Psychological factors determining success in a medical career: A 10-year longitudinal study

Abstract

Background: Systemic review of predictors of success in medical career is an important tool to recognize the indicators of proper training.

Aim: To determine psychological factors that predict success in a medical career. The success is defined as professional competence, satisfaction with medicine as a career, occupational stress and burnout and quality of life (QOF).

Methods: Part I (1999–2005), medical students were examined each subsequent year, beginning with admission. Assessment included academic achievement (high school final examination results, entrance exam results, academic results during medical school) and psychological characteristics (sense of coherence (SOC), depression, anxiety, coping styles, value system and need for social approval). Part II (2008–2009), the same participants completed an Internet survey 4 years after graduation. Results of the postgraduate medical exam were taken under consideration.

Results: Academic achievement predicts only professional competence. Coping styles are significant indicators of satisfaction with medicine as a career. SOC, while assessed with anxiety and depression during studies, enabled us to recognize future QOF of medical graduates. Professional stress is not predictable to such an extent as other success indicators.

Conclusions: There are significant psychological qualities useful to draw the outline of the future job and life performance of medical graduates.

Introduction

The aim of this article is to assess the relationship between success in a medical career, earlier academic achievement and the personality characteristics of medical students and graduates. The majority of existing research relating to the effectiveness of physician's work focuses on how it affects the patient. Nevertheless, the statement that treatment effectiveness also depends on the behaviour and psychophysical state of the physician is very nearly self-evident, as is the claim that those whose quality of life (QOF) is higher are more efficient at work. Analysing the existing scientific reports on success in the medical profession, we observed that studies are few in number, and relate only to certain aspects of success (e.g. the influence of grades obtained during studies on diploma examination results). These studies revealed that little can be predicted on the basis of academic achievement, as far as achieving success during studies or further professional competence is concerned (Richards et al. 1962; Ronai et al. 1984; El Mouzan 1992; Glaser et al. 1992; Minnin et al. 1993). However, there are also results showing a need for transparent and effective admission systems, as well as tools to assess some non-cognitive abilities significant in a medical career (McManus et al. 2005; Cave et al. 2007; Bore et al. 2009; Fernando et al. 2009; Powis 2009).

In 2002, British researchers identified some factors which constitute the basis of predicting success during medical school and later, in course of the career. They did this by means of a meta-analysis of 149 studies (the study group comprised a total of 22,000 people). The factors were divided into three categories:

• academic achievement (cognitive skills), determined on the basis of the grade average in high school, the results of the final high school examination and the admission examination;

• personality (non-cognitive skills);

• demographic factors (Ferguson et al. 2002).

The personality trait most often indicated as a positive predictor of high achievement during medical school and future success in the medical career was ‘conscientiousness’ (Huxham et al. 1980; Hobfoll & Benor 1981; Jones 1991; Ferguson et al. 2000; Skommer & Gromadecka-Sutkiewicz 2005). In one of the studies, however, it was found that conscientiousness, although related to high performance during medical school, was not a predictor of success in clinical practice (Ferguson et al. 2003). It was also found that ‘extraverted’ persons are more successful as paediatricians (Lacorte & Risuci 1993). Phsysicians who score high on the personality traits of ‘conscientiousness’ and ‘extraversion’ feel better prepared for starting work than those who score high on ‘neuroticism’ (Cave et al. 2009). Contradictory results were obtained as far as ‘locus of control’ is concerned, i.e. the subjective feeling of who (or what) has control over events. There are studies which indicate that a high level of internal locus of control is related to successful studies, but others dispute these findings (Grover & Smith 1981; Markert 1984). Anxiety as state (i.e. an emotional state felt by the person at a given moment or in a given context) was negatively related to success in a medical career. However, no such correlation has been proven in the case of anxiety as trait (i.e. the permanent disposition of a person to experience anxiety states, resulting from individual personality characteristics) (Pamphlett & Farnill 1995; Stewart et al. 1999). In addition, students who had a very low or very high level of anxiety (both state and trait) performed worse academically than those with a moderate level (Grover & Smith 1981).

A small number of research reports concern the professional competence of physicians. Some of these studies have explored factors that can be evaluated during medical studies, e.g. interpersonal skills, analytical skills, ability to obtain information or the grade average (Mawhinney 1976; Lipton et al. 1984; Leonardson & Peterson 1985; McManus & Richards 1986; Lipton et al. 1988; Collins et al. 1995; Julian 2005; Peskun et al. 2007). A few studies have analysed factors occurring prior to medical school admission (high school grade average, final high school examination results, university entrance exam results). It has been found, however, that results obtained prior to the medical school admission do not have a significant impact on the professional competence of physicians (Richards et al. 1962; Murden et al. 1978; Ronai et al. 1984; Peskun et al. 2007).

