RESEARCH REPORT

Exploring Relationships Between Personality and Anatomy Performance Gabrielle M. Finn,1* Simon J. Walker,2 Madeline Carter,3 David R. Cox,4 Ruth Hewitson,5 Claire F. Smith6 Centre for Education Development, Hull York Medical School, University of York, Heslington York, United Kingdom 2 Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom 3 School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom 4 Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom 5 Wessex Deanery, NHS Health Education England, Winchester, Hampshire, United Kingdom 6 Department of Anatomy, Brighton and Sussex Medical School, University of Sussex, United Kingdom 1

There is increasing recognition in medicine of the importance of noncognitive factors, including personality, for performance, and for good medical practice. The personality domain of conscientiousness is a well-established predictor of performance in workplace and academic settings. This study investigates the relationships between the “Big Five” personality domains, the facets of conscientiousness and performance in a practical anatomy examination. First- and second-year undergraduate medical students (n 5 85) completed a paper-based questionnaire, which included a 50-item measure of the Big Five personality domains (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) and a 60-item measure of the six conscientiousness facets (orderliness, dutifulness, achievement-striving, self-discipline, self-efficacy, and cautiousness) from the International Personality Item Pool (IPIP). In addition, routinely-collected academic performance scores from the end of semester anatomy practical examinations (spotters) were obtained. Anatomy examination performance correlated moderately with conscientiousness (r 5 0.24, P 5 0.03). Of the six facets of conscientiousness, a positive relationship was observed between anatomy examination performance and achievement striving (r 5 0.22, P 5 0.05). In conclusion, this study found that performance in an anatomy examination was related to higher levels of conscientiousness and, more specifically, to higher levels of achievement striving. The results have implications for selection and C 2015 American Association of Anatomists. assessment in medicine. Anat Sci Educ 8: 547–554. V Key words: gross anatomy education; medical education; medical students; personality; conscientiousness; assessment; big five; anatomy examination; performance

INTRODUCTION Recent decades have seen growing bodies of research reveal that personality is important for learning and academic performance (Lievens et al., 2002, 2009). In medicine, there is increasing recognition of the importance of noncognitive fac*Correspondence to: Dr. Gabrielle M. Finn, Hull York Medical School, University of York, Heslington York YO10 5DD, United Kingdom. E-mail: [email protected] Received 25 July 2013; Revised 5 September 2014; Accepted 20 December 2014. Published online 24 February 2015 in Wiley (wileyonlinelibrary.com). DOI 10.1002/ase.1516

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tors, including personality, for performance in medical school and more broadly for good medical practice (McManus et al., 2013; Tiffin et al., 2014). It has been estimated that 35% of first year medical school performance is not accounted for by academic achievement (McManus et al., 2013). Personality and attitudinal differences are thought to account for at least some of the remaining “dark variance” (McManus et al., 2013), and the role of motivational factors, which influence the extent of deliberate practice and training, have been highlighted as critical for the development of expertise (Ericsson et al., 1993; Ericsson and Lehmann, 1996). A number of medical schools are now incorporating noncognitive assessments in their selection processes (McManus et al., 2013; Tiffin et al., 2014) and in the United Kingdom, noncognitive assessments have recently been introduced for selection into the Foundation Programme (UKFPO,

Anat Sci Educ 8:547–554 (2015)

2013). In response to these changes, a greater understanding of the relationships between personality and performance in a range of medical contexts is required. This article seeks to test the relationships between personality variables and performance in a medical school anatomy examination. This article will first describe a widely-used taxonomy of personality known as the “Big Five,” before summarising evidence on the observed relationships between the Big Five personality domains and performance, including academic and medical school performance. The context of anatomy teaching and assessment in the current study will then be outlined, and the study aims will be presented.

