Divergent Thinking Among Medical Residents: A Comparison Between Pediatrics and Internal Medicine

Divergent Thinking Among Medical Residents: A Comparison Between Pediatrics and Internal Medicine | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Divergent Thinking Among Medical Residents: A Comparison Between Pediatrics and Internal Medicine Sigal Ben-Zaken, Dan Nemet, Alon Eliakim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9020913/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Creativity is increasingly recognized as an essential component of adaptive expertise in contemporary medical practice, supporting clinicians’ ability to navigate diagnostic uncertainty, communicate effectively with diverse patient populations, and respond flexibly to complex clinical situations. Divergent thinking (DT)—the ability to generate multiple, flexible, and original ideas—is considered a key cognitive indicator of creative potential. Although creativity is highly relevant to medicine, particularly in patient-centered fields, empirical research on how medical specialties may foster or constrain DT remains limited. Pediatric medicine, which frequently involves multimodal communication, imaginative engagement, and management of ambiguous behaviors or non-verbal cues, may provide richer opportunities for developing creative cognitive processes than the more structured, protocol-driven environment typical of internal medicine. In addition, life-context factors such as gender and parenthood may also influence creative cognition, yet their contribution within medical training has rarely been assessed. This study examined whether residents in pediatrics differ from those in internal medicine in verbal and figural DT, and whether gender or parenthood explains additional variability. Fifty-eight residents (30 pediatrics; 28 internal medicine) from a major academic medical center completed validated verbal and figural DT tasks from the Runco Creative Assessment Battery. Fluency, flexibility, and originality were scored for each domain. Group differences were analyzed using MANOVAs, univariate ANOVAs, and two-way ANOVAs, and effect sizes were calculated. Pediatric residents demonstrated higher DT scores across most indices, with statistically significant differences in verbal flexibility and in all figural DT measures. Effect sizes were medium in magnitude, indicating meaningful cognitive differences between specialties even when some comparisons did not reach statistical significance. A significant interaction emerged for figural originality, wherein male pediatric residents scored higher than male internal medicine residents, while no such differences were observed among female residents. Parenthood showed a specialty-specific pattern: among internal medicine residents, those with children scored higher on figural DT, whereas no substantial differences were found among pediatric residents. These findings suggest that specialty environments, communication demands, and clinical interaction patterns may shape creative cognitive tendencies during residency. The results highlight creativity as an important yet underdeveloped competency in medical education and support integrating creativity-enhancing training and more flexible, supportive learning environments into residency programs. Figures Figure 1 Figure 2 Introduction Healthcare systems worldwide are undergoing rapid and profound transformation, driven by technological advances, evolving patient needs, demographic shifts, and increasing system complexity (Frenk et al., 2010 ; Topol, 2019 ). These changes require healthcare professionals not only to master clinical knowledge but also to demonstrate adaptability, innovation, and creative problem-solving (Page, 2014 ). Creativity—defined as the ability to generate novel and useful ideas (Sternberg & Lubart, 1999 )—is increasingly recognized as a crucial component of clinical competence and a foundational element of high-quality patient care (Patterson & Zibarras, 2017 ). Despite this growing recognition, creativity remains underexplored in medical training and practice. Creativity in the clinical context goes beyond major scientific breakthroughs; it encompasses the everyday, flexible problem-solving strategies clinicians use to address ambiguous, dynamic, and emotionally charged situations (Green et al., 2016 ; Haidet et al., 2016 ). Natrielli Filho et al. ( 2013 ) conceptualize creativity in medicine as a cognitive-emotional bridge between the objective physiology of disease and the subjective lived experience of the patient. In this sense, creativity enriches the therapeutic alliance, improves communication, supports shared decision-making, and encourages the development of tailored and empathetic care strategies. A major component of creative potential is divergent thinking (DT)—the ability to generate multiple, varied, and original ideas (Guilford, 1967 ; Runco & Acar, 2012 ). DT is typically measured through indices of fluency (number of ideas), flexibility (variety of categories), and originality (uncommonness of responses) (Acar & Runco, 2014 ). DT has been repeatedly shown to predict creative performance across domains, including problem-solving in STEM and health professions education (Alabbasi et al., 2023; Kleinhans et al., 2023 ; Leung et al., 2023 ). Yet, within medical education, empirical research on DT remains scarce. The development of creative potential is strongly shaped by the environment. Multiple theoretical frameworks—including Amabile’s componential theory (Amabile & Pillemer, 2012 ), Sternberg’s investment theory (Sternberg, 2012 ), and Glăveanu’s cultural psychology of creativity (Glăveanu, 2010 )—highlight that creativity emerges through dynamic person-environment interactions. Environments that promote autonomy, risk-taking, playful exploration, and psychological safety consistently enhance creative cognition (Davies et al., 2013 ; Richardson & Mishra, 2018 ; Stierand et al., 2019 ). Conversely, rigid, hierarchical, or highly standardized settings may constrain creative expression. Medical specialties differ substantially in their physical environments, communication demands, diagnostic processes, and patient interactions—all of which may influence the cognitive skills residents develop during training (Beghetto & Kaufman, 2014 ; Zhou et al., 2017). Pediatric medicine, in particular, represents a unique ecological niche. Pediatric departments are typically designed to be colorful, stimulating, and child-friendly, incorporating playrooms, artwork, storytelling spaces, and distraction