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  Table of Contents 
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 140-146

A close look at anesthetists personality construct: Cloninger's personality dimensions in a sample of specialist anesthetists, trainee anesthetists, and nurse anesthetists

1 Department of Anesthesiology and Reanimation, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
2 Department of Anesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
3 Department of Anesthesiology and Reanimation, Bağcılar Training and Research Hospital, Istanbul, Turkey
4 Department of Anesthesiology and Reanimation, Arnavutkoy State Hospital, Arnavutköy, Turkey
5 Department of Anesthesiology and Reanimation, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
6 Department of Anesthesiology and Reanimation, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
7 Department of Anesthesiology and Reanimation, Sevket Yılmaz Training and Research Hospital, Bursa, Turkey

Date of Submission19-Oct-2019
Date of Decision14-May-2020
Date of Acceptance09-Apr-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Dr. Haluk Ozdemir
Department of Anesthesiology and Reanimation, Marmara University Pendik Training and Research Hospital, Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/TheIAForum.TheIAForum_77_19

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Background: Anesthesiology is one of the most distressing specialities of medicine. Personality construct plays a crucial role in how one copes with profession-related stress. In this current study, the personality profiles of specialist anesthetists, trainee anesthetists, and nurse anesthetists were examined using the Turkish version of the temperament and character inventory (TCI).
Materials and Methods: This study included 135 specialist anesthetists, trainee anesthetists, and nurse anesthetists. They were administered the Turkish TCI, Beck's depression inventory, and the Beck anxiety inventory.
Results: Harm avoidance (HA), exploratory excitability, disorderliness, anticipatory worry, and fatigability scores of the three kinds of anesthesia providers were significantly lower than Turkish normative values for the general population, yet congruent second nature scores were significantly higher. Self-directedness (SD), reward dependence (RD), and persistence (P) scores were significantly lower than American normative values; however, HA scores were significantly higher. Between-group analysis showed statistically significant differences in five areas: novelty Seeking, HA, SD, RD, and persistence. On the other hand, no significant differences were found between depression and anxiety scores, although both were higher for trainee anesthetists in their first 2 years of training and for nurse anesthetists who had been working in the field for >10 years.
Conclusion: This pioneering study using Cloninger's TCI provides a comprehensive personality assessment that may have implications for recruitment, crisis management, and professional development during anesthesiology residency training and also within the anaesthesiology practice.

Keywords: Anesthetist, depression, personality, temperament and character inventory

How to cite this article:
Ozdemir H, Basaranoglu G, Erkalp K, Muhammedoglu N, Comlekci M, Abut Y, Suren M, Demirel AM, Saitoglu L. A close look at anesthetists personality construct: Cloninger's personality dimensions in a sample of specialist anesthetists, trainee anesthetists, and nurse anesthetists. Indian Anaesth Forum 2020;21:140-6

How to cite this URL:
Ozdemir H, Basaranoglu G, Erkalp K, Muhammedoglu N, Comlekci M, Abut Y, Suren M, Demirel AM, Saitoglu L. A close look at anesthetists personality construct: Cloninger's personality dimensions in a sample of specialist anesthetists, trainee anesthetists, and nurse anesthetists. Indian Anaesth Forum [serial online] 2020 [cited 2023 Jun 7];21:140-6. Available from: http://www.theiaforum.org/text.asp?2020/21/2/140/295388

  Introduction Top

The constitutes of excellence in anesthesia such as adequate knowledge of basic sciences, fluency at management of practical tasks, team working, situation awareness, and decision-making is well defined. However as emphasised by Smith,[1] the behaviour, attitudes, and anesthetists sense of professional identity binds all these for excellence in anesthesia. Whereas excellent anesthetists are welcomed in the medical community, the “impaired anesthetist” is a serious concern.[2],[3] The dilemma is that high expectations placed on anesthetists increases their stress burden and as a result, their rate of suicide. The literature reports few studies about personality questionnaires for identfying doctors who have a high probability of being successful and satisfied or not in the speciality of anesthesia.[4],[5],[6],[7] Here, we aimed to evaluate the personality profiles of anesthetists by using a well-defined tool, i.e., the temperament and character inventory (TCI). The TCI was developed by Cloninger et al. from a psychobiological model of personality[8] that has the potential to provide comprehensive insight into human personality with respect to genetic traits, learning, self-concept, interaction of personality dimensions with development, and environmental factors.[9]

