Background

Information relating to personality traits, behaviour styles and emotional intelligence of qualified health professionals has been gaining interest in the empirical literature. These non-cognitive traits have been explored to determine if they predict characteristics and outcomes of health professionals and their practice [1]. It has been theorised that practitioners from each health profession, based on their choice of career and occupational requirements, could represent homogenous groups in terms of non-cognitive traits [2, 3].

Personality has been investigated within several health professional fields and is believed to be stable over time [4,5,6,7], influential in professional practice [3] and to precede professional/speciality choice [4, 7]. Personality is expressed as enduring patterns of feelings, thoughts and behaviours by an individual in different environments [8], and understandings about personality have been helpful in guiding clinicians’ vocational choices where some have matched occupational requirements, routines and rewards to personality traits [3]. Personality traits are known to influence an individual’s perspective, attitudes and behaviours which in turn influence how an individual approaches a situation or conflict [9]. Exploring the similarities and differences of personality across health professions may aid in understanding profession-specific strengths and weaknesses, foster mutual understanding, inform professional practice support strategies, and improve understandings to enhance interprofessional practice [1, 10].

Whilst research into personality traits of qualified health professionals is continuing to emerge, empirical studies that explore behaviour styles which are underpinned by personality traits [8] are still limited. Behaviour is known to be developed based on temperament and informs the ways in which we describe ourselves and others [1, 8]. Behaviour is also dependent on the influence of external factors and internal processing of information [1], which leads to a coordinated response (actions or inactions) of an individual to the external and/or internal stimulus [11]. Therefore, despite humans having preferred behaviours underpinned by their beliefs, values and physiological systems, it is thought that through cognitive reasoning one may be able to influence and change the expression of behaviour over time and contexts [12, 13].

In addition to personality and behaviour, emotional intelligence (EI) represents an assortment of non-cognitive skills and capabilities including empathy, professionalism and integrity, and each of these attributes influence an individual’s ability to cope with environmental demands [14]. Higher levels of EI have been associated with increased professional success and better workplace performance [15, 16]. Those with higher EI show increased individual cognitive-based performance [15], higher interpersonal skills with less conflict [17], increased facilitation of intellectual development [16]; and improved quality of work and productivity [18]. EI has been defined as an individual’s ability to monitor their own and others’ feelings, discriminating them and utilising this information to guide thinking and actions [19]. The application of EI therefore requires self-awareness in order to improve EI through practice and feedback [20]. Increased insight into one’s EI has been shown to be integral to enhancing one’s ability to work effectively with colleagues and clients and can result in enhanced patient-centred care, due to increased ability to manage and read emotions [18, 21]. Brewer [22] identified that enhancement of EI is directly associated with an individual’s capacity to develop skills and competency across five domains of self-regulation, self-awareness, empathy, motivation and social skills [22].

Standardised tools for personality, behaviour and emotional intelligence are utilised to allow individuals to have a better understanding of their own and others’ non-cognitive traits and underlying reasons for their behaviour. There is a wide variety of tools available, with the Myers-Briggs Type Indicator (MBTI) [23] being one validated and reliable tool commonly used to study an individual’s personality traits. Behaviour styles is the least measured non-cognitive trait in the empirical literature, with the DiSC behaviour profiling assessment tool [24], being utilised to understand health professional team interactions and performance [25]. There is a vast array of EI measures, with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and Schutte Self Report Emotional Intelligence Test most utilised [26, 27]. These tools have been applied in health and education settings to identify and describe an individual’s motivators for success; preferred behaviours; influences on career pathway development and job satisfaction [28]. Additionally, they may optimise the success of both individuals and professional teams [18, 29].

Frequently within the literature non-cognitive traits are also explored relative to burnout, acknowledging that health professionals often experience higher levels of burnout due to the emotionally challenging and physically demanding nature of healthcare [30, 31]. Burnout is a measure of physical and psychological fatigue from occupational and professional demands and is characterised by high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment [32]. Although the causes of burnout are complex and unclear, burnout and stress are symptomatically similar [33]. Therefore, given non-cognitive traits inform how individuals engage with and cope in different environments, it is understandable that non-cognitive traits are an influencing factor on burnout. Personality has been central in determining burnout, with personality influencing behaviour and performance [30], whilst individuals with higher emotional intelligence and ability to regulate their emotions are shown to have more problem-focused coping styles and hence are less vulnerable to burnout [34].

Although literature on this topic exists, to date there has been no systematic review that synthesises the evidence to profile personality traits, behaviour styles and / or EI capabilities of practitioners across the health professions. This information could be used by educators of health professional students to better understand the personality traits, behaviour styles and EI capabilities of those who have successfully qualified as a health professional. It could also be valuable information for developing strategies to improve performance of student health practitioners beyond their technical skills. Further information about health practitioners’ personality traits, behaviour styles and EI capabilities could also be useful for the higher education sector when establishing the inherent requirements of their entry level health profession programs, and for future students to make decisions about entry into these programs and professional pathways. The purpose of this systematic review was to profile the personality traits, behaviour styles and EI capabilities of qualified health practitioners.