tools to reduce fear and promote wellbeing (Coad & Coad, 2008 ; Koller & Goldman, 2012 ). Beyond the physical environment, pediatricians frequently rely on nonverbal cues, indirect histories, and multimodal communication strategies due to children’s limited ability to articulate symptoms (Plante & Meyers, 2019 ). They often employ pretend play, metaphors, or imaginative explanations to gain cooperation or calm distress—strategies that inherently draw on flexible and original thinking (Moore & Russ, 2006 ; Frygner-Holm et al., 2020 ). In contrast, internal medicine departments are typically more structured and protocol-driven, serving primarily adult patients who can directly report their symptoms and fears (Ibrahim et al., 2016 ). Diagnostic processes tend to follow linear reasoning, with less emphasis on improvisation or creative engagement in the patient encounter. These differences raise the possibility that specialties may cultivate divergent thinking to different extents. Given the growing importance of creativity for medical innovation, adaptability, and patient-centered care (Gauderer, 2009 ; Ness, 2011 ; Oerther & Oerther, 2018 ; Tierney & Farmer, 2011 ), it is essential to understand how training environments shape residents’ creative capacities. Building on person-environment reciprocity and the literature on creativity-supportive environments, we hypothesized that pediatric residents—exposed to complex, ambiguous, emotionally intense, and highly interactive clinical situations—would demonstrate higher divergent thinking performance (fluency, flexibility, originality) compared with internal medicine residents. The present study therefore aims to examine whether practicing pediatric versus internal medicine is associated with differences in verbal and figural divergent thinking abilities among medical residents. Understanding how clinical environments influence creativity has direct implications for the design of medical curricula, the cultivation of adaptive expertise, and the future readiness of healthcare professionals. Beyond professional and environmental influences, emerging research has highlighted the potential role of individual life-context factors—particularly gender and parenthood—in shaping creative cognitive performance. Gender-related differences in divergent thinking have been documented inconsistently, with some studies indicating that women tend to score higher on flexibility or elaboration, while men may show advantages in figural originality, although several recent meta-analyses conclude that effect sizes are generally small and context dependent (Abraham, 2016 ; Baas et al., 2022 ). Parenthood has also been associated with changes in cognitive flexibility, multitasking capacity, and adaptive reasoning, reflecting the complex demands of caregiving such as interpreting non-verbal cues, rapid problem-solving, and managing competing emotional and practical needs (Gibson et al., 2020 ; Matias & Recharte, 2021 ). These experiences may influence divergent thinking differently across individuals. Considering these findings, it is important to examine whether gender and parenthood contribute additional explanatory value in understanding variability in divergent-thinking performance among medical residents. Methods Participants Fifty-eight medical residents (37 females, 21 males; Mean age = 33.1, SD = 2.7) from Meir Medical Center, Sackler School of Medicine, Tel-Aviv University volunteered to participate in the study. Thirty participants were pediatric residents and 28 were internal medicine residents, representing more than 90% of the residents in both departments of the medical center. In Israel, all medical students perform one year of internship before starting their residency. The length of pediatric residency is 4.5 years, and the length of internal medicine residency is 4 years. Participants were healthy (MBMI = 23.5, SD = 4.0) and there were no family relations between the subjects. Participants’ demographic data and baseline measures are presented in Table 1 . Table 1 Participants’ data n Pediatric Internal p 30 28 F/M 23/7 14/14 .04 AGE (M ± SD, Range) 33.5 ± 2.4, 28–38 32.6 ± 2.9, 28–39 ns BMI (M ± SD, Range) 22.9 ± 3.6, 17.1–32.6 24.1 ± 4.3, 15.4–35.1 ns Weekly leisure activity score (M ± SD, Range) 10.6 ± 14.6, 0.0–45.0 11.3 ± 18.5, 0.0–63.0 ns Years of education (M ± SD, Range) 19.2 ± 1.4, 18–25 18.5 ± 1.0, 18–22 .05 Seniority at work (years) (M ± SD) 3.6 ± 2.1, 3.8 ± 3.8, ns Perceived professional skills (M ± SD, Range) 3.6±.7, 2.0–5.0 3.6±.9, 2.0–5.0 ns Procedure All participants completed consent and demographic forms at the outset. They were then introduced to the divergent thinking tasks. No time limit was imposed for completing the divergent thinking tasks. This procedure allowed participants to generate as many ideas as they could without feeling any time pressure. The study was approved by the Institutional Review Board at Meir Medical Center prior to its implementation. Verbal and Figural DT Tasks The Runco Creative Assessment Battery (rCAB) was used to measure verbal and figural DT (M. A. Runco, 1999 ). Adapted from Wallach and Kogan ( 1965 ), the Many Uses of Object task served as the verbal task. It requires participants to list as many uses as possible for different objects. Toothbrush, tyre, and spoon were used for the pre-test task, whilst broom, sock, and bowl were used for the post-test task. Similar to the pattern meanings procedure (Wallach & Kogan, 1965 ), the figural section requires participants to list as many things as they can that a specific figure might be or represent. Compared to other figural tests (e.g., Torrance and Ball, 1984), participants are not required to draw anything (M. A. Runco et al., 2016 ). The term “figural” accounts for the stimuli that are presented to participants. Three different abstract visual designs were given in each testing session. The different uses of objects and representations of figures listed by the participants were scored for fluency (i.e., total number of ideas), flexibility (i.e., number of ideas relating to different categories), and originality (i.e., number of unique ideas). To do so, a lexicon containing every idea from all participants was created for each item. Synonyms were grouped together to avoid bias in the originality scores. Fluency was scored as the sum of the discrete ideas mentioned by each participant. To create a flexibility score, similar ideas were grouped together under a general category. The number of categories ranged from 7–10 for the objects section and 10–14 for the figural