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 Table of Contents  
ORIGINAL RESEARCH ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 26-30

Using a personality inventory to identify risk of distress and burnout among early stage medical students


1 Research, Rancho Research Institute, Downey, California, USA
2 Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
3 Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
4 School of Applied Life Sciences, Keck Graduate Institute, Claremont, California, USA

Date of Web Publication13-Jul-2017

Correspondence Address:
Stephanie A Bughi
DHSc, MS 7601 E. Imperial Hwy, 900 Building, Annex A, Downey, CA 90242
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1357-6283.210499

  Abstract 


Background: Distress and burnout are common among medical students and negatively impact students' physical, mental, and emotional health. Personality inventories such as the Myers-Briggs Type Indicator (MBTI), used in medical education, may have a role in identifying burnout risk early. Methods: The authors conducted a cross-sectional survey study among 185 1st year medical students with the MBTI, the general well-being schedule (GWB), and Maslach Burnout Inventory-Student Survey (MBI-SS). Descriptive statistics and one-way MANOVAs were used to identify the prevalence and differences in MBTI preferences and distress/burnout risk. Results: Response rate was 185/185 (100%). Distress (GWB) was reported by 84/185 (45.4%). High scores on exhaustion were reported by 118/182 (64.8%), cynicism by 76/182 (41.8%), and decreased professional efficacy by 38/182 (20.9%) for the three dimensions of the MBI-SS. Only 21/182 (11.5%) of respondents had high scores on all three dimensions of burnout. Students with MBTI preferences for extraversion reported greater positive well-being (P < 0.05), self-control (P < 0.05), professional efficacy (P < 0.01), and lower levels of depression (P < 0.01) compared with those with introversion preference. Discussion: Distress and burnout are prevalent early in medical training. The significant difference between extraversion and introversion in relation to distress and burnout deserves further study. Use of a personality inventory may help identify students at risk of burnout and allow appropriate early stress management.

Keywords: Burnout, distress, MBTI preference, medical students


How to cite this article:
Bughi SA, Lie DA, Zia SK, Rosenthal J. Using a personality inventory to identify risk of distress and burnout among early stage medical students. Educ Health 2017;30:26-30

How to cite this URL:
Bughi SA, Lie DA, Zia SK, Rosenthal J. Using a personality inventory to identify risk of distress and burnout among early stage medical students. Educ Health [serial online] 2017 [cited 2017 Sep 21];30:26-30. Available from: http://www.educationforhealth.net/text.asp?2017/30/1/26/210499




  Background Top


Physician self-care is an important foundation for quality patient interactions and outcomes, and yet studies suggest that not enough attention is paid to physician well-being, which may be shaped early in medical training.[1] Distress and burnout among medical students are well reported in literature, with studies documenting a prevalence of 20%–50%, including common stressors (e.g., examinations, finances, and relationships).[2],[3],[4],[5] Student physicians' distress and burnout may predict adverse future health status and practice performance.[3],[4],[5],[6],[7] Medical schools now offer programs to improve or maintain student well-being.[7] Strategies to better identify students at risk of distress and burnout are needed for successful outcomes.[3],[4] Administering separate instruments to assess distress and burnout at intervals is not practical given the heavy student burden of evaluations, examinations, and the risk of survey fatigue. Using an instrument, that is, already being deployed in the curriculum is a potential solution to address these obstacles.

The Myers-Briggs Type Indicator (MBTI) is often administered in medical schools as a self-assessment tool to teach about communication and teamwork and for career guidance.[8],[9],[10] Different versions of the MBTI with varying item numbers have been developed.[10],[11] A free online abridged version is available.[12] Studies [6],[13] suggest that exploring MBTI preferences may help ascertain vulnerability and response to stress. According to a study by Davidson et al.,[14] medical school performance has been linked to individual personality traits. The study [14] notes that unlike extraverted medical students, those with a preference for introversion performs well academically during their 1st year of training, but experience more stress and score lower on interpersonal behavioral assessments later in training. A report [6] on medical residents found that introversion and other MBTI preferences of sensing, thinking, and judging were associated with higher burnout scores. In this study, extraversion, intuition, feeling, and perception were noted to be associated with greater social interactions, creative responses, and appreciation of external viewpoints and understanding, respectively.[6] Studies exploring self-identified MBTI preferences, distress, and burnout levels among early stage (1st year) medical students are lacking.[6],[13]

We therefore conducted a survey study among 1st year medical students to examine the purported link between MBTI preferences and distress and burnout scores. We hypothesized that the prevalence of distress and burnout in our sample would mirror that reported (20%–50%) in literature.[3],[4],[5] Our second hypothesis was that students with preferences for extraversion, intuition, feeling, or perceiving on the MBTI would score lower in distress and burnout measures than their dichotomous counterparts.


