CONTEXT Reality weakness is a concept related to severe personality pathology, which has been found to predict emotional disturbances in several studies of Norwegian medical students and doctors. However, we lack characteristics of the individuals with high scores on this deviant trait at medical school.
OBJECTIVES This study aims to investigate the levels of reality weakness at the beginning and at the end of medical school, and further, to analyse which factors that are associated with reality weakness cut-off 0/1 at the end of the curriculum.
METHODS This cross-sectional study uses baseline samples of the Young Doctor Cohort (senior students) and the Medical Student Cohort (junior students) of the NORDOC – study (The Longitudinal Study of Norwegian Medical Students and Doctors). Outcome was the reality weakness dimension of the Basic Character Inventory (BCI-36). Both individual factors (age, previous mental health problems, parental bonding) and medical school-related factors (perceived medical school stress and perceived recording skills) were included in a logistic regression model of reality weakness. RESULTS At the beginning of the curriculum the mean score of reality weakness was 1.9 (SD 1.7), in contrast to 1.1 (SD 1.4) at the end of the curriculum, thus a significant difference in mean score between the two cohorts P < .001 (t = 7.42) with no significant gender difference. Factors independently associated with high reality weakness (cut-off at median or above) amongst senior medical students were; age OR = .88, 95 % Confidence interval: (.80- .97), P = .008; previous mental health problems OR = 3.0 (1.6- 5.6) P < .001; maternal overprotection OR = 1.05 (1.0- 1.09) P = .047; perceived medical school stress OR= 1.04 (1.00-1.08) P = .041; and perceived recording skills OR = 0.95 (.90- .995), P = .032.
CONCLUSIONS Factors associated with high reality weakness amongst senior students were: young age, maternal overprotection (control), and perceived medical school stress. High reality weakness was also associated with lower levels of perceived skills in medical recording. These factors may be of importance both with respect to selection of students to medical school and to support and interventions for the students during the curriculum.