one, each answer being allocated to only one category. The flexibility score represents the number of categories to which a participant’s ideas were allocated. Two researchers independently categorized all ideas, and the inter-rater reliability was 88.5% for flexibility. This procedure is consistent with recommended guidelines (Acar and Runco 2014 ; Runco 1999 ). Finally, the originality score corresponds to the number of ideas that were mentioned by less than 5% of the sample for the objects section and less than 1% for the figural section. The internal consistency (Cronbach α coefficient) for verbal fluency (α = .87), flexibility (α = .72), and originality (α = .76) and for figural fluency (α = .80), for flexibility (α = .77) and originality (α = .79) were moderate-strong. Statistical Analysis The SPSS statistical package, version 25.0, was used to perform all the statistical procedures (SPSS, Chicago, IL, USA). Levene’s tests of homogeneity of variance were conducted on the verbal and figural DT components to test variance equality between the two groups. The two groups’ mean scores were compared to each other on all of the creativity dimensions using MANOVAs followed by univariate ANOVAs. Cohen’s d standardized coefficients were used to descriptively present significant difference between pairs of means. Results Female prevalence among pediatric residents was significantly higher (77%) compared to internal medicine residents (50%) ( χ 2 (1) = 4.459, p = .03). This difference represents the typical gender prevalence difference in these departments. A univariate ANOVA revealed a significant years of education difference between groups, F (1,57) = 3.98, p = .05. Least square difference (LSD) post-hoc tests revealed that the years of education among pediatric residents were somewhat higher ( Mean = 19.2, SD = 1.4) than the years of education of internal medicine residents ( M = 18.5, SD 1.0). We believe that this small difference does not represent a meaningful significance or limitation. There were no significant between group differences for age, F (1,57) = 1.88, p = .18, body mass index (BMI), F (1,57) = 1.32, p = .26, weekly leisure activity score, F (1,57) = .03, p = .87, seniority at work, F (1,57) = .06, p = .80, and perceived professional skills, F (1,57) = .21, p = .65. Levene’s tests of homogeneity of variance conducted on the verbal and figural DT components revealed non-significant ( p > .05) variance differences between the two groups. Skewness and Kurtosis coefficients were all < |2|. Thus, no adjustments for assumption violations were required for testing the study’s hypotheses. Means and SDs for verbal and figural DT components by group (e.g., pediatric and internal medicine residents) are presented in Table 2 . Table 2 Means and SDs for creativity dimensions by specialty Pediatric Internal t df p M SD M SD Verbal Divergent Thinking Fluency 4.93 1.81 3.97 1.84 1.992 1,57 .051 Flexibility 3.89 .98 3.17 1.05 2.656 1,57 .010 Originality 2.94 1.45 2.59 1.53 .890 1,57 .377 Figural Divergent Thinking Fluency 5.77 2.33 4.67 1.63 2.092 1,57 .041 Flexibility 4.58 1.61 3.77 1.10 2.199 1,57 .032 Originality 4.18 2.21 3.21 1.49 1.957 1,57 .049 Verbal and Figural DT fluency and flexibility were higher among pediatric compared to internal medicine residents (see Table 2 and Fig. 1 ). This difference reached statistical significance for verbal flexibility and figural fluency. Similar trend was observed for Verbal and Figural DT originality, but this difference reached statistical significance only for Figural DT. To further evaluate the magnitude of the observed differences between pediatric and internal medicine residents, effect sizes were calculated using Cohen’s d . The results indicated medium effect sizes for most divergent thinking indices. Specifically, pediatric residents demonstrated higher verbal fluency ( d = 0.53), verbal flexibility ( d = 0.71), figural fluency ( d = 0.55), figural flexibility ( d = 0.59), and figural originality ( d = 0.51). A small effect was found for verbal originality ( d = 0.23). These findings suggest that although some group differences did not reach statistical significance, the overall pattern reflects meaningful advantages for pediatric residents across multiple aspects of divergent thinking, particularly in flexibility-related measures. To further explore the effect of gender and gender by specialty on creativity dimensions, two ways ANOVA analysis was performed on all creativity dimensions. Means and SDs for verbal and figural DT by gender and group are presented in Table 3 . Table 3 Means and SDs for creativity dimensions by specialty and gender Pediatric Internal FEMALE MALE FEMALE MALE n 23 7 14 14 M SD M SD M SD M SD Verbal DT Fluency 5.07 1.71 4.48 2.19 4.00 1.46 3.95 2.21 Flexibility 3.92 .82 3.76 1.46 3.16 .98 3.19 1.15 Originality 2.97 1.51 2.86 1.35 2.45 .90 2.74 1.99 Figural DT Fluency 5.64 2.02 6.24 3.30 5.11 1.92 4.24 1.20 Flexibility 4.39 1.35 5.19 2.29 4.00 1.29 3.55 .87 Originality 3.91 1.83 5.05 3.16 3.71 1.68 2.71 1.13 ANOVAs performed on verbal and figural DT dimensions did not revealed main gender effect for any of the creativity dimensions. Close to significant interactional effect of gender by specialty was revealed for Figural DT originality, Wilks’ λ = .93, F (1,57) = 3.98, p < .05, η 2 = .07 (Fig. 2 ). Male pediatric residents scored higher on Figural DT originality compared to male internal medicine residents, while there was no difference among female residents from the different groups. Same trend was observed for Figural DT flexibility, but this difference did not reach statistical significance. Effect sizes (Cohen’s d) were computed for all pairwise comparisons across the four gender-by-specialty groups. Results showed that the largest effects emerged for male pediatric residents, who outperformed male internal medicine residents in figural flexibility (d = 1.11) and figural originality (d = 1.17), indicating very large effects. Moderate-to-large effects also appeared when comparing pediatric and internal medicine residents within both gender groups on flexibility-related measures. In contrast, comparisons between male and female residents within the same specialty revealed mostly small or negligible effects. Overall, the interaction pattern was characterized by substantially higher figural divergent thinking scores among male pediatric residents relative to all other groups, consistent with the statistically significant Specialty × Gender interaction found for figural originality. As shown in Table 4 , pediatric residents