Personality and Performance Personality psychologists generally agree that there are five relatively independent higher-order personality domains, known as the “Big Five” or Five Factor Model (FFM), and this conceptualization has dominated personality research over the last three decades. The Big Five has been criticized for being data-driven rather than theoretical, derived from factor-analytic approaches, and for failing to account for the full range of human personality (Block, 2010). However, it remains a widely-used, well-established model with demonstrated validity and reliability across a number of populations (Barrick and Mount, 1991; Judge and Ilies, 2002; Lievens et al., 2002; O’Connor and Paunonen, 2007; Reiter and Eva, 2011). Although, there are some slight variations in labeling of the Big Five domains (e.g., John and Srivastava, 1999), the widely-recognized five domains include neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness (IPIP, 2014). Evidence indicates that the Big Five domains generalize across different cultures, rating sources, and measures (John and Srivastava, 1999), and they have been described as “the most widely accepted structure of personality in our time” (Judge and Ilies, 2002). The Big Five domains have a long history of development in personality research and there are multiple measures of these domains (John et al., 2008). However, we chose to focus on a measure derived from one of the most extensively-used Big Five inventories, the NEO-PI-R (Costa and McCrae, 1992; IPIP, 2014). Sociable individuals who seek excitement and stimulation and are energetic, positive, assertive, and socially dominant (Lievens et al., 2009) tend to be high in extraversion. Individuals high in agreeableness are typically “cooperative, nurturing, affectionate, sensitive, caring, altruistic, kind, tender minded, and soft hearted” (Lievens et al., 2009) and exhibit prosocial tendencies. Individuals who are high on neuroticism have the tendency to be more anxious, insecure, depressed, worrisome, and emotional (Lievens et al., 2009) Openness to experience is linked to “imagination, curiosity, originality, broadmindedness” (Lievens et al., 2009). Finally, conscientiousness has been described as “reflecting dependability; that is, being careful, thorough, responsible, organized, and planful. . . hard-working, achievement-oriented, and persevering “(Barrick and Mount, 1991). These five domains are believed to represent the normal (nonclinical) range of personality trait differences (Lievens et al., 2002) and have been widely used and validated (Costa and McCrae, 1992). Research indicates that, of the Big Five domains, conscientiousness appears to be the most predictive of performance (Barrick and Mount, 1991; Tett et al., 1991; Mount and Barrick, 1995; Salgado, 1997; Hurtz and Donovan, 2000; 548

Lievens et al., 2002, 2009; George et al., 2011). This domain has been consistently related to job performance across many occupational sectors (Behling, 1998; Barrick and Mount, 2005). In a meta-analytic study, Judge and Ilies, (2002) also found that conscientiousness and neuroticism were related to several indicators of performance motivation, with higher levels of conscientiousness and lower levels of neuroticism predicting greater motivation. Furthermore, empirical evidence suggests that conscientiousness is associated with performance in academic settings (e.g., Conard, 2006, Chamorro-Premuzic and Furnham, 2008). Meta-analytic findings support the importance of conscientiousness for academic performance (O’Connor and Paunonen, 2007; Poropat, 2009), reporting an association between higher levels of this trait and stronger performance. Conscientiousness has also been found to correlate with academic success in high school (Heaven and Ciarrochi, 2008), and it may even act as a stronger marker for achievement than intelligence scores in British University students (Furnham et al., 2003). In a longitudinal analysis of personality and performance at university, Chamorro-Premuzic and Furnham (2003) concluded that conscientiousness was associated with higher levels of academic success, whereas neuroticism was associated with decrements in academic performance. Metaanalytic results have also indicated that conscientiousness was positively correlated with grades and neuroticism was negatively correlated with academic satisfaction, but that there was no effect of extraversion, openness to experience or agreeableness on academic performance (Trapman et al., 2007). Several researchers have examined the role of personality in medical performance. One study conducted across several Flemish medical schools reported that, of the Big Five domains, conscientiousness was the biggest predictor of academic performance across all preclinical years (Lievens et al., 2002). Furthermore, it has been demonstrated that the predictive validity of conscientiousness—as well as of openness and extraversion—increased over time, particularly in the case of conscientiousness (Lievens et al., 2009). Conscientiousness has also been shown to predict performance on a diagnostic classification performance test within undergraduate pathology students (Helle et al., 2010). However, conscientiousness may not always be beneficial. Medical students with high levels of conscientiousness, in combination with high levels of neuroticism, were found to be at greater risk of stress (Tyssen et al., 2007). Each of the broad Big Five domains can be sub-divided into lower-level facets of personality. Facet-level assessment has been recommended by some researchers in order to provide a more fine-grained analysis of personality and, in some cases, better predictive validity for a range of behavior (Saucier and Ostendorf, 1999; Paunonen and Ashton, 2001; O’Connor and Paunonen, 2007; Ruiz et al., 2003). According to IPIP’s representation of Costa and McRae’s (1992) conceptualization of the Big Five, conscientiousness is composed of six facets: orderliness, dutifulness, achievementstriving, self-discipline, cautiousness, and self-efficacy (Costa and McCrae, 1992; IPIP, 2014). Orderliness, as a facet, reflects high levels of organization and the tendency to approach tasks methodically by planning and monitoring progress towards a goal. The facet of dutifulness represents behaving according to ethical principles and feeling an obligation to fulfil commitments. The achievement-striving facet reflects the drive for personal achievement and the tendency Finn et al.

