Performance in Irish Selection and Future Performance in Surgical Training.

Importance: Selection processes for surgical training should aim to identify candidates who will become competent independent practitioners and should aspire to high standards of reliability and validity. Objective: To determine the association between measured candidate factors at the time of an Irish selection and assessment outcomes in surgical training, examined via rate of progression to Higher Specialist Training (HST), attrition rates, and performance as assessed through a multimodal framework of workplace-based and simulation-based assessments. Design, Setting, and Participants: This retrospective observational cohort study included data from all successful applicants to the Royal College of Surgeons in Ireland (RCSI) national Core Surgical Training (CST) program. Participants included all trainees recruited to dedicated postgraduate surgical training from 2016 to 2020. These data were analyzed from July 11, 2016, through July 10, 2022. Exposures: Selection decisions were based on a composite score that was derived from technical aptitude assessments, undergraduate academic performance, and a 4-station multiple mini-interview. Main outcomes and measures: Assessment data, attrition rates, and rates of progression to HST were recorded for each trainee. CST performance was assessed using workplace-based and simulation-based technical and nontechnical skill assessments. Potential associations between selection and assessment measures were explored using Pearson correlation, logistic regression, and multiple linear-regression analyses. Results: Data were available for 303 trainees. Composite scores were positively associated with progression to HST (odds ratio [OR], 1.09; 95% CI, 1.05-1.13). There was a weak positive correlation, ranging from 0.23 to 0.34, between scores and performance across all CST assessments. Multivariable linear regression analysis showed technical aptitude scores at application were associated with future operative performance assessment scores, both in the workplace (ß = 0.31; 95% CI, 0.14-0.48) and simulated environments (ß = 0.57; 95% CI, 0.33-0.81). There was evidence that the interpersonal skills interview station was associated with future performance in simulated communication skill assessments (ß = 0.55; 95% CI, 0.22-0.87). Conclusions and Relevance: In this study, performance at the time of Irish national selection, measured across technical and nontechnical domains in a multimodal fashion, was associated with future performance in the workplace and in simulated environments. Future studies will be required to explore the consequential validity of selection, including potential unintended effects of selection and ranking on candidate performance.

Baseline Assessments of Psychomotor Aptitude Are Associated With the Future Operative Performance of Surgical Trainees: A Prospective Observational Cohort Study.

OBJECTIVE: This study sought to investigate the association between validated psychomotor ability tests and future in-theater and simulated operative performance. BACKGROUND: Assessments of visuospatial ability, perceptual ability, and manual dexterity correlate with simulated operative performance. Data showing the predictive value of such assessments in relation to future performance in the workplace is lacking. METHODS: Core surgical residents in Ireland recruited from 2016 to 2019 participated in assessments of baseline perceptual, visuospatial, and psychomotor ability; Pictorial Surface Orientation (PicSOr) testing, digital visuospatial ability testing, and manual dexterity testing. Operative performance was prospectively assessed using the in-theater Supervised Structured Assessment of Operative Performance (SSAOP) tool, and simulation-based Operative Surgical Skill (OSS) assessments performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point operative performance score. OSS assessments were scored using procedure-specific checklists. Univariate correlations and multiple linear regression analyses were used to explore the association between fundamental ability measures and operative performance. RESULTS: A total of 242 residents completed baseline psychomotor ability assessments. Aggregated fundamental ability scores were associated with performance in submitted workplace-based SSAOP assessments using the Total Checklist score ( P =0.002) and Overall Performance scores ( P =0.002), independent of operative experience, and undergraduate centile scores. Aggregated ability scores were also positively associated with simulation-based OSS assessment scores on multivariable analysis ( P =0.03). CONCLUSION: This study indicates that visuospatial, psychomotor, and perceptual ability testing scores are associated with the future operative performance of surgical residents.

What Can We Learn From the Past? Pandemic Health Care Workers' Fears, Concerns, and Needs: A Review.

