Qualitative results
Of the total cohort of 174 students, 51 completed the pre- and 62 completed post-clerkship surveys that were retained for analysis. The gender split was comparable at time 1 (m=24, f=27) and time 2 (m=28, f=34). Participant ages were also comparable before (m=25.31 years, s.d.=2.18) and after (m=26.00 years, s.d.=2.02).
Clerkship and specialty ranking
Overall specialty preferences remained stable in the pre and post surveys (Table 1). Family medicine, Internal medicine, Emergency medicine, Anesthesiology, and Pediatrics remained the top 5 most popular specialties from the start and end of clerkship. Family medicine remained the top with 15/51 ranking it first in the pre-survey and 15/63 in the post-survey.
Table 1 Top 5 most popular specialties pre-clerkship where n=51, and post-clerkship where n=63 (post-clerkship response in brackets)
Specialty
|
Rank 1
|
Rank 2
|
Rank 3
|
Rank 4
|
Rank 5
|
Family Medicine
|
15 (15)
|
13 (15)
|
4 (3)
|
6 (1)
|
5 (3)
|
Internal Medicine
|
8 (5)
|
4 (5)
|
9 (7)
|
6 (5)
|
5 (5)
|
Emergency Medicine
|
5 (3)
|
7 (12)
|
7 (3)
|
8 (9)
|
4 (2)
|
Anesthesiology
|
2 (1)
|
3 (2)
|
5 (5)
|
5 (5)
|
3 (2)
|
Pediatrics
|
4 (6)
|
6 (0)
|
0 (5)
|
3 (3)
|
2 (3)
|
Tolerance of Ambiguity and Perfectionism for 3rd-year medical students
T-tests were performed to assess the relationship between TOA and perfectionism. The anonymous nature of the survey prevented us from matching participants in pre and post surveys. These are group statistics with different sample sizes (51 pre and 63 post). There is a statistically significant inverse correlation between perfectionism and TOA at time 1(-0.32, p<0.05) (Table 2). This result is maintained in the post-survey (-39, p<0.01). Of interest is that narcissitic and rigid perfectionism were significantly correlated with TOA only at the post survey data collection, whereas self-critical perfectionism showed a non-significant correlation with ambiguity tolerance at both times.
Table 2 Relationship between perfectionism and TOA pre-clerkship and post-clerkship (post-clerkship relationship in brackets)
|
Rigida
|
SelfCritb
|
Narcisc
|
PerfTOTd
|
Rigida
|
|
|
|
|
SelfCritb
|
.56** (.48**)
|
|
|
|
Narcisc
|
-.01 (.20)
|
.20 (.09)
|
|
|
PerfTOTd
|
.75** (.77**)
|
.89** (.79**)
|
.48** (.57**)
|
|
TOAe
|
-.24 (-.42**)
|
-.24 (-.18)
|
-.25 (-.26*)
|
-.32* (.39**)
|
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
a Self-critical perfectionism,
b Rigid perfectionism
c Narcistic perfectionism,
dTotal perfectionism
e Tolerance of ambiguity
Clerkship and Tolerance of Ambiguity and Perfectionism
The differences in mean TOA and perfectionism between pre and post surveys were assessed using t-tests. There was a significant decrease in TOA between the pre and in the post-surveys (p<0.01). Perfectionism levels remained stable (p>0.05) in both the total and subcategories (Table 3).
Table 3 Pre and post-clerkship TOA and perfectionism.
|
Pre Clerkship (n=51)
|
Post Clerkship (n=62)
|
|
|
|
|
|
Mean
|
s.d
|
Mean
|
s.d.
