Why personality testing won't be the future of medical school

I stumbled upon an interesting article in the New York Times a couple of days ago about medical school admissions. Apparently, academics have returned to contemplating the age-old mystery of how medical schools are so hard to get into and yet produce so many doctors who are complete assholes. The Times article raises the question of whether the MCAT, or the SAT of medical school, is really the best sole predictor of whether or not someone should be a doctor. It discusses this question in reference to a recently published study in which researchers administered what I assume to be the NEO-PI-R personality measure to Belgian medical students and followed up on their success in education and practice to see whether personality factors contributed to performance. This test utilizes the Five Factor Model of personality, which is a theory so ridiculously well-supported that competing theorists have more or less been reduced to arguing for slight variations on it rather than challenging it outright, so the researchers seem to be standing on fairly solid methodological grounds.

Anyhow, the results rather unsurprisingly indicate that personality factors can have a large impact on medical school performance, with the factor relating to emotional distress having a negative effect across the board, the factor relating to discipline and planning having a positive effect, and the factor relating to social extraversion having a great deal of impact when the budding docs start to do clinical practicums and residencies. To the layperson in psychology, all this probably seems like a "no shit" kind of thing, but the fact that these influences exist isn't the real news here - it's that they exist and we can measure them in a meaningful way. Indeed, the study authors come out with the logical conclusion: that medical schools should administer personality tests and take their results into account when deciding who to admit. It's all perfectly logical, and it will never, ever happen.

Here's why: the Five Factor Model has two main features that make it such a spectacular measurement of personality: first, it's been replicated across numerous cultures, and second, it's been strongly linked to genetic influences. These things are great because any theory of personality pretty much ipso facto needs to demonstrate some degree of universality and stability, otherwise it won't fit in with what pretty much everyone, including scientists, consider personality to be. The second fact, however, poses a huge problem for competitive medical school admission, and not because it wouldn't actually improve the quality of the trainees (it probably would). Consider a hypothetical: Student X has worked diligently in his or her undergraduate biology and anatomy courses and managed to score in whatever passes for the decent to good range on the MCAT. He/she applies for their dream medical school, only to be denied admission because the personality test has (accurately) pegged him/her as an aloof and unpleasant person whose bedside manner would almost certainly not be highly rated by future patients. What action will this person take, particularly if he/she discovers that the personality factors that the test measures have a strong genetic component and as such, were mostly beyond their control? To make matters worse: research has generally found that women are on the average higher in the emotional distress factor that the researchers found to be a negative influence on medical training, which puts the grim specter of sexism into play. To put it bluntly, any medical school who implements this type of procedure in their admissions ought to turn around and file suit against themselves, just to be able to say they did it before it got all trendy.

Astute readers will note that the MCAT, the current medical school qualification uber alles, is itself constructed to be a general measure of intelligence, which also has a lot of research suggesting it has a strong genetic component, and nothing has stopped medical schools from continuing to utilize it. While that's inarguably true, it's a lot harder to make the case to the legal system or the general public that intelligence shouldn't be a factor in picking out future doctors, because while very few people are against dumb people having jobs, most people are against them having jobs that directly endanger their lives. Whereas doctors with unpleasant personalities, which lead them to do things like make you wait 3 hours for a 15 minute appointment and work to thwart the creation of national health insurance for 90 goddamned years, are practically a storied tradition in America.