Methods

The systematic review protocol was developed utilising the Preferred Reporting Items for Systematic and Meta-Analysis Protocols (PRISMA-P) [35], and registered on the International Prospective Register of Systematic Reviews (PROSPERO) (Registration number CRD42020155113).

Search strategy and key themes

The search strategy was developed by initially running primary searches in key databases using keywords capturing the research question. The identification of relevant articles guided the refinement and formation of the final search strategy and key concepts. There were two key concepts derived within the search strategy, which included: (i) non-cognitive traits and (ii) health professionals. Interventions and outcomes included tools utilised to profile personality traits, behaviour styles and emotional intelligence. The health professionals’ key concept was inclusive of allied health (e.g., physiotherapy, occupational therapy, and speech pathology), nursing, medicine, and dentistry. A full list of search terms for concepts one and two can be found in Additional file 1.

The search terms were further refined using filters dependant on the database searched. The strategy was used to search CINAHL, PubMed, EMBASE (via OVID) and ProQuest Central databases (which provides access to 47 databases across all major subject heading areas including health and medical, social, science, business, arts, humanities, religion, education and technology [36]). The Polyglot Search Translator [37] was utilised to input initial search string (PubMed) of key concepts to adapt the search strategy to the remaining three database search requirements. The search terms and filters used in the systematic search by database is outlined in Additional file 2. Filters utilised for each database were selected based on the available filters for each database. The authors attempted to maintain consistency across all filters selected, though variation is evident due to the construct of each database. To ensure retrieval of studies of relevance to modern health professionals, databases were searched from 1980 onwards. An age limit filter was not used in the search strategy and instead studies of individuals under 18 years of age were excluded when applying the eligibility criteria (Table 1) during the screening process.

Table 1 Inclusion and exclusion criteria
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Selection and screening process

Search results were exported into Covidence (Covidence online systematic review platform, Veritas Health Innovation Ltd., Melbourne, Australia, www.covidence.org) which was used to store all references, identify duplicates, complete title and abstract screening; and determine the number of records for data synthesis.

Utilising the inclusion criteria (Table 1), two reviewer pairs (GM/KS, CL/NM) independently screened titles and abstracts for possible inclusions, with a third reviewer managing conflicts (DR). For records that appeared to meet the inclusion criteria, or those that were not clear, full-text records were obtained. Three reviewers (CL, DR, NM) independently screened full text against the eligibility criteria. Any discrepancies of inclusion were resolved by discussion or reference to third reviewer (NM or DR) to reach consensus. Reasons for exclusions were documented (Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram describing process of study selection [38]

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Critical appraisal

All included papers were critically appraised using the Mixed Methods Appraisal Tool (MMAT) [39]. The MMAT comprises five categories dependent on study design and appraises three methodological domains: qualitative, quantitative, and mixed methods. The tool utilises a dichotomous scoring scale, whereby items scored as ‘no’ were awarded zero points and items scored as ‘yes’ were awarded one point. Each study was appraised according to the relevant methodological domain. Scores were converted to a percentage based on the number of ‘yes’ responses compared to the total number of questions. Studies were considered to have high methodological quality when the total percentage score was equal to or above 75% [40], whilst studies below 75% were deemed to have a lower methodological quality [41].

Two independent reviewers completed the critical appraisal process (CL, NM) for each search stage (initial search (CL, NM) and updated search inclusive of MeSH terms (CT, DR). The level of agreement between the critical appraisers was examined by a Kappa analysis using SPSS, version 24 [42]. Consensus between the two appraisers was determined by a third reviewer (DR, CH) when discrepancies in scores were evident and could not be resolved through a process of discussion.

Data extraction and synthesis

A standardised template agreed prior to data extraction was used to guide extraction of study characteristics and outcome data by a single reviewer (CL), with a second reviewer (NM) validating the data extracted from the includes studies. Data extraction included: (a) methods (study authors, title, aims/objective, location, study design); (b) participants (N = number, profession, age (mean or median; range), gender); (C) non-cognitive traits (health professional behaviour pattern, personality and emotional intelligence assessment measures); and (d) outcomes. Data was recorded in an Excel spreadsheet [43].

The extracted data was synthesised and meta-aggregated for quantitative analysis, and narratively synthesised reporting on emerging concepts and key findings for qualitative analysis. Meta-aggregation was conducted for each of the outcomes assessed utilising the Exploratory Software for Confidence Intervals (ESCI) Meta-Analysis software [44] for mean and standard deviation (SD). Where the SD data was not available the SD was calculated utilising the Cochrane calculator [45] from either p-values or 95% confidence intervals (CI). If the p-value was not available, the highest SD available from other included studies using the same measure was imputed using methods consistent with previous studies [46], and this was required for 31 studies. Where studies only included mean and inter quartile range (IQR), the mean and SD was calculated utilising sample size, median and IQR using methods consistent with previous published studies [47, 48], and this was required for two studies. Where published results did not provide global totals or subscale totals, mean and SD calculations were reported according to the intended tool’s purpose.

