Journal of Vocational Behavior 67 (2005) 3550

www.elsevier.com/locate/jvb

Learning and career specialty preferences

of medical school applicants
Terry D. Stratton a,, Donald B. Witzke b, Carol L. Elam a,
Todd R. Cheever c
a

Department of Behavioral Science, University of Kentucky College of Medicine, OYce of Medical Education,
800 Rose Street, MN104 UKMC, Lexington, KY 40536-0298, USA
b
Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, USA
c
Department of Psychiatry, University of Kentucky College of Medicine, Lexington, KY 40536-0298, USA
Received 19 June 2003

Abstract
The present research examined relationships among medical school applicants preferred
approaches to learning, methods of instruction, and specialty areas (n D 912). Based on conWdential responses to a progressive series of paired comparisons, applicants preferences for lecture (L), self-study (SS), group discussion (GD), and computers (C) were assessed across three
dimensions: (1) comfort; (2) eVectiveness; and (3) interest. Using cluster analysis to generate
four instructional proWles, participants comparative preferences for self-study/lecture versus group discussion/computers (+SS, L/GD, C) were positively associated with interests in
surgery and neurology, whereas opposing preferences (+GD, C/L, SS) corresponded with the
practice of family medicine. Using a matriculant subset (N D 160), analyses indicated that these
relationships remained after controlling for sex and psychological type.
2003 Elsevier Inc. All rights reserved.
Keywords: Medical specialty; Learning style; Instructional method; MyersBriggs Type Indicator

Kimberly Scott and Amy Murphy-Spencer provided assistance with the data collection, and Dr. Robert F. Rubeck was instrumental in conceptualizing this study. We also thank all the medical school applicants who graciously agreed to participate in this study.
*
Corresponding author.
E-mail address: tdstra00@uky.edu (T.D. Stratton).

0001-8791/$ - see front matter 2003 Elsevier Inc. All rights reserved.
doi:10.1016/j.jvb.2003.06.001

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T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

1. Introduction
Vocational choice has far-reaching implications, and the pathways leading individuals to particular occupations can be complex and varied (Peterson, Sampson, &
Reardon, 1991). Within some occupations, the range of embedded specialty and subspecialty areas is vast, often requiring distinctly diVerent skills, talents, and aptitudes.
Nowhere is this more evident than in medicine, which oVers more options for its
practitioners than any other profession (Iserson, 2003, p. 8) and provides numerous
vantage points from which to assess the Wt of a particular specialty (Burack et al.,
1997).
As such, students entering the medical profession must routinely confront two
crucial career decisions. The Wrst involves the initial general choice to become a physician; the second centers on the type or specialty of medicine to practice. While motivational factors have been most recently addressed in the post hoc context of latent,
hidden curriculum eVects on students value systems (Coulehan & Williams, 2001;
GriYth & Wilson, 2001; HaVerty, 1998), the topic of specialty choice has remained a
timely issue in light of recurrent projected shortages and, conversely, gluts of particular types of medical providers (Cohen & Whitcomb, 1997; Council on Graduate
Medical Education, 1996; Ginzberg, 1996).
Spanning multiple literatures, myriad variables have been examined as correlates
of medical specialty choice. Of these, the relationship of personality and medical
specialty choice has been a frequent topic of investigation (Meurer, Bland, & Maldonado, 1996). (For a comprehensive review of this literature, see Borges & Savickas,
2002.)
A developing body of research, much of which has remained separate from the
specialty choice literature, has involved learning styles and its variants such as
learning preferences and cognitive styles. This literature is premised on the theory
that individuals possess varying frameworks or orientations that guide how they
process information. For example, the Kolb Learning Styles Inventory (LSI) measures individual preferences for four learning orientations: abstract conceptualization, concrete experience, active experimentation, and reXective observation (Kolb,
1984). Frequently, these learning styles correspond with preferred instructional
methods (e.g., lectures and group discussion) and/or modalities (e.g., visual, auditory, etc.), and Kolb (1984) hypothesizes that individuals are drawn to and, ultimately, most satisWed in environments compatible or congruent with their
particular learning style.
As medical curricula have broadened to encompass a wider array of instructional approaches, educators have refocused attention on individual learning styles
(Curry, 1999; Shatzer, 1998), although not generally within the context of specialty
choice. Researchers have suggested that students with diVerent learning orientations have diVerent educational needs (Tan & Thanaraj, 1993), and that learning is
attributable, in part, to preferred learning style and the context in which learning
takes place (Lindblom-Ylanne & Lonka, 1999; Newble & Entwistle, 1986) including when in a curriculum it occurs (Aaron & Skakun, 1999; Lindemann, Duek, &
Wilkerson, 2001).

