The Real Colors instrument, administered to students during their first two months of school by a certified facilitator, sorts individuals into four temperament types designated by color: Blue, Green, Gold, and Orange. The tool is designed to help people understand human behavior, uncover the motivators specific to each group of personality characteristics, and improve communication with others. Blue types are typically described as relationship-oriented and empathetic, Green types as analytical and intellectually driven, Gold types as organized and duty-focused, and Orange types as action-oriented and spontaneous. The framework shares conceptual roots with other temperament models used in medical education research, including the Myers-Briggs Type Indicator and the HEXACO model, which have been correlated in previous studies with medical student performance and specialty preference, albeit with inconsistent results across the literature.

To test whether these temperamental categories mattered for actual course outcomes, the researchers linked personality data to a comprehensive set of assessments. Performance was measured through scores on National Board of Medical Examiners anatomy and neuroscience examinations, an institutionally developed neuroscience written exam, neuroscience quizzes, an anatomy laboratory practical examination, and a radiologic anatomy exam. Personality data were available for 193 students in the neuroscience course and 196 students in the anatomy course, spanning four academic years at the school’s Arizona campus. The study received ethical approval from the Mayo Clinic Institutional Review Board under protocol number 21-012951, with a waiver of consent granted, and was conducted in accordance with the principles of the Declaration of Helsinki.

The first striking result was the distribution of personality types within the student population. Blue was by far the most common color among these future physicians, accounting for 43.0 percent of students in the neuroscience cohort and 45.4 percent in the anatomy cohort. Green came second at 29.0 and 28.6 percent respectively, followed by Gold at 16.0 and 14.8 percent, and Orange at just 11.9 and 11.2 percent. This skew toward Blue and Green temperaments offers a quantitative portrait of who applies to and matriculates at a highly selective medical school, and it echoes long-standing observations that certain personality profiles are overrepresented in the physician workforce compared with the general population.

When the researchers applied the Kruskal-Wallis test, a nonparametric statistical method for comparing outcomes across multiple independent groups, they found significant differences between color groups on three assessments: the neuroscience NBME exam, the anatomy NBME exam, and the anatomy laboratory practical examination. These are among the most consequential measures in the preclinical curriculum, since NBME subject exams are standardized national tests and laboratory practicals demand hands-on mastery of three-dimensional anatomical structure. The fact that personality group membership surfaced as a statistically significant factor on precisely these assessments, and not on the institutionally written neuroscience exam, the quiz series, or the radiologic anatomy exam, hints that temperament may interact with specific formats and demands of testing rather than with general academic ability.

Post-hoc analysis using the Dunn-Bonferroni correction, a conservative method that guards against false positives when making multiple pairwise comparisons, sharpened the picture considerably. The significant differences were consistently located between the Green and Orange groups. In other words, the analytical, intellectually oriented Green students and the action-oriented, spontaneous Orange students differed reliably on those three high-stakes assessments. Given that Orange students made up only about 11 to 12 percent of each cohort, they represent a small minority whose experience of the anatomy and neuroscience curriculum may differ in measurable ways from that of their Green classmates. The direction and magnitude of these differences matter for educators trying to ensure that no temperament group is systematically disadvantaged by course design.

The study also took advantage of a natural experiment created by the COVID-19 era: the abrupt shift between virtual and in-person learning environments. A subset of the data was used to examine whether personality characteristics were associated with success in one modality versus the other. The sub-group analysis found no differences in course performance between color groups when comparing virtual with in-person environments. This null result is notable in itself. It suggests that whatever advantages or disadvantages personality confers on particular assessment formats, those effects were not amplified or erased by whether instruction was delivered face-to-face or through a screen, at least for the courses and cohorts examined.

The authors are careful about interpretation, and their conclusions lean toward caution rather than dramatic claims. They suggest that the discrepancies detected in the analysis may be due to learning preferences and preferences for particular learning environments that are potentially related to personality characteristics. They also point out that other measures of performance, such as standardized patient encounters, may enhance understanding of how personality characteristics apply to medical education. Clinical skills assessments, which evaluate communication, empathy, and interpersonal conduct, are precisely the domains where Blue and Orange temperaments might be expected to shine, and where Green and Gold students might face different challenges. Without such measures, the study captures only the cognitive and technical dimensions of medical training, leaving the interpersonal half of the profession unexamined.

