Why medical students choose psychiatry or other specialties is complex and multifactorial (1,2). As many as 100 variables could affect specialty choice (1), and our understanding is limited (2). One factor affecting specialty choice is personality, and a modest literature reveals some personality differences among specialists (1–5). To our knowledge, previous studies have not studied the biological temperament of those choosing psychiatry. Since a significant number of psychiatry residencies include graduates from international medical school, the goals of this preliminary study were 1) to compare the personalities of a sample of international medical graduate (IMG) psychiatry residents with those of a sample of U.S. medical graduate (USMG) psychiatry residents and 2) to compare personalities of IMGs choosing psychiatry as a first choice with personalities of residents selecting it second. To our knowledge, no studies have made these comparisons or have asked psychiatry residents whether psychiatry was first or second choice.

Survey Instrument

We selected Cloninger’s Temperament and Character Inventory (TCI) (6), a 240-item questionnaire that takes about 45 minutes to administer, because it has excellent psychometric properties (7,8) and assesses heritable traits associated with specific neurotransmitters (7,8). The TCI has four temperament dimensions (novelty seeking, harm avoidance, reward dependence, persistence) that are “genetically independent of one another,” and three character dimensions (self-directedness, cooperativeness and self-transcendence), summarized in Appendix 1. Also, we asked what was the resident’s region of origin (Asia, Eastern Europe, US), and whether psychiatry was first or second choice. We did not ask country of origin because responses were anonymous and residents’ listing country could reveal their identities and influence their responses.

Study Sample

We studied psychiatry residents at a Midwest private medical school and an East Coast private medical school, with International Review Board (IRB) approval at both. Sample selection was based on our access to respondents. We tried to survey all eligible residents except those on leave. At the Midwest school, all but three residents were IMGs (born and medically educated outside the U.S.). At the East Coast school, all but three were USMGs. The Midwest school had 36 psychiatry residents, the East Coast school 26. In advance of each TCI administration to groups of residents, we explained the study’s purpose, and each program cleared 45 minutes for TCI administrations. Immediately before administration, we explained the study verbally and in a cover letter, including that responses were anonymous, participation was not required, and refusal carried no penalties.

Statistical Analysis

Using SPSSx, we compared groups using t tests. Because we used multiple tests, we employed Bonferroni correction, requiring p<.01 for significance.

At the Midwest school, 27 residents (75%) completed the TCI. At the East Coast school, 16 residents (61.5%) completed it. Overall response rate was 43/62=69.3%. The response rate is good for this study type, suggesting the sample reflected all psychiatry residents at the two schools.

At the Midwest school, 24 IMG and three USMG residents responded. Psychiatry was the first choice for 14 residents and the second choice for 13.

At the East Coast school, there were 5 IMGs, 11 USMGs. For these 16, psychiatry was first choice for 11, second for 5. Because there were no differences on any TCI measures for residents at either school, we combined the sample for the rest of the analysis.

The IMG residents did not differ significantly in TCI personality traits from USMG residents (Table 1). Those for whom psychiatry was first choice did not differ significantly in personality traits from those who selected it second (Table 2).

In our previous study (5) of 406 medical students entering all specialties, mean scores were: novelty-seeking (mean=20.9); harm avoidance (mean=12.2); reward dependence (mean=17.0); persistence (mean=5.8); self-directedness (mean=34.1); cooperativeness (mean=34.9); and self-transcendence (mean=13.6). These results suggest that residents choosing psychiatry are slightly higher in harm avoidance than those not choosing psychiatry.

We have demonstrated that there are no personality differences between IMGs and USMGs choosing psychiatry. IMGs choosing psychiatry have sometimes been stereotyped as different from USMGs. For example, it has been written that many have been “forced into specialties for which they may not be suited” (8) because they could not find residency positions in specialties (e.g., surgical subspecialties) where residency positions are harder to obtain, “uncomfortable with Western psychological theories such as psychoanalysis (8),” less psychologically minded, and tending to “prefer organic and directive therapies (8).”

If it were true that IMGs entering psychiatry—particularly those for whom psychiatry was second choice—differ from USMGs selecting it, then the personalities of IMGs choosing psychiatry would have been different from those of USMGs choosing it. Our findings suggest that regardless of country of origin, psychiatrists have similar personalities.

Study Limitations

Because the sample was small, conceivably the results do not represent psychiatry residents nationally, and a type II error could not be excluded, requiring caution about generalizing from our sample. Also, it is possible that using a personality inventory other than the TCI might have identified personality differences the TCI did not demonstrate. Finally, we did not explore confounding variables like ethnicity and acculturation, and did not address residents’ actual performance. Further research is indicated beyond this preliminary study.

Our preliminary evidence that IMG and USMG psychiatry residents do not differ on these personality traits, and that residents for whom psychiatry was second choice did not differ in these traits from those selecting it first, suggests that selection of psychiatry—even when it is second choice—is not simply pragmatic or situational and is based to some extent on personality. Even when IMG psychiatry residents preferred another specialty (e.g., orthopedics) in which residency positions were hard for IMGs to obtain, second choice of psychiatry is meaningful and may suit the resident’s personality. The fact that an IMG practiced a different specialty in his or her own country or preferred another specialty initially should not exclude a resident from further consideration, as long as the resident is currently interested in psychiatry and meets the program’s other admissions standards. We recognize, of course, that many factors other than personality affect specialty choice and performance as a physician and that the results of this preliminary study cannot be used to predict who will be a good resident or attending psychiatrist.