BACKGROUND: Health care workers (HCWs) have been engaged in fighting dangerous epidemics for hundreds of years, more recently in severe acute respiratory syndrome, H1N1, Middle East respiratory syndrome, and now coronavirus disease 2019. A consistent feature of epidemic disease results is that health care systems and HCWs are placed under immense strain. METHODS: A focused narrative review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to examine the main concerns and anxieties faced by HCWs during recent epidemics and to determine the supports deemed most important to those HCWs to keep them at the frontline. PubMed, Web of Science, and the Cochrane Library were searched in March 2020 using terms "Healthcare" OR "Medical" AND "Staff" OR "Workers" OR "Front line" AND "Concerns" OR "Anxiety" OR "Stress" AND "Pandemic" Or "Epidemic." RESULTS: Twenty-five studies that reported the concerns and expectations of an estimated 13,793 HCWs in 10 countries (Canada, China, Greece, Hong Kong, Japan, Liberia, Netherlands, Saudi Arabia, Singapore and Taiwan) during pandemic situations were identified. Health care workers identified personal and family safety, appreciation, and the provision of personal protective equipment and adequate rest as primary concerns. Informal psychological supports were favored over formal employment-based group interventions. DISCUSSION: Despite being hailed by the media as heroes, HCWs face social stigmatization and experienced high levels of anxiety and fear regarding personal safety and the health of their colleagues and family. Health care workers are more likely to seek peer-to-peer psychological support but also benefit from knowing that formal psychological supports are available to them.

Resident Training for Successful Professional Interactions.

BACKGROUND: Conflict between healthcare professionals is a common feature of modern healthcare environments, contributing to more stressful working conditions and burnout in frontline staff. In the Royal College of Surgeons in Ireland we undertook to design and deliver a course called 'Professional Interactions' which would equip junior residents in surgery and other acute care specialties with the skills to better manage conflict and bullying. METHODS: The design of this course was based on a Transformative Learning Theory conceptual framework. Key teaching modalities included rational discourse, role-playing, simulations, case studies, reflection exercises and experience with critical incidents and feedback. This experiential learning session was followed with an online short course to reinforce the learning objectives. RESULTS: We in the National Surgical Training Programme have been delivering structured mandatory education to our residents on this topic for over a decade. Each iteration of this programme has been modified based on resident and faculty feedback as well as emerging evidence in the field of communication skills. Recent course evaluation data included feedback from 203 course participants, which represented a 66% response rate. Ninety-two percent of those respondents rated the course as 'Excellent' or 'Good' and that they would use the skills learned 'Daily or 'Weekly'. 85 percent reported a perceived improvement in conflict management skills. CONCLUSIONS: Conflicts and difficult interactions between colleagues in the workplace are a frequent feature of healthcare practice. Teaching residents skills to manage these interactions more successfully may help towards developing a culture of mutual respect in hospital-based practice.

Self-reported surgeon health behaviours: A multicentre, cross-sectional exploration into the modifiable factors that impact surgical performance with the association of surgeons in training.

INTRODUCTION: Surgeons regularly educate patients on health promoting behaviours including diet, sleep and exercise. No study thus far has explored surgeons' personal compliance with these health behaviours and their relationship with surgical performance. The primary outcomes of this study were self-reported health, health related behaviours, wellbeing, fatigue and surgical performance. METHODS: A survey of validated themes on health related behaviours, workplace variables and performance was distributed to surgical trainees and consultants in the UK and Ireland through the Association for Surgeons in Training (ASiT). Non-parametric analysis was used to determine inferential associations. RESULTS: Ninety five surgeons (51.5% female, 39.9% registrars) completed the survey. 94% and 74% reported 'good' or better overall health and mental wellbeing respectively. The majority (54.7%) reported inconsistent sleep patterns. Less than a quarter engage in regular exercise. Sixty two and 64.2% reported being regularly fatigued and bothered by feelings of anxiety and/or depression respectively. Poor self-reported health and wellbeing were associated with poorer reported off-call performance (p < .01). Higher levels of fatigue negatively impacted self-reported surgical and non-surgical task proficiency (p < .01). DISCUSSION AND CONCLUSION: Surgeons reported high levels of overall health. However, healthy behaviours around sleep, diet and exercise were not consistently reported. Fewer reported good mental health and emotional well-being. Self-reported health behaviours including sleep and physical activity were associated with surgical performance. Strategies to improve modifiable lifestyle factors which will optimise physical health, mental wellbeing and levels of fatigue may optimise surgical performance.

Five things I wish I had known when I became a consultant.