Results

Literature search and selection

The results of the literature search, screening and selection process are outlined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format in Fig. 1.

Participants

Of the 321 studies included 112,691 participants from 53 different countries were reported, ranging from 10 to 5148 participants in each study. Most participants were nurses (n = 64,250), followed by doctors (n = 36,029), allied health (n = 5068), dentists (n = 4139), unidentified health professionals (n = 2247), paramedics (n = 744), nursing assistants (n = 177 and pathologists (n = 37). The 5068 allied health participants included occupational therapists (n = 1944), dietitians (n = 776), physiotherapists (n = 684), pharmacists (n = 298), psychologists (n = 118), radiologists (n = 117), social workers (n = 8) and non-defined health professionals (n = 1123).

Methodological quality of included studies

The level of agreement between the two initial critical appraisers using the MMAT was 74.05% (Cohen’s Kappa (K) = 0.841, p = < 0.01), and in the updated search 88.89% (Cohen’s Kappa (K) 0.602, p = < 0.05) indicating a high level of agreement. Following a consensus process, 100% agreement was achieved for all studies critically appraised. Two hundred and seventeen studies achieved YES responses for more than 75% of the questions, indicating that they were of high methodological quality and 104 of the included studies did not meet this threshold and were therefore not considered high methodological quality studies as interpreted according to Radomski, Wozney [40] and Horswood, Baker [41]. Papers of high quality consistently demonstrated complete outcome data utilising an appropriate outcome measure that was administered as intended. Lower quality papers were generally not able to demonstrate if the sample was representative of the target population, with uncertainty regarding confounder accountability or risk of nonresponse bias.

Tools used to assess personality traits, behaviour styles and emotional intelligence across the health professionals

The 321 included studies used 148 different outcome measure tools (with some tools having multiple versions, or reporting data in different formats), across the measures of personality traits (n = 84 tools), behaviour styles (n = 8), and emotional intelligence (n = 56). Eighty-four of these tools measured personality traits inclusive of 281 different personality trait subscales; eight measured behaviour styles across seven categories; 56 measured emotional intelligence including 102 subscale items (Additional file 3).

Profiling the personality traits, behavioural styles and emotional intelligence of health professionals

Relevant results from each included study were tabulated and are presented in the data extraction table (Additional file 4). The meta-aggregation included 292 studies, and qualitative synthesis included 35 studies, noting 6 studies were both qualitatively and qualitatively analysed (Fig. 1). Results from each of the studies have been synthesised according to the measured factor, subscale/category and the health professional population in the following sections.

Personality traits

Personality was the most measured factor with 171 studies (n = 65,581). Ninety-eight of these studies were in nursing [1, 9, 49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142], 52 in medicine [1, 30, 58, 90, 94, 100, 143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185], 14 in allied health [10, 28, 89, 178, 186,187,188,189,190,191,192,193,194,195,196], seven in dentistry [197,198,199,200,201,202,203], three were unidentified health professional groups [94, 204, 205], three in paramedics [206,207,208], one in nursing assistants [209], and one in pathologists [210]. Data from 143 of these studies were meta-aggregated (Table 2) and 20 were narratively synthesised by profession and personality trait (presented below).

Table 2 Meta-aggregated results for personality traits of health professionals (n = 143 studies)
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Nursing

Sixty-one tools were utilised to investigate nursing personality across the 98 included studies (n = 31,971). Synthesised results demonstrate that nurses exhibited high levels of agreeableness [51, 53, 55, 61, 64, 71, 75, 77, 78, 82, 100, 102, 105], assertiveness [50], dominance [52, 106], conscientiousness [53, 55, 61, 64, 75, 78, 82, 100, 105] and hardiness [53, 63, 83, 92, 97, 98, 101]; Nurses were shown to have lower levels of abstractedness [52, 106], apprehension [52, 106], boldness [52], imagination [50], independence [50, 52] and neuroticism [51, 62, 70, 71, 79, 89, 100]. The literature is less clear on traits of openness, with some studies reporting high levels [51,52,53, 55, 60, 61, 64, 77, 100, 216] whilst other studies reported lower levels [71]. The same was evident for extroversion-introversion: a greater number of studies identified high levels of extroversion in nurses [50,51,52, 71, 74, 77, 104, 137], however there were also multiple studies identifying nurses to be more introverted [50, 56, 69, 84, 93, 111, 124] in nature. Nurses were identified to have higher levels of sensing and judging personality traits [73, 87, 94, 111, 124, 137]. Finally, Huang, Cai [217] examined nurses’ personality relative to psychological distress and identified that nurses with mod-severe psychological distress demonstrate significantly more negative personality traits (53%), compared to those who have none-mild distress demonstrating 97% positive traits.

