Interests in becoming a surgeon were associated with higher rates of psychopathy, even more so in women

What kind of Dr do you want to be?: A cross-sectional study measuring personality and sex effects of medical students. Irem F. Kashikchi, Bayram M. Savrun, Peter K. Jonason. Personality and Individual Differences, Volume 205, April 2023, 112075, https://doi.org/10.1016/j.paid.2022.112075

Abstract: Turkish medical students (N = 376; 145 men, 231 women) aged 18–25 (M = 20.36, SD = 2.02) reported on their personality and post-graduation specialty preferences. We found (1) sex differences in interests in psychiatry in favor of women (suppressed by Machiavellianism and competitiveness) and surgery in favor of men (mediated by psychopathy and competitiveness), (2) interests in basic/diagnostic medicine were associated with higher rates of narcissism and competitiveness in women, (3) interests in surgery were associated with higher rates of psychopathy (mediated by masculinity and competitiveness), and (4) interests in psychiatry were associated with less competitiveness. In women, psychopathy was correlated with interests in surgery more than basic/diagnostic medicine whereas competitiveness was more strongly correlated with interests in basic/diagnostic medicine than psychiatry. In men, competitiveness was more correlated with interests in psychiatry than surgery. Lastly, the relationship between interests in basic/diagnostic medicine and competitiveness was more strongly correlated in women than in men. Results are discussed in relation to sociocultural and evolutionary models of vocational interests.

Introduction

The reasons people make choices is determined by their personality and context; this includes their choices in professions. To date, research on medical specialty selection has (1) been limited to actual physicians (Bucknall et al., 2015), (2) focused on socially desirable personality traits (Milić et al., 2020), and (3) was quite Western in nature (Grasreiner et al., 2018). In this study, we provide a broad account of individual differences in vocational interests in medicine among Turkish medical students.

Like all other choices, the appeal of medical preferences may come down to what perceived utility each serves in people's lives. The motivational goals for being a medical doctor may center around communion (i.e., helping others) and agency (i.e., earning status) and each of these may be differently appealing to different people as a function of their personality and their sex. People characterized, either directly or indirectly, by seeking status may pursue medicine to satisfy these desires. For instance, those characterized by narcissism (e.g., sense of entitlement, grandiosity; Morf & Rhodewalt, 2001), Machiavellianism (e.g., pragmatism, duplicitousness; Jones & Paulhus, 2009), and psychopathy (e.g., callousness, antisociality; Hare et al., 2012), and those who enjoy competition (Buser et al., 2014) may be especially prone to seek status, compete with others (Vedel & Thomsen, 2017), and have less empathy compared to non-surgical areas (Walocha et al., 2013) which may inform their vocational interests (Jonason et al., 2014). Unsurprisingly, these traits are common in surgeons (Bucknall et al., 2015) where little direct interaction with patients is required and being a surgeon is considered particularly prestigious (Murphy, 2018); limited empathy and heightened interest in status are agentic characteristics. In contrast, where direct interaction with patients and empathy are job requirements like in psychiatry, these traits are likely not only costs, but may also dissuade people characterized by these traits to choose a profession like psychiatry. As such, more empathy should enable choices in psychiatry as a specialty reliant on emotional intelligence and interpersonal interactions (Chen et al., 2012). Therefore, we predict the Dark Triad traits and competitiveness should be associated with greater interests in surgery, whereas more empathy should be associated with greater interests in psychiatry.

Beyond personality traits, there are sex/gender effects on medical preferences. For instance, surgery is often preferred by men whereas women tend to prefer psychiatry (Öğrenci Seçme ve Yerleştirme Merkezi, 2020; but see Milić et al., 2020). More generally, girls/women choose more “people-oriented” jobs (i.e., communal) and boys/men are more interested in jobs that require dealing with “things” (Luoto, 2020). Some researchers contend these sex differences are a function of learned social roles of what are considered appropriate jobs for men and women (Wood & Eagly, 2012) whereas other researchers contend these sex differences are manifestations of different evolved biases that enabled the reproductive fitness of our female (i.e., being more group-oriented provides protection for women) and male (i.e., acquiring status earned men greater access to mating opportunities) ancestors (Puts, 2010). Whichever perspective is correct, we think replication and extension of these sex differences and gender role effects may be revealing here.

To better understand these sex/gender effects we consider the idea of (1) sex-typical and (2) sex-atypical job preferences. First, we expect that greater masculinity should be linked to preferences for surgery, whereas greater femininity should be linked preferences to psychiatry. In reference to the second point, understanding how gender non-conforming people make their specialty choices may further elucidate sex/gender effects in preferences. For example, women who chose male-typical occupations are more assertive and tough-minded compared to women in female-typical jobs (Lemkau, 1983) and men who prefer female-typical jobs are more emotionally sensitive compared to other men preferring male-typical occupations (Lemkau, 1984). There are two ways to test these issues. First, examining whether the correlations between the personality traits and preferences differed in the sexes (i.e., moderation). For instance, if sex-typical traits, like psychopathy, are more strongly correlated with sex-typical professions, like surgery, in men than in women, we will have shown that when “properly matched”, traits predict preferences in sex-differentiated ways. Second, we test whether sex differences are a function of the personality traits. For instance, if the removal of variance of a sex-atypical trait like empathy in men makes the sex difference grow, we have shown that the sex differences are larger when considering more sex-typical people (i.e., suppression). Alternatively, men and those high in psychopathy may think of their patients as “things” more than women and those low in psychopathy, translating into a reduction of sex differences in interest for surgery by psychopathy (i.e., mediation).

Last, because surgical and psychiatric specialties may require considerably different characteristics, they might be considered as the two extreme ends of a specialty preference spectrum. Hence, we include more “neutral” specialties (i.e., basic/diagnostic medicine) requiring both patient-physician contact like psychiatry as well as some surgical practices when the occasion arises (i.e., removal of melanoma). By this, we can examine personality and sex differences in specialty preferences in a broader context.

In the current study, we examine the vocational interests (i.e., basic/diagnostic medicine, surgery, psychiatry) of medical students through the lens of personality psychology in broad (i.e., the Dark Triad traits) and narrow (e.g., competitiveness) manifestations overall and in men and women. We explore the possibilities that (1) these correlations are different in men and women, (2) sex differences in preferences may be a function of personality traits, and (3) narrowband traits may serve as the mechanisms that link broadband traits to medical specialties. Importantly, we do this in a Turkish, as opposed to a Western sample, thereby adding sampling heterogeneity to the areas of vocational interests and medical specialization preferences to see whether previous findings were Western-specific.