to “go the extra mile” to succeed. Self-discipline refers to high levels of motivation to begin and complete a task despite boredom or obstacles. Cautiousness refers to the tendency to gather information, deliberate, and consider the consequences before making a decision or taking action. Finally, self-efficacy refers to belief in one’s competence and capability to achieve tasks effectively (Costa and McCrae, 1992). Although there is some variation in the conceptualization and measurement of the facet-level constructs, which is to be expected given the increased specificity of the constructs (Saucier and Ostendorf, 1999), there is also considerable overlap (Soto et al., 2011). Furthermore, the IPIP representation of the NEO-PI-R facets is used in the current study as it offers a widely-used taxonomy of conscientiousness, which could serve as a valuable starting point to guide further research. Evidence on the predictive validity of the Big Five facets is more limited than at the domain level and is somewhat mixed. However, there is some evidence that conscientiousness facets are associated with academic performance. For example, De Fruyt and Mervielde (1996) reported positive correlations between all of the conscientiousness facets and academic performance. O’Connor and Paunonen (2007) reviewed facetlevel evidence and highlighted self-discipline and achievement striving as important for academic success. They reported correlations between these facets and academic achievement ranging in magnitude from r 5 0.18 to r 5 0.46 for self-discipline and from r 5 0.15 to r 5 0.39 for achievement-striving. Dutifulness has also been found to predict academic performance in some studies, with correlations ranging from r 5 0.25 to r 5 0.38 (O’Connor and Paunonen, 2007). To our knowledge, researchers have not directly investigated the relationships between personality and anatomy examination performance. This study aims to investigate the relationships between different personality domains, the facets of conscientiousness and academic performance as measured by a practical anatomy examination.

lum for medical students (McHanwell et al., 2007). Interjected into the content are clinical areas describing examples of anatomy as applied to practice. The workbook contains 20 questions per practical to help students ascertain if they are working to the required level.

METHODS This study was granted ethical permission from the University of Southampton, Faculty of Medicine Ethics Sub-committee. First- and second-year undergraduate medical students (n 5 428; Y1 5 218, Y2 5 210) enrolled on the Bachelor of Medicine five year program over the academic year 2011– 2012 were invited to participate in the study. Following an introductory lecture, during which consent was sought, participants completed a paper-based questionnaire, which included a 50-item measure of the Big Five personality domains (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) and a 60-item measure of the six conscientiousness facets (orderliness, dutifulness, achievementstriving, self-discipline, self-efficacy, and cautiousness) from the International Personality Item Pool (Goldberg, 1999; IPIP, 2014), based on the NEO-PI-R personality inventory (Costa and McCrae, 1992). The IPIP representation of the NEO-PI-R domains and facets was specifically designed to measure constructs similar to those in the NEO-PI-R, but is freely available for research purposes (IPIP, 2014). Example items include “I am always prepared” (conscientiousness) and “I have a vivid imagination” (openness to experience). Participants responded to each item using a five-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). Completion of the inventory takes around 20 minutes (IPIP, 2014). In addition to the self-report data collected from the students, routinely-collected academic performance scores from the end of semester anatomy practical examinations were obtained. Each student completed two IAPP (spotter) examinations (see below), which were aggregated by the examination office before data were provided for this study.