|
t-value
|
Df
|
p-value
|
95%CI
|
|
SelfCrita
|
3.22
|
0.91
|
3.24
|
0.86
|
0.12
|
111
|
0.91
|
-0.31
|
0.35
|
Rigidb
|
3.24
|
0.97
|
3.12
|
0.99
|
0.62
|
111
|
0.54
|
-0.48
|
0.25
|
Narcisc
|
1.79
|
0.59
|
1.81
|
0.68
|
0.15
|
111
|
0.88
|
-0.22
|
0.26
|
PerfTOTd
|
2.69
|
0.59
|
2.67
|
0.59
|
0.13
|
111
|
0.90
|
-0.24
|
0.21
|
TOAe
|
59.47
|
8.26
|
43.90
|
7.61
|
10.41
|
111
|
0.00
|
-18.53
|
-12.58
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
s.d., Standard Deviation, Df, Degrees of freedom, CI, Confidence Interval
a Rigid perfectionism,
b Self-critical perfectionism,
c Narcistic perfectionism,
dTotal perfectionism
e Tolerance of ambiguity
Relationship between TOA and perfectionism with specialty choice
The relationship between TOA and perfectionism with specialty choice was assessed by grouping the top 3 specialties. This was done because of the lower than anticipated response rate, but also because family medicine, internal, and emergency medicine can be classified as primary care specialties. Family medicine, internal, and emergency were grouped and then compared to other remaining specialties. The pre and post surveys were analyzed separately.
For the pre survey, there was a significant difference between the primary care group and “other” with regards to rigid perfectionism (p=0.01) and total perfectionism (p=0.01) (Table 4) with the primary care specialties having lower perfectionism scores. This relationship was not found in the post-survey (p>0.05) (Table 5). There was a non significant relationship between specialties and self-critical perfectionism, narcissistic perfectionism, and TOA (p>0.05). Of note was the decrease in self reported TOA for both groups over the period of the one year clerkship.
Table 4 Relationship between specialty choices and TOA and perfectionism pre-clerkship
|
Primary care (n= 28)
|
Other (n=23)
|
|
|
|
|
|
|
Mean
|
s.d.
|
Mean
|
s.d.
|
t-value
|
df
|
p-value
|
95%CI
|
|
|
SelfCrita
|
3.08
|
0.75
|
3.40
|
1.06
|
1.27
|
49
|
0.21
|
-0.83
|
0.19
|
|
Rigidb
|
2.91
|
0.98
|
3.63
|
0.82
|
2.80
|
49
|
0.01
|
-1.24
|
-0.20
|
|
Narcisc
|
1.65
|
0.55
|
1.96
|
0.61
|
1.86
|
49
|
0.07
|
-0.63
|
0.02
|
|
PerfTOTd
|
2.50
|
0.54
|
2.92
|
0.59
|
-2.62
|
49
|
0.01
|
-0.73
|
-0.10
|
|
TOAe
|
60.04
|
9.34
|
58.77
|
6.86
|
0.54
|
49
|
0.59
|
-3.44
|
5.97
|
|
|
|
|
|
|
|
|
|
|
|
|
|
s.d., Standard Deviation, Df, Degrees of freedom, CI, Confidence Interval
a Self-critical perfectionism,
bRigid perfectionism
c Narcistic perfectionism,
dTotal perfectionism
e Tolerance of ambiguity
Table 5 Relationship between specialty choices and TOA and perfectionism post-clerkship
|
Primary care (n= 23)
|
Other (n=17)
|
|
|
|
|
|
|
Mean
|
s.d.
|
Mean
|
s.d.
|
t-value
|
df
|
p-value
|
95% CI
|
|
SelfCrita
|
3.05
|
0.76
|
3.45
|
1.01
|
1.43
|
38
|
0.16
|
-0.97
|
0.17
|
Rigidb
|
2.96
|
0.89
|
3.38
|
1.21
|
1.28
|
38
|
0.21
|
-1.10
|
0.25
|
Narcisc
|
1.89
|
0.71
|
1.63
|
0.76
|
1.13
|
38
|
0.27
|
-0.21
|
0.74
|
PerfTOTd
|
2.59
|
0.56
|
2.75
|
0.74
|
0.76
|
38
|
0.45
|
-0.58
|
0.26
|
TOAe
|
44.15
|
5.38
|
41.28
|
9.77
|
1.19
|
38
|
0.24
|
-2.01
|
7.76
|
s.d., Standard Deviation, Df, Degrees of freedom, CI, Confidence Interval
a Self-critical perfectionism,
bRigid perfectionism
c Narcistic perfectionism,
dTotal perfectionism
e Tolerance of ambiguity