Nursing assistants

Nursing assistants were investigated in one study (n = 177) [209], with results indicating that nurse assistants’ exhibit personality traits with high levels of likeability (18.63 ± 3.07) and ambition (20.58 ± 5.28), and low levels of sociability (11.33 ± 4.76) and intellectance (openness to new experiences) (11.96 ± 4.52).

Medicine

The 52 studies investigating medical professionals (n = 21,125), used 33 different outcome tools (some with multiple versions). Results demonstrated doctors have high personality traits of dominance [154], instrumentality [211], perfectionism [154], reasoning [154], reward-dependence [1, 148, 149, 151], sensitivity [154], shrewdness [154], anxiety [179], agreeableness [181], openness [181] and tension [154]. Medical professionals were shown to have low levels of narcissism [58], abstractedness [154], neuroticism [90, 100, 147, 152, 153, 157, 181, 218], psychoticism [58, 90, 153] and social boldness [154]. The literature was unclear in terms of extroversion-introversion with some studies indicating higher levels of introversion [94, 145, 152, 153, 164], where others indicated higher levels of extroversion [150, 155, 218], and one had a balanced representation of both introversion and extroversion [183]. The same was evident for the personality trait of openness with Reeve [154] indicating lower levels, and van Mol, Nijkamp [100] finding higher levels, whilst the remaining studies investigating openness recorded average levels [150, 156, 157, 218].

Dentistry

Of the seven studies investigating dentists (n = 3664), three studies qualitatively reported on personality traits utilising the Myers-Briggs Type Indicator (MBTI) [198,199,200], and one study investigated aspiration utilising The Aspiration Index [197]. Dentists most commonly presented with ISTJ (i.e. introversion-sensing-thinking-judging; 16.0–54%) and ESTJ (extroversion-sensing-thinking-judging; 13.0–14.3%), with higher levels of judging and perceiving [198, 199]. Aspiration was primarily driven by intrinsic importance [197].

Allied health

Campbell, Eley [187] and Campbell, Eley [188] investigated allied health personality as a collective professional group utilising the Temperament and Character Inventory and found very high personality traits of cooperativeness (83.38 ± 0.00), self-directedness (77.39 ± 0.00), persistence (72.38 ± 0.00), reward dependence (71.87 ± 0.00), and low self-transcendence (44.98 ± 0.00). These results (n = 1123) indicated that allied health clinicians are highly self-motivated, work well in a team, but are less spiritual in nature.

Dietetics

Three studies investigated dietitians (n = 776) [10, 28, 190]. Two studies utilised the Temperament and Character Inventory [10, 28], with results identifying high cooperativeness (80.79 ± 2.01), persistence (73.53 ± 5.03), self-directedness (74.30 ± 6.96), harm avoidance (56.85 ± 9.78) and novelty seeking (54.11 ± 2.47); with low self-transcendence (42.37 ± 3.43) [10, 28]. Hagan and Taylor [190] utilised the Myers-Briggs Type Indicator, and demonstrated ESFJ (i.e., extroversion-sensing-feeling-judging; 16.7%) was the most common combination of personality traits, with sensing and judging being the most prevalent across all personality combinations for dietitians.

Occupational therapy

Two studies explored occupational therapists’ personality [191, 195]. Lysack, McNevin [191] (n = 128) utilised the Kiersey-Bates Personality Inventory, and found occupational therapists exhibited sensing-perceiving (SP) (49%) and intuitive-feeling (NF) (27%) traits, suggesting they are resourceful, and sensitive to the needs of people. Radonsky [195] assessed against the Myers-Briggs Type Indicator (MBTI) with results demonstrating ISF (i.e., introversion-sensing-feeling-judging, 69%) was the most common personality trait.

Physiotherapy

Four studies (n = 495) investigated physiotherapists’ personality traits [186, 191, 193, 194]. Buining, Kooijman [186] and Kooijman, Buining [193] utilised the Big Five Inventory identifying highest in rank association with agreeableness (3.75 ± 0.03), conscientiousness (3.69 ± 0.00), extroversion (3.49 ± 0.00), openness (3.42 ± 0.00) and neuroticism (2.38 ± 0.00). Lysack, McNevin [191] identified that physiotherapists exhibited a sensing-judging (SJ) (66%) temperament. These results suggest that physiotherapists are generally calm, relaxed, secure, stable and resilient clinicians. Finally, Martinussen, Borgen [194] examined Type A personality with the Revised Jenkins Activity survey and established higher levels of Achievement strivings (3.5 ± 0.44) compared to impatience-irritability (2.4 ± 0.57).

Pharmacy

Pharmacists were investigated in two studies (n = 298). One study utilised the Big Five Inventory [192] across traits of agreeableness, conscientiousness, extroversion, neuroticism, and openness. The other study investigated ascendence, cautiousness, emotional stability, original thinking, personal relations, responsibility, self-esteem, sociability, and vigour utilising the Gordon Personality Profile Index [189]. Results indicated that pharmacists exhibit average or above scores across all items. The highest scoring traits were agreeableness, extroversion, openness, and responsibility; suggesting pharmacists are cooperative, outgoing and responsible.