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

37

Most eVorts to incorporate learning styles into vocational behavior research have
occurred at the broader, occupational level where diVerences between individuals are
likely to be maximized. Studies that have extended this focus to specialty choice
within occupations have been far fewer in number, and have frequently yielded interpretable results only at a similarly general level; that is, within medicine, between surgical and non-surgical specialties, primary versus non-primary care specialties, and
so on.
Research on learning styles and specialty choice have been sparse and inconsistent
(Plovnick, 1975; Sadler, Plovnick, & Snope, 1978; Wunderlich & Gjerde, 1978).
Examining learning preferences (italics added), Jewett et al. (1987) found signiWcant
diVerences in doctors approaches to learning and interacting with others among the
diVerent career specialties (p. 244). Baker, Reines, and Wallace (1985), responding to
their Wnding that residency programs tended to exhibit a characteristic distribution
of learning styles, hypothesized that individuals learning styles are dynamic and may
be adaptable to the particular work-related parameters of the program.
Lacking in this literature is a more comprehensive examination of the linkages
between personality and educational orientations as they pertain to career specialty
choice. Toward this end, the present study examined relationships among medical
school applicants learning style preferences and preferred areas of medical practice.
In expanding the focus to include various personality dimensions, psychological type
data from a matriculant subset are introduced into the model and correlated with
learning and career preferences.
SpeciWcally, three research questions were examined. First, do applicants preferred learning styles and instructional methods coincide with preferences for certain
medical specialties? Second, are individuals learning styles and instructional method
preferences related to psychological type? Third, is psychological type implicated in
any observed relationship between various learning preferences and practice in a
given medical specialty?

2. Method
2.1. Participants
Study participants were 912 applicants to a medical school in the southeastern
United States during the 19971998 (n D 523) and 19981999 (n D 389) admissions
years. Eleven (1.2%) of these respondents failed to specify their sex; as a result, analyses comparing males and females are based on 901 applicants.
Applicants ranged in age from 19 to 48 yearswith an average of 23.3 years
(SD D 4.2 years). Most applicants were US citizens (97.4%), in-state residents (74.8%),
and from non-rural counties (75.2%). Participants were 81.4% Caucasian, 6.6%
African-American, and 5.8% of Indian/Pakistani originwith the remainder comprising various other races.
The research protocol was approved by the medical center institutional review
board.
was set at 6.05 for all analyses; all tests were two-tailed.

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T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

