INTROVERTS V/S EXTROVERTS IN MEDICINE

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If personality is an unbroken series of successful gestures…

̴  F. Scott Fitzgerald

A contemplation by Fitzgerald on the ‘romantic readiness’ and ‘responsiveness’ of his character- The Great Gatsby, tries to breakdown Gatsby’s magnetism and energy, and is an astute observation of what drives men(women) of prominence to their success. Till date readers are conflicted if they can categorize the character of Jay Gatsby as introverted or extroverted.

Which gives us the perspective that it is difficult to shelve people into the compartments of introversion or extroversion and we all simply fall on a spectrum that stretches between the extremes. After all there are as many personalities as there are people. (व्यक्ती तितक्या प्रकृती)

 Traits of extroversion and introversion were first introduced by the famous psychologist Carl Jung.

Fascinated by Jung’s theory of psychological types, Isabel Myers and her mother Katherine Briggs saw that the theory could have real-world applications. During World War II, they began researching and developing an indicator to help understand individual differences. They developed a four-point system (MBTI system) of classifying personalities into 16 broad categories (still most widely used) –

  • Based on your energy source: Extraversion (E) or Introversion (I)
  • Based on your preferred way of taking in information: Sensing (S) or Intuition (N)
  • Based on processing information and deriving conclusions: Thinking (T) or Feeling (F)
  • Based on your approach to the outside world: Judging (J) or Perceiving (P)

Myers-Briggs personality test

Image source: https://study.com/academy/lesson/personality-personality-types-examples-descriptions.html

WHERE DO YOU GET YOUR ENERGY FROM?

Do you feel at home in a herd or are you a solitary creature by nature? As discussed, human personality traits fall on the spectrum of introversion and extroversion depending on our energy sources for thriving.

While introverts derive their energy in solitude and function most optimally in isolated settings, extroverts thrive on the energy of the crowds around them and function best in limelight (Arbetter, 1991)

Barring psychological pathologies (neuroticism or overt oppressive behavior) all of us show tendencies towards either ends of this spectrum within social limits.

Accordingly, the natural choice of profession is often guided by our personality traits- with the introverts favoring creative pursuits and the extroverts taking up leadership roles.

WHICH IS BETTER?

Both introversion and extroversion carry their benefits and burdens.

It is a noisy, chaotic world out there, racing forward in the fast lane. To stand out in the crowd, one is expected to be fast and to be loud enough to be heard, both the traits that are natural to the extrovert. Leadership qualities of quick decisions, oration, collaboration, all innate to the extrovert, catapult him(her) to the forefront of most public fields. While our society and education system clearly favour a more confident, outspoken persona for success, history has a fair share of hugely successful introverts who found ways to express their innately perceptive ideas from the shadows of obscurity.

Thus when author Susan Cain spoke about the power of introversion in workplace, in her bookQuiet: the power of the introverted mind in a world that can’t stop talking”, she showed concern at the approach used by some of the western medical schools who had begun to screen applicants for ‘people skills’ (which roughly translates to extroversion). She expressed a general appeal to our educational systems to encourage an environment that notices and nurtures the quiet ones as equally as it does to the stronger voices.

INTROVERTS V/S EXTROVERTS IN MEDICINE-IS ONE BETTER THAN THE OTHER?

Medicine is a branch that deals deeply with the human experience. Since medicine finds its origin in understanding deviation from general wellbeing and pain (a psychosomatic involvement), the dealings of a doctor with his patient often go beyond the managing the clinical pathology and stablishing a connection with the patient. Naturally it is easy to classify medicine as an extroverted profession.

PERSONALITY DETERMINANTS AND THEIR ROLE IN MEDICAL SCHOOL

How often do we hear the phrases “Speak up!”, “Publish or perish!”, or sit through endless presentations and journal clubs, where we are trained to make sure that our knowledge and understanding be heard? The rigorous and highly interactive nature of medical training can inadvertently favor extroverted individuals. Needless to say, confident, extroverted doctors have distinct advantage in the race for the spotlight.

For example, G. Belojevic et al studied 123 medical students (43 males and 80 females) in terms of their mental performance in noise and found that extroverted subjects performed significantly faster in noise, compared to the quiet condition. Among introverted subjects, concentration problems and fatigue were more pronounced in noise, compared to quiet conditions.

So what does this say about the those who shy away from the spotlight?  Does inadequate participation limit their knowledge or clinical expertise in anyway? Or do they conveniently get labelled as bookworms who score well in theory and suffer in practice?

Indeed, introverted students have higher academic success in the 1st year (Lievens F, et al 2002), and they are probably the ones whose notes are most borrowed during exams! The picture, however, changes drastically as the students enter the clinical wards.

Davidson B et al summarized the strengths and weaknesses of introverts and extroverts in medical education-

Adapted from: Davidson B., Gillies R. A., Pelletier A. L.: Introversion and Medical Student Education;  Teaching and Learning in Medicine, 27(1), 99–104 DOI: 10.1080/10401334.2014.979183

Noureddine et al in their letter to the editor of Academic Medicine note that medical students are constantly encouraged to be proactive on the wards; however, they are not often provided with skills, workshops or training on how to effectively meet communication expectations.

Authors Reinoud de Jongh and Anne de la Croix voice their concern, “Everyone misses out on learning opportunities when a group of students is not heard or feels uncomfortable to speak up.”

