Influence of Personality Traits on Mental Health and Performance of Medical Residents and Physicians: A Systematic Review and Meta-analysis

Abstract Background: Medical residents and physicians face persistently high-demand environments marked by heavy workloads, time pressure, night duties, and emotionally intense clinical encounters. These conditions increase vulnerability to stress-related outcomes, including burnout and impaired mental health, and can affect functioning at work. Personality traits are relatively stable individual differences and might help explain why some doctors experience greater stress vulnerability or use less adaptive coping strategies than others. Evidence linking the Big Five personality traits to stress, coping, and performance outcomes in residents and physicians has grown, but it remains difficult to apply because of inconsistent findings and heterogeneous measures. This systematic review and meta-analysis aim to synthesize the existing literature on how the Big Five personality traits influence these outcomes in medical residents and physicians. Methods: We conducted a PRISMA-aligned systematic review and meta-analysis (PROSPERO CRD42023483408). PubMed, Embase, MEDLINE (Ovid), Cochrane Library, Scopus, and Web of Science were searched from database inception to Nov 15, 2023. Searches were updated periodically through Jan 2026. Eligible studies were primary research in English involving medical residents and/or practicing physicians that assessed at least one Big Five trait using a recognized Five-Factor Model instrument and reported an association with a validated or clearly defined stress, coping, performance, or professional skills/aptitudes related outcome in medical residents or physicians. Studies exclusively involving medical students were excluded. Risk of bias was assessed using the AXIS tool (supplemented by Joanna Briggs Institute items) for cross-sectional studies and the Cochrane Risk of Bias 2 tool for the randomized trial. Where at least three comparable studies were available, effect sizes were pooled using random-effects models with restricted maximum likelihood estimation after Fishers z transformation; remaining studies were synthesized narratively. Results: Of the 4,967 records identified, 34 studies (21,379 participants) met the inclusion criteria; most were cross-sectional (30/34), with three longitudinal studies and one randomized trial. Meta-analyses were restricted to 11 studies reporting Maslach Burnout Inventory subscales and three studies reporting GHQ-12 psychological distress. Neuroticism showed the clearest and most consistent adverse associations: for emotional exhaustion (pooled r=0.418, 95% CI 0.219 to 0.616, p<0.001), for depersonalization (pooled r=0.304, 95% CI 0.166 to 0.442, p<0.001), and for personal accomplishment (pooled r=-0.244, 95% CI -0.393 to -0.094, p=0.005). Conscientiousness, Extraversion, and Agreeableness showed small protective patterns, with lower emotional exhaustion and depersonalization and higher personal accomplishment, although associations with stress were weak and generally non-significant. Openness showed a weaker, selective pattern, with lower depersonalization and higher personal accomplishment, but no clear association with emotional exhaustion or stress. Moderator analyses suggested that associations for Neuroticism, Conscientiousness, and Agreeableness varied more by experience and region than by specialty, whereas Extraversion was moderated mainly by experience; Openness showed little evidence of consistent moderation. Narrative synthesis of studies not included in the main meta-analyses was broadly concordant: Neuroticism was the most consistent vulnerability marker for burnout, distress, maladaptive coping, and poorer work-related outcomes, whereas Conscientiousness and, to a lesser extent, Extraversion were linked to more adaptive coping and more favorable performance-related indicators. Agreeableness showed modest prosocial and attitudinal benefits, and Openness remained the least consistent trait across outcomes. Overall risk of bias was low to moderate for most observational studies, although heterogeneity was substantial across pooled analyses. Conclusions: Big Five personality traits have modest correlation with physicians and residents burnout, distress, coping, and work-related functioning. Neuroticism emerged as the clearest vulnerability marker, whereas Conscientiousness and, to a lesser extent, Extraversion and Agreeableness showed small protective associations. Interpretation is limited by the predominance of cross-sectional designs, reliance on self-report, substantial heterogeneity, and restricted geographic representation. These findings support the use of personality traits as a supportive and formative resource within medical education and workforce well-being, but not for deterministic selection or labelling. Larger longitudinal and intervention studies using multi-method outcomes are needed to clarify mechanisms and causal pathways.