The TCI based on Cloninger's personality model has two basic components: temperament and character. Temperament refers to automatic emotional responses to experience. Temperament dimensions are thought to be a series of genetically independent traits that are both moderately inheritable and stable throughout the life. The four temperament dimensions are novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P).[9]

NS tends to be associated with low basal dopaminergic activity and is related to neural systems involved in behavioral activation and appetitive responses. NS evaluates sensitivity to new experiences, exploratory behavior, curiosity, impulsiveness, extravagancy, and disorderliness.[9]

HA tends to be associated with high serotonergic activity and is related to neural systems involved in behavioral inhibition and aversive responses. HA evaluates pessimism, shyness, carefulness, and fear of physical and moral injuries.[9]

RD tends to be associated with low noradrenergic activity and is related to neural systems involved in behavioral reinforcement. RD evaluates the need for social contact, attachment, dependence, and sentimentality.[9]

P tends to be associated with glutaminergic systems. P evaluates the stability of behavior even in the absence of positive or negative cueing.[9]

Beside temperament, Cloninger's personality model also elaborates three character traits: Self-directedness (SD), cooperativeness (Cp), and self-transcendence (ST). Character traits are influenced by socio-cultural learning, they mature over time, and they develop in progressive steps throughout the life. Character traits are believed to be more culturally inherited than temperament traits which are not influenced by socio-cultural learning.

SD evaluates the ability to set personal goals and keep oneself directed to them.[9] Cp evaluates ability to be tolerant, compassionate, and empathic toward people.[9]

ST evaluates a sense of being part of a broader reality, that is, in touch with other beings on a spiritual level. It also measures idealism as opposed to conventionalism.[9]

  Materials and Methods Top

The anesthetists included in this study were recruited in a time frame of 6 months from the anesthesiology departments of private, public, university, and training hospitals in Turkey. The study was reviewed by the local ethics committee and informed written consent was not required. The participants were asked to participate on a volunteer basis and their identities were not requested. Unwillingness to participate was the only exclusion criteria of the study.

The TCI was administered to all the participants together with a one–page demographics questionnaire (age, gender, profession, years of experience, place of work), a short version of the Marlowe-Crowne Social Desirability Scale, the Beck depression inventory (BDI), and the Beck anxiety inventory (BAI). The TCI is a 240-item true-false, self-administered questionnaire constructed to assess Cloninger's four temperaments (NS, HA, RD, and P) and his three character dimensions (SD, Cp, and ST). The analyses of the questionnaire allows the calculation of these main scores as well as 25 subscores corresponding to the 3–5 subscales of each main dimension.

The Turkish version of the TCI has been adapted by Kose et al. and approved by Cloninger and validated in a Turkish population study.[10]

Depression was assessed by the BDI, a self-report 21-item measure with response possibilities ranging from 0 (the least) to 3 (the most) used in this study to evaluate depressive symptoms of the prior seven days.[11],[12] Likewise, anxiety was for the same period of time assessed by the BAI, a self-report 21-item measure with responses ranging from “Not at all” to “Severely.”[13],[14]


Statistical analyses were performed using the SPSS (Statistical Package for the Social Sciences) for Windows 15.0. The total TCI dimensions scores, BDI, BAI, and all corresponding demographical data were entered into SPSS. All analyses used α = 0.05 with an accompanying 95% confidence level for measuring significant differences between variables. Within-group correlations between TCI scores were performed using the Pearson's correlation coefficient. T-test was used to determine significant differences between groups. ANOVA and two-way ANOVA were used to make multiple comparisons between TCI scores among groups. The groups are compared with Cloninger's normal community sample and the Turkish normative values.