Context Anatomy forms an integral aspect of medical training; it is required to gain conceptual and spatial awareness of the human body, for both the learning of normal and pathological physiology. This study aims to investigate the relationships between the Big Five personality domains and the facets of conscientiousness with achievement in the end of year anatomy practical laboratory (spotter/ steeple-chase) examinations. Data were collected from the University of Southampton Faculty of Medicine. Within the five year Bachelor of Medicine program, students study in a system based spiral curriculum whereby students revisit topics as they progress through each year (Bruner, 1960). The anatomy teaching runs parallel to the systems based modules taught throughout Year 1 and Year 2, incorporating lectures, gross anatomy practical sessions, surface anatomy sessions, histology practicals, and small group tutorials. Students in gross anatomy sessions learn by using a range of methods including prosections, demonstrations, models, radiology, and touch screen computers. Students experience around 30 hours of anatomy teaching time per module. Furthermore students are provided with workbooks to guide their learning. The workbooks are a mixture of text book style information that is interjected with activities for students to complete in the laboratory session. The anatomy curriculum is aligned to the core curricuAnatomical Sciences Education

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The Practical Laboratory Anatomy Examination (Spotter) is Called an Integrated Anatomy Practical Paper (IAPP), it consisted of 60 items and totals 120 marks (Smith and McManus, 2015). There are 30 questions, each with two parts (part A and part B, each part being work 2 marks). The parts are not related, for example part A might ask for the identification of the superficial inguinal ring and part B might ask for the nerve supply to the cremaster muscle. There is one IAPP per semester and it covers the anatomy and other content applicable to the given modules within the semester. The IAPP examination includes questions on gross anatomy, histology, embryology, radiology, and clinically related anatomy (Smith and McManus, 2015). The IAPP uses anatomical prosections (formalin based), pathology museum pots, osteology, models, and imaging material, e.g., MRI scans. The questions are typed out next to the specimen and students have 1 min per question to answer part A and B. The students write their answers on a mark sheet on a clip board. The space for answers is a small text box and answers are typically three to four words. Next to each answer box is a score box for 0, 1, or 2 marks. The marker puts a line through, which box is appropriate. The mark sheets are then optically read and the results totaled. 549

Table 1. Descriptive Statistics for Year 1, Year 2, Females, and Males

Year 1 mean (6SD)

Year 2 mean (6SD)

Females mean (6SD)

Males mean (6SD)

Extraversion

3.29 (60.69)

3.25 (60.60)

3.24 (60.67)

3.29 (60.56)

Conscientiousness

3.54 (60.65)

3.62 (60.51)

3.54 (60.59)

3.65 (60.55)

Agreeableness

3.86 (60.50)

3.82 (60.57)

3.81 (60.47)

3.89 (60.66)

Openness

3.47 (60.49)

3.45 (60.49)

3.40 (60.51)

3.57 (60.40)

Neuroticism

2.63 (60.72)

2.57 (60.60)

2.67 (60.67)

2.48 (60.61)

Self-efficacy

3.69 (60.44)

3.74 (60.50)

3.63 (60.48)

3.86 (60.40)

Orderliness

3.46 (60.86)

3.59 (60.76)

3.50 (60.80)

3.56 (60.81)

Dutifulness

4.13 (60.38)