In 2005, Norwegian researchers published the results of a 10-year longitudinal study conducted in all medical schools in the country, exploring satisfaction with medicine as a career. The first study took place at the very beginning of the educational process; the second, in the middle of studies; the third, during the last year of medical school; and the fourth, as in our study, 4years after graduation. The authors pointed out that the factors which had the greatest impact on satisfaction with medicine as a career were ‘the perception of one's clinical abilities at the end of studies’ and ‘having a father who is a physician’ (Finset et al. 2005). Other factors occurring during studies and affecting subsequent satisfaction with the professional career were ‘the level of stress experienced during studies’, ‘identification with the role of the physician at the end of studies’ and, especially in the case of men, ‘good relations with peers’ (Gude et al. 2005).

As mentioned before, success during medical school is usually determined on the basis of the grade average (Ferguson et al. 2002). It is no easy task to define success in a medical career in a more comprehensive way. One of the fundamental problems is the comparison of the competencies required in different specialties. This phenomenon is recognized in literature as the ‘criterion problem’, and does not apply only to medical professions (Murden et al. 1978; Ripley et al. 1981; McManus et al. 1998). Moreover, for methodological reasons, it is difficult to assess the number of correct diagnoses, correctly prescribed medicines, or effective treatment of patients, or to measure physician–patient interactions. Success in a medical career is usually defined in the literature on the basis of postgraduate examination results (Ferguson et al. 2002; Goho & Blackman 2006; Jefferies et al. 2007). In addition, the following factors are taken into account (McManus et al. 2003):

• satisfaction with medicine as a career;

• stress;

• burnout;

• research output;

• career progression;

• dropout.

This article is an attempt to approach this issue in a multifaceted way. We analysed the relation between academic achievement and selected personality characteristics measured at the time of admission and during studies, and success in the medical career within 4 years after graduation. It was assumed that anxiety and depression are the most significant symptoms of stress overload in the case of students. By contrast, the sense of coherence (SOC) (i.e. the sense of comprehensibility, manageability and meaningfulness), coping styles, value systems and the need for social approval variable have been studied as a manifestation of the ability of the personality to integrate distressing events. However, success is defined in this study not only as high professional competence, but also as satisfaction with the chosen career, a low level of experienced stress and burnout, and a high QOF for the physician. It was assumed that the measures of the QOF will be general well-being and health, life satisfaction and the amount of income. One advantage of our study is that all these factors pertain to the same study group.

Table

Practice points

Success in a medical career depends more on personality than academic achievement. Grade points average score explains postgraduate medical competence. Future satisfaction with a medicine as a career, work stress and burnout, and physicians’ QOF are related to the SOC, depression, anxiety and coping styles at admission and during medical education.

Methods

Participants

The first part of the study took place a few days before the admission test in June 1999. All individuals (n = 940) who had applied to Medical University of Gdańsk, Poland received a letter with questionnaire (response rate was 39%, n = 365). Only those who passed the admission exam were taken into consideration for the purposes of our research (n = 320). The procedure was repeated subsequently at the end of every academic year (2000–2005). Questionnaire were sent to all medical students. They were told that we assessed personality characteristics during medical school. The response rate was as follows: in Year 0 (admission), n = 178 of 320 (56% response rate), in Year 1, n = 178 of 320 (56%); in Year 2, n = 129 of 280 (46%); in Year 3, n = 127 of 302 (42%); in Year 4, n = 121 of 288 (42%); in Year 5, n = 58 of 271 (21%); in Year 6, n = 138 of 240 (57%). In the 5 years after graduation, the authors cooperated with institutions responsible for postgraduate medical education in Poland. The Medical Examination Centre in Poland provided access to the examination results of postgraduates (the State Examination for Medical Doctors) for 268 identified physicians (n = 268 of 320, 84% response rate). We also cooperated with the Polish Chamber of Physicians and Dentists in Gdańsk, Poland, where we found the addresses of 255 medical doctors who had participated in the first part of the study. The response rate in this group was 21% (n = 54). The mean age of respondents on 1st of July 2009 was 29.5 ± 0.8 years (69% female).