Paramedics

Three studies investigated paramedics’ personality traits [207, 208, 219]. Paramedics were found to have highest scores in conscientiousness and lowest scores in neuroticism across both the Big Five Inventory (n = 395) [207] and NEO-Five Factor Inventory-Short Form (n = 252) [208]. Bergmueller, Zavgorodnii [206] investigated paramedics’ personality traits (n = 97) utilising the Freiburg Personality Inventory. Results indicated that paramedics exhibit intermediate association across all 12 attributes of emotional liability, extroversion-introversion, irritability, masculinity-femininity, mental balance, neuroticism, openness, reactive aggressivity, spontaneous aggressivity, shyness, and sociability. Despite all attributes of personality being intermediate levels, for those aged < 35 years, paramedics demonstrated higher mental balance, extraversion-introversion, and masculinity-femininity than those aged ≥45 years. In addition, those aged ≥45 years demonstrated lower levels of spontaneous aggression. These results suggest that paramedics have a balanced personality, though have slight variation relative to their age.

Pathologists

Iorga, Soponaru [210] was the only study to investigate pathologist personality utilising the Big Five Inventory, with highest scores in extraversion (3.98 ± 0.73) and agreeableness (3.97 ± 1.09).

Radiologists

Sciacchitano, Goldstein [196] was the only study to investigate radiologist personality utilising The Personal Views Survey II. Results indicated that Radiologists have a high level of hardiness (89.9 ± 11.9), suggesting they have a higher level of resilience.

Social workers

Social worker personality trait of neuroticism was assessed in one study (n = 8) [178], identifying they exhibited lower levels of neuroticism (11.55 ± 2.16) compared to their medical colleagues.

Table 2 provides detailed information about the personality traits of health professionals.

Behaviour styles

Of the 321 studies, ten studies investigated behaviour (n = 6709); five of these were with nurses [99, 220,221,222,223], three studies were in medicine [25, 175, 224], one study was with occupational therapists [225], and one study in psychologists [226].

Nursing

Four studies (n = 2068) were included in the meta-aggregation [99, 220,221,222] (Table 3), and one study reported narratively (n = 3396) [223]. Two studies [99, 220] demonstrated moderate association to Type B behaviours (relaxed, patient and friendly); whilst two other studies demonstrated high association with Type A behaviours (ambitious, organised, impatient, punctual and irritable). Keogh, Robinson [223] described nurses to have high dominance (39%) and conscientiousness (35%) behaviours. Table 3 provides detailed information about the behaviour styles of health professionals.

Table 3 Meta-aggregated results for behaviour styles of health professionals (n = 7 studies)
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Medicine

Three studies (n = 742) in medicine investigated behaviour utilising different tools. Marcisz-Dyla, Dąbek [175] investigated Type A behaviour utilising the Framingham Type A Scale. Results concluded that doctors equal had Type A (33.1%), Type B (33.8%) and intermediate (33.1%) behaviours [175]. Ogunyemi, Mahller [25] demonstrated that doctors have a higher prevalence of Conscientiousness (5.14 ± 0.16) and Steadiness (4.93 ± 0.00), compared to Dominance (2.90 ± 0.14) and Influence (3.63 ± 0.00) utilising the DiSC assessment tool [25] (Table 3) [224]. study demonstrated doctors have slightly more association with Type A behaviours (mean score of 86.44, where 84 is neutral).

Occupational therapy

Bailey [225] investigated behaviour traits exhibited by occupational therapists using the Rokeach Values Survey. Results concluded that lovingness, mature love and inner harmony are associated with occupational therapy clinicians; whilst capability and sense of accomplishment behaviours are more likely associated with occupational therapy administrators [225].

Psychology

Matthews, Heimreich [226] studied Type A behaviours in psychologists, with results demonstrating slightly higher Type A behaviours (10.3 ± 3.4).

Emotional intelligence

One hundred and forty five studies investigated emotional intelligence (n = 42,795) Nurses were investigated in 105 studies [20, 79, 80, 82, 91, 102, 213, 216, 227,228,229,230,231,232,233,234,235,236,237,238,239,240,241,242,243,244,245,246,247,248,249,250,251,252,253,254,255,256,257,258,259,260,261,262,263,264,265,266,267,268,269,270,271,272,273,274,275,276,277,278,279,280,281,282,283,284,285,286,287,288,289,290,291,292,293,294,295,296,297,298,299,300,301,302,303,304,305,306,307,308,309,310,311,312,313,314], 33 studies explored EI with medical doctors [239, 253, 257, 265, 315,316,317,318,319,320,321,322,323,324,325,326,327,328,329,330,331,332,333,334,335,336,337,338,339,340,341,342], three were in dentistry (n = 661) [343,344,345], three studied EI in occupational therapists (n = 1369) [346,347,348], two in physiotherapists (n = 189) [349, 350], one in radiologists (n = 22) [351] and six collectively explored health professionals [31, 342, 352,353,354,355]. Meta-aggregation of 142 of the studies is provided in Table 4; the remaining three studies [227, 236, 351] were synthesised narratively.