  Methods Top


This is a cross-sectional survey study of one class of 185 1st year medical students at an urban California medical school. Participants were students in a Professionalism course who had already completed their MBTI personal preference online [12] as part of a session on team-building. During a second session, 1 month later, they were invited to complete and submit an anonymous paper-and-pencil survey comprising two instruments: the general well-being schedule (GWB) and Maslach Burnout Inventory-Student Survey (MBI-SS). Survey administration was timed so as not to coincide with any external stressor such as examinations. Students scored themselves on the measures and were given information resources to self-manage high stress levels. The study received the Institutional Review Board approval.

Instruments

We selected the MBTI because of its utility in the context of relating effectively to others with different MBTI preferences and for building effective teams.[8],[9],[10] It is a valid and reliable instrument (test-retest reliability 0.85) that has been used with medical students and healthcare professionals.[8],[9],[10] The MBTI explores four dichotomies of personal preferences: extraversion-introversion, sensing-intuition, thinking-feeling, and judging-perceiving.[8],[9] Dichotomy one, extraversion-introversion, refers to personal sources of energy; extraverts draw energy from social interactions in contrast to introverts who reflect on experiences and concepts.[8],[9] Dichotomy two, sensing-intuition, signifies how one receives information; sensing types prefer facts and data while intuitive types focus on possibilities and theoretical knowledge.[8],[9],[10] Dichotomy three, thinking-feeling, focuses on how decisions are made; thinkers make decisions based on logic, whereas feelers consider other people, personal information, and values.[8],[9],[10] Dichotomy four, judging-perceiving, indicates coping with the outside world; judgers favor structure and organization compared to perceivers, who opt for choices and flexibility.[8],[9],[10] We elected the online version of the MBTI [12] for our study for its ease of administration.

We chose the validated GWB [3],[15],[16] as a measure of current distress in medical students. The 18-item GWB measures subjective wellness using six subscales of emotions (anxiety, depression, positive well-being, self-control, vitality, and general health) experienced within the past month.[15],[16] Total GWB scores range from 0 to 110, with values of 0–60 indicating severe distress, 61–72 moderate distress, and 73–110 reflecting positive well-being.[15],[16] Depression and anxiety are reverse scored.[15],[16] The GWB has a high test-retest reliability (0.68–0.85) and internal consistency coefficient (0.91 for men and 0.95 for women).[15],[16]

We chose the widely used MBI-SS [17],[18] to assess three dimensions of burnout (exhaustion, cynicism, and decreased professional efficacy). Responses for each of the 15 survey items range from 0 (never) to 6 (every day), with low scores on professional efficacy and high scores on both exhaustion and cynicism suggesting overall burnout.[17],[18] Burnout levels are scored as low, moderate, and high.[18] The MBI-SS has shown good validity and reliability (0.74–0.81 emotional exhaustion, 0.59–0.86 cynicism, and 0.67–0.79 professional efficacy) among medical students.[17],[18]

Data collection and analyses

We collected completed anonymous paper survey responses with self-reported MBTI preferences, and entered the data into Excel. We used descriptive statistics to report demographics and prevalence. We tested quality of the data using reliability and effect sizes. We performed parametric tests based on our adequate sample size and balanced gender distribution. Using one-way MANOVAs (Hotelling's Trace), we examined the differences of MBTI personal preferences (i.e., independent variables) with distress, burnout, and related aspects (i.e., dependent variables) as measured by GWB and MBI-SS scales and subscales, respectively. In addition, we conducted two-tailed Pearson correlation and multiple regressions to assess the relation between distress and burnout variables. Alpha <0.05 was considered to be statistically significant for all tests. We used IBM SPSS Statistics for Windows version 22.0 for data analyses.


