Cross-cultural studies on psychosocial factors that can influence medical students' and physicians' performance are scarce, despite the consensus among medical educators that psychosocial attributes are among the multiple facets of physicians' clinical competence (Gonnella, Hojat, Erdmann, & Veloski, 1993a). In addition to personality attributes, cultural factors contribute to both patients' and physicians' behavior (Guillemin, Bombardier, & Beaton, 1993) and may influence academic performance. An important issue that needs empirical scrutiny is whether personal and psychosocial attributes that predict academic achievement in medical school and professional performance in medical practice vary in different cultures.
Evidence suggests that the most significant predictor of future academic success in health care education, like other professional schools, is past academic performance (Blacklow, Goepp, & Hojat, 1991; Campbell & Dickson, 1996; Glaser, Hojat, Veloski, Blacklow, & Goepp, 1992; Gonnella & Hojat, 1983; Hojat, Gonnella, Veloski, & Erdmann, 1993; Hojat, Gonnella, Erdmann, & Veloski, 1997; Lyons, Grifone-Field, Hyslop, & Hoertz, 1993; Rosenfeld, Hojat, Veloski, Blacklow, & Geopp, 1992). Although this view has been supported in different cultures, it appears to be more applicable when measures of knowledge attainment are investigated.
Other evidence suggests that when clinical performance rather than knowledge attainment is taken into consideration, previous academic performance loses some of its predictive strength, and psychosocial attributes take on increased importance in predicting success (Gonnella, Hojat, Erdmann, & Veloski, 1993a, 1993b, 1993c; Hojat, Robeson, Damjanov, Veloski, & Glaser, 1993; Hojat, Vogel, Zeleznik, & Borenstein, 1988). These findings are consistent with the performance paradigm in medicine suggested by Gonnella, Hojat, Erdmann, and Veloski (1993c). These researchers propose that in addition to acquired factual knowledge and skills, personality factors contribute to academic and professional success (Hojat, Glaser, & Veloski, 1996; Hojat, Robeson et al., 1993; Hojat et al., 1988). This proposition is further supported by recently published works that suggest it is not solely academic achievement (e.g., grades) or cognitive abilities (e.g., intelligence quotient, or I.Q.), but also psychosocial attributes (e.g., p ersonality, and emotional quotient, or E.Q.), that can enhance professional effectiveness (Goleman, 1995; Mayer & Salovey, 1995).
Further support for the importance of psychosocial factors in academic performance in medical school and beyond is provided by the findings that suggest the power of prediction is enhanced when psychosocial attributes are included in the prediction models (Hojat, Robeson, Damjanov, Veloski, & Zeleznik, 1992; Hojat, Vogel, & Zeleznik, 1988; Zeleznik et al., 1988; Keck et al., 1979). This phenomenon of increased shared variance was also noticed when personality scales were added to the admission measures in predicting performance in the first and second years of medical school and scores on medical licensing examinations (see for example Hojat, Vogel et al., 1988; Hojat, Gonnella et al., 1992; Hojat, Robeson et al., 1993).
Kegel-Flom (1975) found that peer ratings of residents could also be predicted by a combination of personality inventory measures. Hunt and colleagues (1987) compared the performance of residents who had academic difficulties in medical school (considered for dismissal or probation) with that of their counterparts without such difficulties. The residents who had academic difficulties generally received lower ratings than did the other residents on items measuring knowledge and skills, but the observed differences were not statistically significant except on one item dealing with the quality of relationships with patients. …