with children obtained higher mean scores on all Verbal DT dimensions compared with pediatric residents without children; however, none of these differences reached statistical significance. No meaningful differences were observed between the two pediatric groups on any of the Figural DT dimensions. Among internal medicine residents, no differences were found between those with and without children on Verbal DT measures. In contrast, internal medicine residents with children showed higher scores on all Figural DT dimensions compared with those without children, with group differences approaching statistical significance for figural fluency and flexibility. Effect size estimates indicated moderate to large differences in Figural DT among internal medicine residents (Cohen’s d = 0.76–0.84), while differences among pediatric residents on Verbal DT were in the small-to-moderate range (d = 0.62–0.76) and negligible for Figural DT Table 4 Means and SDs for creativity dimensions by specialty and parenthood Pediatric Internal No children Children F df p No children Children F df p n 8 22 15 13 M SD M SD M SD M SD Verbal DT Fluency 3.96 1.72 5.29 1.75 3.41 1,28 .07 4.00 2.15 4.17 1.34 .06 1,26 .82 Flexibility 3.42 1.09 4.06 .90 2.68 1,28 .11 3.18 1.10 3.33 .92 .15 1,26 .70 Originality 2.29 1.41 3.18 1.43 2.29 1,28 .14 2.78 1.91 2.56 .77 .14 1,26 .71 Figural DT Fluency 5.71 3.13 5.80 2.05 .01 1,28 .92 4.29 1.33 5.47 1.48 4.79 1,26 .04 Flexibility 4.42 1.94 4.64 1.53 .11 1,28 .75 3.56 1.07 4.28 .71 4.05 1,26 .05 Originality 4.36 2.83 4.11 2.01 .08 1,28 .77 2.87 1.25 3.89 1.45 3.88 1,26 .06 Discussion The present study examined divergent thinking (DT) among pediatric and internal medicine residents, focusing on fluency, flexibility, and originality in both verbal and figural domains. Consistent with our hypotheses, pediatric residents demonstrated higher DT scores than internal medicine residents, with significant group differences observed in verbal flexibility and in all three figural DT measures. These findings align with the conceptualization of DT as a core indicator of creative potential (Runco & Acar, 2012 ) and suggest that the pediatric training environment may provide more frequent affordances for generating multiple, flexible, and original responses. Creativity as an Outcome of Person–Environment Interaction Creativity as an Outcome of Person–Environment Interaction The higher DT performance among pediatric residents is congruent with sociocultural theories of creativity, which view creative potential as emerging from interactions between individuals and their cultural, social, and environmental contexts (Amabile & Pillemer, 2012 ; Glăveanu, 2010 ). Although residents in both specialties undergo similar formal medical education and technical training, their day-to-day practice environments differ substantially. These differences appear to extend beyond clinical content and touch upon the social, communicative, and emotional demands of each specialty. The pediatric setting is characterized by imaginative and child-oriented spatial design, playful elements, communication challenges with young children, and frequent use of pretend play to reduce fear and pain (Moore & Russ, 2006 ). Such environments may foster flexibility, openness, and a broader range of associative thinking—key components of divergent thought (Runco, 2014 ). In contrast, internal medicine often emphasizes protocol-driven decision-making, structured environments, and communication with articulate adult patients (Ibrahim et al., 2016 ) [אם תרצי, אוסיף מקור זה] , potentially affording fewer opportunities for spontaneous creative adaptation. This interpretation is consistent with prior work showing that professional environments vary in their “creativity affordances.” For example, dancers trained in improvisational genres (e.g., modern or contemporary) scored higher on verbal and figural DT than dancers trained in more structured forms like ballet (Fink & Woschnjak, 2011 ). These parallels highlight how environmental constraints and affordances may shape the development of creative cognitive tendencies across professions. Gender Differences and Selection Mechanisms Interestingly, gender differences played a central role in explaining group disparities. Male pediatric residents demonstrated significantly higher DT scores than male internal medicine residents, whereas such differences did not emerge among female residents. This is notable given that pediatric residency programs in Israel are highly competitive, with 70–75% of trainees being female. One possible explanation is a selection effect: creative male medical graduates may possess qualities that are particularly valued in competitive pediatric admissions processes, aligning with theories suggesting that creativity confers adaptive advantages in socially complex environments (Simonton, 2014 ). While speculative, this interpretation is consistent with research indicating that creative abilities may influence professional pathways and success when environmental demands align with creative strengths (Hennessey & Amabile, 2010 ). Parenthood as a Contributor to Creative Cognitive Processes The study also revealed nuanced associations between parenthood and DT. Among internal medicine residents, those with children demonstrated higher figural DT scores than those without children. While prior work has not systematically examined parenthood as a factor associated with adult creativity, these findings may be understood in light of theories emphasizing experiential, affective, and relational contributors to creativity (Sternberg & Lubart, 1999 ; Amabile & Pillemer, 2012 ). Parenting often involves complex emotional regulation, perspective-taking, and rapid adaptation—processes that may generalize to non-verbal creative tasks. In contrast, among pediatric residents, parenthood was associated with moderately higher verbal DT scores but produced negligible differences in figural DT, suggesting that the pediatric environment itself may overshadow or absorb the influence of parenthood. Creativity in Medical Practice: A Necessary but Underdeveloped Skill The findings reinforce longstanding arguments that creativity is an essential component of adaptive expertise in medicine (Ness, 2011 ). Creative thinking supports diagnostic reasoning, personalized care, communication with diverse patient populations, and innovation in unpredictable or ambiguous situations. Despite this, creativity remains underrepresented in formal medical curricula worldwide, with most creativity-related learning occurring informally