clinical performance skill tests?

Dear Sir

An objective structured clinical examination (OSCE) and clinical performance examination (CPX) are well-known practical tests to assess the students in a simulation-based situation. Various responses can be provoked when clinical practices are tested in these simulated exams. Some students have an uncomfortable or anxious feeling, and do not perform well, but others do their best without any uneasiness, even in a first attempt, irrespective of the grades of the written exams. What leads to this difference? Personality is defined as the fundamental character of a person that distinguishes an individual, and the sum of an individual's behavioral and emotional characteristics. Among numerous ways to define and categorize personalities, the Myers-Briggs Type Indicator (MBTI) is one of the most well-known and popular tools. Examining medical student personality is known to be useful to counsel their learning style or difficulties in educational process and future career development. Moreover, personality traits measured by the MBTI are significantly related to anxiety sensitivity and academic achievement in undergraduate students (Nyland et al. 2000; Kameda et al. 2003). Thus, we postulated that personality could be an important factor influencing the results of the clinical performance tests.

Raw data were obtained from 55 fourth-grade medical students. They had all completed the regular courses and passed exams. To assess personality types, we used the Korean version of the MBTI questionnaire. The proportion of four paired MBTI dimensions was Introversion–Extroversion (67.3% versus 32.7%), Sensing–Intuition (76.4% versus 23.6%), Thinking–Feeling (61.8% versus 38.2%), and Judging–Perception (56.4% versus 43.6%). The dominant personality types were ISTJ (23.6%), ESTJ (14.5%), and ISTP (10.9%). The first OSCE test showed higher scores in Extraversion, Judging, and Sensing–Judging types compared to the counterparts, but this effect was not observed in the second OSCE test. On the CPX, Extraversion, Sensing, and Judging types had a higher score, as measured by standardized patients.

According to the results, specific personality traits affect the results of clinical performance skill exams, but the effect could have faded away with the increase of student's experience and proper educational training or feedback. We hope this study will help medical students when they reflect on a difficulty in performance tests by their own personality which could be overcome by proper education and training, and also give useful information to examiners when they guide or instruct students about clinical performance tests. This emphasizes the importance of faculties’ role to encourage and educate medical students properly, not to leave them to fall behind the competition (Ramani 2006).