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Health Professions Education 6 (2020) 31e46
www.elsevier.com/locate/hpe

Myers-Briggs Type Indicator in Medical Education: A Narrative

Review and Analysis*
Vignesh Ramachandran a,*, Asad Loya a, Kevin P. Shah a, Shreya Goyal a,
Esha A. Hansoti b, Andrew C. Caruso c,d
a
Baylor College of Medicine, Houston, TX, USA
b
University of Texas Southwestern Medical Center, Dallas, TX, USA
c
Department of Medicine, Baylor College of Medicine, Houston, TX, USA
d
Michael E. DeBakey VA Medical Center, Houston, USA
Received 30 October 2018; revised 25 March 2019; accepted 26 March 2019
Available online 11 April 2019

Abstract

Purpose: Health professionals are moving beyond traditional roles as vessels of science and are expected to exhibit excellence in
psychosocial sciences, communication, and humanities. Medical education has shifted focus to non-cognitive aspects of training,
which have been correlated with clinical performance, professionalism, interpersonal skills, and in-service exam scores. Psy-
chometric tests are a means to gauge an individual's personality and behavioral characteristics. They have been used in various
professional settings. The Myers-Briggs Type Indicator (MBTI) is an introspective psychometric questionnaire explaining an
individual's decision-making, perception, and interactions. Medicine has used the MBTI by surveying providers and trainees.
Particular interest is paid to its use in medical education. This review aims to provide a comprehensive review and analysis of MBTI
use in medical education.
Method: A PubMed search (1975e2018) was performed to identify studies addressing MBTI in medical education using a
combination of Boolean and MeSH search terms. Forty articles were included in the final review.
Results: Overall, 30% (12/40) of articles addressed MBTI in specialty/training setting selection, 52.5% (21/40) addressed MBTI
in medical curricula, and 17.5% (7/40) addressed MBTI in evaluation/selection of trainees. MBTI preferences of different
specialties showed inconsistencies. MBTI improves trainee communication skills, identifies those at risk for burnout, directs use
of personalized study resources, among other domains. Biases in medical school and residency admissions processes are
unearthed with MBTI. Furthermore, certain MBTI traits show stronger correlation with trainee clinical evaluations than board
exam scores.
Conclusion: MBTI is a potentially powerful tool for medical education. However, a large portion of studies (30%) investigate its
role in specialty choice, a domain with inconsistent results. Instead, MBTI may be better served to provide trainees with indi-
vidualized study environments/resources, enhance communication skills, and provide burnout screening and support. Furthermore,

*
None of the five above authors have competing interests.
Peer review under responsibility of AMEEMR: the Association for Medical Education in the Eastern Mediterranean Region.
* Corresponding author. Baylor College of Medicine, 1 Baylor Plaza, DeBakey Building, M-210, MS: BCM368, Houston, TX 77030-3411,
USA.
E-mail address: [email protected] (V. Ramachandran).

https://doi.org/10.1016/j.hpe.2019.03.002
2452-3011/© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
32 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

it may address biases in the subjective medical school and residency interview processes and increase class psychodynamic di-
versity. New era problem-based learning and team-based learning may be enhanced with MBTI. In these ways, the application and
interpretation of this psychometric tool may advance personalized medical education in the 21st century.
© 2019 King Saud bin Abdulaziz University for Health Sciences. Production and Hosting by Elsevier B.V. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Curriculum; Medical education; Myers-Briggs; Resident; Student

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.1. Search strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.2. Selection criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.3. Data extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.4. Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3. Results and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.1. Specialty/practice setting selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.2. Evaluation/selection of trainees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.3. Student performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
3.4. Burnout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.5. Clinical skills and communication classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.6. Student study methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.7. Clinical practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.8. Study limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Ethical approval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Other disclosure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