through clinical encounters, reflective practices, or individual differences in coping and communication (Ness, 2011 ; Green et al., 2016 ). Moreover, while creativity training programs in other disciplines have consistently improved fluency, flexibility, originality, and creative performance (Clapham, 2003 ; Scott et al., 2004 ), medical training has not widely adopted structured creativity-enhancing interventions. This gap persists despite evidence that artistic and humanities-based activities can enhance observational skills, empathy, and creative insight among medical learners (Haidet et al., 2016 ; Root-Bernstein, 2015 ; D. & R., 2003). Integrating such approaches into medical education may support the development of cognitive and interpersonal capacities foundational to creative clinical decision-making. Theoretical Integration The current study supports multi-level theoretical models of creativity that integrate: cognitive components , such as divergent thinking (Guilford, 1967 ; Runco & Acar, 2012 ); social-environmental influences , such as freedom, autonomy, and playful environments (Hennessey & Amabile, 2010 ; Davies et al., 2013 ); cultural frameworks , emphasizing relational and dialogical processes (Glăveanu, 2010 ); life experiences that enrich creative cognition (Simonton, 2014 ). The emerging pattern suggests that creativity among medical residents is not merely an individual trait but the product of an interaction between professional culture, everyday clinical demands, environment design, and personal background. Implications for Medical Education These findings highlight opportunities to strengthen creativity in medical training: Formal creativity curricula Evidence-based creativity training programs—adapted from business and design fields—could enhance DT and problem-solving skills among medical trainees (Clapham, 2003 ; Scott et al., 2004 ). Arts and humanities integration Programs involving narrative writing, visual arts, improvisation, and creative making have demonstrated benefits for reflective capacity, empathy, and creative insight (Green et al., 2016 ; Haidet et al., 2016 ). Environment design Pediatric settings exemplify how physical spaces can foster playfulness, flexibility, and patient-centered innovation. Applying similar principles—colour, space, interaction, sensory cues—elsewhere in medicine may support creative thinking. Cultivating adaptive expertise Encouraging residents to navigate uncertainty, question assumptions, and explore multiple solutions reflects the skills necessary for innovation and resilience in modern healthcare (Ness, 2011 ). Faculty development Supervisors and program directors should be trained to recognize, encourage, and model creative problem-solving behaviours. Limitations Several limitations warrant consideration. First, the cross-sectional design precludes causal inference regarding whether creativity influenced specialty choice or was shaped by residency training. Longitudinal studies are needed to trace creative development over time. Second, the sample was drawn from a single medical center, limiting generalizability across cultures, healthcare systems, or residency structures. Third, although DT tasks are validated measures of creative potential, they do not directly assess real-world creative performance (Runco & Acar, 2012 ). Fourth, parenthood was measured categorically without accounting for children’s ages or engagement in caregiving, which may vary widely. Finally, self-selection biases may influence residency choice, particularly among male pediatric residents, limiting conclusions about environmental determinants. Conclusion Pediatric residents demonstrated higher divergent thinking than internal medicine residents, particularly in the figural domain and predominantly among male residents. These findings underscore the contribution of environmental affordances, interpersonal demands, and specialty-specific culture to the development of creative cognitive tendencies in medicine. Parenthood also showed specialty-dependent associations with DT, suggesting that life experiences outside clinical training may shape creative potential. Together, the results highlight creativity as an important yet underdeveloped competency in medical practice and emphasize the need to integrate structured creativity training and supportive environments into medical education. Declarations Ethics approval and consent to participate The study was approved by the Institutional Review Board (IRB) of Meir Medical Center. All participants provided written informed consent prior to participation. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors’ contributions SBZ conceptualized and designed the study, supervised data collection, and drafted the manuscript. DN contributed to study design, statistical analysis, and manuscript revision. 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Thinking Skills and Creativity, 47 , 101296. https://doi.org/10.1016/j.tsc.2022.101296 Matias, M., & Recharte, L. (2021). Parenting and cognitive flexibility. Journal of Adult Development, 28 , 265–276. https://doi.org/10.1007/s10804-020-09365-9 Moore, M., & Russ, S. (2006). Pretend play as a resource for children. Journal of Developmental and Behavioral Pediatrics, 27 (3), 237–248. https://doi.org/10.1097/00004703-200606000-00011 Natrielli Filho, D. G., et al. (2013). Medicine and creativity. São Paulo Medical Journal, 131 (4), 281–282. https://doi.org/10.1590/1516-3180.2013.1314638 Ness, R. B. (2011). Teaching creativity in medicine. Academic Medicine, 86 (10), 1201–1203. https://doi.org/10.1097/ACM.0b013e31822bbb9f Oerther, D. B., & Oerther, S. E. (2018). Creativity in healthcare. Nursing Outlook, 66 , 340–346. https://doi.org/10.1016/j.outlook.2018.04.008 Page, T. (2014). Notions of innovation in healthcare. International Journal of Innovation and Sustainable Development, 8 (3), 217–231. https://doi.org/10.1504/IJISD.2014.066609 Patterson, F., & Zibarras, L. D. (2017). Selecting for creativity and innovation potential. Advances in Health Sciences Education, 22 (2), 417–428. https://doi.org/10.1007/s10459-016-9731-4 Plante, W. A., & Meyers, K. (2019). Pediatric communication challenges. Pediatric Clinics of North America, 66 , 1–12. Richardson, C., & Mishra, P. (2018). Learning environments that support student creativity. Thinking Skills and Creativity, 27 , 45–54. https://doi.org/10.1016/j.tsc.2017.11.004 Root-Bernstein, R. (2015). Arts as adjuncts to STEM. Asia Pacific Education Review, 16 (2), 203–212. https://doi.org/10.1007/s12564-015-9362-0 