2.2. Measures
2.2.1. Paired comparison scaling
Three preference variables were assessed using a paired comparison scaling
methodology (Thurstone, 1927): (a) instructional methods [lecture (L), computer
(C), self-study (SS), and group discussion (GD)]; (b) approaches to learning
(problem solving, memorizing facts, digging out knowledge, discussing issues,
applying information, organizing concepts, and spoon-feeding); and (c) medical
specialties (surgery, internal medicine, pediatrics, family medicine, pathology,
obstetrics/gynecology, psychiatry, neurology, and emergency medicine). In the
paired comparison format, each response is contrasted with all others such that all
possible combinations (or pairs) are presented, allowing respondents to make comparative rather than absolute judgments (Ghiselli, Campbell, & Zedeck, 1981). The
nine medical specialties resulted in 36 pairs of comparisons listed in a systematic
but arbitrarily chosen order: the Wrst category (surgery) being contrasted with all
others; next, internal medicine being contrasted with all others except surgery, and
so forth.
Using a series of computations, scores were then calculated separately across
each response category (medical specialty). Responses to all pairs resulted in a complete ranked set of optionsranging, in this case, from 0 (preferred below all alternatives) to 100 (preferred above all alternatives). In this fashion, it was possible to
relate the preference for each specialty relative to all others, with measures representing the percentage of time a given response is chosen relative to the alternatives.
Applicants preferences toward instructional methods and approaches to learning
were calculated similarly, with the former assessed across three dimensions: (1) comfort (I feel most comfortable in the following instructional method); (2) eVectiveness (I feel that I learn the most from the following instructional method); and (3)
interest (I am most interested in learning from the following instructional
method). Based on responses to matched-pairs items, composite scores were
calculated by combining applicants perceived comfort with, eVectiveness of, and
interest in group discussion (
D .80), self-study (
D .81), lecture (
D .82), and computers (
D .76).
2.2.2. MyersBriggs Type Indicator
The MyersBriggs Type Indicator (MBTI) is a typology-based inventory designed
to measure individuals propensities toward certain psychological traits (Jung, 1921/
1971). Using responses to a series of forced-choice items, the MBTI classiWes individuals according to psychological type. Implicit in the MBTI is how individual preferences for learning are implicated in speciWc types, and how they inXuence
information processing, test-taking, and motivation (Pelley & Dalley, 1997; Shain,
1995). It is in this application that the MBTI is often used as an indirect measure of
learning style.
Comprised of four distinct bipolar dimensions, the MBTI generates proWles based
on individuals preference for: (1) ExtraversionIntroversion (EI)an outer/people-oriented vs. inner/idea-oriented orientation; (2) SensingIntuitive (SI)a

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

39

present/concrete vs. future/abstract preference for information processing; (3) ThinkingFeeling (TF)an objective/logical vs. subjective/evaluative approach to
decision-making; and (4) JudgingPerceiving (JP)a planned/organized vs. Xexible/
spontaneous approach to life (Healy & Woodward, 1998; Johnson, Johnson, Murphy, Weiss, & Zimmerman, 1998; Myers & Myers, 1994).
Criterion validation of the scores was established by documenting residency
match data of the graduating matriculants by MBTI type, and comparing these to
published results documenting variations in primary care versus non-primary care
specialties (Stilwell, Wallick, Thal, & Burleson, 2000). Construct validation
was conducted by examining the correlations of speciWc dimensions (e.g., EI) with
expected instructional method preferences (e.g., group discussion and self-study),
and by comparing mean scores of male and female subjects on those dimensions
shown to be most discriminating (i.e., TF and JP). Although the factor structure
of the MBTI has been suggested to contain several higher-order components
(Johnson et al., 1998), a recent meta-analytic study led Caprano and Caprano
(2002) to conclude, In general, the MBTI and its scales yielded scores with strong
internal consistency and testretest reliability estimates, although variation was
observed (p. 590).

3. Results
Table 1 contains specialty preferences for the sample. The highest specialty preference levels were for primary care disciplines (i.e., family medicine, pediatrics, and
internal medicine). Conversely, pathology and psychiatry were among the least preferred specialties. Specialty preference varied signiWcantly by sex, with men having
higher mean scores than women on surgery, t (899) D 7.03, p < .001, d D .47, internal
medicine, t (899) D 4.49, p < .001, d D .31, neurology, t (899) D 4.39, p < .001, d D .29,
and emergency medicine, t (899) D 3.38, p D .001, d D .23. Women reported signiWcantly higher preferences for obstetrics/gynecology, t (899) D 13.49, p < .001, d D .83.
With the exception of obstetrics/gynecology and surgery, specialty preference diVerences by sex were generally small.
As Table 1 also indicates, applicants most-preferred approaches to learning were
applying informationfollowed by discussing issues, problem solving, organizing concepts, digging out knowledge, memorizing facts, and spoon-feeding. Women preferred
discussion-based approaches to learning signiWcantly more than did men,
t (852) D 4.86, p < .001, d D .32, whereas the reverse was true for problem solving,
t (899) D 5.13, p < .001, d D .34. Applicants showed the greatest preference for group discussion (GD) (M D 59.3, SD D 21.4)followed by self-study (SS) (M D 53.0, SD D 28.1),
lecture (L) (M D 49.7, SD D 26.3), and computers (C) (M D 37.9, SD D 20.1). Instructional method preferences did not vary signiWcantly by applicants sex.
Cluster analysis was used to generate proWles based on applicants preferred
approaches to learning and instructional methods. Using applicants learning and
instructional method preferences, a hierarchical clustering method starting with each
case as a cluster of 1 was used on a random subset of cases (n D 200) to identify the