4.11 (60.39)

4.06 (60.36)

4.20 (60.40)

Achievement striving

3.90 (60.54)

3.91 (60.46)

3.87 (60.52)

3.98 (60.47)

Self-discipline

3.10 (60.85)

3.30 (60.64)

3.22 (60.72)

3.21 (60.81)

Cautiousness

3.45 (60.63)

3.52 (60.54)

3.45 (60.57)

3.55 (60.60)

71.18 (69.35)

67.77 (610.07)

69.58 (610.07)

68.81 (69.71)

Domains

Facets

Anatomy examination performance (%)

All IAPP examinations are blueprinted to the learning outcomes in line with the Anatomical Society core curriculum (McHanwell et al., 2007). The IAPP is standard set using a modified Ebel’s technique (Ebel, 1979). All data were collected anonymously using students’ anonymous identification codes. Results from the personality questionnaires were linked to anatomy performance data using these codes.

Data Analysis Anonymized data were entered into SPSS statistical package, version 19 (SPSS Inc., Chicago, IL). Examination results were then converted to Z-scores (a standardized score that is a statistical measurement of a score’s relationship to the mean in a group of scores) for Year 1 and Year 2 consecutively; using Z-scores enabled data to be analyzed simultaneously as it was standardized. Independent t-tests were used to compare the personality and anatomy examination performance data by year group and by sex. Associated Levene’s tests were applied to ascertain whether the sample variances were equal. Pearson correlations were used to test the relationships between the self-reported Big Five personality domains, the six self-reported facets of conscientiousness, and anatomy examination performance.

RESULTS Participation for this study was 20% (Y1 5 38/218; Y2 5 47/ 210; n 5 85/428). In total 56 females and 28 males partici550

pated. The sex of one student was undisclosed. The cohorts from which the participants were invited had ratios of 40% males: 60% females; this is typical of UK medical schools at present. Low participation rates were, in part, due to availability of students as many were on clinical placements and were thus not able to participate in the voluntary survey. These placements were timetabled by the medical school and therefore there was no selection bias with regard to clinical placements in those who participated. All variables (the Big Five personality domains, six facets of conscientiousness and anatomy examination performance) were analyzed by year group and sex. Table 1 shows the means and standard deviations for each variable for Year 1, Year 2, females and males, respectively. Table 2 shows the correlations for each variable with anatomy examination performance (%) for the whole sample. No statistically significant differences due to gender or year group were detected, therefore primary correlational analyses were conducted on the whole sample, although correlations for Year 1 and Year 2 are shown for reference in Table 2. All scores for the Big Five domains and facets of conscientiousness were analyzed for differences between genders but there were no significant differences for the Big Five domains or for the facets of Orderliness, Dutifulness, Achievement striving, Self-discipline, or Cautiousness (Table 3). The only facet to demonstrate a significant difference between genders was Self-efficacy (t 5 2.23, P 5 0.03), with females scoring lower. A significant, positive correlation was observed between conscientiousness and anatomy examination performance Finn et al.

Table 2. Correlations of Factors and Facets with Anatomy Examination Performance (%) by Year Group and Combined (Standardized Scores) Anatomy examination performance (%) Year 1

Year 2

Total (Year 1 1 Year 2)

R-value

P-value

R-value

P-value

R-value

P-value

Extraversion

0.03

0.84

0.09

0.55

0.06

0.57

Conscientiousness

0.31

0.06

0.20

0.17

0.24

0.03a

Agreeableness

0.24

0.15

20.08

0.60

0.05

0.63

Openness

20.26

0.11

0.10

0.50

20.06

0.58

Neuroticism

20.17

0.32

0.04

0.80

20.06

0.57

Self-efficacy

0.19

0.26

0.04

0.82

0.10

0.38

Orderliness

0.03

0.87

0.15

0.31

0.09

0.38

Dutifulness

0.18

0.29

20.01

0.96

0.07

0.50

Achievement striving

0.36

0.03a

0.08

0.57

0.22

0.05a

Self-discipline

0.28

0.10

20.04

0.79

0.12

0.27

Cautiousness

0.06

0.71

0.10

0.50

0.08

0.45

Domains

Facets

a

Denotes a statistically significant result (P < 0.05); R-value 5 Pearson’s correlation coefficient.

