An exploratory study on the contribution of graduate entry students personality to the diversity of medical student populations

Recent recommendations by professional bodies involved in the evaluation and accreditation of undergraduate medical education are emphasizing the importance of diversifying the population of medical students [1, 2]. Graduate-entry programmes are expected to contribute to such diversification [3‐5] as these programmes are expected to admit an alternate pool of medical students who are more similar to the general population, and to ‘widen the access’ to tertiary students who are able to achieve higher learning and academic performance in medical school than secondary students [6, 7].

Historically, in Europe, medical schools admitted by and large 17- to 18-year-old high school leavers to 6–7 year programmes. More recently, government initiatives in some European countries—for example, UK, Ireland and Portugal—have allocated a significant number of medical school places, into identical or shorter (typically 4-year) programmes, to students who have completed tertiary degrees: the ‘graduate entry’ students [3, 4, 8].

In Portugal, the specific availability of places for graduate applicants began in 2007 and is currently 15 % of the current annual medical student intake. There are now eight medical schools, one of which accepts graduate students exclusively. The remaining seven schools accept students through two pathways: the specific pathway for graduate entrants (15 % places) and the national general application and admissions process (residual) which accepts applicants based on ranking of high school academic performance. Therefore, Portugal offers an interesting context to clarify how graduate entry programmes are contributing to the diversity of undergraduate medical student populations.

Personality is an important variable in the context of medical education as it influences such disparate phenomena as academic and postgraduate performances [9, 10], student empathy [11, 12], clinical skills [13, 14], engagement in extracurricular activities [15] and career preferences [16]. The characterization and eventual contribution of graduate entry students’ personality profiles to the diversity of medical student populations across institutions remains mostly unaddressed [10]. The exception is a recent multi-institutional study in Australia, which compared undergraduate and graduate entry schools and found significant but small magnitude differences in conscientiousness and agreeableness between schools [17]. This study was conducted to clarify whether high school and graduate entry students differ in their personality profiles. To this purpose we have chosen another cultural context—Portugal—but have used the same model of personality—the Big Five. The study addressed the following questions related to personality differences between graduate entry and high school entry students: First, do graduate entry students contribute to diversify the personality profiles of medical student populations across institutions? Second, do graduate entry students contribute desirable personality dimensions in a doctor such as higher conscientiousness and openness to experience and lower neuroticism? Third, can diversity in personality across schools be explained by the sex and age of the students? The three medical schools analyzed offer different programme types: University of Beira Interior and University of Minho run 6-year programmes accessed through the general admissions process; University of Minho also runs a 4-year graduate entry parallel track programme and University of Algarve runs a 4-year graduate entry only programme. These medical schools are also located in different regions of Portugal; University of Minho is in the north, University of Beira Interior is in the centre and University of Algarve in the south. Therefore, these medical schools could provide interesting contexts for the present study.

This exploratory study contributes to the debate on the diversity of student populations in medical schools and shows that graduate entry and high school student populations are different pools of personality profiles [6, 19]. The graduate entry students scored significantly lower on neuroticism and higher on conscientiousness, openness to experience, agreeableness, and extraversion. However, the differentiating element in terms of personality was not related to being or not being a graduate at entry to medical school, but with the fact that graduate students are older students.

The initial analysis showed that, as compared with high school entrants, graduate entry students’ personalities were more tailored for success in medical education. Conscientiousness is the dimension that has been more thoroughly associated with academic success in medical schools [10, 14]. Highly conscientious students are hard-working, persistent and organized [14, 20]. Openness to experience blends openness—which includes traits such as active imagination and aesthetic sensitivity—with intellect—that involves intellectual curiosity and insightfulness. Such sociability related traits have been deemed important for the successful acceptance of the dynamism of clinical settings [10, 20]. Furthermore, one study found that conscientiousness, extraversion and openness were increasingly significant contributors to predict academic success in clinical phases of the medical curriculum [20]. Neuroticism, on the other hand, comprises characteristics such as anxiety, fearfulness, and insecurity in relationships. The lower levels of neuroticism in graduate entry students should reduce the vulnerability of students to stress, both academic and at the workplace [21]. A deeper exploration of the above findings showed that personality differences could be accounted for by age, as significant main effects of the above variables were lost when age was used as a covariate. Controlling for age revealed that the differences that subsisted—neuroticism, agreeableness and conscientiousness—were explained by sex alone. A recent study, conducted in Australia, led to alternative findings, namely that there are small magnitude differences in personality between undergraduate and graduate entry students when age and sex are controlled [17]. Further research must be conducted to clarify these cross-cultural discrepancies.

We further hypothesized that there would be variability of student personality profiles between medical schools and found school effects in the dimensions of neuroticism and openness to experience. However, such differences could not be attributed to medical school or programme structure but were mainly explained by student sex and age. Once more, sex and age emerged as primary factors to explain variability in personality profiles. However, it should be noted that we could be dealing with a selection bias in older graduate entry students since in the programmes of the Universities of Algarve and Minho the students were selected with the use of MMIs. Therefore, within our dataset, the different admissions processes were not important to explain the personality differences. In other words, differences in the personality of graduate entry students in a problem-based learning medical school with a 4-year programme and a high school entry 6-year programme were explained by the age and sex of student populations and not by aspects related to the school. The influence of sex and age is also reported in studies on the general population, in which women are associated with higher scores for neuroticism and agreeableness and lower for extraversion and age correlates with three personality dimensions, negatively for extraversion and openness, and higher on Conscientiousness, a recurrent finding related to the ‘psychosocial maturity’ of the participants [22‐24].

Our study suffers from the limitations of being confined to one country, to a limited number of schools and programme types and a possibly biased sample from one of the schools due to lower response rate. We also feel that providing comparative data on academic performance and personality could further enhance our study. We have, however, no such data at this point, which is also a limitation of the present study. In spite of these limitations, it is one of the few multi-institutional studies on differences in medical student personalities. It would be important to confirm our findings, cross-culturally, in schools applying other admission models.

This study suggests that graduate entry students contribute in desirable ways to the personality pool of medical students and that student age and sex are primary sources of variability. Thus, this study’s major implication for medical education research and practice is that diversifying the personality of admitted students implies diversifying the age and sex of the admitted students.