  Results Top


All 185 students completed the three instruments (100% response rate). Students took an average of 15 min to complete the GWB and MBI-SS in class.

Demographics and participant MBTI preferences

Ninety-two (52.3%) of the students were male. Age range was 18 to over 30; 148 (83.1%) were 22–25-year-old. Seventy-six (43.7%) students self-identified mainly as Asian and 58 (33.3%) non-Hispanic white/Caucasian. More students reported a preference for intuition over sensing and judgment over perception while the other two paired preferences were evenly distributed. Introversion (vs. extraversion) was favored by 94 (51.9%), intuition (vs. sensing) 122 (68.5%), feeling (vs. thinking) 89 (50.3%), and judgment (vs. perception) 150 (83.3%). [Table 1] shows student demographic and MBTI personal preferences.
Table 1: Demographics and Myers-Briggs Type Indicator Personal Preferences

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Prevalence of distress (General Well-Being) and burnout (Maslach Burnout Inventory-Student Survey)

Overall, positive well-being was reported by 101 (54.6%) students, with 84 (45.4%) reporting overall distress (GWB). Of the 84 (45.4%) who reported distress, 47 (25.4%) noted moderate distress and 37 (20.0%) severe distress. For the MBI-SS, 21 (11.5%) of the respondents had high-level scores on all three dimensions of burnout (i.e., exhaustion, cynicism, and decreased professional efficacy), 6 (3.3%) moderate-level scores, 6 (3.3%) low-level scores, and 149 (81.9%) had variable scores in each burnout dimension. Examination of the MBI-SS subscales showed that 118 (64.8%) experienced high-level exhaustion, 76 (41.8%) cynicism, and 38 (20.9%) decreased professional efficacy. The prevalence of moderate-level exhaustion, cynicism, and decreased professional efficacy was 48 (26.4%), 73 (40.1%), and 42 (23.1%), respectively. The prevalence of low-level exhaustion was 16 (8.8%), cynicism 33 (18.1%), and decreased professional efficacy 102 (56.0%).

Differences between distress, burnout, and MBTI personal preferences

We conducted one-way MANOVAs to assess if there were MBTI differences between distress and burnout based on the linear combinations of the six GWB subscales and the three MBI-SS subscales, respectively. We found a statistically significant difference between extraversion-introversion preferences and scores on the GWB scale (Hotelling's Trace = 0.087, F {6, 174} =2.52, P < 0.05, η2 = 0.08). Of the six GWB subscales, depression (F {1, 179} =10.4, P < 0.01, η2 = 0.06), positive well-being (F {1, 179} =4.58, P < 0.05, η2 = 0.03), and self-control (F {1, 179} =4.57, P < 0.05, η2 = 0.03) were statistically significantly different for extraversion and introversion. Lower depression scores were found with extraversion (mean (M) =15.6; standard deviation [SD] =2.83) compared to introversion (M = 14.1; SD = 3.49). In addition, higher scores on positive well-being and self-control were shown with extraversion (M = 10.1; SD = 2.41 and M = 12.0; SD = 2.36) than introversion (M = 9.33; SD = 2.52 and M = 11.2; SD = 2.71). We found a statistically significant difference between extraversion-introversion preference and MBI-SS scores (Hotelling's Trace = 0.079, F {3, 174} =4.58, P < 0.01, η2 = 0.07). Univariate analysis showed that professional efficacy (F {1, 176} =11.8, P < 0.01, η2 = 0.06) contributed statistical significance toward distinguishing extraversion from introversion. Greater professional efficacy scores were reported with extraversion (M = 28.8; SD = 4.44) than introversion (M = 26.2; SD = 5.54) preference. With respect to the other MBTI preferences, there was a statistically significant difference between thinking-feeling and GWB scores (Hotelling's Trace = 0.102, F {6, 170} =2.89, P < 0.05, η2 = 0.09). Vitality (F {1, 175} =6.59, P < 0.05, η2 = 0.04) was statistically significantly different for thinking and feeling; higher vitality scores were noted in feeling (M = 12.0; SD = 3.27) than thinking (M = 10.7; SD = 3.44) preference. We found no other statistically significant difference between MBTI personal preference and distress and burnout scores as reflected by the GWB or MBI-SS scales and subscales.