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T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

Table 1
Mean scores and standard deviations of medical school applicants specialty, learning, and instructional
method preferences
Men (ND531)
Mean (SD)

Women (ND370)
Mean (SD)

Sig. t

Specialty preference
Family medicine
Pediatrics
Internal medicine
Emergency medicine
Surgery
Neurology
Ob/Gyn
Pathology
Psychiatry

80.0 (23.7)
68.1 (25.7)
67.7 (21.4)
59.9 (26.8)
48.3 (27.7)
42.5 (27.6)
35.1 (26.8)
28.9 (25.2)
20.2 (25.7)

79.4 (22.3)
72.1 (27.2)
60.7 (23.6)
53.8 (26.3)
35.5 (25.4)
34.5 (26.5)
59.9 (27.6)
31.4 (27.0)
23.7 (27.8)

NS
NS
p 6 .001
p 6 .001
p 6 .001
p 6 .001
p 6 .001
NS
NS

Learning preference
Applying information
Discussing issues
Problem solving
Organizing concepts
Digging out knowledge
Memorizing facts
Spoon feeding

85.7 (17.3)
67.4 (24.4)
64.6 (21.6)
57.2 (23.5)
37.1 (23.8)
25.0 (18.1)
3.0 (10.3)

84.2 (19.4)
74.9 (21.5)
57.2 (21.1)
58.4 (22.5)
38.4 (24.2)
24.0 (17.8)
3.1 (10.7)

NS
p 6 .001
p 6 .001
NS
NS
NS
NS

Instructional method preference

Group discussion (GD)
Self study (SS)
Lecture (L)
Computers (C)

59.8 (22.0)
53.7 (28.3)
49.2 (27.1)
37.3 (20.4)

58.7 (20.6)
52.2 (27.7)
50.1 (25.1)
39.0 (19.4)

NS
NS
NS
NS

(%)

(%)

Sig. 2

Instructional method cluster membership

+SS, GD/L, C (cluster #1)
33.5
+SS, L/GD, C (cluster #2)
23.9
+GD, L/C, SS (cluster #3)
23.5
+GD, C/L, SS (cluster #4)
19.0

35.9
22.4
23.5
18.1

NS

Mean preference is the percentage (%) of time an option is chosen over all other alternatives.
Instructional methods are comprised of applicants: (1) experience with; (2) eVectiveness of; and (3) interest in group discussion (
D .80), self study (
D .81), lecture (
D .82), and computers (
D .76).

optimal number of conceptually distinct groups. Examining a scree plot of errors

(not shown), a 4-cluster solution was determined to best Wt the sample data. Clusters
were identiWed as comprising applicants preferring: (1) self-study and group discussion over lecture and computer (+SS, GD/L, C); (#2) self study and lecture over
group discussion and computer (+SS, L/GD, C); (#3) group discussion and lecture
over computer and self-study (+GD, L/C, SS); and (#4) group discussion and computer over lecture and self-study (+GD, C/L, SS). Applicants learning preferences
did not contribute to the meaningful separation of the clusters and were dropped
from the classiWcation analysis. A less computationally intensive k-means clustering
technique then situated all cases (N D 912) within the speciWed number of clusters.