  Results Top

Demographic data are shown in [Table 1]. The anesthetists participating in the study delivered their inventories in the hospital settings where they worked; therefore, the overall response rate could only be determined by comparing the number of tests printed and those completed. Our evaluation revealed a 68% completion rate, which seems to be a good percentage compared with the return rates of other studies in the same subjects. Given that the complexity of a questionnaire is known to influence its completion, the 125-item TCI is used in most studies because of its relative simplicity. In our study, however, we used the 240-item TCI since the subscale data are more precise.
Table 1: Demographic data

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[Table 2] shows the correlation of TCI scales and age with the sample groups of the BDI and of the BAI scores.
Table 2: The correlation of the sample groups' beck depression ınventory and beck anxiety ınventory scores with temperament and character ınventory scales and age

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A mild negative correlation was found between age and NS and ST (r = −0.172, P < 0.05; r = −0.240, P < 0.05, respectively) and between the BDI an Confidence interval (r = −0.172, P < 0.05).

A mild positive correlation was found between the BAI and HA (r = 0.174, P < 0.05) and between the BDI and H (r = 0.237, P < 0.01).

The specialist anesthetist group was significantly older than the trainee anesthetist group. In-between group analyses of NS scores found statistically significant difference between the 3 groups. NS scores were highest in the trainee anesthetist group, whose members had each been working for <2 years. This score was also higher in the nurse anesthetist group and tends to decline as each group's years of experience increases.

No significant difference was found between the groups for RD scores in all groups. RD tends to decrease as the experience of work years increases. The subscale of dependency (RD4) increases in specialist anesthetists (P < 0.045).

When comparing the P scores, no significant difference was found between the groups. P scores of specialist anesthetists tend to decrease as their years of experience increase, while the P scores in trainee anesthetists tend to increase as years of experience decrease. In the nurse anesthetists group, the initial increase decreased after 10 years of experience.

There were no Statistically significant differences between the groups for SD scores, but SD scores increase as the experience of the individuals increases. Subscale of SD and Responsibility scores were statistically higher than in the other two groups (P = 0.01). Responsibility was highest in the most experienced groups. The C scores showed no statistically significant difference among the groups, but the subscale of C as well as Social Acceptance was marginally higher compared to the other two groups (P <0.05).

SD scores were lowest among the specialist anesthetists who had >10 years of experience in the field. Beck Depression and Anxiety Inventory scores showed no significant difference between the groups, but were found highest in the trainee anesthetist groups who had at least 2 years of practice. These scores were also higher in the nurse anesthetist groups who had >10 years of experience. [Table 3] shows the correlations of the sample group with TCI scales and subscales.
Table 3: The correlations of the sample group with Temperament and Character Inventory scales and subscales

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The SD scores were found significantly higher in the female anesthetists compared to their male anesthetists (P = 0.021). The subscale of SD, Congruent second nature scores, NS subscale of Irregularity, and HA subscale of fear of uncertainty were found significantly higher among the females (P = 0.009, P = 0.038, and P = 0.043, respectively).

When groups are compared as to the hospital settings in which they worked, NS scores were highest for the specialist anesthetists who work at university hospitals. HA scores were found lower and RD scores were higher among the private hospital anesthetists. P scores were lower in the university hospital anesthetists and higher in the private hospital anesthetists and this was statistically significant (P = 0.028). SD scores were higher among the private hospital anesthetists and lower in the anesthetists who worked in the public hospitals. C scores were found lowest in the public hospital anesthetists and this was statistically significant (P = 0.04). ST scores were found higher in the training hospitals anesthetists and lower in the private hospital anesthetists.