Table 4 Meta-aggregated results of emotional intelligence (n = 142 studies)
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Health professionals

Health professionals’ EI was investigated in six studies (n = 1973) utilising the Multidimensional Measure of Emotional Intelligence [31, 353], Bar-On’s Emotional Quotient Inventory [352], Brief Emotional Intelligence Inventory for Senior Citizens [354], Wong and Law Emotional Intelligence Scale [355] and Schutt Self-Reports Emotional Intelligence Test [342]. All six studies demonstrated that health professionals generally have average EI, and this trend is observed across each subscale of EI also as outlined in Table 4.

Nursing

Global emotional intelligence scores varied in nurses from low [259] (1 study; n = 131), average [20, 82, 233, 237, 241, 245, 254, 259, 267, 268, 277, 295, 298, 299, 301, 306, 307, 358] (18 studies, n = 2521), to above average and higher [79, 230, 231, 238, 249, 262, 290, 310] (8 studies, n = 2011). Nurses also demonstrated average adaptability [233, 241, 245, 253, 264] (5 studies, n = 827); positive altruistic behaviours, commitment and emotional stability [238] (1 study, n = 170); and high emotionality [228, 252] (2 studies, n = 582). Interpersonal abilities ranged from low [233] (1 study, n = 277) to average [20, 234, 237, 240, 241, 245, 264] (7 studies, n = 3857). However interpersonal relationships were reported to be very high in nurses [241, 245, 253, 264] (4 studies, n = 550). These results suggested that nurses have low to average EI overall, but positively exhibit self-less, committed and emotional stable relationships.

Medical

Global EI scores for medical practitioners ranged from average [253, 257, 317, 320, 321, 339] (6 studies, n = 915) to above average [265, 316, 318, 319, 322, 327] (6 studies, n = 3367), across seven different outcome tools. Subscale items of EI results demonstrated medical practitioners exhibit high natural acting emotional labour strategies [318] (1 study, n = 740), intra and interpersonal emotional intelligence [253] (1 study, n = 120), and self-control [316, 319, 327] (3 studies, n = 2377); whilst also displaying low benefiting from emotions [257] (1 study, n = 50), and markedly low general mood and stress management [253] (1 study, n = 120). These results suggest doctors have high ability to manage their own emotions, and require less effort to change their emotions, but potentially struggle with feeling satisfied. Nooryan, Gasparyan [253] established that training in EI within medical professionals also aids in reducing stress.

Dentistry

Dentists were found to exhibit high levels of emotional intelligence across three studies (n = 661), utilising the Schutte Self-Report Emotional Intelligence Test [343, 344] and Emotional Intelligence Screening Test [345]. Dentists also were reported to have light levels of empathy [343], which suggests that dentists have a greater than average ability to appreciate the emotions of others and can more easily understand their patients point-of-view.

Occupational therapy

Occupational therapists had higher than normal EI across three studies (n = 1369) [346,347,348]. One utilised the Trait Emotional Intelligence Questionnaire-Short Form [346] examining global EI. The second study utilised the Swinburne University Emotional Intelligence Test, which identified occupational therapists have a high ability to understand emotions (78.46 ± 8.24) [347]. Finally, McKenna, Webb [348] utilised the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), which identified higher than normal scores across all sub scales of well-being (5.79 ± 0.82), self-control (4.93 ± 0.88), emotionality (5.76 ± 0.73) and sociability (5.07 ± 0.78).

Radiology

Abu Awwad, Lewis [351] investigated chief radiologist emotional intelligence relative to their years of experience. Results found high mean scores across global and subscale scores (5.15–6.25) with no significant differences found across global, subscale scores, or years of experience [351].

Physiotherapy

Nizar Abdul Majeed, Mohammed Abdulrazzaq [350] was the only study to assess physiotherapy emotional intelligence utilising the Genos Emotional Intelligence Inventory – Concise Questionnaire (GEII). Results indicated that physiotherapists have a moderate (129.36 ± 18.314) level of emotional intelligence, that is negatively correlated with occupational stress [350].

Discussion

The primary purpose of this systematic review was to profile the personality traits, behaviour styles, and EI of qualified health practitioners. By meta-aggregating results from multiple studies, we aimed to explore the differences and similarities between the health professions, critically appraising and collating the empirical literature reporting on this topic. In total, 321 publications were included with 68% achieving high methodological quality score on the MMAT checklist. The distribution of health professionals across the systematic review demonstrates that research is limited and inconsistent within this field with at least one of the non-cognitive traits being investigated in each of the 13 health professional groups; nursing (personality, behaviour, emotional intelligence), medicine (personality, EI), nursing assistants (personality), dentistry (personality, EI), dietetics (personality), occupational therapy (personality, behaviour, EI), physiotherapy (personality, EI), pharmacy (personality), psychologists (behaviour), radiologists (personality, EI), social workers (personality), pathologists (personality) and paramedics (personality).

