The following abstract was developed during the 2013 Research Summit and presented at the 2013 NAEMSE Symposium in Washington, DC.

Affective Domain Matters: Personality Traits of Paramedic Students and Their Effect on Cognitive Performance

David Page, MS, NREMT-P; Billy James, PhD; Luke Stanke, PhD.c; Michael L. Bowen, NREMT-P

Introduction: Educators were interested in measuring affective domain behavioral traits of previously thought to be associated with empathetic behavior. Extensive research has been performed to describe personality characteristics of high functioning employees and ideal profiles for law enforcement candidates. The M5-50 (McCord 2002), NEO Personality Inventory (NEO PI-R; P. T. Costa, Jr., & R. R. McRae, 1992) and International Personality Item Pools (IPIP; Goldberg 1999) are a validated, reliable and published or commercially available personality inventories used for these purposes. The dimensions of Agreeableness, Conscientiousness and Neuroticism, also described as Emotional Stability, appear to have particular utility in the identification and training of ideal paramedic students. These traits may also have utility in predicting elements of caring or empathetic behaviors.

Hypothesis: Personality Traits of students entering a paramedic  program are correlated to cognitive performance on a paramedic entrance exam.

Methods: Consenting Paramedic Students (PS) beginning their educational program and enrolled in programs using Fisdap, an IRB approved prospectively collected online testing and tracking tool for EMS students, completed the new Fisdap Entrance Exam (EE; *coefficient alpha = .90). Thirty relevant affective domain elements from the M5-50 were embedded into the 126 item EE. The EE is designed to measure cognitive performance (CP) with breakdowns in Math, Reading, Inference/Analysis, Anatomy, Physiology, and EMT level critical thinking. Logit scores for the EE and the cognitive traits were obtained through item response scaling techniques using the Rasch model (Rasch, 1960). The logit scores were then converted to true scores using the test characteristic curve for each measure. A multiple regression was then completed using the estimated true scores to determine the proportion of variance accounted for by the traits on the EE.
*Previous research has shown a reliability of 0.9. The alpha coefficient represents the amount of reliability within an exam.

Results: A total of 861 students entering 52 distinct paramedic programs across 28 states in the US completed the EE. Average scores are shown in Table 3.

Figure 2 displays a scatterplot of the Cardiology logit scores and the Entrance exam logit scores, and shows a positive linear relationship between the two variables.
Figure 2.
Note: Density of students located at a particular score. Higher density values equals more people having that score. Highest value equals the mode.
Statistical Analysis: The correlation matrix between the personality traits and cognitive section scores in Table 1 shows weak but statistically significant positive correlations between conscientiousness (C), agreeableness (A) and overall cognitive performance (CP).
The matrix shows strong-to-very strong correlations between each of the personality traits. The more a student is agreeable, the more they will be conscientious and vice versa. Both C and A are inversely related to Neuroticism. Meaning students with high neuroticism scores will have low conscientious and low agreeableness scores. Further interpretation of Table 1 show that there is a positive association with A and C on CP, while there is a negative association between N and all other scores.
The regression fit is as follows: CP (Cognitive Performance) = β0 + β1(Agreeableness) + β2(Conscientiousness) + Β3(Neuroticism)
Table 2 is a summary of a multiple regression using personality traits to account for cognitive performance scores and displays the multivariate regression coefficients, standard errors, and p-values for the full model. Only one personality trait, Neuroticism, shows a statistically significant association (p<.01) with overall cognitive performance scores (CP).
The entire model that included all three personality traits accounted for 2% of total variance in CP scores. While only the N score from the multivariate regression showed a statistically significant association with CP scores.
Using information about the correlations between the dependent variables in Table 1, the results of this multivariate regression suggests there is multicollineary, which explains the non-significant values for the A and C variables.
On average, examinees with higher levels of neuroticism obtained lower overall cognitive performance  scores (β3 = -0.13, p=.01), this suggest for a 1 point increase on the N measure, we can expect a 0.13 point decrease in cognitive performance (CP) score.
Figure 1.
Discussion: To our knowledge this is the first time the personality traits of agreeableness, conscientiousness and neuroticism have been measured using the M5-50 inventory in Emergency Medical Technicians entering a paramedic training program. Similar to other public safety professions, these personality traits would seem to be important in identifying candidate traits that may be assets or liabilities to their ability to care for patients. While it appears that overall students had low Neuroticism scores, there do appear to be some with high scores. This could represent a red flag that affects the ability for a student to succeed, or more critically, a concern for patient care. More research is needed to determine  how these personality traits affect overall success and actual field performance, if at all. The statistically strong relationship between Neuroticism and poor overall performance on the EE should also be further investigated. The early indication might be that this score is a good tool to identify students who may need extra coaching or perhaps professional assistance prior to, or during paramedic school.
It is encouraging to see high levels for agreeableness and conscientiousness in this population as these traits have been previously been shown to correlated with teamwork and empathetic behaviors respectively. Traits that are critical to Emergency Medical Services.
Finally, measuring affective domain traits with a previously validated instrument and tying these measurements to cognitive domain performance in EMS education may represent a serious breakthrough in our field. These measurements present new possibilities for workforce screening, documentation and development of specific coaching strategies for success.
This group involved in this project continues to collect data hoping to uncover any predictive nature of these traits on progress and eventual graduation of these candidates. We are very thankful for the support from the EMS education community that has helped pilot test the Fisdap EE and report their results.
Conclusion: Conscientiousness and neuroticism appear to be measurable personality traits that are associated with cognitive performance in Paramedic Students. Future research is needed to correlate and predict how affective traits and cognitive performance are associated with student success such as improved retention at jobs, high patient satisfaction scores, and other important outcomes for the individual and workforce.