Institution

The Medical University of Gdansk (GUMed) is the largest medical school in northern Poland. The GUMed educates (in Polish and English) more than 5000 undergraduate and postgraduate students at four faculties: Health Sciences, Medicine, Pharmacy and Biotechnology. The admission requirements are based on the high school final examination results (equivalent of the Advanced Level General Certificate of Education in England) and the medical university admission test. Medical training in Poland lasts for 6 years and is divided into 2 years of basic science and 4 years of clinical training. Graduates must complete 1 year of internship, providing medical assistance under supervision, mainly in hospital settings. They gain a licence to practice medicine when they pass the State Physicians’ Examination. The test results determine whether or not further medical specialization will be possible.

Research methods

The baseline assessment in the first part of the study included the following instruments:

• the sense of coherence (SOC-29) by Antonovsky (Antonovsky 1993; Dudek & Makowska 1993; Pasikowski 2001);

• the depression scale (MMPI-D) of the Minnesota Multiphasic Personality Inventory by (Hathaway and McKinley 1943, 1951; Matkowski 1992);

• the Spielberger State-Trait Anxiety Inventory (STAI) (Spielberger et al. 1970; Wrześniewski & Sosnowski 1996);

• the coping responses inventory by Moos (Moos 1986; Holahan & Moos 1987);

• the Rokeach value system (Brzozowski 1986, 1987, 1989);

• the need for social approval inventory by Wilczyńska and Drwal (Drwal 1995).

The baseline assessment in the second part of the study included the following:

• the Maslach Burnout Inventory (MBI);

• a self-designed survey including questions derived from ‘Social diagnosis: the conditions and quality of life in Poland’, a multi-factor, longitudinal study which began in the year 2000 (Czapiński & Panek 2000, 2003, 2005, 2007, 2009).

The choice of some of the questions used in this survey enabled the authors to make comparisons between the QOF of young doctors and the general Polish population (N = 26,178), all aged 25–34 (N = 4188) and representing the same educational level (n = 4895). The questions in the survey were related to:

• satisfaction with medicine as a career (Cronbach alpha = 0.80; r = 0.67);

• occupational stress and burnout (Cronbach alpha = 0.64; r = 0.14); in order to identify the symptoms of professional burnout, the MBI Maslach questionnaire was used (Pasikowski 2000; Schaufeli et al. 2001);

• QOL, which consisted of general well-being and health (Cronbach alpha = 0.74, r = 0.40), life satisfaction (Cronbach alpha = 0.83; r = 0.25) and size of income (Czapiński & Panek 2009).

Statistical analysis

Multiple linear regression analysis was carried out using the Forward method. The survey research was conducted according to the longitudinal paradigm for 10 years. The results of such studies often lack a significant number of data. To remove data gaps, we replaced them by interpolation, as recommended in the literature (Piriyakul 2006).

Ethical committee

This longitudinal research programme was conducted in accordance with the guidelines of the Bioethics Committee of the Medical University of Gdańsk, Poland, which reviewed and approved the project.

Results

General predictors of success

Regression analysis of professional competence showed that 9% of this can be predicted by grades on the high school final examination and the admission exam and 21% by grades obtained during medical school. None of the selected personality characteristics showed any relation to professional competence (Figure 1, Table 1).

Figure 1. Impact of significant predictors of success in a medical career. Notes: Exam, high school final and university entrance exam; Med Stud, results during medical study; SOC, sence of coherence; Dep, depression; Anx, anxiety; Cop, coping styles; Appr, the need for social approval.

Table 1.  Learning results and personality characteristics in relation to success in a medical career (general predictors of success).