They summarized their observations and suggestions:

  • Teaching strategies and assessments tend to be biased towards extraverted students.
  • Both teachers and students should reflect on their position on the introvert-extravert scale.
  • Talking about and learning from differences in personality promotes inclusion and collaboration.
  • Teachers should know different ways of asking students to contribute to group discussions.
  • ‘Introverted skills’ need to be recognized, trained, taught and rewarded in education.

PERSONALITY DETERMINANTS IN MEDICAL PRACTICE

The most introverted and extroverted doctors, according to Medscape:

A report surveyed over 15,543 physicians across 29 disciplines, found that 38% of respondents said they were an even mix of introverted and extroverted, while 35% said they leaned toward introverted and 28% said they leaned toward extroverted.

 

The most introverted specialties included:

Public health and preventative medicine specialists (48%);

Pathologists (45%);

Rheumatologists (40%);

Physical medicine and rehabilitation specialists (39%); and

Allergy and immunology specialists (39%).

The most extroverted specialties were:

General surgeons (35%);

Urologists (35%);

OB/GYNs (34%);

Gastroenterologists (34%);

Plastic surgeons (32%); and

Oncologists (32%)

A study by Mian Lv  investigated the influence of introversion-extraversion personality traits on the knowledge-sharing intention of online health communities (OHCs) using personality trait theory and social capital theory. The results show that extraversion personality, interaction, and reciprocity positively influence the physicians’ and patients’ knowledge-sharing intention.

On the other hand, in her personal essay- ‘Are Some of the Best Doctors Cerebral Introverts?’ author Susan Cain reminisces the approach of her gastroenterologist father (an introvert) who honed his skills through kindness, curiosity, and a thirst for quiet study even after his retirement.

Author Jacqueline Baxter notes that leadership roles within healthcare demand assertiveness, networking, and external communication with diverse stakeholders (from patients to administrative staff) which may be challenging and mentally draining for introverts, who tend to prefer more introspective and contemplative approaches to problem solving

She however also points to research which shows that introverts can bring a great deal to the table in leadership positions because they are more likely to listen and process the ideas of their team; they consider ideas deeply before acting.

To assist the introverts fare better in in public scenarios, Baxter advocates a 4 Ps Process to overcome these challenges:

PREPARE for heavy situations such as meetings,

PRESENCE by showing you are interested and aware through making eye contact or asking a question

PUSH yourself out of your comfort zone

PRACTICE new behaviors such as telling stories, public speaking.

THE INDIAN PERSPECTIVE

Back home, the admission of students into medical college is still reliant on entrance examinations (which introverts play well to their strengths). The concept of screening interviews that is prevalent in the USA hasn’t been picked up in our country. Consequently, it would be safe to say that we have a healthy ratio of introverts to extroverts making it to the top of our profession.

Indeed, in her post-graduation thesis (for the degree of Master of Social Work, Massachusetts), author Sara Fudjack speaks of pathologization of introversion in the USA and observes that India ‘since ancient times, has placed a high premium on deep, reflective thought, mindfulness, meditation, and all the inner workings of the mind have to offer.’ These introspective study practices that were prevalent in pre-colonialism times were preserved during colonialism and even in the post-colonialism era.

Even so, in the age of social media that is fast overtaking our country the onus to stand out or be heard is not diminished and the introverts are often seen to struggle in mainstream practice.

IN CONCLUSION

Just as it takes a village to raise a baby, it often takes a team to cure a patient. The strongest team is the one that plays to the strengths of each of its team members. To quote Jacqueline Baxtera more diverse leadership team including both introverted and extroverted individuals, could contribute to a richer and more balanced decision making process.

As for the individual practice scenario, it is the survival of the most adaptable.

 

You can learn more about your personality type here: https://www.myersbriggs.org/my-mbti-personality-type/myers-briggs-overview/

References:

https://susancain.net/are-some-of-the-best-doctors-cerebral-introverts/

Jacqueline Baxter: Why so few Medical leaders are introverts and what this means for healthcare https://www.medicalinterviewsuk.co.uk/2023/11/13/why-so-few-medical-leaders-are-introverts-and-what-this-means-for-healthcare/

 

Jongh et al Version 2. MedEdPublish (2016). 2021; 10: 107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939523/

 

https://www.advisory.com/daily-briefing/2018/01/17/happy-doctors

Noureddine et al  Academic Medicine 93(6):p 822, June 2018. | DOI: 10.1097/ACM.0000000000002222

Belojevic G.  et al Volume 21, Issue 2, June 2001, Pages 209-213 https://doi.org/10.1006/jevp.2000.0188

Davidson B., et al Introversion and Medical Student Education: Challenges for Both Students and Educators;  Teaching and Learning in Medicine, 27(1), 99–104 DOI: 10.1080/10401334.2014.979183

http://itarget.com.br/newclients/cbc.org.br/wp-content/uploads/2015/03/01022015TLM.pdf

Sustainability 2023, 15(1), 417; https://doi.org/10.3390/su15010417

http://Smith Scholar Works https://scholarworks.smith.edu/cgi/viewcontent.cgi?article=1658&context=theses


 

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About the author

Dr. Sai Surve-Rane is a Consulting Periodontist practicing in Sindhudurg, a regular medical writer, and an occasional poet. She has to her credit, multiple clinical studies published in peer reviewed journals, few poems and short stories published in various anthologies. Her first poetry compilation Just Another Wave, published in 2021, was well received.

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