Perhaps the most practical takeaway from the research is its recommendation about how personality instruments should actually be used in medical schools. The authors conclude that these tools may be best utilized not to predict grades or gatekeep admissions, but to foster effective communication and teamwork skills and to help educators develop instructional methods and materials that appeal to learners with diverse preferences. In a profession where physicians must collaborate across specialties, communicate with patients from every walk of life, and function in high-stress teams, understanding one’s own temperament and that of colleagues could deliver benefits that far outweigh any marginal correlation with an exam score. The finding that nearly half of one class shares a single dominant color also underscores the risk of homogeneous teams and the value of deliberately mixing temperaments in small-group learning.

For the broader field of medical education research, the study adds a rigorous data point to a literature long criticized for inconsistency. Previous efforts to correlate personality with performance have produced contradictory findings, partly because of varied instruments, small samples, and differing outcome measures. By using a validated facilitator-administered instrument, a large multi-year cohort, standardized national exam scores, and appropriate nonparametric statistics with corrected post-hoc comparisons, the Mayo team has modeled a methodologically sound approach. The results confirm that personality is not irrelevant to medical student outcomes, but neither is it destiny. The effects are selective, appearing on some assessments and not others, and they did not interact with the pandemic-driven shift to virtual learning. As medical schools continue to refine admissions, curriculum design, and learner support, this study suggests that personality data can inform how educators teach and how students work together, while grades on the next anatomy practical will still depend, above all, on the hours a student puts into the dissection lab.

Subject of Research: The relationship between medical students' personality characteristics and their academic performance in anatomy and neuroscience courses

Article Title: Do personality characteristics impact medical student learner outcomes in anatomy and neuroscience courses?: a retrospective observational study

Article References: Vanood, A., Langley, N. R., Hoerth, M. T., Chhabra, N., Drazkowski, J., Bright, R., Cannon, K., Thorn, P. M., & Shah, A. (2026). Do personality characteristics impact medical student learner outcomes in anatomy and neuroscience courses?: a retrospective observational study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10476-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10476-4

Keywords: medical education, personality, Real Colors instrument, anatomy, neuroscience, NBME exams, Mayo Clinic, psychometrics, learning environments, medical students, temperament, retrospective study

The study’s methodological core is the combination of classic sociometry with modern mixture modeling. In traditional sociometric research, children are asked whom they like most and whom they like least among their classmates, and these nominations are converted into standardized scores for peer acceptance, peer rejection, social preference, and social impact. Kang and Shin fed these four dimensions simultaneously into a latent profile analysis, a technique that searches for hidden subgroups of individuals who share similar patterns across multiple continuous variables. Rather than asking researchers to impose arbitrary thresholds, the method lets the data themselves reveal how many meaningful groups exist and where their boundaries lie. The analysis converged on a three-profile solution that closely mirrors the classical categories of popular, rejected, and average, but derives them empirically rather than by rule.

What elevates the study beyond a descriptive exercise is its second question: what predicts membership in each profile? The researchers drew on three domains that developmental science has long flagged as influential in early social competence. The first is temperament, assessed through the preschool version of Cloninger’s Temperament and Character Inventory, which captures traits such as harm avoidance and reward dependence. The second is executive functioning, the family of self-regulatory abilities that includes inhibition, working memory, and attentional flexibility, measured with the Early Years Toolbox. The third is the quality of the teacher-child relationship, evaluated with the Student-Teacher Relationship Scale, which distinguishes warm, close bonds from relationships marked by conflict and dependency.

The predictive findings are striking in their nuance. Children with low temperamental harm avoidance, low reward dependence, and low behavioral inhibition were more likely to fall into the rejected profile. At first glance this seems counterintuitive; bold, uninhibited children might be expected to charm their peers. The authors’ interpretation is that in the preschool years, a lack of inhibition combined with low wariness can translate into behaviors that classmates find aversive: grabbing toys, interrupting, ignoring social cues, or dominating play. Harm avoidance, often framed negatively in adult personality research, may serve a protective function in early childhood, helping children pause before actions that alienate others.

