Tag Archives: Personality

More on Medical School Admission

I thank Celia Taylor for drawing my attention to an important paper on the relationship between personality test results, and cognitive and non-cognitive outcomes at medical school.[1] Everyone accepts that being a good doctor is about much more than cognitive excellence. That isn’t the question. The question is how to select for salient non-cognitive attributes? The paper is a hard read because one must first learn the acronyms for all the explanatory and outcome tests. So let the News Blog take the strain!

The study uses a database containing entry level personality scores, which were not used in selection, and outcomes following medical training. To cut a long story short “none of the non-cognitive tests evaluated in this study has been shown to have sufficient utility to be used in medical student selection.” And, of course, even if a better test is found in the future, it may perform differently when used as part of a selection process than when used for scientific purposes. I stick by the conclusions that Celia and I published in the BMJ many years ago [2]; until a test is devised that predicts non-cognitive medical skills, and assuming that cognitive ability is not negatively associated with non-cognitive attributes, we should select purely on academic ability. I await your vituperative comments! In the meantime can I suggest a research idea – correlate cognitive performance with the desirable compassionate skills we would like to see in our doctor. Maybe the correlation is positive, such that the more intelligent the person, the more likely they are to demonstrate compassion and patience in their dealings with patients.

— Richard Lilford, CLAHRC WM Director


  1. MacKenzie RK, Dowell J, Ayansina D, Cleland JA. Do personality traits assessed on medical school admission predict exit performance? A UK-wide longitudinal cohort study. Adv Health Sci Educ Theory Pract. 2017; 22(2): 365-85.
  2. Brown CA, & Lilford RJ. Selecting medical students. BMJ. 2008; 336: 786.

Wrong Medical Theories do Great Harm but Wrong Psychology Theories are More Insidious

Back in the 1950s, when I went from nothing to something, a certain Dr Spock bestrode the world of child rearing like a colossus. Babies, said Spock, should be put down to sleep in the prone position. Only years later did massive studies show that children are much less likely to experience ‘cot death’ or develop joint problems if they are placed supine – on their backs. Although I survived prone nursing to become a CLAHRC director, tens of thousands of children must have died thanks to Dr Spock’s ill-informed theory.

So, I was fascinated by an article in the Guardian newspaper, titled ‘No evidence to back the idea of learning styles’.[1] The article was signed by luminaries from the world of neuroscience, including Colin Blakemore (who I knew, and liked, when he was head of the MRC). I decided to retrieve the article on which the Guardian piece was mainly based – a review in ‘Psychological Science in the Public Interest’.[2]

The core idea is that people have clear preferences for how they prefer to receive information (e.g. pictorial vs. verbal) and that teaching is most effective if delivered according to the preferred style. This idea is widely accepted among psychologists and educationalists, and is advocated in many current textbooks. Numerous tests have been devised to diagnose a person’s learning style so that their instruction can be tailored accordingly. Certification programmes are offered, some costing thousands of dollars. A veritable industry has grown up around this theory. The idea belongs to a larger set of ideas, originating with Jung, called ‘type theories’; the notion that people fall into distinct groups or ‘types’, from which predictions can be made. The Myers-Briggs ‘type’ test is still deployed as part of management training and I have been subjected to this instrument, despite the fact that its validity as the basis for selection or training has not been confirmed in objective studies. People seem to cling to the idea that types are critically important. That types exist is not the issue of contention (males/females; extrovert/introvert), it is what they mean (learn in different ways; perform differently in meetings) that is disputed. In the case of learning styles the hypothesis of interest is that the style (which can be observed ex ante) meshes with a certain type of instruction (the benefit of which can be observed ex post). The meshing hypothesis holds that different modes of instruction are optimal for different types of person “because different modes of presentation exploit the specific perceptual and cognitive strengths of different individuals.” This hypothesis entails the assumption that people with a certain style (based, say on a diagnostic instrument or ‘tool’) will experience better educational outcomes when taught in one way (say, pictorial) than when taught in another way (say, verbal). It is precisely this (‘meshing’) hypothesis that the authors set out to test.

Note then that finding that people have different preferences does not confirm the hypothesis. Likewise, finding that different ability levels correlate with these preferences would not confirm the hypothesis. The hypothesis would be confirmed by finding that teaching method 1 is more effective than method 2 in type A people, while teaching method 2 is more effective than teaching method 1 in type B people.

The authors find, from the voluminous literature, only four studies that test the above hypothesis. One of these was of weak design. The three stronger studies provide null results. The weak study did find a style-by-treatment interaction, but only after “the outliers were excluded for unspecified reasons.”

Of course, the null results do not exclude the possibility of an effect, particularly a small effect, as the authors point out. To shed further light on the subject they explore related literatures. First they examine aptitude (rather than just learning style preference) to see whether there is an interaction between aptitude and pedagogic method. Here the literature goes right back to Cornbach in 1957. One particular hypothesis was that high aptitude students fare better in a less structured teaching format, while those with less aptitude fare better where the format is structured and explicit. Here the evidence is mixed, such that in about half of studies, less structure suits high ability students, while more structure suits less able students – one (reasonable) interpretation for the different results is that there may be certain contexts where aptitude/treatment interactions do occur and others where they do not. Another hypothesis concerns an aspect of personality called ‘locus of control’. It was hypothesised that an internal locus of control (people who incline to believe their destiny lies in their own hands) would mesh with an unstructured format of instruction and vice versa. Here the evidence, taken in the round, tends to confirm the hypothesis.

So, there is evidence (not definitive, but compelling) for an interaction between personality and aptitude and teaching method. There is no such evidence for learning style preference. This does not mean that some students will need an idea to be explained one way while others need it explained in a different way. This is something good teachers sense as they proceed, as emphasised in a previous blog.[3] But tailoring your explanation according to the reaction of students is one thing, determining it according to a pre-test is another. In fact, the learning style hypothesis may impede good teaching by straightjacketing teaching according to a pre-determined format, rather than encouraging teachers to adapt to the needs of students in real time. Receptivity to the expressed needs of the learner seems preferable to following a script to which the learner is supposed to conform.

And why have I chosen this topic for the main News Blog article? Two reasons:

First, it shows how an idea may gain purchase in society with little empirical support, and we should be ever on our guard – the Guardian lived up to its name in this respect!

Second, because health workers are educators; we teach the next generation and we teach our peers. Also, patient communication has an undoubted educational component (see our previous main blog [4]). So we should keep abreast of general educational theory. Many CLAHRC WM projects have a strong educational dimension.

— Richard Lilford, CLAHRC WM Director


  1. Hood B, Howard-Jones P, Laurillard D, et al. No Evidence to Back Idea of Learning Styles. The Guardian. 12 March 2017.
  2. Pashler H, McDaniel M, Rohrer D, Bjork R. Learning Styles: Concepts and Evidence. Psychol Sci Public Interest. 2008; 9(3): 105-19.
  3. Lilford RJ. Education Update. NIHR CLAHRC West Midlands News Blog. 2 September 2016.
  4. Lilford RJ. Doctor-Patient Communication in the NHS. NIHR CLAHRC West Midlands News Blog. 24 March 2017.