1. Introduction individuals reduces implicit bias in the application

process and increases admission of underrepresented
The role of health professionals has evolved over minority students.10
the last century. Health professionals are no longer Psychometric tests gauge an individual's personality
merely vessels of science. They are expected to exhibit and behavioral characteristics. They are used various
excellence in psychosocial sciences, communication, professions such as business, sports, and law.11e13 The
and humanities. Health professions education has also Myers-Briggs Type Indicator (MBTI) is one of the
evolved to fit these new roles.1 From the addition of a most widely known and used.14 MBTI constitutes a
combined psychology-sociology section to the Medical method of explaining an individual's decision-making,
College Admission Test (MCAT) to incorporation of perception, and interactions in the world.15,16 The
problem and team-based learning activities into med- standard MBTI consists of 93 questions branching re-
ical curricula, educators have given weight to these sults into four dichotomies: Extraversion versus Intro-
traits.2e4 From the admissions standpoint, non- version, Sensing versus Intuition, Thinking versus
cognitive (personality, self-efficacy, empathy) aspects Feeling, and Judging versus Perceiving, producing 16
of the application process are given increasing impor- distinct types or preferences.14 This framework has
tance compared to cognitive determinants (MCAT and popularized its use as a vehicle for team-building,
grade point average).5,6 Furthermore, non-cognitive communication, leadership, conflict resolution, and
factors have been associated with increased clinical career advancement in various academic and profes-
performance, professionalism, interpersonal skills, and sional settings, including healthcare. 17e19
board scores in medical students and residents.7e9 One area of particular use of MBTI in healthcare is
Furthermore, assessing psychosocial aspects of within medical education. In students, MBTI has
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46 33

been used to enhance introspection, awareness of extraction, authors V.R. and A.L. consolidated the
others, specialty selection, communication, and lead- independently-derived spreadsheets. At this time, V.R.
ership.20e23 It may also predict student performance, and A.L. identified preliminary themes in the data
decrease evaluative bias, and cater educational pro- which were amenable to categorization. Categorization
grams to personality types.24e27 Despite this wide- was completed independently by V.R. and A.L. with
spread use in the literature spanning decades, a review discrepancies resolved by consensus between authors
of the literature and with subsequent analysis of its V.R. and A.L. with third reviewer (A.C.C.) available
utility is strikingly lacking. for adjudication. Extracted quantitative data included
In this study, we provide such a comprehensive re- all MBTI personality trends within included studies.
view and critical analysis of MBTI use in medical Both quantitative and qualitative data were categorized
trainee education (medical students and resident phy- into one of seven sections: specialty/practice setting
sicians). In doing so, we aim thorough describe the selection, evaluation/selection of trainees, student
literature present and provide frameworks for refining performance, burnout, clinical skills and communica-
and advancing the use of such psychosocial personality tion classes, student study methods, and clinical prac-
indices in medical education. tice. Additionally, other information extracted for
eligible studies included: authors, year, study design,
2. Methods population traits, study setting, results, and analytical
findings. Microsoft Excel 2016 (Microsoft Corpora-
2.1. Search strategy tion, Redmond, Washington, U.S.) was used as a
software to extract, compile, and store data.
A literature review was conducted using PubMed to
curate studies addressing MBTI in medical education. 2.4. Analysis
Literature review was performed on August 29, 2018 for
studies between 1975 and 2018. PubMed was searched An extensive literature search identified 695 total
using the following Boolean search operations: MBTI articles. After removing duplicates, 239 articles
OR Myers-Briggs OR Myers Briggs. MeSH analysis was remained. Review of these articles' titles and abstracts
used to identify the following additional search terms removed 185 additional articles meeting exclusion
that were added to increase sensitivity and specificity: criteria (158 articles were grossly out of scope dis-
Myers-Briggs Type Indicator OR Myers Briggs Type cussing MBTI outside of medicine altogether, 16 ar-
Indicator OR Indicator Myers-Briggs Type.28 ticles discussing MBTI use in faculty not trainees, 11
articles not in English language) leaving 54 articles
2.2. Selection criteria eligible for full manuscript review. Of these, 13 more
were excluded (8 articles not in English language, 3
Titles and abstracts of all papers were read by two articles out of scope discussing MBTI use in faculty
independent authors (V.R. and A.C.) for inclusion: (1) not trainees, 2 articles were opinion pieces). In the end,
use of MBTI in medicine/medical practice/medication a final count of 40 articles were used to conduct the
education; (2) qualitative or quantitative analysis. Ar- review article herein and presented in (Fig. 1). The 41
ticles were excluded if: (1) full-text manuscripts not articles were reviewed and grouped: 32% (13/41)
available; (2) full-text manuscripts not in English; (3) addressed MBTI in specialty/training setting selection,
full-text manuscripts solely focused on dental/nursing/ 51% (21/41) addressed MBTI in medical curricula, and
pharmacy non-medicine health professions. Discrep- 17% (7/41) addressed MBTI in evaluation/selection of
ancies resolved by consensus between authors V.R. and trainees (Table 1).
A.L. with third reviewer (A.C.C.) available for
adjudication. 3. Results and discussion

