Author: Alan Friedman
In organized neurosurgery, neurosurgery residents are selected based on personality.1 Practicing neurosurgeons are coached throughout their professional careers to address the critical role that personality and leadership skills play in the complex practice of medicine.2 This trend has the potential to improve clinical outcomes, enhance patient safety, and may ultimately reduce physician burnout.
We have worked extensively with many neurosurgical departments and programs on resident selection, leadership development, coaching, wellness, and stress management. This mirrors our work in other specialties as well, including orthopaedics, otolaryngology, emergency medicine, anesthesiology, family medicine, internal medicine, and pediatrics. Our work shows the importance of using a data-based approach to understand personality traits in order to gain greater insight into interpersonal interactions. Personality, thought processes, and behavior are all separate constructs that can be measured with both personality and behavioral assessments.
The German psychologist Kurt Lewin postulated that behavior is a function of a person's personality and their environment.3 An individual's motivational profile ultimately determines what behavior is exhibited. This is a significant and appreciable foundation for thinking about different traits that are the underpinning of how we behave. Lewin's equation can be expanded further to explain the relationship between a person's behavior, thought processes, and personality. Consider the following equation:
Behavior is a direct representation of positive and negative thought processes. Both behavior and thought processes are a function of personality, environment, and meaning. Personality can be evaluated using the Five-Factor model and produces consistent results in both observation and self-assessment.4 Yet, it is often ignored or, worse, analyzed using assessments that have not been validated.
Personality assessment is an effective tool for professionals in all industries. This is especially true in healthcare, where professionalism is directly related to patient satisfaction and quality of care. Effective organizations and departments dedicate time and resources to understanding each variable of the aforementioned formula.
In the modern clinical environment, teamwork is key. Every member of a neurosurgical team brings a diverse and valuable set of personality attributes. To leverage the strengths and mitigate the challenges of the individuals who comprise the team, it is important to use the proper tools to provide this data. This can then be used to promote and encourage behaviors conducive to improvements in clinical outcomes and patient safety. Chairs, program directors, members of the faculty/partners, residents, allied health professionals and staff benefit from the selfawareness that is created by this process.5
Additionally, these types of assessments can play an important role in selecting medical students for residency. There are several effective ways to evaluate whether a potential neurosurgical trainee has the cognitive capacity and technical skills to manage complex diagnoses and interventions. However, it is more difficult to determine whether a candidate has the nontechnical skills necessary to make difficult decisions under pressure, successfully manage/lead others and build rapport with his/her patients.
Another way to think about this type of process is to analogize it to how medical students and residents are trained. A variety of disparate data points are ordered and collected, this information is then combined with expertise, judgment and experience to positively impact an outcome. The same algorithm can be applied to behavior.
Assessments allow us to find commonalities between groups of potential residents. For example, in a survey of 54 applicants for Cleveland Clinic's 2014-2015 resident program, participants who had published a higher-than-average number of papers (more than ten) scored higher on a specific personality trait linked to neuroticism. Their responses suggested more even-tempered and composed reactions in stressful situations. Applicants who had attended lower-ranking medical schools (below 40th) scored higher on creative and imaginative thinking. With a more objectively based understanding of each applicant's personality, the selection committee in this case had a better understanding of the usual tendencies, stress tendencies and motivations of the applicants.
The ACGME Neurological Surgery Milestone Project requirements state that residents must demonstrate competency in six domains.6 Two are Interpersonal Communication Skills and Professionalism. More recently, the addition of the ACGME Common Program Requirements<sup7< sup=""> including wellness and stress management help ensure a clinical learning environment that fosters development of the skills, knowledge, and attitudes necessary to take personal responsibility for patient care. Understanding personality can help with all these requirements and assist in creating a culture of open communication, which is important for team effectiveness.
Personality assessments have value beyond the resident selection process. These tools can be used as an effective way to facilitate coaching and development for residents, practicing neurosurgeons and other members of the organized neurosurgical community. Each individual has a unique personality. The more extremity in a person's personality, the more energy that will need to be expended to regulate those tendencies from becoming behaviors that can work either for or against the goals of the individual, program, etc.
This capability can impact (positively or negatively) reputations, ruin professional relationships and ultimately can compromise patient care. Using personality as a basis to understand the intrapersonal perspective (from within) can help neurosurgeons at every stage of their career to become more self-aware of their innate traits. With this awareness, they can learn how to better harness their strengths and avoid allowing their challenges to impede their clinical effectiveness. This foundation was recently provided to interns who participated in the SNS New England Intern Boot Camp.8
The increased attention being placed on the link between personality and behavior follows a national trend. Businesses across the country are adopting the agile practices of the tech industry, which include more frequent performance assessment and management that focuses on the team rather than the individual. With this movement, healthcare leaders can facilitate an environment in which each team member can understand and navigate their behavior with as much proficiency as they manage technical skills.
IN THE MODERN CLINICAL ENVIRONMENT, TEAMWORK IS KEY. EVERY MEMBER OF A NEUROSURGICAL TEAM BRINGS A DIVERSE AND VALUABLE SET OF PERSONALITY ATTRIBUTES. TO LEVERAGE THE STRENGTHS AND MITIGATE THE CHALLENGES OF THE INDIVIDUALS WHO COMPRISE THE TEAM, IT IS IMPORTANT TO USE THE PROPER TOOLS TO PROVIDE THIS DATA.
1) Lubelski, D., Healy, A. T., Friedman, A., Ferraris, D., Benzel, E. C., & Schlenk, R. (2016). Correlation of personality assessments with standard selection criteria for neurosurgical residency applicants. Journal of Neurosurgery, 986-994.
2) van Loveren, H. R., Yusuf, F. R., & Paidas, C. N. (2018). The Benefits of Coaching in the Ultimate Contact Sport: Neurosurgery. Congress Quarterly, 14-18.
3) Encyclopaedia Britannica. (2017). Kurt Lewin. Retrieved from Encyclopædia Britannica: https:// www.britannica.com/biography/Kurt-Lewin
4) McCrae, R. R., & Costa, P. T. (1987). Validation of the Five-Factor Model of Personality across Instruments and Observers. Journal of Personality and Social Psychology, 52(1), 81-90.
5) Zuckerman, J. D., Friedman, A., & Castro, M. (2018, February 21). Self-Awareness: The Ladder to Leadership Success. Retrieved from Chief Learning Officer: http://www.clomedia.com/2018/02/21/selfawareness-ladder-leadership-success/
6) Neurological Surgery Milestones. (n.d.). Retrieved from ACGME: https://www.acgme.org/Portals/0/PDFs/Milestones/NeurologicalSurgeryMilestones. pdf
7) Accred. Council for Graduate Medical Education, A. (n.d.). Common Program Requirements. Retrieved from http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements Education, A. C. (n.d.). Retrieved from http://www. acgme.org/What-We-Do/Accreditation/Common- Program-Requirements
8) Society of Neurological Surgeons. (n.d.). The Society of Neurological Surgeons Resident Courses. Retrieved from The Society of Neurological Surgeons: http://www.societyns.org/BootCamp/BootCampCourses.asp