	Postgraduate medical competence	Satisfaction with medicine as a career	Professional stress and burnout	QOL
				General well-being and health	Life satisfaction	Income
	R^2	R^2	R^2	R^2	R^2	R^2
	F (df)	F (df)	F (df)	F (df)	F (df)	F (df)
Academic achievement
High school final and university entrance exam	0.09***	0.11	0.10	0.01	0.03	0.21
	3.867 (7,269)	0.966 (6,48)	0.766 (6,48)	0.310 (1,53)	0.278 (6,48)	0.642 (7,47)
Results during medical studies	0.21***	0.01	0.01	0.15	0.10	0.31
	11.954 (6,270)	0.054 (6,48)	0.094 (6,48)	4.147 (1,53)	0.855 (6,48)	1.356 (6,48)
Personality characteristics, 1999–2005
Sense of coherence	0.06	0.40*	0.16**	0.88**	0.40*	0.54***
	0.672 (21,252)	2.599 (11,43)	10.66 (1,54)	7.033 (12,42)	2.599 (11,43)	13.166 (2,52)
Depression	0.03	0.12*	0.09*	0.23*	0.12*	0.41**
	1.099 (7,269)	3.561 (2,52)	5.50 (1,54)	7.038 (1,53)	3.561 (2,52)	4.868 (3,51)
Anxiety (state and trait)	0.04	0.17**	0.12**	0.58***	0.17**	0.48**
	0.795 (14,262)	5.222 (2,52)	7.23 (1,54)	9.525 (3,51)	5.222 (2,52)	4.690 (4,50)
Coping styles	0.16	0.69**	0.20	0.02	0.16	0.01
	0.726 (56,220)	2.813 (24,30)	1.31 (9,46)	0.395 (1,53)	1.513 (6,48)	0.761 (1,53)
Value system (goals in life)	0.44	0.40	0.42	0.01	0.40	0.02
	0.925 (126,150)	0.718 (26,28)	0.80 (20,26)	0.297 (1,53)	0.718 (26,28)	1.031 (1,53)
Value system (modes of conduct)	0.44	0.50	0.58	0.02	0.50	0.03
	0.951 (126,150)	1.075 (26,28)	1.53 (26,29)	0.408 (1,53)	1.075 (26,28)	1.213 (1,53)
The need for social approval	0.01	0.01	0.09*	0.24*	0.01	0.01
	0.586 (5,221)	1.073 (1,53)	5.56 (1,54)	7.41 (1,53)	0.031 (1,53)	0.459 (1,53)
Personality characteristics, year of medical school
0 year, incoming year–1999	0.13	0.42**	0.69**	0.01	0.26	0.48
	0.666 (51,225)	3.218 (10,45)	3.066 (23,32)	0.310 (1,53)	1.551 (10,44)	2.246 (7,47)
First year of medical school–2000	0.13	0.37	0.77**	0.15	0.45	0.12
	0.655 (50,226)	1.300 (17,38)	3.287 (26,28)	4.147 (1,53)	1.269 (21,33)	3.007 (1,53)
Second year of medical school–2001	0.19	0.32	0.75***	0.02	0.06	0.02
	0.980 (52,224)	1.671 (12,43)	4.838 (21,34)	0.421 (1,53)	0.687 (4,50)	0.230 (1,53)
Third year of medical school–2002	0.15	0.67*	0.50	0.11	0.47	0.47**
	0.758 (51,225)	2.146 (27,28)	1.368 (23,32)	1.403 (2,52)	1.479 (20,34)	4.407 (4,50)
Fourth year of medical school–2003	0.14	0.73***	0.32***	0.27*	0.47**	0.15
	0.707 (52,224)	4.774 (20,35)	6.106 (4,51)	4.009 (2,52)	3.981 (10,44)	1.972 (2,52)
Fifth year of medical school–2004	0.17	0.45***	0.66***	0.51	0.27**	0.36**
	0.917 (52,224)	4.791 (8,47)	3.676 (19,36)	2.486 (7,47)	6.315 (3,51)	6.183 (2,52)
Sixth year of medical school–2005	0.16	0.41*	0.54***	0.27**	0.68**	0.61
	0.836 (51,225)	2.539 (12,43)	8.039 (7,48)	8.450 (1,53)	2.658 (24,30)	1.546 (3,51)

Notes: *p < 0.05; **p < 0.01; ***p < 0.001.

In this study, 69% of satisfaction with a medical career can be predicted by the influence of previously used coping styles, 40% by the impact of the SOC, 17% by the level of anxiety and 12% by the level of depression of the respondents. Regression analysis concerning subsequent levels of studies indicated that 42% of satisfaction with the choice of a medical career can be predicted by the combined influence of personality at admission, 67% in the third year of medical school, 73% in the fourth year of medical school, 45% in the fifth year of medical school and 41% in the sixth year of medical school.

In the group of physicians we surveyed, 16% of the work-related stress and the level of professional burnout can be predicted by the influence of the SOC, 12% by the influence of the level of anxiety, 9% by depression and 9% by the influence of the need for approval. Analysis of the subsequent phases of medical studies demonstrated that 69% of future stress and burnout is predicted by the combined influence of personality at admission, 77% by the combined influence of personality in the first year of medical school, 75% in the second year, 32% in the fourth year, 66% in the fifth year and 54% in the sixth year.

In this study, QOL consisted of three aspects: general well-being and health, life satisfaction and the size of income. In regards to the level of general well-being and health of these physicians, 88% is predicted by the impact of the general SOC, 58% by the level of anxiety and 23% by the level of depression. Analysis of the subsequent phases of medical studies demonstrated that 27% of the general well-being and health within 4 years after graduation can be predicted by the combined influence of personality in the fourth year of studies and 27% in the sixth year.