Personality traits

The results from included studies suggest that all health professionals demonstrate agreeable, cooperative and self-directed traits, with low levels of neuroticism supporting the concept that health professionals are relaxed, calm, stable individuals who have the ability to work well in teams, which are all required within the complex social context of healthcare environments [369]. However, most other personality traits exhibit some variation across health professional groups. Recognising that non-cognitive traits can enhance individual understanding and possibly predict the conduct of health professionals Eley and Eley [1] it is important to explore these differences.

One of the most consistent results pertaining to health professional personalities is the sensing-judging trait. Most health professional groups exhibit high sensing-judging scores on personality measures, suggesting that they perceive information through direct, objective, factual senses and utilise mental functions through structured planning that is decisive, controlled and committed [370]. Occupational therapists are an exception to this, exhibiting higher sensing-perceiving and intuitive-feeling, suggesting they have more indecisive mental functions, subjective perceptions and make decisions based on experiences and compassion. One explanation for this variation within occupational therapy is that these health professionals tend to place more emphasis on psychological well-being, giving greater attention to occupational performance of the whole person, compared to a body structure impairment approach taken by many of the other health professions [191].

Extroversion-introversion personality trait varied across professions with nursing and medicine demonstrating variability of these traits across the continuum. Comparatively, physiotherapists and pharmacists all showed greater attenuation to extroversion. Previous research supports this with person-orientated health professionals such as physiotherapists working in more socially engaging roles over longer occasions of service and therefore attracting more extroverted individuals to the profession [188]. Interestingly, pharmacists possess both person-oriented and technique-orientated skills, with non-homogeneous personality traits dependant on the primary skills required within their role [189]. The results of this systematic review suggest that most pharmacists are in person-orientated positions that are conducive to a more extroverted nature, with higher social interactions, than other technique-oriented positions which are more physically or emotionally separate from patients [188] which attract more introverted individuals.

Nurses and medical practitioners were found to have higher levels of dominance and lower levels of abstractedness suggesting that they are inclined to be more assertive, forceful and stubborn, and are grounded, practical, solution-orientated individuals [106]. Dominance relates to the amount of control that an individual either submits to or exercises over others, ranging from dominance to submissive [371, 372]. The current review suggests that both medical practitioners and nurses tend to exhibit more control, are not concerned with conflict, and will exhibit traits of assertiveness when presenting their views. This is of particular interest given the proximity of the working relationship for these professions, where they frequently perceive differences in clinical assessment data or intervention techniques which could create disagreement [373] and impact the collaborative team approach to healthcare if each did not trust and respect the input of the other professional.

Behaviour styles

Personality traits are believed to contribute to an individual’s behaviour style, which is an expression of internally coordinated responses to both internal and external stimuli [11]. Behaviour Style was only investigated in four professions. Nurses exhibited both Type A and B behaviour, with higher association to Type A. Type A behaviour is associated with competitiveness, time urgency and tendency towards anger and hostility with an external locus of control; whereas Type B represents easy-going, relaxed and unhurried behavioural tendencies, internal locus of control with less compulsive and perfectionistic behaviours than Type A [221, 374]. Great attenuation of Type A behaviours aligns with nurses’ personality traits of dominance which supports the inclination of more assertive behaviours, influenced by viewing time as an enemy. Given the clinical environment is considered to be unpredictable, challenging and stressful [375], this would predispose nurses to frustration, which has been previously documented as counterproductive to career success [374]. Similarly, male psychology scientists were also associated with having higher Type A behaviours, identifying that the more Type A behaviour is exhibited, the more likely an individual is to prefer challenging tasks and competitiveness that influences work satisfaction.

Occupational therapists demonstrated differences in behaviours dependant on their role as a clinician or administrator. It perhaps is not surprising that clinicians are demonstrating higher lovingness, inner harmony and mature love, as health professionals are expected to be compassionate and empathetic when working with patients, where administrators are sought for their more pragmatic and objective characteristics [225]. Administrators also often undertake the operational management of others, which may explain why they demonstrate a higher emphasis on capability than clinicians. The research demonstrates that there is a behavioural focus shift from clinician to administrator that could help individuals to identify areas for development if they wish to transition between these roles. Additionally, it may also be helpful for individuals making decisions about entry into higher education programs and career choices, identifying areas to focus development that might not be aligned with their preferred behavioural style.

Medical professionals were found to be more successful in executing tasks, high performance on examination and high level patient safety with high behaviour profiles of Dominance and Conscientiousness, acknowledging the competitive nature of health care and that these traits are associated with high level performance which are required in the medical field.