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

41

Cases were fairly evenly distributed across clusters, with 313 (34.3%) in cluster #1,
215 (23.6%) in cluster #2, 213 (23.4%) in cluster #3, and 171 (18.8%) in cluster #4.
Cluster membership did not diVer signiWcantly by sex. Using the instructional
method variables, a multiple discriminant function analysis (not shown) correctly
classiWed some 95% of cases in their designated instructional method cluster. The
classiWcation error rate did not vary substantively by educational cluster.
3.1. Instructional method and specialty preferences
In response to the Wrst research question, Do applicants preferred instructional
methods coincide with preferences for certain medical specialties?, one-way analysis
of variance (ANOVA) with Tukey b multiple comparison tests were used to examine
diVerences in mean specialty preferences across clusters. Fig. 1 details the mean specialty preferences among applicants comprising the instructional method clusters.
While there is generally much similarity among the clusters, signiWcant diVerences are
seen within surgery, F (3, 908) D 7.58, p < .001, family medicine, F (3, 908) D 3.63,
p D .013, and neurology, F (3, 908) D 3.46, p D .016. The Tukey b multiple comparison
test revealed the mean preference for family medicine among respondents in the
+GD, C/L, SS cluster (#4) to be signiWcantly higher compared with applicants in
clusters #1 (+SS, GD/L, C) and #2 (+SS, L/GD, C). In contrast, these trends were
reversed in neurologywith applicants in the +GD, C/L, SS cluster reporting signiWcantly lower preferences than those in the +SS, L/GD, C cluster.
With regard to surgery, the diVerences are more complex. In addition to applicants
in cluster #2 (+SS, L/GD, C) having signiWcantly higher mean preferences for sur-

Fig. 1. Instructional method mean cluster center and specialty preferences of medical school applicants.

42

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

gery than their counterparts in clusters #1 (+SS, GD/L, C) and #4 (+GD, C/L,
SS), the Tukey b multiple comparison test also found a statistically signiWcant diVerence in mean preference levels between applicants in clusters #3 (+GD, L/C, SS)
and #4 (+GD, C/L, SS). The exact nature of this diVerence is not immediately
apparent, but the one aspect unique to cluster #4 is a relatively high preference for
computers.
Fig. 2 provides a more detailed examination of instructional method preferences
among students who preferred family medicine (n D 329), surgery (n D 56), and neurology (n D 43) above all other specialties (i.e., 100%). As shown, mean preference
levels for all three specialties are characterized by a comparatively lower assessment of computers as instructional methods. However, preferences toward family
medicine and neurology are clearly distinguished by opposing preferences for selfstudy and group discussion. In contrast, mean preferences for self-study (57.9%),
group discussion (54.8%), and lecture (57.5%) are virtually identical among applicants most interested in surgery. So, while applicants interest in surgery is positively associated with preferences for lecture and self-study and negatively
associated with group discussionthey are also characterized by an especially low
preference for the use of computers. The correlation of applicants instructional
method and specialty preferences bears this out. While somewhat similar in their
learning proWle, applicants most interested in surgerycompared to neurologyhave a somewhat higher preference for lecture and a lower preference for
computers.

Fig. 2. Instructional method preferences among applicants most preferring family medicine, surgery, and
neurology.

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

43

3.2. MyersBriggs Type Inventoryx

To determine if individuals instructional method preferences were related to psychological type, MyersBriggs Type Inventory (MBTI) data for 160 of the 177
matriculants (90%) comprising the entering classes of 19971998 and 19981999 were
examined. The largest groups of students were characterized as ESTJ (13.8%) and
ISTJ (13.1%); the smallest proportions, INFP (0.6%) and ISFP (1.3%). Continuous
measures for each dimensional pole were documented for: Extraversion (M D 14.6,
SD D 5.7), Introversion (M D 11.7, SD D 5.9), Sensing (M D 12.8, SD D 7.6), Intuition
(M D 11.1, SD D 5.7), Thinking (M D 13.2, SD D 7.7), Feeling (M D 8.0, SD D 5.0),
Judging (M D 18.0, SD D 6.3), and Perceiving (M D 9.1, SD D 6.3).
Using Pearson product moment correlation coeYcients, the ThinkingFeeling
dimension was found to be most closely associated with various specialty preferences.
Positive correlations with Thinkingand negative correlations with Feeling
signiWcantly corresponded with students interests in Surgery, Neurology, and Emergency Medicine. The reverse trend was evident regarding specialty preferences for
Ob/Gyn and Pediatrics. Only one other relationshipa positive correlation between
Sensing and a preference for Family Medicinewas statistically signiWcant.
Examining the association between matriculants MBTI dimensions and instructional method preferences, only a single statistically signiWcant relationship was
found: extraversion was positively correlated, r D .22, p D .005, and introversion was
negatively correlated, r D .17, p D .037, with a preference for computers. The directional nature of relationships among other dimensions and instructional methods
was predictable (e.g., introversion positively correlated with lecture, and negatively
correlated with group discussion), although these associations were not statistically
signiWcant.
Prior to introducing the personality variables into the model, we attempted to replicate the pattern of relationships between instructional method and specialty preferences found in the larger applicant sample. Although a reduction in statistical power
contributed to a signiWcant Wnding only in the case of surgery, F (3, 156) D 4.76,
p D .003, similar patterns of mean preferences were found for both family medicine
and neurology across instructional method clusters.
Our Wnal analysis focused on testing whether or not psychological type is implicated in the observed relationships between various learning preferences and practice
in surgery, family practice, and neurology. Using analysis of covariance (ANCOVA),
the relationship between instructional method cluster and specialty preference was
re-examined controlling for matriculant sex and psychological type. Quantitative
measures of relevant MBTI dimensions were introduced as covariates to control for
variance in the dependent variable attributable to psychological type. Sex of matriculant, which positively correlated with preferences for surgery, r D .24, p D .002, was
also speciWed as a control variable. In the case of surgery, the statistically signiWcant
relationship between instructional method preference and specialty preference
remained even after controlling for the TF dimension of personality and matriculant sex, F (3, 151) D 3.82, p D .011. A visual examination of the marginal (adjusted)
means showed very little variation from the ANOVA modelwith matriculants in

