Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 57, Num. 10, 2003, pp. 431-436

Indian Journal of Medical Sciences, Volume 57, Number 10, October 2003, pp. 431-436

COMPARISON OF TEMPERAMENT AND CHARACTER PROFILES OF ANESTHESIOLOGISTS AND SURGEONS: A PRELIMINARY STUDY

S Mitra, P K Sinha,* K K Gombar,** D Basu***

MD, Senior Lecturer; *Assistant Professor; **Professor; ***Associate Professor. From the Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh; *Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum; and ***Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India.

Correspondence: Dr. Sukanya Mitra, c/o Dr. D. Basu, Department of Psychiatry, PGIMER, Chandigarh-160012, India. E-mail: db_sm@satyam.net.in

Accepted Date: 15-09-2003

Code Number: ms03027

ABSTRACT

Background: Given the high levels of stress in anesthesiologists and also their close working liaison with surgeons, it may be worthwhile to compare the personality profiles of these two groups of professionals.
Aim: To compare the personality profiles of surgeons and anesthesiologists, using a well-standardized and validated instrument.
Settings and Design: Survey (cross-sectional) on surgeons and anesthesiologists working in several medical institutes in India.
Material & Methods: The self-report Temperament and Character Inventory, 125-item version (TCI-125) was mailed out to an incidental sample of surgeons and anesthesiologists working in medical institutes in India. Of the 200 questionnaires sent (100 to anesthesiologists and surgeons each), 93 completed responses were returned (46 anesthesiologists, 47 surgeons; return rate 46.5%).
Statistical Analysis: Student's unpaired 't' test; P<0.05 was considered statistically significant. Results: The mean scores of anesthesiologists vis-à-vis surgeons on the various temperament dimensions were Novelty seeking: 8.6 vs. 9.2; Harm avoidance: 7.3 vs. 8.1; Reward dependence: 8.1 vs. 8.0; and Persistence: 3.0 vs. 3.1, respectively. Similar scores for the character dimensions were Self-directedness: 16.9 vs. 15.9; Cooperativeness: 17.5 vs. 16.5; and Self-transcendence: 7.0 vs. 6.7, respectively. There was no significant difference between the surgeons and anesthesiologists on any of the temperament and character variables of personality chosen for the study.
Conclusion: Personality measures did not differ significantly between surgeons and anesthesiologists in this preliminary investigation. If replicated on a larger and more representative sample, the findings have clinical relevance to improve the working relationship between these two groups of closely working professionals.

Key words: Anesthesiologists, Surgeons, Personality.

INTRODUCTION

With the advancement of anesthesia as a specialty ever since the inception of ether anesthesia, the role of anesthesiologists has become multifaceted. The functioning of an anesthesiologist ranges from operation theatre to the intensive care units and today virtually encompasses all the areas of patient care management. With the increasing workload, there is an increase in the stress level^1-3 associated with the day-to-day working. The major sources of stress at work were identified as lack of control (42%), professional relationship (25%) and work overload (23%). On the administrative and domestic front the major stressor was administrator responsibility (41%).¹

Personality is known to be an important intervening variable between stressors and the experience of stress. Personality includes the ways in which people deal with stressors and thus influences behavior and performance.⁴ Given the high levels of stress reported for anesthesiologists, it may be useful to study of the personality of anesthesiologists. Some studies have focused on personality of `budding' anesthesiologists (i.e., medical students who have not yet either taken up or completed anesthesiology as their specialty subject), and only a few have studied the personality of qualified anesthesiologists as such.^4-8

An important workplace characteristic of anesthesiologists that distinguishes them from most other medical specialists is their close working liaison with surgeons, and workplace conflicts between them may add to the stressors in an anesthesiologist's job. Indeed, brainstorming groups at stress management seminars for anesthesiologists in UK have repeatedly identified `professional relationship, in particular with surgeons' as one of the major sources of stressors¹ (italics added). Could it be partly related to differences in personality between the surgeons and the anesthesiologists? This has not been studied till date to the best of our knowledge.

In this study, we compared the personality profiles of specialist surgeons and anesthesiologists, using a well standardized and validated instrument.

MATERIAL & METHODS

The personality assessment instrument used for this study was the 125-item version of Temperament and Character Inventory (TCI-125).⁹ This is an internationally recognized instrument with established psychometric properties, based on a psychological model of personality.¹⁰ In this model, personality is conceived of as a combination of "temperament" and "character". Temperament is that component of personality which is highly stable, heritable, genetically homogeneous, and biologically determined. Character is the component of personality which is less innate and more acquired, i.e., weakly heritable, less stable, and influenced by life experience as well as biological factors. Taken together, temperament and character traits describe a person's personality fairly comprehensively, and they have a well-researched evidence base.⁹ TCI-125 measures four dimensions of temperament (Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence) and three dimensions of character (Cooperativeness, Self-directedness, and Self-transcendence).

This self-rating instrument, along with a face sheet noting basic demographic and career-related facts (age, sex, anesthesia/surgery as specialization, years of experience), was mailed out to surgeons and anesthesiologists working in several medical institutes in India. The sampling was incidental. Participation was explicitly voluntary and confidential. Institute Ethics Committee approval was obtained. Of the 200 questionnaires sent (100 to anesthesiologists and surgeons each), 93 completed responses were returned (46 anesthesiologists, 47 surgeons; return rate 46.5%). Results were analyzed by the Statistical Package for Social Sciences and P<0.05 was considered as statistically significant.