(r 5 0.24, P 5 0.03). There were no significant relationships between anatomy examination performance and the other four personality domains (openness, extraversion, agreeableness, and neuroticism) (Table 2). Of the six facets of conscientiousness, achievement striving was positively correlated with anatomy examination performance (r 5 0.22, P 5 0.05). There were no significant relationships between anatomy examination performance and the facets of self-efficacy, orderliness, dutifulness, self-discipline, or cautiousness (Table 2).

DISCUSSION This study aimed to investigate the relationships between the Big Five personality domains, the facets of conscientiousness and performance on a practical anatomy examination. The results demonstrated a positive correlation between a selfreport measure of conscientiousness and anatomy examination performance.

Conscientiousness and Performance Conscientiousness reflects the tendency to apply effort and persist in working towards goals, to be more organized and planful, and to be motivated to achieve goals. All of these tendencies have clear implications for academic performance, including anatomy performance (Costa and McCrae, 1992; Anatomical Sciences Education

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Ferguson et al., 2003; Doherty and Nugent, 2011; Woolf and McManus, 2011). In the context of the current study, it is conceivable that students who were low on conscientiousness did not set themselves goals to learn, did not focus on the task in hand (studying anatomy/passing their examinations) and may have adopted a less planful approach to their learning. Further research is needed into the mechanisms that account for the relationship between conscientiousness and performance in anatomy (e.g., objective measures of time spent studying, or the extent to which students persist in and direct effort towards learning goals), to build on existing findings (Conard, 2006). No relationships were detected between anatomy examination performance and extraversion, agreeableness, openness to experience, or neuroticism. Given that high scores on the anatomy examination required good individual—rather than team—performance, the absence of significant relationships with extraversion and agreeableness are understandable. Similarly, the tendency to be broadminded and imaginative (openness to experience) or be worrisome and emotional (neuroticism) are less relevant to good performance in a practical anatomy examination. Several researchers recommend assessing personality at the facet level, to obtain a finer-grained analysis of personality traits (Paunonen and Ashton, 2001). In the current study, we focused on the facets of conscientiousness and found that achievement striving was positively related to anatomy examination success. The facet of achievement-striving is 551

Table 3. Factor and Facet Level Analysis by Gender Using Independent Sample t-tests Females mean (6SD)

Males mean (6SD)

t-Value

P-value

Extraversion

3.24 (60.67)

3.29 (60.56)

0.37

0.72

Conscientiousness

3.54 (60.59)

3.65 (60.55)

0.77

0.44

Agreeableness

3.81 (60.47)

3.89 (60.66)

0.69

0.49

Openness

3.40 (60.51)

3.57 (60.40)

1.57

0.12

Neuroticism

2.67 (60.67)

2.48 (60.61)

21.26

0.21

Self-efficacy

3.63 (60.48)

3.86 (60.40)

2.23

0.03a

Orderliness

3.50 (60.80)

3.56 (60.81)

0.31

0.76

Dutifulness

4.06 (60.36)

4.20 (60.40)

1.58

0.12

Achievement striving

3.87 (60.52)

3.98 (60.47)

0.94

0.35

Self-discipline

3.22 (60.72)

3.21 (60.81)

20.31

0.98

Cautiousness

3.45 (60.57)

3.55 (60.60)

0.76

0.45

Domains

Facets

a

Denotes a statistically significant result (P < 0.05); t-value 5 Independent sample t-test.