2.3. Data extraction An overview of the studies extracted can be found

in Table 1.
After initial selection of manuscripts (Section
selection criteria), authors V.R. and A.L. independently 3.1. Specialty/practice setting selection
extracted qualitative and quantitative data from each
paper independently into Microsoft Excel spread- The MBTI has been utilized in medical students'
sheets. Upon completion of independent data specialty choice and resident physicians' selection of
34 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

needed to best guide students if the MBTI or other

personality indices are used for specialty selection.
Brown et al. show that fifty-seven percent of medical
students change their MBTI preferences between first
and fourth years. Thus, if the MBTI is useful for spe-
cialty selection, students should be administered the
MBTI prior to the residency application period in fourth
year.40 Regardless, findings vary between studies (Table
1), suggesting that the MBTI requires re-evaluation in
aiding students' specialty selection.
Colloquially, certain specialties have been charac-
terized by personalities. Surgeons are depicted as
needing to be more Extroverted and Conscientious.66
Alternatively, Internal Medicine physicians are
considered more Introverted, “thinkers”, and empa-
thetic.67 These generalizations, however, lack depth as
medicine becomes further subspecialized.68,69 For
example, Park et al. demonstrated that procedural In-
Fig. 1. Diagram of search strategy yielding 41 articles used in
ternal Medicine fields (Cardiology and Gastroenter-
construction of this review of the use of the Myers-Briggs Type In-
dicator in medical education. ology) have different personality traits than
Endocrinology and Primary Care.70,71 Similarly, Gen-
eral Surgery was the gateway to subspecialized fields
practice setting for decades. Multiple studies show that like Orthopaedics and Otolaryngology; however,
different MBTI preferences are associated with direct-entry residencies now exist for such fields. The
different specialty choice.21,22,39,43,46,55,64 These personality preferences of students entering these fields
studies are limited and studies are often not repro- may vary greatly and could explain why studies have
duced. Despite being a focus of MBTI use within failed to identify significant differences between per-
medical education, distributions in MBTI preference sonality traits/preferences of those entering surgical
by specialty choice in longitudinal and cross-sectional subspecialties or even between surgical and nonsur-
investigations are inconsistent calling into question its gical fields.72 Additionally, Family Medicine residents
utility in this realm.35,38,40,42,52 For instance, compared have varying MBTI preferences by training setting,
with data from the 1960s, the preference of resident further limiting MBTI utility in specialty selection as
physicians in all specialties between 1980s and 1990s medical students with different types likely seek
indicate a shift towards Thinking (55%; 44% in 1950s) different characteristics in selecting training pro-
and Judging types (59%; 53% in 1950s) from Feeling grams.55 Lastly, female medical students with Feeling
and Perceiving.36 Furthermore, evaluation of practice preferences were more likely to choose Family Medi-
setting by MBTI preference are lacking and insuffi- cine than Thinking types, highlighting the impact of
cient to make conclusions. For instance, isolated gender differences in specialty choice.36 A lack of
studies by Taylor et al. showed that there were sig- literature on MBTI preferences of rural practitioners
nificant differences in MBTI between civilian and and military physicians limits conclusions for these
military family practice residents, but not between the populations.
community-based and university-based residents.
Meanwhile, Royston et al. notes that Extraverted type 3.2. Evaluation/selection of trainees
students were more likely intend on practicing in a
rural setting.30,55 These studies are not large enough or Medical school admissions committees are to admit
reproduced to warrant definitive conclusions. qualified students broadly representing the commu-
A person's MBTI type may also change within a nities they serve. The necessity for social account-
few years. Taylor et al. showed that within a few ability and diversity is widely discussed in academic
years significant preference differences developed medicine.73 As such, much research and call-for-action
amongst Family Medicine residents, highlighting has focused on ethnic and socioeconomic underrepre-
the ever-changing personalities of individuals during sentation.74,75 However, psychological diversity should
training.55 Therefore, evidence-based research is also be considered as personality preferences may
Table 1
Summary of papers studying Myers-Briggs Type Indicator in medical education.
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
The association between Yang et al.22 2016 835 N/A Multi- Medical Data from 2011 Retrospective Other
Myers-Briggs Type Institutional Students AAMC surveys of
Indicator and Psychiatry multiple instituitions
as the specialty choice.
A standardized patient Lifchez et al.29 2014 40 N/A Single- Residents Johns Hopkins Prospective Other
model to teach and assess institutional University School of