PURPOSE: To report the advice consultants wish they had received on their appointment and to see if that advice differs by gender, or length of time since appointment. METHODS: An anonymous survey of consultants was undertaken through the alumni offices of the Royal College of Surgeons in Ireland, the Royal College of Physicians of Ireland and the College of Anaesthesiologists of Ireland. A link to a Qualtrics survey was sent and consultants were asked to list the five pieces of advice they wish they had been told on appointment. Free text boxes without limits were used. The responses were analysed and themes identified and subjected to statistical analysis. RESULTS: A total of 379 consultants responded. The top five pieces of advice were, in order, self-care, work-life balance, relationships with colleagues, teamwork and continuous education. There was a majority of male respondents (60%) and just over 60% of respondents had more than ten years' experience as a consultant. Gender analysis showed that only one of the top five categories-continuous education-demonstrated a significant difference between male and female respondents (p < .001). Self-care was significantly less likely (p < .04) to feature as advice given in those more than twenty years a consultant. Females were significantly more likely to advise learning to 'say no' than males (p < .001). More males had responses in relation to 'financial advice' (p = .002) and 'teaching' (p = .04) compared to females. CONCLUSION: The emergence of 'self-care' and 'work-life balance' as the top pieces of advice suggests that consultants regret that they have not looked after their health. The fact that 'self-care' was significantly less likely to feature among consultants more than twenty years in practice may point to generational differences.

Objective assessment of surgical trainees' non-technical skills: Improved performance following a two-year program of instruction.

BACKGROUND: Non-technical skills (NTS) encompass personal skills such as communication, situational awareness, decision making, teamwork and leadership. Poor performance of these skills has been shown to contribute to medical error. The Royal College of Surgeons in Ireland (RCSI) has delivered a mandatory program of instruction in NTS to all surgical trainees since 2005. We investigated whether the NTS of surgical trainees improved after the first two years of this program. METHODS: Baseline data was collected in a three-station OSCE assessment of NTS at the beginning of Year one and again at end of Year two of surgical training. RESULTS: Trainees' mean percentage NTS scores improved significantly over the two-year period for the NTS assessment (P < .001). A significant difference was demonstrated using within-subject (paired) t-tests between the Year one and two time points for all three OSCE stations: Consent (-5.39; P < .001); Colleague Conflict (-8.63; P < .001); and Disclosure of Error (-7.56; P < .001). CONCLUSIONS: RCSI offers a unique mandatory program of instruction in NTS. There was a statistically and practically significant improvement in the NTS scores of surgical trainees over the two-year period of the program.

Grief reactions and coping strategies of trainee doctors working in paediatric intensive care.

BACKGROUND: The death of a child can have significant emotional effects on doctors responsible for their care. Trainee doctors working in the paediatric intensive care unit (PICU) may be particularly vulnerable. The aim of this study was to examine the emotional impact of, and grief reactions to, a child's death in PICU trainee doctors, along with coping strategies they used. METHODS: In a prospective, cross-sectional, observational study, qualitative and quantitative data were recorded on anonymised, written questionnaires. Grief severity was assessed using the Texas Revised Inventory of Grief. Emotional impact was assessed using the shortened Impact of Event Scale. The BriefCOPE tool was used to assess coping strategies. Qualitative data was analysed using conventional content analysis. Data are presented as median (inter-quartile range) or number (%). RESULTS: All invited trainee doctors (23 anaesthetists; 5 paediatricians) completed the questionnaire (age, 30 [29-34] yr; 13/28 [46%] female). Two (7%) doctors experienced severe grief (Texas Revised Inventory of Grief score <39), with five (18%) doctors severely affected by the deaths as measured by the Impact of Event Scale. Qualitative analysis revealed prominent themes of sadness, helplessness, guilt, shock, and concern for the bereaved family. There was limited use of coping strategies. Speaking with another trainee doctor was the principal coping strategy. Requests for debriefing sessions, greater psychological support and follow-up with the patient's family were frequently suggested. CONCLUSIONS: Paediatric deaths evoke significant grief and emotional reactions in a subset of PICU trainee doctors. Trainee PICU doctors highlighted a lack of professional support and tailored debriefs.

'All by myself': interns' reports of their experiences taking consent in Irish hospitals.