characterised by the need for personal achievement, working hard towards goals and being driven to succeed. It is likely that individuals scoring highly on the measure of achievement-striving study hard to achieve examination success and, as a result, perform well in the anatomy examination. The importance of achievement striving for academic and job performance has been reported elsewhere (O’Connor and Paunonen, 2007), and the findings presented here extend this conclusion to the anatomy examination performance domain. The lack of a gender difference in the Big Five domains and facets (with the exception of self-efficacy, on which females had a lower mean score) is of interest, given previous research which has reported that women tend to score more highly on agreeableness and neuroticism (e.g., Costa et al., 2001; Lehman et al., 2013). However, research has highlighted that some of the small effect sizes and inconsistency across studies at the domain level may be due to facet level effects working in opposite directions (Weisberg et al., 2011). For example, within the extraversion domain, women tend to score higher on facets measuring warmth and positive emotions, but men tend to score higher on facets measuring assertiveness (Costa et al., 2001). It is possible that such gender differences were disguised at the domain level. In addition, gender differences may be moderated by age. Weisberg et al. (2011) found that differences in agreebleness were larger among older individuals but differences in neurotism were more pronouced among younger individuals. Therefore gender differences in agreebleness may not have been evident in our sample of undergraduate medical students. Although no statistically significant difference was detected on neuroticism, the female mean score was higher that the male score. 552

Gender differences are not usually detected at the domain level of conscientiousness (Weisberg et al., 2011), but there is some evidence of gender differences at the facet level (Costa et al., 2001). We found a gender difference on the facet of self-efficacy, with women having a lower mean score, reflecting lower levels of confidence in competence. However, we did not find an association between the self-efficacy facet and anatomy examination performance. Our findings contribute to the body of research highlighting the importance of noncognitive factors in medicine. Our data provide further evidence on the assessment of conscientiousness in medical school, which could potentially be used to inform selection processes in medicine, as well as informing the assessment of professional behaviors in medical school. In addition to its implications for academic success, conscientiousness has been shown to be an important indicator for the behavioral performance of medical students (Finn et al., 2009; McLachlan et al., 2009; Tiffin et al., 2011; Chaytor et al., 2012; Kelly et al., 2012). These behavioral correlates of conscientiousness are also related to peer and faculty ratings of the professionalism of medical students (Finn et al., 2009; McLachlan et al., 2009). Further exploration of the links between conscientiousness, professionalism and performance in the context of anatomy and medical education are warranted, particularly since it is well-documented that the dissecting room is a favorable environment in which to teach about professionalism and conduct (Lachman and Pawlina, 2006; Pawlina, 2006). Furthermore, for most institutions, professionalism and behavioral assessments are commonplace within the anatomy course (Lachman and Pawlina, 2006; Pawlina, 2006; Gregory et al., 2009; Camp et al., Finn et al.

2010; Youdas et al., 2013). Given the importance of conscientiousness and professionalism for good medical practice, future research could also investigate how different measures of conscientiousness (e.g., self-report inventories, behavioral correlates) could be utilized in selection and assessment in medicine. Plaisant et al. (2011) suggested that engagement in personality assessment could enable medical educators to formulate strategies for the best development of academic and clinical competencies in medical students. The findings reported here represent the first step in understanding the relationships between personality and performance in anatomy. Further research could explore whether the results of personality tests could inform the design of more tailored teaching and skill development.

