Rural temperament and character:

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Rural temperament and character A new
perspective on retention of rural doctors
Diann Eley The University of Queensland, Rural
Clinical School, School of Medicine Louise Young
The University of Queensland, School of
Medicine Thomas R Przybeck Washington
University, Department of Psychiatry, School of
Medicine, St. Louis, MO USA
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The rural doctor is an entity in itself but not
well defined

• Mostly anecdotal narrative descriptions

• Rural practice requires different skills traits
  from urban counterparts

• Temperament and Character Inventory (TCI)
• Psychobiological model of personality
• Cloninger, Svrakic, Przbeck. Archives of General
  Psychiatry 1993 50 975-990.

Study Aim To describe how individual profiles
(levels combinations) of temperament
character traits influence GPs who flourish or
fail in rural medicine
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• Temperament Traits
• mildly heritable,
• developmentally stable,
• emotion based
• not influenced by socio-cultural learning

Four dimensions of Temperament

• Novelty Seeking NS (exploratory, impulsive,
  curious vs stoicism, frugality, regimented)

• Harm Avoidance HA (anxious, worrying, doubtful
  vs outgoing, confidence, vigour, risk taking)

• Reward Dependence RD (sentimental, warm,
  attached vs aloof, withdrawn, independent)

• Persistence PS (industrious, ambitious
  perfectionist vs indolent, modest)

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• Character Traits
• a reflection of personal goals values
• are moderately influenced by socio-cultural
  learning
• mature progressively throughout life

Three dimensions of Character

• Self Directedness SD i.e. self-concept
  (responsible, reliable, long term goals vs
  blaming, ineffective, short term goals)

• Cooperativeness CO i.e. concept of relationships
  (empathic, constructive, vs critical,
  opportunistic)

• Self-Transcendence ST i.e. global concept
  (idealistic, humble vs practical, arrogant)

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• Methods
• Two successive studies

• Mixed method, cross sectional design -
  qualitative quantitative methods

• Study 1 Exploratory/Pilot - Purposive sampling,
  Rural GPs (n13), 7- 40 years (mean 23.1)
  experience in RRMA 5-7 practice in Central
  Southern Queensland
• All completed demographic questionnaire and
  TCI-R140 plus a semi- structured interview
• Triangulation of data sources described the
  findings

Study 2 Comparison of rural urban GPs - Postal
distribution of research materials to 286 rural
GPs 258 urban GPs Multivariate statistics
compared the two groups logistic regression
predicted rural or urban practice from TCI
dimensions
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RESULTS
Study 1 Pilot study of 13 rural GPs

• Interview findings concur with the literature

• CHARACTER ALL docs highly self-directed (SD),
  cooperative (CO), objective (ST)

• TEMPERAMENT ALL very caring reward dependent
  (RD) persistent (PS). But more variation in
  Harm Avoidance (HA) Novelty Seeking (NS)

• Longer serving GPs, intent on staying rural
  lower HA higher NS compared to shorter serving
  GPs intending to leave (plt.01)

Study 2 Comparison of rural versus urban GP
cohorts

• Response rates 42 (n120) for rural 36
  (n94) for urban GPs

• Rural GPs significantly lower HA higher NS
  compared to urban GPs

• NS HA independently predictive of rural or
• urban membership (plt.01)

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Implications for Recruitment

• Differences detected were Novelty Seeking (NS)
  and Harm Avoidance (HA) both temperament
  traits more innate not likely to change

• These traits could be identifiable in persons
  regardless of prior life experience or
  educational exposure

• Character traits are developmental
  identification in established rural doctors may
  suggest areas for special training or counselling
  of students with an interest in rural practice

• The higher curiosity level of a person high in NS
  might suggest that this is the impetus
  responsible for students/graduates to engage with
  rural medicine

• The majority of medical students are not of rural
  origin with little or no knowledge of rural
  life. High levels of NS
• could be a contributing factor to
• testing the unknown i.e. going bush!

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Implications for Retention

• Harm Avoidance (HA) has many adaptive advantages.
  A measure of anticipatory anxiety the ability
  to tolerate uncertainty

• Persons low in HA portray greater confidence when
  faced with uncertainty optimism in situations
  that would worry most people

• Rural GPs with low HA may be innately more suited
  to their environment more likely to be
  retained for longer periods

• Consider the rural GP as a unique entity - a
  mixture of both a primary care specialist who is
  also a proceduralist

• Data imply that temperament levels of Reward
  Dependence (RD) warm, dedicated, sociable may
  vary

• Levels of Novelty Seeking (NS) Harm Avoidance
  (HA) may be
• most descriptive of individuals who
• cope in rural medicine

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SUMMARY
A starting point to establish a psychobiological
profile for rural doctors This preliminary work
may be the precursor to a new approach to the
recruitment and retention of rural health
professionals

• Predicting students who may be best suited to a
  rural career

• Provide medical schools with more information
  regarding counselling students for (or against)
  rural medicine

• Inform policy associated with incentives
  retention strategies for existing rural doctors,
  nurses allied health professionals

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• Study Limitations
• Cross sectional study measuring variables at
  one point in time
• Small sample size, from one state
• Acknowledge the myriad of demographic,
  developmental environmental factors that
  influence an individuals life choices
  psychological profile
• Response rate long questionnaire, rural focus,
  busy doctors

• This paper was compiled from the following
  citations
• Eley D, Young L, Prysbeck T. Exploring the
  temperament and character traits of rural and
  urban doctors implications for retention of the
  rural workforce. Journal of Rural Health (USA) In
  Press Accepted 07 March 2008.
• Eley D, Young L, Shrapnel M. Rural temperament
  and character A new perspective on recruitment
  and retention of rural doctors. Australian
  Journal of Rural Health 2008 16, 12-22
• Acknowledgements
• This research was supported by grants from the
  Australian Research Council and the Central and
  Southern Queensland Training Consortium

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Temperament Descriptors
Taken from Cloninger et al, 1994
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Character Descriptors
Taken from Cloninger et al, 1994
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Queensland AUSTRALIA (a BIG place a LONG way
away)