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T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

the +L, SS/C, GD cluster showing the highest preferences for surgery (M D 53.09),
and students in the +C, GD/L, SS cluster showing the lowest (M D 32.60). A cursory review of other specialtiesnamely family practice and neurologyfound little
attenuation in the relationship of specialty and instructional method preferences due
to the introduction of related personality covariates.
Extending this examination to individual instructional methods, zero-order
and partial (in parentheses) Pearson product moment correlation coeYcients
again holding constant applicant sex and the TF dimension of the MBTIfound
no attenuating eVects for lecture, r D .08 (prTF, Sex D .09), computers, r D .20
(prTF, Sex D .19), self-study, p D .17 (prTF, Sex D .16), and group discussion, p D .16
(prTF, Sex D .16).

4. Discussion
Learning preferences, as measured, did not markedly contribute to the separation
of clusters, with post hoc analysis revealing only modest associations with specialty
preferences. For example, preferences for surgery were positively associated with
memorizing facts, r D .12, p 6 .001, and negatively correlated with discussing issues,
r D .13, p 6 .001. Preferences for problem-solving correlated with preferences for
two medical specialtiespositively for internal medicine, r D .10, p D .003, and negatively for obstetrics-gynecology, r D .12, p 6 .001. Preferences for discussing issues
and problem-solving also diVered signiWcantly by sex, with males rating a higher
preference for self-study, and females preferring group discussion.
Modest but statistically signiWcant relationships were found between learning
preferences and certain psychological types measured by the MBTI. Using continuous measures of each dimension, sensing was positively and intuition was negatively
related to memorizing facts, while thinking and feeling, respectively, were positively
and negatively associated with problem solving. Not surprisingly, introversion correlated negatively with a preference for discussing issues. While not substantive eVects,
these relationships do oVer some cursory evidence of the predictive validity of the
learning preferences measure.
The positive correlation observed between the extraversion dimension and a stated
preference for computers as an instructional method is not unprecedented, since
extroverts tend to prefer visual learning strategies (Ehrman & Oxford, 1988). However, this explanation is at odds with the fact that preferences for the practice of surgeryan action-oriented specialty (Wallick, Cambre, & Randall, 1999, p. 466)
known to attract extroverts (Stilwell et al., 2000)are correlated negatively with the
use of computers. It may be that computers, while representing a visual modality, are
not perceived as suYciently hands-on for individuals interested in the practice of
surgery.
Exactly why specialty preferences for surgery, family medicine, and neurology corresponded to preferences for and against certain instructional methods is a matter of
some conjecture. In general, it has been suggested that occupations that are very
broadly deWned tend also to be more accommodating of individuals with diVering