  Discussion Top

Anesthesiology is perceived as one of the most stressful specialities in the field of medicine.[15] This study used a battery of psychological and personality tests to identify certain personality characteristics of anesthetists as a whole along with the relation of their characteristics with anxiety and depression. The use of personality tests for assessing personality traits of anesthetists in the recruitment of trainees and consultants was begun by Kluger et al.[5] To the best of our knowledge, no study has specifically investigated the personality profiles of anesthetists, whether they were trainee, specialist, or nurse anesthetists.

Personality assessment provides a description of a person's fundamental emotional needs and of the higher cognitive processes that modulate thoughts, feelings, and behavior. Our main hypothesis was that anesthetists would have high HA scores, but we also investigated the association of BDI and BAI with other TCI dimensions.

Our study found no difference in the HA scores between the groups, although HA scores were lowest in the nurse anesthetist group and tended to increase in step with the increase in working years. HA scores reflect an individual's state of anticipatory anxiety because of the possibility of harm. High HA scores confirm our hypothesis that almost all anesthetists pay much attention to patients in the pre-, intra-, and postoperative periods. The close contact of modern anesthesia to the monitoring equipment could be the cause and result of this. The high HA scores parallels the increase in the years of work experience which may relate to increase in sensitivity and experience.

Low scorers in HA may be too optimistic to react quickly enough to possible danger and thus this is not a desirable characteristic in an anesthetist. In our study, we found a positive correlation with HA and BDI and BAIs.

No statistically significant difference was found between the groups for RD. RD scores tend to decrease with increasing age. Comparing the other two groups, the dependency subscale of RD was found statistically higher in the specialist anesthetist. The RD scores of private hospital anesthetists are found higher than those of other hospital anesthetists. Low scores in RD point to objectivity without the need for satisfying others or personal freedom. The disadvantage of this trait is distance in social behaviors, social withdrawal, and separation (depersonalization). In this regard, our study confirms the idea which describes anesthetists as people who are “independent and like to work alone.”[16] The low RD scores shows that being less objective is a positive attribute for an anesthetist.

ComparingPscores showed no difference between the groups. Pscores decreased as experience of the specialist anesthetists increased, but increased as the experience of trainee anesthetists decreased. For the nurse anesthetists, their increase in experience in the first 10 years correlated with decreasedPscores. Pscores were lower in anesthetists who worked in university hospitals but higher for those in private hospitals (P = 0.028). Generally, individuals with lowPscores tend to be lazy, unstable, languid, and easily waivered.[9] The lowPscores of those working in university hospitals may be related to their focus on academic studies in addition to their routine work in the wards. The highPscores of those in private hospitals may be related to good financial situations in those hospitals.

In this study, SD scores showed no significant difference between the groups. SD scores tend to increase with years of experience. Responsibility, a subscale of SD, was highest in the specialist anesthetists group. Specialist anesthetists have the primary responsibility of the medical prodecures and the legal issues related to anesthesia in operation rooms, so the increase in responsibility scores in all these specialty groups may be related to their increase in knowledge and abilities. That specialist anesthetists have the highest SD scores is accepted as normal and is a result we also expected.

The study found negative correlation between the NS and age, but no significant difference among the groups when compared to NS. NS scores were highest among the trainee anesthetists in their first 2 years of training. The NS scores were also higher in the nurse anesthetists who are in their 1st year in this occupation. These scores tend to decrease as their experience increases. The decrease in NS after the 1st year of training, both in trainee and nurse anesthetists, requires a close look at and reevaluation of our training systems.