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

professionalism and Medicine
communication skills:
the effect of personality
type on performance
Medical student Royston et al.30 2012 141 N/A Single- Medical Pacific Northwest Retrospective Other
characteristics predictive institutional Students University of Health
of intent for rural Sciences College of
practice Osteopathic
Medicine.
Do personality differences Bell et al.31 2011 complex 2004e2009 Single- Medicat Indiana University Prospective Quasi-
between teachers and institutional Students School of medicine experimental
learners impact students'
evaluations of a surgery
clerkship?
The personal interview: Quintero et al.20 2009 complex 2004e2006 Single- Medical Penn State College of Prospective Other
assessing the potential institutional Students Medicine
for personality similarity
to bias the selection of
orthopaedic residents.
Personality types and Sefcik et al.32 2009 263 2006e2007 Single- Medical Midwestern Prospective Quasi-
performance on aptitude institutional Students University/Chicago experimental
and achievement tests: College of
implications for Osteopathic Medicine
osteopathic medical in Downer's Grove
education. Illinois
Non-cognitive variables and Neral et al.33 2008 98 3 years Single- Medical University of Prospective Other
residency choice. (unspecified) institutional Students Mississippi Medical
Center
Personality preference McNulty et al.34 2006 116 N/A Single- Medical Loyola University Prospective Other
influences medical institutional Students Stritch School of
student use of specific Medicine
computer-aided
instruction (CAI).
(continued on next page)

35
Table 1 (continued )

36
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
Personality type and Wallick et al.35 1999 1262 N/A Single- Medical Lousiana State Retrospective Other
medical specialty choice. institutional Students University School of
Medicine
Myers-Briggs type and Stilwell et al.36 2000 3987 N/A Multi- Medical Lousiana State Retrospective Other
medical specialty choice: Institutional Students University School of
a new look at an old Medicine
question.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Does the admissions Wallick et al.37 2000 complex N/A Single- Medical Louisiana State Prospective Quasi-
committee select medical institutional Students University Health experimental
students in its own Sciences Center
image?
Personality types in Wallick et al.38 1999 1797 1988e1998 Single- Medical Louisiana State Prospective Other
academic medicine. institutional Students University Health
(but compared Sciences Center
to past data
from multiple
instituitions)
Physician personality types Sliwa et al.39 1994 78 N/A Single- Residents Northwestern Prospective Quasi-
in physical medicine and institutional University Medical experimental
rehabilitation as School
measured by the Myers-
Briggs Type Indicator.
Changes in medical Brown et al.40 1994 35 1992e1993 Single- Medical University of Prospective Other
students' Myers-Briggs institutional Students Tennessee, Memphis,
“preferences” between College of Medicine
their first and fourth
years of school.
Personality, clinical Lacorte et al.41 1993 30 N/A Single- Residents Department of Prospective Other
performance and institutional Pediatrics, Brooklyn
knowledge in paediatric Hospital center and
residents. Department of
Surgery, North Shore
University Hospital
New results relating the Friedman et al.42 1988 521 students N/A Single- Medical University of North Retrospective Other
Myers-Briggs Type institutional Students Carolina at Chapel
Indicator and medical Hill School of
specialty choice. Medicine
Personality types of family Harris et al.43 1985 75 1977e1980 Single- Residents University of Utah Prospective Quasi-
practice residents as institutional Family Practice experimental
measured by the Myers- (but compared residency program
Briggs type indicator. to area
physicians)
Teaching Communication Itri et al.44 2017 21 2015 Single- Residents University of Virginia Prospective Other
Skills to Radiology institutional
Residents.
The influence of surgeon Contessa et al.45 2013 27 N/A Single- Residents Saint Raphael campus Prospective Other
personality factors on institutional of Yale New Haven
risk tolerance: a pilot Hospital in New
study. Haven, Connecticut.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Anesthesiology resident Schell et al.27 2012 36 N/A Single- Residents University of Prospective Other
personality type institutional Kentucky College of
correlates with faculty Medicine
assessment of resident
performance.
Personality types of Zardouz et al.21 2011 137 2008e2009 Single- Medical University of Prospective Quasi-
otolaryngology resident institutional Students California, Irvina experimental
applicants as described
by the Myers-Briggs
Type Indicator.
Personality profiling of the Swanson et al.46 2010 39 2009 Single- Residents Department of Prospective Other
modern surgical trainee: institutional Surgery, University of
insights into generation Minnesota
X.
Personality type and Davis et al.47 2005 63 N/A Single- Medical University of Prospective Quasi-
clinical evaluations in an institutional Students Arkansas experimental
obstetrics/gynecology
medical student
clerkship.
Resident physicians who Johnson et al.48 2003 206 N/A Single- Residents Medical University of Retrospective Quasi-
continue Balint training: institutional South Carolina experimental
a longitudinal study
1982e1999.
Residents' formal Blake et al.49 1995 36 N/A Single- Residents Department of Family Prospective Other
knowledge acquisition institutional Medicine, University
and preferred learning of Mississippi
styles. Medical Center
Family practice residents' Musham et al.50 1994 16 N/A Single- Residents Department of family Cross- Quasi-
perspectives on Balint institutional medicine, University sectional experimental
group training: in-depth of South Carolina
interviews with frequent
and infrequent attenders.
(continued on next page)