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

45

talents, interests, and values (Holland & Holland, 1977). If true, perhaps individuals
interested in family medicine prefer group discussion because they perceive this
method as oVering the greatest diversity of experience. Group discussion might also
parallel both a breadth of individual styles and family medicines concern with the
total health care of the individual and family (Taylor, 1999, p. 72).
Moreover, counseling skills are essential or very important to family medicine
(Bergus, Levy, Randall, Dawson, & Jogerst, 1997). As the Wrst point of contact for
many patients, family physicians provide a wide range of preventive care to diverse
populations (Gjerde, Levy, & Xakellis, 1998)much of which demands a very high
level of psychosocial involvement (Marvel, Doherty, & Weiner, 1998). Indeed, Taylor
(1999) notes that students interested in family medicine frequently describe themselves as humanistic, people-oriented, and understanding (p. 76).
A similar explanation may help to understand the preference for self-study
instruction among those interested in neurology, a discipline characterized by
Wallick et al. (1999) as one of several cerebral specialties (p. 467). Once a predominantly diagnostic Weld where consultations were referred to as diagnose and adios
(PWzer Pharmaceuticals Group, 2002, p. 76), the practice of neurology may be viewed
by some applicants as heavily dependent on detailed, technical expertise that is best
acquired in an intensely focused, self-directed approach.
Neurologists, notes Coombs (1978), are seen as brainy and emotionally withdrawn from patients (cited in Taylor, 1999, p. 138). Further characterized as perfectionistic, intense, and compulsive (Taylor, 1999, p. 138), neurologists are similar
to neurosurgeons save for one personality trait: the former specialty attracts more
introverts; the latter, more extroverts. This corroborates the present Wnding that distinguishes specialty preferences for surgery from neurology based on divergent preferences for lecture and self-study.
According to Taylor (1999), surgery is probably most associated with a personality type, characterized by descriptors such as decisive, aggressive, compulsive, perfectionistic, and hard working (p. 229). Unfortunately, this provides little insight
into the apparent lack of preference for computers as an instructional method among
applicants interested in this specialty. In fact, with the advent of highly advanced
computer simulations for training in minimally invasive surgery (e.g., Risucci, Geiss,
Gellman, Pinard, & Rosser, 2002), for example, one might expect applicants with a
knowledgeable interest in surgery to exhibit a stronger preference for using computers
to learn. Coupled with this is the attraction of surgery to students with science backgrounds (Elam, 1994; Zeleznik, Hojat, & Veloski, 1983), where the use of computers
and high-tech instructional media might be prevalent. On the other hand, because the
art and science of surgery require both a physical and mental prowess, the potential
applications of computers in surgical education may not have been readily apparent
to this group. Conversely, because surgery represents a very goal-oriented discipline,
individuals interested in it may simply Wnd the acquisition of information more
straightforward when presented in a lecture format.
The distribution of MBTI types contained within the matriculant sample
(N D 160) was similar to that reported in other medical student populations (Stilwell
et al., 2000; Wallick et al., 1999) with a tendency toward thinking and judging types.

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Like Stilwell et al. (2000), the present data also showed the TF dimension to be correlated with preferences for surgery versus primary care. However, the EI dimensionsometimes reported to be a strong discriminator of specialty preferencewas
not strongly related to any specialty.
In the matriculant sample, the statistically signiWcant diVerences in surgery preferences across instructional method clusters remained even after controlling for
respondents sex and score on the TF dimension of the MBTI. However, although
this same pattern was observed in other specialties (e.g., family medicine and neurology), this constitutes a very preliminary test of the role played by psychological type
in understanding individual preferences for particular medical specialties and
instructional methods. As such, these Wndings are far from conclusive and should be
interpreted accordingly.
This study is limited by several factors. First, the cross-sectional and correlational design limits any discussion of causal relationships. Second, by forcing
respondents to choose between alternatives, a paired-comparison methodology
may artiWcially induce rank orderingresulting in diVerences that might not otherwise exist. In addition, due to the large number of comparisons presented, paired
items were not listed randomly. What eVect, if any, this may have had on applicants responses is not known. Third, some learning preferences presented (e.g.,
problem solving and discussing issues) may not be mutually exclusive. While the
correlation of learning styles with instructional method preferences (not shown)
did oVer cursory evidence of their construct validity, it is unknown whether or not
a more established measure of learning style might have contributed to the separation of statistical clusters. Lastly, garnering responses from applicants seeking
acceptance to medical school highlights the problematic nature of admissions data
and using applicants rather than matriculants as participants. Indeed, it is hardly
surprising that students applying to a new curriculum featuring computer and
group discussion components reported interests in learning via these methods even
though they were deemed to be less eVective. While this demonstrates that many
applicants are keenly aware of curricular foci, it may also suggest that disingenuous viewpoints may be elicited from some prospective students regarding their
support for and/or interest in particular educational approaches. Moreover, initial
preferences for certain types of instruction (Moore, 1991) and medical specialties
(Bland, Meurer, & Maldonado, 1995) have been known to change (Matteson &
Smith, 1977). This does not necessarily imply, however, that these early impressions
are less valid (Bland et al., 1995). In any event, the use of composite measures under
these circumstances may not be optimal.
The use of the MBTI may also present certain limitations. Despite its widespread popularity in counseling settings (Jackson, Parker, & Dipboye, 1996), the
MBTI has been criticized on psychometric grounds for using forced-choice
response formats and dichotomous scoring (Carlson, 1989), and on conceptual
grounds for falsely assuming categorical preferences (Arnau, Thompson, & Rosen,
1999). Although the use of continuous MBTI measures may be justiWed (Arnau,
Green, Rosen, Gleaves, & Melancon, 2003), it is unclear how other measures of personality (e.g., NEO Personality InventoryRevised (NEO PI-R)) or psychological type