BACKGROUND: Obtaining patient consent is a fundamental process in surgical practice and is integral in respecting and safeguarding patient autonomy. It has been reported that the task of consenting patients frequently lies with junior doctors, who have the least experience of the procedure. AIM: To examine the role of interns in the consent process in the Irish context as well as to identify their concerns. METHODS: A 12-point questionnaire, assessing interns' experience with surgical consent, was circulated to interns in three Irish university teaching hospitals based in different geographical locations. Interns who had never worked in a surgical team were excluded from the analysis. RESULTS: Out of 104 interns, 60 interns returned questionnaires. Of these, 58 (96.7%) had consented a patient for a surgical procedure. Forty-four interns (73.3%) had never been supervised by a senior doctor. Of the 58 interns who had obtained surgical consent, six interns (10.3%) reported knowledge of 'all' the steps of the procedure. Only five interns (8.6%) reported that they were aware of all the risks of the procedures and 34 interns (58.6%) reported they knew 'most' of the risks. Twenty-five interns (43%) reported that they had, at some point, been explained the risks of the procedures by a senior colleague. CONCLUSION: The majority of interns reported that they had taken consent for a procedure without full knowledge of the procedure and its complications. Supervision or instruction from a senior colleague was reported by a minority.

Use of a Novel Measure of Nontechnical Skills in Surgical Trainees: Is There an Association With Technical Skills Performance?

OBJECTIVE: To investigate whether scores on a psychological measure of concentration and interpersonal characteristics, The Attentional and Interpersonal Style Inventory (TAIS), are associated with performance of surgical skills. DESIGN: Postgraduate surgical trainees completed an operative surgical skills assessment in the simulation laboratory and the psychological measure (TAIS). The surgical skills assessment consisted of 6 tasks (3 per trainee): laceration suturing; lipoma excision; incision and closure of a laparotomy wound; bowel anastomosis; saphenofemoral junction ligation and basic laparoscopic skills. The association between operative surgical skill performance and TAIS factors was investigated. SETTING: The TAIS assessments and surgical skills assessments were conducted at the National Surgical Training Centre at the Royal College of Surgeons in Ireland (RCSI). PARTICIPANTS: One hundred and two surgical trainees in years one and two (PGY 2-3 equivalent) participated in the study. RESULTS: Performance on 2 of the 6 tasks assessed (bowel anastomosis and lipoma excision) were positively associated with multiple TAIS factors (energy, confidence, competitiveness, extroversion, self-criticism and performing under pressure). Another factor, focus over time, was significantly associated with scores on the lipoma excision task. CONCLUSIONS: Trainees with high levels of energy, confidence, competitiveness, extroversion, and focus over time and low levels of self-criticism demonstrated better performance on specific technical skills tasks.

How good are doctors at introducing themselves? #hellomynameis.

BACKGROUND: This explorative study was triggered by the '#hellomynameis' campaign initiated by Dr Kate Granger in the UK. Our objectives were twofold: first, to measure rates of introduction in an Irish hospital setting by both consultant and non-consultant hospital doctors. Second to establish whether such practices were associated with patient perceptions of the doctor/patient interaction. METHOD: A patient 'exit' survey was undertaken following doctor-patient consultations in both acute (surgical and medical assessment units) and elective settings (outpatient clinics). The survey was carried out over a 5-month period by three trained clinical observers. RESULTS: A total of 353 patients were surveyed. There were 253 outpatients and 100 inpatients surveyed. There were 121 outpatients (47.8%) who attended a surgeon, 73 were medical (28.8%), while 59 (23.3%) were divided between obstetrics, gynaecology and ophthalmology. One hundred acute presentations were surveyed: 52% in the emergency department, 20% to the acute medical assessment unit, 21% attended the acute surgical assessment unit and 7% attended other specialties/departments. CONCLUSION: According to the returned forms, 79% of doctors (n=279) introduced themselves to patients. Eleven per cent (39) of doctors did not introduce themselves, and 8.5% of patients (30) were unsure whether the doctor had introduced themselves. Five patients left their response blank.Consultants were significantly more likely (P=0.02) to introduce themselves or shake hands than non-consultant hospital doctors. Gender had no bearing (P=0.43) on introductions or handshakes regardless of grade of doctor.Three hundred and seventeen patients (89.7%) felt that an introduction had made a positive difference to their healthcare visit. Thirty patients (8.5%) felt it did not make a difference and 8 patients (2.2%) were unsure or failed to answer.This study has highlighted the importance of introductions to patients. Definite evidence of an introduction was documented in 79% of patients with 14.5% either not receiving or could not recall whether an introduction had been made on repeat visits. 6.5% stated that they did not receive an introduction.

Smartphones in clinical practice: doctors' experience at two Dublin paediatric teaching hospitals.