The influence of the general SOC predicts 40% of future life satisfaction; the impact of anxiety, 17%; and the influence of depression, 12%. Analysis of the subsequent phases of medical school demonstrated that 47% of life satisfaction is predicted by the combined influence of personality in the fourth year of medical school, 27% in the fifth year and 68% in the sixth year.

The influence of the SOC predicts 54% of the size of income; the impact of anxiety, 48%; and the level of depression, 41%. Analysis of the subsequent phases of medical school showed that 47% of the amount of income can be predicted by the influence of personality in the third year of medical school and 36% in the fifth year.

Detailed predictors of success

A detailed analysis of the variables revealed that academic achievement in the fifth (ß = 0.23; p = 0.004) and sixth years of medical studies (ß = 0.15; p = 0.044) was of crucial significance for predicting future professional competence (Table 2). The higher the academic achievement, the higher the professional competence, measured by the results of the National Medical Examination.

Table 2.  Academic achievement and personality characteristics in relation to success in a medical career (detailed predictors of success).

		0	First	Second	Third	Fourth	Fifth	Sixth
Medical competence	Results during medical school						+	+
Satisfaction with medicine as a career	SOC comprehensibility						+	−
	SOC manageability		+	−		−	+
	SOC meaningfulness			+				−
	Anxiety–trait		−
	Depression						−
	APC logical analysis
	APC positive reappraisal	+			−
	APC seeking guidance and support		−	+
	APC problem solving	+				−
	AVC cognitive avoidance		+			−
	AVC acceptance or resignation	+			+	−	−
	AVC seeking alternative rewards	−		+		−	+
	AVC emotional discharge	−				+
Professional stress and burnout	SOC comprehensibility							−
	Need for social approval				−
QOL General well–being and health	SOC comprehensibility			+		−
	SOC manageability			−		+	−
	SOC meaningfulness		−		+	−		−
	Anxiety–state	−
	Anxiety–trait			−
	Depression							−
	Need for social approval			+
QOL life satisfaction	SOC comprehensibility						−	+
	SOC manageability		−	+		+	−
	SOC meaningfulness			−				+
	Anxiety–state	+	−
	Depression						+
QOL income	SOC meaningfulness		+
	Anxiety–trait							−

Notes: +, +ß; −, −ß; SOC, sense of coherence; QOL, quality of life; APC, approach coping styles; AVC, avoidant coping styles.

Constellations of particular personality characteristics at the time of admission to medical school and during the subsequent years of medical studies are significant in terms of predicting satisfaction with the choice of a medical career. Among the components of the general SOC, the level of comprehensibility in the fifth (ß = 1.30; p = 0.007) and sixth year of studies (ß = −0.97; p = 0.048) is especially significant. The higher the sense of comprehensibility in the fifth year of studies, and the lower in the sixth year of studies, the higher the satisfaction. What is also important is the level of manageability in the first year of medical school (ß = 1.12; p = 0.014), the second (ß = −0.88; p = 0.030), the fourth (ß = −0.74; p = 0.049) and the fifth (ß = 0.99; p = 0.035). Satisfaction is higher if the sense of manageability is higher in the first and fifth years of studies, and lower in the second and fourth years of studies. In addition, the sense of meaningfulness in the second (ß = 0.72; p = 0.031) and sixth years of studies (ß = −0.70; p = 0.017) are also significant. Satisfaction with the choise of a medical career is greater if the sense of meaningfulness is higher in the second year of medical school and lower in the sixth year. The level of ‘trait’ anxiety at admission (ß = 0.33; p = 0.003) and during the first year of studies (ß = −0.73; p = 0.003) is also vital as a predictor of future satisfaction with a medical career. The higher the level of this variable at admission, and the lower in the first year of studies, the higher the satisfaction. The level of depression in the fifth year of medical school is also of particular importance (ß = −0.06; p = 0.017). The lower the level of depression, the greater the future satisfaction with the chosen career.