37
Table 1 (continued )

38
Paper Name Author(s) Year of Total Study Nature of Study Subject Location of study Study type Experiment
Publication Participants Duration group Type
of Study
Examining whether certain O'Connell et al.51 1993 57 1991 Single- Standardized University of Illinois Prospective Quasi-
Myers-Briggs institutional Patients College of Medicine experimental
“personality preferences” and Dentistry
can be used as criteria to
select standardized
patients.
A comparative view of the Eicke et al.52 1993 44 1988e1991 Single- Residents University of Prospective Other

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Myers-Briggs type institutional Mississippi Medical
indicator. Center
Osteopathic medicine and Melnick53 1990 n/a N/A N/A N/A N/A Other
primary care practice:
plan or serendipity?
Factors associated with the Martin et al.54 1990 26 N/A Single- Residents Medical University of Retrospective Other
frequency of after-hours institutional South Carolina
in-person patient Family Medicine
consultations. Center
Personality types of family Taylor et al.55 1990 778 N/A Single- Residents Department of Family Cross- Other
practice residents in the institutional Medicine, Oregon sectional
1980s. (but used Health Sciences
national data) University School of
Medicine
Correlates of burnout Lemkau et al.56 1988 67 1984 Single- Residents Family practice Prospective Quasi-
among family practice institutional residencies associated experimental
residents. with Wright State
University.
The effect of physician Ornstein et al.57 1988 53 N/A Single- Residents Family practice Retrospective Other
personality on laboratory institutional residencies associated
test ordering for with Wright State
hypertensive patients. University.
A comparison of Rezler et al.58 1977 complex 1973e1974 Single- Medical University of Illinois Prospective Quasi-
personality types among institutional Students Medical Center experimental
female student health (and other
professionals healthcare
profession
students)
Types of family practice Quenk et al.59 1975 complex N/A Multi- Residents University of New Prospective Quasi-
teachers and residents: a Institutional Mexico, School of experimental
comparative study. Medicine
Comparison of the Leiden et al.60 1986 81 students N/A Single- Medical University of Nevada Prospective Other
abbreviated and original institutional Students School of Medicine
versions of the Myers-
Briggs Type Indicator
personality inventory.
A small-group instruction Brinton et al.61 1984 Complex N/A Single- Medical University of Utah Prospective Quasi-
experiment in medical institutional Students School of Medicine experimental
education.
Evaluation of computer- Mcnulty et al.62 2009 811 N/A Single- Medical Loyola University Prospective Other
aided instruction in a institutional Students Chicago Stritch
gross anatomy course: a School of Medicine
six-year study.