The low RD and NS scores in our study can be evaluated as signs of a maturing process. The nonsignificant differences between the groups may be considered as continuing maturity of the specialist and nurse anesthetists. Low RD scores show the distance between interpersonal relations and may reflect the protective mechanism of these health workers. Kluger et al.'s study[5] showed some important differences between the male and female anesthetists. The females self-reported themselves as more calm, tolerant, and patient than their male counterparts.[5],[17] Higher concentration demands and limited possibilities to control work were reported more frequently by female anesthetists than by their male colleagues. Work at intensive care units was particularly demanding and burdensome for female anesthetists.[18]

The predominancy of female participants in our study is a limitation (F = 88). Among the anesthetists in our study, three scores are found significantly higher in the females than in the males: SD and its subscale of the congruent second nature, the NS subscale of disorderliness, and the HA subscale of the fear of uncertainity. In another study,[19] the female anesthetists showed higher stress than the males. Hawton et al. reported the higher suicide rates in female doctors than in their male counterparts.[20] This result indicates that the study group should undergo further follow-up for personality disorders because low RD scores are found with Cluster A type personality disorders.[21] These low RD scores highlighted the premorbid characteristics of our sample and provide information about possible depression in future. Svaric et al.[21] showed that the low SD and C scores mark personality disorders. In this study, personality disorders related to low C scores. Those who lack ability to be cooperative are defined as lacking intolerance and being uninterested in others. Although some of our sample C scores were found low, there was not even one low score in SD. In this context, the low C sores may highlight the determination of the personality disorder in our group. The low scorers inPare lazy, unmotivated, and do not seek higher achievements. They also tend to dissuade.[9],[21]

Calati et al.[22] by using TCI in clinical groups and general population, searched for the relationship between suicide and personality construct. In this study, when compared with the general population, those who attempted suicide had higher HA, lower SD, and lower C scores. One of the striking findings of our study is that our sample outcomes are similar to Calati's.[22] The tendency of anesthetists to commit suicide has been investigated[23],[24] and, when compared by age, it was found that anesthetists' suicide rates are 3–4 times higher than both those in other branches of medicine and of the normal population.[17],[25],[26],[27] Social isolation may be triggered by patients' negative feedbacks, marriage, financial problems, long working hours, lack of time for a real rest, and being away from family and friends.[28] In young anesthetists taking on numerous responsibilities in the early stages of their careers, depression may be exacerbated by rotational duties, lack of sleep,[29] the lack of daylight in most operation theaters, and disruption of the circadien rhythm.[30] In a qualitative study by Larsson et al., trainee anesthetists interviewed about difficulties at work revealed feelings of insufficiency, inadequacy, and problems with the professional role. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.[31] Cause–-specific mortality risks for anesthetists showed that the risk of drug-related death among anesthetists is highest in the 1st five years after graduation from medical school and consistently remains higher than that of physicians.[32] In our study, there were no questions for the inquiry of anesthestists for substance abuse. This may seem a limitation to our study.

Combined with our results, this finding emphasizes that special attention should be given to trainees who are in their 1st year of training.

The anaesthetists who had been diagnosed with anxiety disorder or depression was not excluded from the study. This may seem as a limitation to our study, but the inclusion of the anesthetists who has these disorders to the study design may well served the understanding of the relationship between personality traits and the depressive/anxiety disorders. With the inclusion of BAI ans BDI, the participants would be aware of the probable depressive and anxiety situations which they may have. This may have led to early diagnosis and treatment.

  Conclusion Top

In this study by using a battery of psychological and personality tests we would like to identfy the certain personality traits and its relation with anxiety and depression in a group of Turkish anesthetists. This pioneering study using Cloninger's TCI provides a comprehensive personality assessment that may have implications for recruitment, crisis management, and professional development during anesthesiology residency training and also within the anesthesiology practice.

Financial support and sponsorship


Conflicts of interest

There are no conflict of interest.

  References Top

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Kluger MT, Laidlaw T, Khursandi DS. Personality profiles of Australian anesthetists. Anaesth Intensive Care 1999;27:282-6.  Back to cited text no. 5
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Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific mortality risks of anesthetists. Anesthesiology 2000;93:922-30.  Back to cited text no. 23
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  [Table 1], [Table 2], [Table 3]


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