Some additional factors that proved to be particularly essential in terms of predicting satisfaction with the choice of a medical career are the level and dynamics of coping with stress. Using logical analysis in order to cope with difficulties in the second year of medical school is one of the significant coping styles (ß = 0.66; p = 0.014), together with the positive reappraisal at admissions (ß = 0.17; p < 0.001), and in the third (ß = −0.85; p < 0.001) and fourth years of medical school (ß = 0.72; p < 0.001). Seeking guidance and support in the first (ß = −0.34; p < 0.001) and second years of studies (ß = 0.28; p < 0.001) is also important, alongside problem solving at admission (ß = 1.15; p = 0.001), and during the third (ß = 0.67; p < 0.001) and fourth year of medical school (ß = −0.68; p < 0.001). Avoidant coping styles comprise:

• cognitive avoidance in the first (ß = 0.09; p = 0.003) and fourth years of studies (ß = −0.08; p = 0.007);

• acceptance–resignation at admission (ß = 0.17; p = 0.002) and during the third (ß = 0.40; p < 0.001), fourth (ß = −0.43; p < 0.001) and fifth years of studies (ß = −0.13; p = 0.035);

• seeking alternative rewards at the time of admission (ß = −0.18; p = 0.001) and during the fourth (ß = −0.16; p = 0.003) and fifth years of studies (ß = 0.31; p < 0.001);

• using emotional discharge in order to cope with stress at admission (ß = −0.30; p < 0.001) and during the fourth year of studies (ß = 0.65; p < 0.001).

As a predictor of the level of work-related stress and professional burnout, several components of the general SOC should be given special attention:

• comprehensibility in the sixth year of studies (ß = −0.41; p = 0.002);

• ‘trait’ anxiety in the fourth year of studies (ß = 0.17; p = 0.010);

• depression in the third year of studies (ß = 0.30; p = 0.023);

• the need for social approval in the third year of studies (ß = −0.01; p = 0.022).

High levels of work-related stress and a high degree of professional burnout correlate with:

• a low level of the sense of comprehensibility in the sixth year of medical school;

• a high level of ‘trait’ anxiety-in the fourth year;

• a high level of depression in the third year;

• a low level of the need for social approval in the third year of studies.

The components of the overall SOC are of particular importance for predicting general well-being and health, especially:

• comprehensibility in the second (ß = 0.20; p < 0.001) and fourth years of medical school (ß = −0.17; p = 0.001);

• manageability in the second (ß = −0.07; p = 0.009), fourth (ß = 0.18; p < 0.001), fifth (ß = −0.28; p = 0.003) and sixth years (ß = 0.21; p = 0.007);

• meaningfulness in the first (ß = −0.06; p = 0.014), third (ß = 0.27; p = 0.002), fourth (ß = −0.32; p < 0.001), fifth (ß = 0.23; p = 0.001) and sixth years of medical school (ß = −0.14; p = 0.049).

The following variables are also vital:

• ‘state’ anxiety at admission (ß = −0.14; p = 0.040);

• ‘trait’ anxiety in the second year of medical school (ß = −0.15; p = 0.014);

• depression in the sixth year (ß = −0.03; p = 0.014);

• the need for social approval in the second year (ß = 0.08; p < 0.012).

The components of the general SOC are also significant for explaining the level of life satisfaction. The following variables are of particular importance:

• comprehensibility in the fifth (ß = −2.18; p = 0.007) and sixth years of medical school (ß = 1.55; p = 0.048);

• the sense of manageability in the first (ß = −1.83; p = 0.014), second (ß = 1.50; p = 0.030), fourth (ß = 1.21; p = 0.049) and fifth years (ß = −1,77; p = 0.035);

• the sense of meaningfulness in the second (ß = −1.43; p = 0.031) and sixth years of studies (ß = 1.35; p = 0.017).

Moreover, ‘trait’ anxiety at admission (ß = 5.06; p = 0.003) and during the first year of medical studies (ß = −4.90; p = 0.003) is of vital importance, together with the level of depression in the fifth year (ß = 0.97; p = 0.017).

In order to predict the size of income, the sense of meaningfulness in the first year of medical school (ß = 0.09; p < 0.001) and ‘trait’ anxiety-trait at admission (ß = 0.15; p = 0.031) and during the sixth year of studies (ß = −0.55; p = 0.006) should be taken into consideration.

Discussion

The results reported here provide useful information about the psychological determinants of professional success in young physicians. In the model of success used here, the majority of criteria proved to be dependent on the personality characteristics of the respondents: depression, anxiety, SOC, stress coping styles and the need for social approval, excluding, surprisingly, the hierarchy of values. The QOF, satisfaction with medicine as a career and the level of stress and vulnerability to burnout while performing the professional role are the functions of relatively permanent psychological variables. Only professional competence is related to the earlier academic achievement.