The results of the current review provide nurses, psychologists and doctors with information regarding the drivers of their behaviours, potential influences on how they interact with the team, and implications for career success. It is therefore important to consider these traits not only for career success, but in the education of health professional students. If educators and students are informed of the typical profiles of qualified health professionals, and the implications of these on their performance; this knowledge could be applied during student education and training within both the university and clinical learning environment settings, potentially leading to desirable behavioural change and improved performance [12].

Emotional intelligence

EI is known to influence an individuals’ ability to perceive, understand and cope with the environmental demands and pressures [14]. Therefore awareness and ability to monitor one’s own emotional response and others’ feelings, whilst discriminating between them, provides useful information for clinicians to guide their thinking and actions [376]. The literature demonstrates high homogeneity of overall EI scores within professional groups, with most health professionals exhibiting average to above average EI. The exception was nurses who, on aggregated results, demonstrated low to average EI. Howie, Heaney [305] has suggested that higher levels of EI could explain why some practitioners are better at delivering patient-centred care than others. Despite demonstrating lower global EI, nurses demonstrated very high interpersonal relationships, with emotional stability and commitment to their patients than their medical practitioner colleagues. This supports literature outlining the importance of the nurse-patient relationship, which indicates that nurses who are unable to develop a relationship with patients are more likely to have patients demonstrating ‘difficult’ behaviours, impacting on patient care [377].

Despite medical professionals exhibiting average EI, they perceive that the benefits of emotions are low, suggesting that they do not perceive emotionality in their work context as important and are less likely to utilise it. Lucius-Hoene, Thiele [378], identified that medical practitioners tend to communicate in a neutral manner without emotional content. However, if medical practitioners were to display appreciation, sympathy and support, they may play a pivotal role in the patients coming to terms with their illness and feeling understood and respected [378]. There is very little literature identifying why there is a difference between professional groups in terms of EI subscales. However, it is possible that nurses have a higher interpersonal and emotional stability than medical practitioners because they historically would spend more direct clinical care time with a patient.

Implications for health professions

The studies included in this review have identified both consistency and variation between health professionals with respect to personality traits, behavioural styles and EI, with various implications to professional practice and patient interactions. Considering the evidence, the characterisation of health professionals based on these traits will aid health professionals to understand their own non-cognitive features and how these might be useful in predicting performance within their chosen profession [1] with the potential to adapt these to enhance success in their professional roles. Utilisation of this information could be implemented at all stages of a clinician’s career development. This could start from pre-registration, providing students with an understanding and systematic training in humanistic qualities [379] within their programs, including decision making for entry into a health professional program. Further this could continue within the professions to target training to reduce stress and burnout [253] and enhance teamwork and communication between professions [380].

Despite highlighting the benefits of being able to understand health professional non-cognitive characteristics, it is evident that there are gaps in the literature in profiling these traits across all health professional groups. To date, most research has been in the medical and nursing professions, with the majority of literature focused on personality and EI. There is inconsistency in tools used to measure traits, making comparisons within and between professions difficult. There is limited research exploring non-cognitive characteristics of allied health practitioners and very little exploration of behaviour styles in health practitioners.

This review is the first of its kind and provides substantial aggregated information to inform readers about the personality traits, behaviour styles, and EI of health professionals. However, gaps in the literature are evident where several health professional groups are not represented across all measured factors, and there is a lack of literature on behaviour styles of health professionals when compared to other characteristics. This systematic review represents the most comprehensive review to date of the literature relating to health professional non-cognitive characteristics, capturing 321 studies across a range of health professions.

Understanding and knowledge of the non-cognitive profiles of health professionals would be valuable in supporting students before and during university training, as well as in their early career [1]. Understanding these non-cognitive traits provides academics, practitioners, clinical educators and students insight into how their own and other professionals’ traits might influence their engagement, success and challenges within academic training, clinical placement and the workplace. Furthermore, it provides students and health professionals greater knowledge to support decision making in selecting university programs, making career pathway choices and undertaking further professional development based on their own personality traits, behaviour styles and EI.

Conclusion

Personality traits, behaviour styles and EI are non-cognitive characteristics of health professionals. All health professional groups demonstrate agreeable, cooperative, and self-directed personality traits with lower levels of neuroticism. However, physiotherapists and pharmacists have a higher level of extroversion which is likely to be related to the person-oriented aspects of their role compared to other health professional groups. Medicine and nursing are more dominant and less abstracted in their expression of personality and are inclined to be more assertive and forceful than other professions. Nurses and psychologists tend to exhibit Type A behaviour styles, including higher levels of competitiveness, time urgency, and with an external locus of control. Comparatively, occupational therapists appear to demonstrate behaviour dependent on their role, with clinician behaviour focused on patient interactions, whereas administrators are more pragmatic and objective with a focus on the operational management of others. Collectively, health professionals exhibit average to above average global EI, except for nurses who demonstrate average to low EI on standardised assessments.