Relation between distress and burnout constructs

We performed Pearson correlation to examine the relation between distress and burnout as measured by GWB and MBI-SS scales. A high sum score on the GWB, which suggests greater well-being, was negatively associated with MBI-SS's exhaustion (P< 0.01) and cynicism (P< 0.01) and positively correlated with professional efficacy (P< 0.01). High scores on all six GWB subscales were negatively related with exhaustion (P< 0.01) and cynicism (P< 0.05) and positively correlated with professional efficacy (P< 0.01). With multiple regression analyses, GWB subscales accounted for 38% of the variance in exhaustion, 19% cynicism, and 17% professional efficacy. The significance found in both constructs suggests that the GWB subscales are unique predictors of all three MBI-SS dimensions. [Table 2] shows the correlation coefficients and multiple regressions for both distress and burnout.
Table 2: Correlation coefficients and multiple regressions of General Well-Being and Maslach Burnout Inventory-Student Survey variables

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  Discussion Top


In this exploratory survey study, our first hypothesis was met– we confirmed a high rate of distress and burnout among 1st year medical students, comparable to what has been described (20%–50%) in literature.[3],[4],[5],[18] Moderate and severe distress were reported by 45.4% of students. Over 10% of our students reported high burnout scores as defined by the components of exhaustion, cynicism, and decreased professional efficacy.

We partially met our second hypothesis that students with extraversion, intuition, feeling, or perceiving preferences on the MBTI compared with their counterparts would score lower in distress (GWB) and burnout (MBI) measures. Students with a preference for extraversion had lower scores for depression and greater scores for positive well-being, self-control, and professional efficacy compared with students with a preference for introversion. In addition, we found higher vitality scores among students with feeling preference compared with thinking preference. Other studies [3],[6],[19] (on medical students, medical residents, and general population) have reported lower stress and burnout scores and greater well-being with extraversion preference, and less depersonalization with feeling preference. This may be partially explained by the greater social coping mechanisms and acceptance of external viewpoints associated with extraversion and feeling preferences, respectively.[3],[6],[13],[14],[19] We found no other significant differences between the other MBTI preferences and the GWB and MBI-SS scales and subscales. Understanding the relation between MBTI preferences and vulnerability to distress and burnout can help educators build balanced and functional teams.[20] Being a part of functional teams over functioning as individuals is a preference expressed by millennials.[21] One intervention for educators to consider is to cultivate peer support through introversion-extraversion pairings when tailoring assignments and constructing student teams, both for classrooms and for peer support and mentoring.[22]

Our study has several strengths. The measures we chose have been widely used in other studies on medical students and health professionals. We addressed the link between the MBTI and distress and burnout at an early stage of training, which has not been previously reported. We selected robust statistical analysis methods for our sample, which permitted clear interpretation. We had a 100% response and a brief interval between administration of MBTI and GWB and MBI-SS scales. The study has some limitations. Generalizability may be limited because it was conducted at a single institution. The prevalence of distress and burnout may fluctuate across the academic year and for different levels of training, and we cannot project the differences we found to other years or stages of training. Although there may be some recall bias for the GWB (for past month's experiences), we expected no more than that seen in a general population. One theoretical limitation is that the MBTI, which is often used in different teamwork settings to understand trait dichotomies, is a dynamic and complex instrument. Student responses may be influenced by environmental factors and the tendency to select perceived socially desirable responses. Because it is considered to be a personality “type” instrument and not an analytic tool, it cannot be used to design specific stress management strategies.


  Conclusion Top


Our findings regarding MBTI preferences and distress and burnout among early stage medical students offer a potential for an additional function for the MBTI. Administering the MBTI early in medical training may help students self-assess their potential risk for distress and burnout.[14] Once students self-identify their risk, stress management interventions may be offered earlier.[3],[4],[7] We suggest larger multi-institutional studies to confirm our observations, including surveying students at different developmental stages. We conclude that use of the MBTI may be extended beyond the context of team building and career counseling to include early identification of distress and burnout risk.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.



 
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