The results obtained on the National Medical Examination were considered in this study to be an indicator of professional competence, and 21% can be predicted on the basis of academic achievement. Competences can also be predicted (9%) on the basis of the final high school examination results and university admission exams. A more thorough analysis was needed to determine the degree of specificity of the subsequent phases in the medical education. Academic achievement in the last 2 years of medical school turned out to be the most significant. The higher these grades, the better the National Medical Examination result. It appears, then, that success in terms of professional competence is only partially conditioned by academic achievement. What is puzzling is the fact that the grades obtained during the whole of medical studies are related to such a low extent to the professional examination, whose result determines the possibility of beginning a specialization in Poland. The fact that earlier learning results do not correlate with the other three aspects of success in the medical career is also noteworthy. Whether or not someone will be a professionally satisfied doctor, who is able to cope with stress at work and leads a happy life, does not depend on whether good results were achieved during studies. What does it depend on?

Both satisfaction with medicine as a career, and the level of stress and professional burnout related to doing this job, are additionally conditioned by such personality characteristics as the SOC, depression and anxiety. In addition, satisfaction with medicine as a career is also modified by stress-coping styles, and the level of stress and degree of professional burnout are conditioned by the need for social approval. However, future satisfaction is 69% predictable by coping styles and 40% by the SOC.

In terms of satisfaction with medicine as a career, stress-coping styles proved to be the most important factors, while the other personality characteristics we investigated turned out to be less significant, i.e. the SOC, anxiety and depression. It seems that avoidant coping styles are more useful in adapting to the environmental requirements during medical studies than approach coping styles.

At the time of admission, a candidate who will later present a high level of satisfaction with medicine as a career has a strong tendency to notice positive aspects of a situation, demonstrates the ability to solve problems, accept limits and abandon a previously adopted perspective. Such a person also has a low level of readiness to seek alternative sources of satisfaction and discharge emotional states by action, despite being susceptible to experiencing anxiety states.

During the first year of medical school, such a student has a low level of readiness to seek guidance and support when faced with difficulties, along with a high level of readiness to deny reality. This individual is also characterized by a strong sense of having all the necessary resources to solve a problem, and a low level of susceptibility to react with anxiety. In the second year, the likelihood of future satisfaction with medicine as a career is enhanced by logical analysis of difficult situations and readiness to seek guidance and support of other people in such circumstances. In addition, future satisfaction is predicted by the ability to find alternative sources of satisfaction when faced with failure, while maintaining a low sense of having all necessary resources to cope, but a strong sense of the meaningfulness of overcoming difficulties. In the third year, future satisfaction is predicted by low readiness to notice positive aspects of difficult situations, but high readiness to solve problems, with the preserved ability to accept restrictions and abandon the previously adopted perspective. A fourth-year student who later turns out to be satisfied with choosing a medical career is a person with a low tendency to choose avoidant styles of coping when faced with difficult situations, i.e. has a low readiness to negate problems, accept restrictions or seek alternative sources of satisfaction. At the same time, such a person has a low sense of having all necessary resources to cope with problems. In the fifth year of studies, future satisfaction is not related to the ways of coping with difficult situations, but rather to a strong conviction that the world is predictable and organized, and that the person possesses the necessary resources to face challenges brought by the environment. In addition, this person has a low tendency to interpret failures in terms of losses and to react with a low mood. At the end of studies, future satisfaction is not predicted on the basis of coping styles or emotional states, i.e. depression or anxiety, but on the basis of a low tendency to perceive the world as predictable and understandable, together with a weak sense of the meaningfulness of actions undertaken when faced with difficulties.

Significant markers of success are a low level of stress and a lower tendency to experience professional burnout. These indicators can be predicted mostly on the basis of the clinical years. Therefore, in the third year of studies, they are related to a low tendency to interpret failures in terms of loss, and a high need for functioning in accordance with social expectations. In the fourth year, they correlate with a low readiness to respond with anxiety, and in the sixth year, with a high sense of the orderliness and predictability of events. Interestingly, however, the level of future work-related stress cannot be predicted on the basis of the styles of coping during medical studies. Furthermore, none of the investigated variables allows us to predict the level of stress and the tendency to experience professional burnout to such an extent, as in the case of other success indicators.

In this study, we analysed the QOF of these physicians by taking into account three aspects: general well-being and health, life satisfaction and size of income. QOF was found to depend on earlier personality characteristics, not on academic achievement. With reference to our model, what can be predicted most accurately is general well-being and health, while life satisfaction can be predicted to a lower extent, and the amount of future income can hardly be determined. In all three cases, the styles of coping with difficult situations, alongside the system of values and the need for social approval, proved to be useless in terms of formulating any predictions. The most significant psychological quality is the SOC, i.e. a generalised conviction that the world is understandable and meaningful, an individual possesses all necessary resources to cope with it, and coping is an effort worth making.