Implications for Teaching Anatomy Our findings have potential implications for the teaching of anatomy. Personality traits such as conscientiousness represent dispositional tendencies and, although there are some changes over the course of the lifespan (Heatherton and Weinberger, 1994), they are generally regarded as relatively stable over time (John and Srivastava, 1999). However, the behaviors that are exhibited by individuals high in conscientiousness could be highlighted and relevant skills training could be provided. Conscientiousness is demonstrated by behaviors related to organization, perseverance, and industriousness. Organizational skills, such as planning activities and time management, could be trained, although engaging in this training would likely be more effortful for individuals who are low in conscientiousness as such behaviors are not in their typical behavioral repertoire. However, within a motivated medical student population it may be possible to work with students to help them develop patterns of behavior which will have a positive impact on their learning. For some students, simply recording laboratory attendance and punctuality and making them aware of their typical behavioral patterns (and the potential impact on their performance) could prompt students to make positive changes. Improved attendance would likely have a positive impact upon performance, especially if coupled with a more organized approach to learning once within the laboratory. Educational activities aimed at encouraging conscientious behaviors could be tied into a promotion of a deep approach to learning, which has been linked to engagement in work before, during and after a practical session and active engagement in learning tasks, for example getting their hands in, making diagrams and applying the clinical context (Smith and Mathias, 2010). Mentorship of students with lower levels of conscientiousness, by either faculty or more conscientious peers, may help some students to adapt. This could involve a skills resource set for students, which offers them guidance on how to learn anatomy.

Limitations The study has several potential limitations. Study participants were drawn from a relatively homogenous population of medical students attending a single medical school. They selfselected into the study, which could have led to bias in the results if only the more conscientious students volunteered to participate. However, there was a range in the conscientiousness scores measured at both the domain and facet levels (with comparable or slightly greater standard deviations than larger Anatomical Sciences Education

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studies; e.g., Lievens et al., 2009) as well as a range in the scores on the anatomy examination indicating this as unlikely to be the case. Only one of many available personality inventories was utilized; however, it was selected because of appropriateness for the research questions and its proven reliability and validity. Future research could replicate the study in different medical schools and it would be informative to extend it beyond a focus on practical anatomy assessments. This study did not find any significant relationships between the other facets of conscientiousness and anatomy examination performance; however, this could be attributed to the small sample size.

CONCLUSIONS This study found that performance in an anatomy examination was related to higher levels of conscientiousness and, at a more specific level of analysis, to higher levels of achievement striving. To our knowledge, this is the first investigation of the relationships between the Big Five personality domains, the six facets of conscientiousness and anatomy examination performance. These results could lend evidence towards medical school selection.

NOTES ON CONTRIBUTORS GABRIELLE M. FINN, B.Sc., Ph.D., P.G.Cert. T.L.H.E., is a senior lecturer in medical education and Postgraduate Program Director for Health Professions Education at Hull York Medical School. University of York, York, UK. She is the Membership Chair for the Anatomical Society. Her research interests include anatomy pedagogy, assessment, professionalism, and identity formation. SIMON J. WALKER, B.Sc. (Hons), is a medical student in the Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK with a previous degree in Biomedical Sciences from Durham University. He has an interest in medical education, specifically personality, selection, and anatomy pedagogy. MADELINE CARTER, Ph.D., is an Associate Director for the Centre for Medical Education Research at Durham University, School of Medicine and Health in Durham, UK. She is a fellow of the Wolfson Research Institute for Health and Wellbeing and her research interests include workplace bullying, professionalism, selection, training, and medical education. DAVID R. COX, M.Sc., M.B.B.S., is a foundation doctor at the Aintree University Hospital, NHS Foundation Trust, Liverpool, UK. His research interests are simulation and anatomy pedagogy. RUTH HEWITSON, B.Sc., M.B.B.S., is a foundation doctor (Southampton) in the Wessex Deanery, NHS Health Education England, Winchester, Hampshire, UK. She undertook work on this project as part of her Bachelor of Science project in the fourth-year of her medical degree in the Faculty of Medicine at the University of Southampton, Southampton, UK. CLAIRE F. SMITH, B.Sc., P.G.C.E., Ph.D., H.E.A., F.A.S., is Head of Anatomy at Brighton and Sussex Medical School. She is also Chair of Education Committee for the Anatomical Society and a member of the Court of Examiners for the Royal College of Surgeons England. Her research is in understanding the learning experience including: approaches to learning, learning psychometrics, and spatial ability. LITERATURE CITED Barrick MR, Mount MK. 1991. The big five personality dimensions and job performance: A meta-analysis. Person Psychol 44:1–26.

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