V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

Advanced communication Ang63 2002 n/a 2001 Single- Medical University of Chicago Prospective Other
skills: conflict institutional Students Hospitals
management and
persuasion.
Square pegs in round holes: Gilligan et al.64 1999 complex 1994e1997 Single- Medical St. George's Hospital Prospective Quasi-
has psychometric testing institutional Students and in London, U.K. experimental
a place in choosing a Residents
surgical career? A
preliminary report of
work in progress.
Using a personality Bughi et al.65 2017 185 N/A Single- Medical Keck School of Prospective Other
inventory to identify risk institutional Students Medicine
of distress and burnout
among early stage
medical students.
N/A ¼ not applicable.

39
40 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

underlie performance, empathy, clinical skills, and in an Obstetrics/Gynecology clerkship did not correlate
career choices.76e80 MBTI use has revealed peculiar with National Board of Medical Examiners (NBME)
findings in admissions processes. The MBTI types of scores (P > 0.05). Additionally, while NBME scores do
175 first-year medical students were the same as the not correlate with the MBTI Extraversion type
MBTI types of the admissions committee on all di- (P > 0.05), a correlation was observed between Ex-
chotomies, reflecting a possible bias in the commit- traversion preference and clinical evaluation ratings
tee.37 On the other hand, longitudinal assessment of the (P ¼ 0.005).47
MBTI types of 1797 first-year Louisiana State Uni- While preclinical medical student performance is
versity School of Medicine medical students between largely based on knowledge-based assessments, clin-
1988 and 1998 show no significant changes in MBTI ical performance is heavily determined by subjective
types apart from a preference for Intuition over evaluations by faculty and residents.89 Clinical clerk-
Sensing compared to 9 other schools within a dataset ship grades are important in residency selection with
of 12 schools. This may signify that committees prefer some specialty program directors citing it as one of the
certain characteristics/traits in their accepted appli- most crucial factors.26 Thus, identifying variables
cants that limits personality diversity. 35 associated with clinical clerkship grades is important.
The personality similarities between friends in- Lee et al. surveyed a cohort of 2395 medical students
crease the likelihood of shared likes, dislikes, and ac- who completed one or more required clerkships (In-
tivity preferences, reinforcing behavior patterns.81e83 ternal Medicine, Surgery, Obstetrics/Gynecology, Pe-
As such, admitting students with preferences mirror- diatrics, Neurology and Psychiatry). The authors show
ing those of the committee is detrimental. Increasing that more reserved students (in patient presentations,
psychological diversity may enrich the learning envi- answering questions) are more likely to report lower
ronment and produce more well-rounded physicians grades in Internal Medicine, Pediatrics, Psychiatry
who can better interact and care for diverse patient clerkships (all P < 0.05). Additionally, other associa-
populations. Admissions committee biases should be tions with lower clerkship grades were: males in Ob-
addressed. To this end, some medical schools have stetrics/Gynecology and Psychiatry; Asians in
integrated Computer-based Assessment for Sampling Obstetrics/Gynecology, Pediatrics and Neurology (all
Personal characteristics (CASPer), a tool assessing P < 0.05). Alternatively, more assertive students
interpersonal skills and decision-making, to account received lower grades less frequently in all clerkships
for psychological differences between applicants.84,85 (P < 0.03) except Internal Medicine.89 These findings
Such tools should be considered more widely in question the validity of clinical evaluations in assessing
medical school admissions to promote diversity. student performance due to possible biases and lack of
At the resident level, Orthopaedic faculty physi- correlation with objective evaluation through shelf
cians ranked Orthopaedic residency interviewees more exam scores. Extraversion may enable students to
favorably when they shared particular personality openly demonstrate enthusiasm, knowledge, team-
preferences (P ¼ 0.044), highlighting innate bias. This work, and communication with evaluators and patients,
bias was not present in interview rankings by basic which may help to better subjective grading. Further-
scientists or orthopaedic resident interviewers.20 This more, the MBTI may explain findings by Lee et al. as a
questions the validity/weight given to the subjective student's response to a particular clerkship environment
components of medical school/residency admissions, may influence how they are perceived. The authors
such as interviews where biases may manifest and postulate males may respond to the Obstetrics/Gyne-
applicants may not project their true personality cology clerkship setting with an Introversion prefer-
traits.21,86 However, Powis et al. do show that in- ence (projecting greater reticence), but with equivalent
terviews may predict academic performance and may clinical skills and knowledge to females.89,90
hold value in candidate selection.87 Therefore, a more At the resident level, long-term clinical perfor-
uniform approach to the trainee interview process may mance evaluations of Anesthesiology residents are
be required to limit biases and increase validity, fair- higher for Extraverted and Sensing types than their
ness, and reliability.88 counterparts (P < 0.05). However, daily performance
scores are higher only for Sensing than Intuition
3.3. Student performance types (P < 0.05).27 Paediatric faculty physician
evaluations of resident knowledge is directly associ-
Grading on clinical rotations have been analyzed ated with scores on in-training exams (P < 0.01) and
using MBTI. Clinical evaluations of medical students Extraversion type (P < 0.01), but inversely associated
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46 41