INTRODUCTION: We conducted a study at two main centres for paediatric surgery in the Republic of Ireland, Temple Street Children's University Hospital (TSCUH) and Our Lady's Children's Hospital Crumlin (OLCHC). AIM: The aim of the study was to assess doctors' opinions, frequency and methods of smartphone use in clinical practice. METHODS: Doctors (n = 265) at the two hospitals were invited to complete a 12-item survey. Descriptive statistics were calculated accordingly. RESULTS: Almost 50% (132/256) responded; 98.4% owned a smartphone and 76% owned an iPhone. Seventy-nine percent used medical apps and 59% used the OLCHC formulary. Ninety-seven percent used smartphones for inter-team communication with 73.5% (n = 97) using WhatsApp. Smartphone camera was used by 57% for clinical photos and 41% for photos of radiological imaging. Only 42% reported obtaining consent for smartphone camera use from patients or guardians. Ninety-two percent either 'strongly agreed' or 'agreed' that smartphones positively impact their practice. CONCLUSION: Smartphone usage is universal among healthcare professionals and their influence is growing in patient care.

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain.

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Impact of a clinical decision making module on the attitudes and perceptions of surgical trainees.

BACKGROUND: Decision making, a cognitive non-technical skill, is a key element for clinical practice in surgery. Specific teaching about methods in clinical decision making (CDM) is a very recent addition to surgical training curricula in the UK and Ireland. Baseline trainee opinion on decision-making modules is unknown. The Royal College of Surgeons in Ireland's postgraduate training boot camp inaugural CDM module was investigated to elucidate the impact on the attitudes of CDM naïf trainees. METHODS: Three standardized two-hour workshops for three trainee groups were delivered. The trainees were assessed by an anonymous questionnaire before and after the module. Change in attitude of the trainees was determined by comparing Likert scale ratings using the Wilcoxon signed-rank test. RESULTS: Fifty-seven newly appointed basic surgical trainees attended these workshops. A statistically significant rise in the proportion of candidates recognizing the importance of being taught CDM skills (P == 0.002) revealed the positive impact of the module, as did the increased understanding of different aspects of CDM like shared decision making (P == 0.035) and different styles of decision making (P == 0.013). CONCLUSION: These observed positive changes in trainee understanding and attitude toward CDM teaching supports the adoption of standardized modules into the curricula. More study is needed to define whether these modules will have measurable sustained enhancements of CDM skills.

National survey of clinical communication assessment in medical education in the United Kingdom (UK).

BACKGROUND: All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. METHODS: The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. RESULTS: Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. CONCLUSIONS: It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.

How do United Kingdom (UK) medical schools identify and support undergraduate medical students who 'fail' communication assessments? A national survey.

BACKGROUND: The doctor's ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students' clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who 'fail' communication assessments across all UK medical schools. METHODS: Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education. RESULTS: All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes. CONCLUSIONS: This survey has demonstrated that few Medical Schools have no identifiable system of managing their students' clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.

Emotional intelligence assessment in a graduate entry medical school curriculum.

BACKGROUND: The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor's EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. METHODS: Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. RESULTS: Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. CONCLUSIONS: This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school.

Personality factors and medical training: a review of the literature.

CONTEXT: it has been acknowledged that certain personality characteristics influence both medical students' and doctors' performance. With regard to medical students, studies have been concerned with the role of personality, and performance indicators such as academic results and clinical competence. In addition, the link between personality and vulnerability to stress, which has implications for performance, has been investigated at both undergraduate and postgraduate levels. Most of the studies cited in the literature were published before the year 2000. The authors therefore undertook a literature search to determine whether any prospective systematic studies have been published since 2000. METHODS: a review of the literature for 2000-2009 was performed, using the databases MEDLINE, PsycINFO and CINAHL. The search terms used were 'personality', 'performance', 'stress' and 'medical student'. Specific inclusion criteria required studies to be cohort studies carried out over a minimum period of 2 years, which measured medical student scores on valid and reliable personality tests, and used objective measures of performance and stress. RESULTS: the authors identified seven suitable studies. Four of these looked at personality factors and academic success, one looked at personality factors and clinical competence, and two looked at personality factors and stress. The main personality characteristic repeatedly identified in the literature was conscientiousness. CONCLUSIONS: the personality trait known as conscientiousness has been found to be a significant predictor of performance in medical school. The relationship between personality and performance becomes increasingly significant as learners advance through medical training. Additional traits concerning sociability (i.e. extraversion, openness, self-esteem and neuroticism) have also been identified as relevant, particularly in the applied medical environment. A prospective national study with the collaboration of all medical schools would make it possible to further investigate these important but initial findings.