RESULTS

Of the 93 completed and returned questionnaires, 46 were from anesthesiologists and 47 from surgeons. Their age, gender, and specialist experience data are shown in table 1. There were more males in both the groups, with relatively fewer females amongst surgeons, though the difference was not statistically significant.

The TCI profiles of the two groups are shown in table 2. All the differences between the groups on the four temperament dimensions and the three character dimensions were statistically non-significant.

DISCUSSION

This study did not find any significant differences on any of the seven personality dimensions compared between anesthesiologists and surgeons in the sample studied. To the best of our knowledge, this is the first such comparison of personality profiles between anesthesiologists and surgeons using the TCI-125.

The strength of the study derives from the facts that qualified and actually practicing professionals were compared (in contrast to earlier studies comparing students or resident doctors; see below), and that a comprehensive, standardized and well-validated psychometric instrument was used. However, the limitations of the study should also be kept in mind. This was a small, exploratory study with an incidental sample. The response rate (46.5%) was low but probably acceptable, and it was higher than those of earlier published studies of similar nature from Australia (33%)⁴ and Canada (42.3%).⁷ Nevertheless, the low response rate should make one cautious before generalizing the findings of this study to the entire population. Further, the voluntary nature of the participation in this study might mean inclusion of a biased sample (though then that should be so in both the study groups). However, one can not but accept only voluntary participation in such studies, for both ethical and practical reasons.^4,7,8 Thus, these caveats place a limit on the generalizabilty of the findings. It would also be interesting to study cross-cultural aspects of personality in this context.

The lack of finding significant personality differences between these two specialist groups may appear surprising. Surgeons have often been perceived by non-surgeons or students of other medical specialties in various terms with negative connotations such as dominating, cold, impersonal, impatient, aggressive, authoritarian, arrogant, prestige-driven, and egotistical.^11-13 More objective personality trait testing by formal psychometric instruments, commonly using 16-Personality Factors (16-PF)¹⁴ and other such personality tests, however, have yielded mixed results. While the study by Coombs et al.¹⁵ did not find any significant difference between surgeons and non-surgical specialists on an extensive battery of personality tests, an earlier study found residents in family practice and internal medicine to score higher on six dimensions of `humanistic attitudes' than surgery residents.¹⁶ The only available study comparing personality and temperament profiles of actually practicing surgeons with those of other practicing physicians¹⁷ found a distinctive and homogeneous personality profile of the surgeons. In this study, surgeons appeared to be stable extroverts, competitive, structured, practical, adjusted, social, and stress-tolerant. They tended to score lower than other physicians on creativity, withdrawal, rebelliousness and total stress.

Earlier surveys on anesthesiologists in UK,⁶ Canada,⁷ and Australia,⁴ all using 16-PF, could not consistently identify any distinctive and homogenous personality profiles, though some gender and age-related differences were found. Comparisons with other specialties have been rare. In one earlier study,¹⁸ consultant anesthesiologists were found to be more conscientious and realistic but less outgoing and tender-minded than psychiatrists. Two recent studies from New Zealand by same authors using Cloninger's TCI-125 compared anesthesiologists with physicians, one with a retrospective sample⁸ and the other with a prospective sample.⁵ Both found physicians to be significantly more Cooperative and marginally more Persistent than specialist anesthesiologists.

It is interesting to note that direct head-to-head comparison between anesthesiologists and surgeons was rare. Schwartz et al's study¹⁷ on surgical personality did incorporate anesthesiologists (number not given), but only as a part of a larger and heterogeneous comparison group involving seven other specialty physicians as well. Our study focused specifically on the question whether qualified anesthesiologists (rather than `would-be' anesthesiologists) could differ from qualified surgeons (rather than `would-be' surgeons) on dimensions of temperament and character as defined in TCI-125.

Coming back to the point raised at the beginning of the discussion, contrary to intuitive belief, no significant differences were found on any of the dimensions of temperament and character between anesthesiologists and surgeons. Ascribing this lack of significant differences in personality to inadequacy of the measuring instrument seems quite unlikely (though theoretically can not be ruled out) because TCI-125 is a fairly comprehensive, well-researched and psychometrically sound tool with a robust research evidence base.^9,10 Further, the only other study using TCI-125 did find differences between anesthesiologists and physicians.^5,8 Other explanations have been suggested,¹⁵ but our study, being preliminary and exploratory in nature, is not equipped to pursue these. Future studies should address these issues.

Nevertheless, the fact that anesthesiologists and surgeons in this study did not differ significantly in their personality profiles is interesting because it is counterintuitive. If replicated on larger and different samples, this might mean that the perceived personality differences between anesthesiologists and surgeons do not exist in reality. The clinical relevance of the study is that the findings can be used to alleviate the often held negatively perceived views about surgeons amongst anesthesiologists, and vice versa. This may have positive implications for the working liaison between these two closely working groups. However, as emphasized above, it is imperative to first replicate these findings on a larger sample with a higher response rate before drawing firm conclusions.

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