with age (P < 0.01).41 For fellowship selection, per- delaying therapeutic dialogue and mental health care.
sonal knowledge of the applicant and recommenda- Additionally, Perceptive, Feeling, and Intuitive Family
tion letters are the most important factors.91e93 As Medicine residents are less emotionally exhausted,
such, resident clinical evaluations, which may influ- show less depersonalization, and have greater sense of
ence the quality of department recommendations, accomplishment compared to Judging, Thinking,
may need re-evaluation and validation of their utility. Introverted and Sensing peers, respectively
While most MBTI and standardized testing litera- (P < 0.05).56 The authors postulate Perceptive types
ture show no association, a few studies do. Osteopathic may more readily recognize their burnout. Overall, the
Intuition-Feeling medical students have significantly MBTI may serve as a preventative “screening” tool for
lower scores on medical licensing exams than other first-year medical students and residents, identifying
types despite no difference in medical school entrance “risk factor” preferences for burnout.
exam scores (P ¼ 0.002).32 At the resident level, first
and third-year Family Medicine resident in-training 3.5. Clinical skills and communication classes
exam scores showed significant differences for
Feeling (score increase of 109.4 points) versus Various industries use the MBTI to improve
Thinking (72.2 points, P ¼ 0.02) and Judging (101.0 communication skills.18,19 This has permeated into
points) versus Perceptive types (60.0 points, medical education as well. After a communication
P ¼ 0.03).49 Similarly, Extraversion was independently skills workshop incorporating the MBTI, fourth-year
predictive of in-service scores amongst Pediatrics res- medical students reported increased confidence and
idents.41 Possibly, certain exams may be more condu- attitudes towards conflict management and resolu-
cive to particular personality types. These results may tion.63 Similarly, MBTI has been favorably utilized in
be hindered by sample size or selection bias. communication workshops for Radiology residents.44
In a majority of Intuitive-Thinking Surgery residents,
3.4. Burnout self-reported comfort in delivering bad news correlated
with evaluation by standardized patients (SP) and did
Burnout increases risk of depression, anxiety dis- not correlate with prior education on the topic.103 With
orders, sleep abnormalities, fatigue/lethargy, substance respect to SPs, another study showed the MBTI pref-
use, divorce, and suicide.94 U.S. physician burnout and erences of SPs do not significantly differ from those of
satisfaction worsened between 2011 and 2014 and now the general population.51 Educating and assessing
more than 50% of U.S. physicians experience profes- interpersonal and professional communication skills is
sional burnout.95 However, burnout begins early in difficult.104 Resident often indirectly learn these skills
training. Between 28% and 45% of medical students through observation of superiors.103 Patients and phy-
and 27%e75% of residents experience burnout.96 Such sicians differ significantly in their MBTI dimensions;
findings have led to policy changes, duty hour re- yet, current communication models assume all patients
strictions, and support for trainees within a culture of respond similarly.105,106 To that extent, Allen et al.
wellness.97 However, limited in the discussion of present the MBTI as the most suitable tool for this
trainee burnout is the role of personality types. purpose as it is principally a psychometric test.107
Drummond discusses character traits that may manifest Early incorporation of the MBTI in clinical skills
in physicians when they are burned out.98 Trainees' training of medical students may allow for an indi-
perceptions of and reactions to stressors in the work vidualized communication framework that can be
environment may predispose them to burnout differ- applied to patient care. This concept may extend to
ently.99 Fundamentally, the MBTI identifies how in- appropriate use of body language and emotional touch
dividuals interact with their environment as a product with patients, allowing for increased communication
of their interests, needs, values, and motivations. One and emotional intelligence.108
study examining MBTI and burnout in underclassmen
medical students showed that Extraversion types have 3.6. Student study methods
greater positive well-being, professional efficacy, and
lower levels of depression compared to Introversion Students have different learning styles, which may
types (all P < 0.05).65 Studies not using MBTI show be due to their backgrounds and experiences.109 While
introverted trainees are more likely to burnout than some literature has reported this not be true, other
extroverts.100e102 Hypothetically, introverts facing studies have shown that different/individual learning
stress may be less likely to discuss their struggles, styles do exist.110e116 Diverse educational programs
42 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46