Runco, M. A. (1999). Divergent thinking. In Encyclopedia of Creativity (pp. 577–582). Academic Press. Runco, M. A. (2014). Creativity: Theories and themes (2nd ed.). Academic Press. Runco, M. A., & Acar, S. (2012). Divergent thinking as an indicator of creative potential. Creativity Research Journal, 24 (1), 66–75. https://doi.org/10.1080/10400419.2012.652929 Runco, M. A., et al. (2016). Which test of divergent thinking is best? Creativity: Theories–Research–Applications, 3 , 4–18. Scott, G., Leritz, L. E., & Mumford, M. D. (2004). The effectiveness of creativity training. Creativity Research Journal, 16 (4), 361–388. https://doi.org/10.1080/10400410409534549 Simonton, D. K. (2014). Creative performance and developmental antecedents. Intelligence, 45 , 66–73. https://doi.org/10.1016/j.intell.2013.04.007 Sternberg, R. J., & Lubart, T. I. (1999). The concept of creativity. In Handbook of Creativity (pp. 3–15). Cambridge University Press. Sternberg, R. J. (2012). The assessment of creativity: An investment-based approach. Creativity Research Journal, 24 (1), 3–12. https://doi.org/10.1080/10400419.2012.652925 Stierand, M., et al. (2019). Paradoxes of creativity. Journal of Creative Behavior, 53 (2), 165–170. https://doi.org/10.1002/jocb.224 Topol, E. (2019). Deep Medicine: How artificial intelligence can make healthcare human again. Basic Books. Tierney, P., & Farmer, S. (2011). Creative self-efficacy. Journal of Applied Psychology, 96 (1), 113–123. https://doi.org/10.1037/a0020956 Wallach, M. A., & Kogan, N. (1965). Modes of thinking in young children. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 03 Apr, 2026 Editor invited by journal 09 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 06 Mar, 2026 First submitted to journal 03 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9020913","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618677229,"identity":"79f58252-09ee-4aaf-a122-f5ee88ce6604","order_by":0,"name":"Sigal Ben-Zaken","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYDACZiB+2MAgxwfl8/DhUw3XktjAYMwG08KGTzUcALUktsE4BLXIt7Nf/JC4oy69jYHHgOFHDYMMQS0Gh3mKJRLPsOWCtDD2HCPCYQbMPAkSiW08uW3ybzcw8DYQoUW+mSf5R2KbRDobA+8Gxr/EaGE4zH4MaItBAkgLM1G2AP3CZpF4JsGwjYH/w2GZYxJEOKz/+OMbH3fUyfMzsCU+fFNjY89P0GGgsIWBAwwMEoQ1MDCwPyBG1SgYBaNgFIxkAABHpjEE+VQIwwAAAABJRU5ErkJggg==","orcid":"","institution":"Levinsky-Wingate Academic College","correspondingAuthor":true,"prefix":"","firstName":"Sigal","middleName":"","lastName":"Ben-Zaken","suffix":""},{"id":618677230,"identity":"30098a33-f49c-440a-9dae-9d7c01f78794","order_by":1,"name":"Dan Nemet","email":"","orcid":"","institution":"Meir Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Nemet","suffix":""},{"id":618677231,"identity":"06961754-3216-4f59-b229-6a4a4669674b","order_by":2,"name":"Alon Eliakim","email":"","orcid":"","institution":"Meir Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Alon","middleName":"","lastName":"Eliakim","suffix":""}],"badges":[],"createdAt":"2026-03-03 13:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9020913/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9020913/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106544422,"identity":"53f38325-9f72-47b1-bde2-78e17b7e83a5","added_by":"auto","created_at":"2026-04-09 16:40:56","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58050,"visible":true,"origin":"","legend":"\u003cp\u003eDivergent Thinking Scores among MD\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9020913/v1/45141de7945b301d9bbc9885.jpg"},{"id":106544427,"identity":"775991db-2c17-49bf-a554-e7ca624572fd","added_by":"auto","created_at":"2026-04-09 16:40:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":49162,"visible":true,"origin":"","legend":"\u003cp\u003eFigural DT by gender and specialty\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9020913/v1/606270ba2c300f3365f970b5.jpg"},{"id":106724879,"identity":"d35cb2e2-c101-4249-8e89-cbe47e90ecb0","added_by":"auto","created_at":"2026-04-12 18:30:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1510700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9020913/v1/0e0929c2-cf23-4749-9818-15ba988ca116.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Divergent Thinking Among Medical Residents: A Comparison Between Pediatrics and Internal Medicine","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealthcare systems worldwide are undergoing rapid and profound transformation, driven by technological advances, evolving patient needs, demographic shifts, and increasing system complexity (Frenk et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Topol, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). These changes require healthcare professionals not only to master clinical knowledge but also to demonstrate adaptability, innovation, and creative problem-solving (Page, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Creativity\u0026mdash;defined as the ability to generate novel and useful ideas (Sternberg \u0026amp; Lubart, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1999\u003c/span\u003e)\u0026mdash;is increasingly recognized as a crucial component of clinical competence and a foundational element of high-quality patient care (Patterson \u0026amp; Zibarras, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Despite this growing recognition, creativity remains underexplored in medical training and practice.\u003c/p\u003e \u003cp\u003eCreativity in the clinical context goes beyond major scientific breakthroughs; it encompasses the everyday, flexible problem-solving strategies clinicians use to address ambiguous, dynamic, and emotionally charged situations (Green et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Haidet et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Natrielli Filho et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) conceptualize creativity in medicine as a cognitive-emotional bridge between the objective physiology of disease and the subjective lived experience of the patient. In this sense, creativity enriches the therapeutic alliance, improves communication, supports shared decision-making, and encourages the development of tailored and empathetic care strategies.