Similarly to the variables already discussed, QOF is shaped by the SOC, depression and anxiety. For general well-being and health, 80% is predicted by the SOC, 58% by the level of anxiety and 23% by depression during medical school. The same personality characteristics are predictors of life satisfaction (40% by SOC, 58% by anxiety, 12% by depression) and the future income of young physicians: 54% by SOC, 48% by anxiety, 41% by depression.

The future general well-being of a candidate for medical studies is related only to a low tendency to react with anxiety, while in the case of a first-year student it correlates with a weak sense of the meaningfulness of the efforts being made. On the other hand, during the second year of studies, the future state is conditioned by a high level of comprehensibility, low level of manageability, low readiness to react with anxiety and a high need to perform in accordance with social requirements. General well-being during the clinical years is mostly connected with the SOC, and only in the sixth year is it also determined by a low tendency to react to life situations with a sense of loss and depression.

Future life satisfaction, as a component of the QOF, is predictable on the basis of the SOC and its selected aspects for most of the stages of medical education, except for admission and the third year of studies. The tendency to respond with anxiety is a predictor for future life satisfaction only in the case of a candidate for medical studies and a first-year student. A high level of readiness to react with sense of loss and depression is an additional predictor of the future life satisfaction of fifth-year students, in addition to the criterion of the SOC.

The future income level is the least predictable element of the QOF on the basis of psychological variables; the only statistically significant indicator was a high readiness to react with anxiety in the case of a candidate for medical studies. As far as a first-year student is concerned, a strong sense of meaningfulness was significant, and in the final stage of studies, i.e. the sixth year, a low readiness to react with anxiety.

It is worth noting that, on the basis of these results, each subsequent year of medical studies can provide more information about the factors conditioning success in a medical career. The first 3 years of studies are only a source of knowledge about the indicators of future success in professional life: satisfaction with medicine as a career and the level of stress. Meanwhile, from the third year of studies onwards (the clinical years), predictions can be made about the future QOF of doctors: their general well-being and health, their life satisfaction and the amount of income.

One asset of the presented model of factors related to the success in a medical career would seem to be the fact that most of the differentiated indicators are dependent on relatively permanent personality characteristics, i.e. the SOC and styles of coping with stress, as well as clinical symptoms of inadequate personality mechanisms, such as stress and depression. Our research confirmed the utility of taking into account anxiety and depression as predictors of success in a medical profession, which has been already suggested in the literature (Pamphlett & Farnill 1995; Stewart et al. 1999). At the same time, our study has introduced the concept of personality factor, which constitutes a global measure of the level of personality integration in terms of the SOC and coping styles, which broadens the list of universal psychological variables presented in the literature, which are useful for the purpose of describing the phenomenon in question (Jones 1991; Lacorte & Risuci 1993; Collins et al. 1995; Pamphlett & Farnill 1995; Stewart et al. 1999; Ferguson et al. 2000, 2002, 2003; Finset et al. 2005; Gude et al. 2005; Julian 2005; Peskun et al. 2007). Therefore, success in a medical career seems to be a consequence of the level of personality structure integration, and not a simple result of the medical education process.

Acknowledgements

We are very grateful to our respondents for taking part in our research. We thank Prof. Mariusz Klencki, MD, PhD, of the Medical Examination Center, Poland, for his permission to analyse examination results of postgraduates; Zdislawa Cieplińska, Medical University of Gdańsk, for organizational help; Prof. Bruce D. MacQueen, PhD, English Institute University of Gdańsk, for language support; Krzysztof Wójcikiewicz, MD, the Polish Chamber of Physicians and Dentists, Gdańsk, for organizational help; and Karol Karasiewicz, PhD, the Department of Statistics and Psychometrics, Institute of Psychology, University of Gdansk, for statistical advice. Authors Waldemar Budzinski and Malgorzata Tartas designed the first part of a study of medical students, initiated it and carried out data collection (1999–2005). Waldemar Budzinski was responsible for the management of the first part. Maciej Walkiewicz and Mikolaj Majkowicz designed and initiated the second part of a study of medical graduates (2008–2009). Maciej Walkiewicz was responsible for the management of the second part of the study and for the statistical analysis. Maciej Walkiewicz, Mikolaj Majkowicz, Malgorzata Tartas and Waldemar Budzinski analysed and interpreted data from the entire longitudinal study. The manuscript was written by Malgorzata Tartas and Maciej Walkiewicz with the help from Mikolaj Majkowicz and Waldemar Budzinski. All authors approved the final version.

Declaration of interest: The authors report no declarations of interest.