and instructional media accommodate individualized medical education research, is one of many such tests,
learning.117,118 Medical students with Sensing prefer- all of which are not validated. However, when
ence utilize both online discussion-based and tutorial compared to Sixteen Personality Factor Questionnaire
computer-aided instruction programs more than Intui- and the abbreviated MBTI, the original MBTI form
tive types (P < 0.05). Judging types only prefer shows compared results.52,60 Studies with small sample
discussion-based applications relative to Perceiving sizes limit generalizability of results. Observational
types, who utilize multiple modalities. These studies studies and lack of longitudinal studies limit extrapo-
emphasize that personality types can greatly influence lation of findings. The utility of results from older
preferred study methods.34,62 Medicine demands life- studies are questionable as specialties have evolved
long learning and trainees and educators should over time. From our standpoint, errors in data extrac-
explore individualized approaches.106 The MBTI may tion and identification of papers may diminish findings
assist in doing so, especially at transition points in or, theoretically, could contradict our results. Addi-
training, such as for first-year medical students and tionally, the majority of studies are American as we
post-graduate year one residents.119 excluded manuscripts not published in English. This
Intuitive-Feeling medical students prefer small may be a source of potential bias given that teaching
group courses over lectures (P < 0.05).61 Numerous and learning may differ in different parts of the world.
medical schools have incorporated problem-based Thus, the role of MBTI and its findings within medical
learning, team-based learning, and flipped classroom education may be different in different parts of the
models into curriculum instead of traditional large world. This makes our findings less generalizable.
group lectures, improving medical student satisfaction Furthermore, personality changes can occur over time
and performance.120e122 The MBTI could be used at and even throughout medical school. This concept,
the college level to identify medical schools with coupled with papers spanning decades, makes our re-
curriculum models best suited for students. view in some ways less applicable/translatable to
everyday practice given that older findings may not
3.7. Clinical practice necessarily hold true today in the ever-changing land-
scape of medical education. Lastly, it is difficult to
The MBTI has also been used to examine how resi- make generalized claims based off one or two studies.
dent physicians practice medicine. No differences exist However, given the limited scope of the literature, we
on in-person consultation frequency by MBTI temper- have tried to make associations and provide insights
ament of Family Medicine residents;54 however, Intui- that may probe these concepts further in more exper-
tive Family Medicine residents order 20.5% more tests imental studies.
than Sensing types in outpatient settings (P < 0.05).
Surgical trainees with Thinking, Extraverted, and 4. Conclusion
Perception personality types have higher risk tolerance
than other types.57 Family Medicine residents who The MBTI is a potentially powerful tool for medical
completed short- and long-term Balint training, a form education. However, its predominant role of assisting
of medical communication emphasizing emotional and trainees with specialty choice is questionable. Instead,
personal understanding and the therapeutic potential of the MBTI may be better served to develop new-era
the doctor-patient relationship, are significantly more curricula, provide trainees with personalized study
likely to be Intuitive types (P < 0.05).48,50 During environments (ex. Small groups), communication skills
medical school, students are exposed to new knowledge, training, and burnout support, and unearth biases in
models of reasoning, and perception of information, admissions and evaluation processes. In these ways,
which often changes their MBTI preferences.58 This the MBTI may advance personalized medical educa-
may influence their practice of medicine later. As such, tion in the 21st century.
different training environments may lend to different
practice behaviors, which ultimately determine the value Disclosures
of care provided to patients.129
None.
3.8. Study limitations
Ethical approval
Several limitations exist in our study. The MBTI,
while the most commonly used personality index in Not applicable.
 V. Ramachandran et al. / Health Professions Education 6 (2020) 31e46 43

Funding 12. Goodstein LD, Lanyon RI. Applications of personality assess-

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