\u003c/p\u003e \u003cp\u003eA major component of creative potential is divergent thinking (DT)\u0026mdash;the ability to generate multiple, varied, and original ideas (Guilford, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1967\u003c/span\u003e; Runco \u0026amp; Acar, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). DT is typically measured through indices of fluency (number of ideas), flexibility (variety of categories), and originality (uncommonness of responses) (Acar \u0026amp; Runco, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). DT has been repeatedly shown to predict creative performance across domains, including problem-solving in STEM and health professions education (Alabbasi et al., 2023; Kleinhans et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Leung et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Yet, within medical education, empirical research on DT remains scarce.\u003c/p\u003e \u003cp\u003eThe development of creative potential is strongly shaped by the environment. Multiple theoretical frameworks\u0026mdash;including Amabile\u0026rsquo;s componential theory (Amabile \u0026amp; Pillemer, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), Sternberg\u0026rsquo;s investment theory (Sternberg, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), and Glăveanu\u0026rsquo;s cultural psychology of creativity (Glăveanu, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e)\u0026mdash;highlight that creativity emerges through dynamic person-environment interactions. Environments that promote autonomy, risk-taking, playful exploration, and psychological safety consistently enhance creative cognition (Davies et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Richardson \u0026amp; Mishra, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Stierand et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Conversely, rigid, hierarchical, or highly standardized settings may constrain creative expression.\u003c/p\u003e \u003cp\u003eMedical specialties differ substantially in their physical environments, communication demands, diagnostic processes, and patient interactions\u0026mdash;all of which may influence the cognitive skills residents develop during training (Beghetto \u0026amp; Kaufman, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Zhou et al., 2017). Pediatric medicine, in particular, represents a unique ecological niche. Pediatric departments are typically designed to be colorful, stimulating, and child-friendly, incorporating playrooms, artwork, storytelling spaces, and distraction tools to reduce fear and promote wellbeing (Coad \u0026amp; Coad, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Koller \u0026amp; Goldman, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Beyond the physical environment, pediatricians frequently rely on nonverbal cues, indirect histories, and multimodal communication strategies due to children\u0026rsquo;s limited ability to articulate symptoms (Plante \u0026amp; Meyers, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). They often employ pretend play, metaphors, or imaginative explanations to gain cooperation or calm distress\u0026mdash;strategies that inherently draw on flexible and original thinking (Moore \u0026amp; Russ, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Frygner-Holm et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, internal medicine departments are typically more structured and protocol-driven, serving primarily adult patients who can directly report their symptoms and fears (Ibrahim et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Diagnostic processes tend to follow linear reasoning, with less emphasis on improvisation or creative engagement in the patient encounter. These differences raise the possibility that specialties may cultivate divergent thinking to different extents.\u003c/p\u003e \u003cp\u003eGiven the growing importance of creativity for medical innovation, adaptability, and patient-centered care (Gauderer, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Ness, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Oerther \u0026amp; Oerther, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Tierney \u0026amp; Farmer, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), it is essential to understand how training environments shape residents\u0026rsquo; creative capacities. Building on person-environment reciprocity and the literature on creativity-supportive environments, we hypothesized that pediatric residents\u0026mdash;exposed to complex, ambiguous, emotionally intense, and highly interactive clinical situations\u0026mdash;would demonstrate higher divergent thinking performance (fluency, flexibility, originality) compared with internal medicine residents.\u003c/p\u003e \u003cp\u003eThe present study therefore aims to examine whether practicing pediatric versus internal medicine is associated with differences in verbal and figural divergent thinking abilities among medical residents. Understanding how clinical environments influence creativity has direct implications for the design of medical curricula, the cultivation of adaptive expertise, and the future readiness of healthcare professionals.\u003c/p\u003e \u003cp\u003eBeyond professional and environmental influences, emerging research has highlighted the potential role of individual life-context factors\u0026mdash;particularly gender and parenthood\u0026mdash;in shaping creative cognitive performance. Gender-related differences in divergent thinking have been documented inconsistently, with some studies indicating that women tend to score higher on flexibility or elaboration, while men may show advantages in figural originality, although several recent meta-analyses conclude that effect sizes are generally small and context dependent (Abraham, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Baas et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Parenthood has also been associated with changes in cognitive flexibility, multitasking capacity, and adaptive reasoning, reflecting the complex demands of caregiving such as interpreting non-verbal cues, rapid problem-solving, and managing competing emotional and practical needs (Gibson et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Matias \u0026amp; Recharte, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These experiences may influence divergent thinking differently across individuals. Considering these findings, it is important to examine whether gender and parenthood contribute additional explanatory value in understanding variability in divergent-thinking performance among medical residents.