Going Beyond the Numerical Scoresheet: Identifying Maladaptive Narcissistic Traits in Residency Applicants

Certain personality traits assessed during interviews have been shown to negatively predict performance in residency. An informal needs assessment at our institution suggested that it would be particularly important to identify traits associated with maladaptive narcissism (i.e., entitlement, difficulty accepting criticism, and arrogance). The objective of this study was to evaluate an interview station designed to identify narcissistic personality traits among applicants to our general surgery residency program.

An interview station was developed in which applicants were provided negative feedback as a simulated evaluation. Two interviewers (1 staff surgeon, 1 senior resident) interviewed 48 applicants at this station. The 48 participants were also asked to complete the Narcissism Personality Index (NPI-40), which assesses adaptive and maladaptive facets of narcissism. NPI-40 scores were compared to the interview station scoresheet, which included numerical rating scales and a subjective "red flag" system used to identify concerns related to professionalism or personality.

Linear regression demonstrated a significant correlation between red flags on the negative feedback station and a high maladaptive proportion of narcissism on the NPI-40 (p = 0.02). The numerical interview score and the proportion of maladaptive narcissism score did not reach significance (p = 0.05). There was a high inter-rater reliability between interviewers' numerical scores (r = 0.89) and in determining red flags (σ = 0.83).

We designed an interview station that successfully identified general surgery residency interviewees displaying high proportions of maladaptive narcissistic traits. Despite an objective scoring process, subjective opinion of interviewers was more valuable in identifying these applicants. Our findings suggest that the written comments of surgeons in interview stations designed to identify applicants with difficulty accepting negative feedback may provide valuable information that is not captured by the numerical scoring process.