Equally intriguing is the finding about reward dependence, the temperament dimension reflecting sensitivity to social approval and reinforcement. Children with moderate levels of reward dependence were more likely to belong to the popular profile than children with very high levels. This suggests that an intense hunger for social reward, although it can motivate engagement, may also make a child appear clingy, overeager, or socially demanding to four- and five-year-old peers who are still learning the give-and-take of friendship. Moderate reward dependence, by contrast, appears to hit a developmental sweet spot: enough motivation to seek out and maintain interaction, without the intensity that overwhelms playmates.

The teacher-child relationship emerged as a second powerful predictor, and here the direction of effects is especially consequential for practice. Children in less close teacher relationships were more likely to be rejected by peers, while children with less conflictual teacher relationships were more likely to be popular. This pattern aligns with a growing body of longitudinal work showing that teachers function as social gatekeepers in early classrooms. A warm teacher-child bond can signal a child’s value to the group, while visible conflict between teacher and child may license peer disliking. The authors frame this within Bronfenbrenner’s bioecological model, in which proximal relationships between the child and the adults around them shape development nested within ever-wider systems of influence.

The theoretical stakes of the study extend to how educators understand risk. Peer rejection in early childhood is not a trivial matter of playground politics. Meta-analytic evidence links peer acceptance to academic achievement, and longitudinal studies show that rejection in the preschool years forecasts poorer school adjustment, internalizing symptoms, and later psychopathology. By identifying which children cluster into the rejected profile, and by pinpointing the temperamental, cognitive, and relational factors that push them there, the study offers a screening logic that is more precise than simply flagging children with low acceptance scores. A rejected child with high inhibition poses a different intervention problem from a rejected child with high harm avoidance, and the profile approach makes such distinctions visible.

Executive functioning, notably, played a less dominant role in the analysis than temperament and teacher relationships, though the study contributes to an ongoing debate about which self-regulatory skills matter most for peer standing. Prior longitudinal work has shown that executive function predicts the growth of peer relationships over time, sometimes even more strongly than emotion understanding. The present findings suggest that in a cross-sectional snapshot of four- and five-year-olds, the crystallized temperamental dispositions and the relational climate surrounding the child may be the more immediate differentiators of social group membership. Inhibition did appear in the rejected-profile prediction, tying impulsive action tendencies to peer aversion, but its effect was embedded within a broader configuration of traits rather than standing alone.

The study’s cultural context deserves attention. All participants were Korean children, and the researchers situate their work within a Korean early childhood landscape that has seen intense discussion of children’s social development, including research on classroom surveillance and its effects on teacher practice. Whether the three-profile structure and its predictors replicate in Western samples remains an open question, particularly given evidence that peer relationship dynamics and the salience of particular temperamental traits can vary across cultures. The data and study materials are publicly available through the Open Science Framework, and the study was approved by the Institutional Review Board at Chungbuk National University, transparency measures that should facilitate cross-cultural replication efforts.

For practitioners, the message is clear and actionable. Kang and Shin argue that support for young children’s peer relationships should be tailored to the child’s individual profile rather than delivered as a one-size-fits-all social skills curriculum. A rejected child may need help with behavioral inhibition and impulse control; a child on the edge of popularity may simply need a teacher relationship with fewer conflict-laden exchanges to consolidate peer standing. Teachers, in this framing, are not passive observers of classroom social hierarchies but active participants whose warmth or friction ripples outward into the peer ecology. As early childhood classrooms become increasingly recognized as the crucible where lifelong social trajectories begin, studies like this one provide the empirical map that educators have long needed to intervene early, precisely, and humanely.

Subject of Research: Latent peer relationship profiles and their predictors among young children

Article Title: Latent Profiles and Predictors of Young Children’s Peer Relationships

Article References: Kang, S., & Shin, N. (2026). Latent Profiles and Predictors of Young Children’s Peer Relationships. Early Childhood Education Journal. https://doi.org/10.1007/s10643-026-02352-z

Image Credits: AI Generated

DOI: 10.1007/s10643-026-02352-z

Keywords: peer relationships, latent profile analysis, temperament, executive functioning, teacher-child relationship, peer rejection, peer acceptance, early childhood, sociometry, preschool children, Latent, Profiles