T.D. Stratton et al. / Journal of Vocational Behavior 67 (2005) 3550

47

(e.g., Personal Preferences Self-Description Questionnaire (PPSDQ)) might have

performed.
The model tested examines psychological type as one mechanism by which applicants preferences for certain instructional methods are linked to interest in selected
medical specialties. It was hypothesized that this relationship may be spurious,
caused by a common (i.e., shared) linkage to some underlying psychological type(s).
In this schema, for example, applicants exhibiting a surgical personality
(McGreevy & Wiebe, 2002; Schwartz et al., 1994; Thomas, 1997) may also have an
identiWable learning style (Baker et al., 1985) that contributes to their desire to practice surgery. Our Wndings failed to Wnd convincing support for this hypothesis,
suggesting that each of these constructs, as operationalized, is partially uniquely
related to specialty preference.
If medical education can be viewed as a continuum, expanding this line of inquiry
to include students at various stages in the medical curriculumrather than merely
front end applicants to the larger professionmight help elucidate the role of
learning styles in relation to specialty choice. For example, students at varying levels
of education can have dramatically diVerent perceptions of a particular vocation
(Leong & Zachar, 1991). Similarly, ones location within this developmental continuum may reXect additional factors known to impede or alter the vocational decision-making processsuch as cognitive complexity (Winer & Gati, 1986), vocational
maturity (Blustein, 1988), and career decision-making self-eYcacy (Gianakos, 2001).
By focusing on specialties within the Weld of medicine, we have provided one
example of how various preferences for learning and instruction may shed some light
on the preference for and, perhaps, the perceived practice characteristics of very
diVerent specialties embedded within an occupation. Medicine may be most illustrative of specialty choice, since the designation of cardiovascular surgeon, for example,
ultimately serves as a primary source of individual identity, status within the profession, and occupational prestige. Moreover, specialties within medicine may be somewhat unique in the widespread availability of specialty-related information, the
required Wrsthand exposure encouraged by admissions committees, and the highly
structured and standardized graduate and post-graduate training processes. Still,
most professions share some of these characteristics, and may oVer distinct specialties
that attract individuals with varying personalities, learning styles, and instructional
method preferences.
Future research would be well motivated to focus on several key questions that
remain unanswered. First, knowing that individuals of certain psychological types
are drawn to certain medical specialties, does a congruent match of preferred
learning styles with actual instructional or practice modalities measurably result in
enhanced learning, knowledge retention, job satisfaction, or some other desirable
outcome? Second, how mutable are individual preferences for learning and instruction, at what point in the educational continuum might they be susceptible to change,
and what is their role and actual inXuence in specialty selection? Lastly, and on a
more applied level, how are MBTI data currently used in career counseling in medicine, how should they be used, and what evidence guides the advice given to students
contemplating practice in certain specialties?

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