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003e Fifty-eight medical residents (37 females, 21 males; Mean age\u0026thinsp;=\u0026thinsp;33.1, SD\u0026thinsp;=\u0026thinsp;2.7) from Meir Medical Center, Sackler School of Medicine, Tel-Aviv University volunteered to participate in the study. Thirty participants were pediatric residents and 28 were internal medicine residents, representing more than 90% of the residents in both departments of the medical center. In Israel, all medical students perform one year of internship before starting their residency. The length of pediatric residency is 4.5 years, and the length of internal medicine residency is 4 years. Participants were healthy (MBMI\u0026thinsp;=\u0026thinsp;23.5, SD\u0026thinsp;=\u0026thinsp;4.0) and there were no family relations between the subjects. Participants\u0026rsquo; demographic data and baseline measures are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF/M\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23/7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14/14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGE (M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4, 28\u0026ndash;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9, 28\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6, 17.1\u0026ndash;32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3, 15.4\u0026ndash;35.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeekly leisure activity score (M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.6\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6, 0.0\u0026ndash;45.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;18.5, 0.0\u0026ndash;63.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of education\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4, 18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0, 18\u0026ndash;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeniority at work (years) (M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerceived professional skills (M\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD, Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6\u0026plusmn;.7, 2.0\u0026ndash;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u0026plusmn;.9, 2.0\u0026ndash;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003cp\u003e All participants completed consent and demographic forms at the outset. They were then introduced to the divergent thinking tasks. No time limit was imposed for completing the divergent thinking tasks. This procedure allowed participants to generate as many ideas as they could without feeling any time pressure. The study was approved by the Institutional Review Board at Meir Medical Center prior to its implementation.\u003c/p\u003e \u003cp\u003e Verbal and Figural DT Tasks\u003c/p\u003e \u003cp\u003eThe Runco Creative Assessment Battery (rCAB) was used to measure verbal and figural DT (M. A. Runco, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Adapted from Wallach and Kogan (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1965\u003c/span\u003e), the Many Uses of Object task served as the verbal task. It requires participants to list as many uses as possible for different objects. Toothbrush, tyre, and spoon were used for the pre-test task, whilst broom, sock, and bowl were used for the post-test task. Similar to the pattern meanings procedure (Wallach \u0026amp; Kogan, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e1965\u003c/span\u003e), the figural section requires participants to list as many things as they can that a specific figure might be or represent. Compared to other figural tests (e.g., Torrance and Ball, 1984), participants are not required to draw anything (M. A. Runco et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The term \u0026ldquo;figural\u0026rdquo; accounts for the stimuli that are presented to participants. Three different abstract visual designs were given in each testing session.\u003c/p\u003e \u003cp\u003eThe different uses of objects and representations of figures listed by the participants were scored for fluency (i.e., total number of ideas), flexibility (i.e., number of ideas relating to different categories), and originality (i.e., number of unique ideas). To do so, a lexicon containing every idea from all participants was created for each item. Synonyms were grouped together to avoid bias in the originality scores. Fluency was scored as the sum of the discrete ideas mentioned by each participant. To create a flexibility score, similar ideas were grouped together under a general category. The number of categories ranged from 7\u0026ndash;10 for the objects section and 10\u0026ndash;14 for the figural one, each answer being allocated to only one category. The flexibility score represents the number of categories to which a participant\u0026rsquo;s ideas were allocated. Two researchers independently categorized all ideas, and the inter-rater reliability was 88.5% for flexibility. This procedure is consistent with recommended guidelines (Acar and Runco \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Runco \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Finally, the originality score corresponds to the number of ideas that were mentioned by less than 5% of the sample for the objects section and less than 1% for the figural section. The internal consistency (Cronbach α coefficient) for verbal fluency (α\u0026thinsp;=\u0026thinsp;.87), flexibility (α\u0026thinsp;=\u0026thinsp;.72), and originality (α\u0026thinsp;=\u0026thinsp;.76) and for figural fluency (α\u0026thinsp;=\u0026thinsp;.80), for flexibility (α\u0026thinsp;=\u0026thinsp;.77) and originality (α\u0026thinsp;=\u0026thinsp;.79) were moderate-strong.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe SPSS statistical package, version 25.0, was used to perform all the statistical procedures (SPSS, Chicago, IL, USA). Levene\u0026rsquo;s tests of homogeneity of variance were conducted on the verbal and figural DT components to test variance equality between the two groups. The two groups\u0026rsquo; mean scores were compared to each other on all of the creativity dimensions using MANOVAs followed by univariate ANOVAs. Cohen\u0026rsquo;s d standardized coefficients were used to descriptively present significant difference between pairs of means.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eFemale prevalence among pediatric residents was significantly higher (77%) compared to internal medicine residents (50%) (\u003c/b\u003eχ\u003csup\u003e2\u003c/sup\u003e (1)\u0026thinsp;=\u0026thinsp;4.459, \u003cem\u003ep\u003c/em\u003e = .03). This difference represents the typical gender prevalence difference in these departments.\u003c/p\u003e \u003cp\u003eA univariate ANOVA revealed a significant years of education difference between groups, \u003cem\u003eF\u003c/em\u003e (1,57)\u0026thinsp;=\u0026thinsp;3.98, \u003cem\u003ep\u003c/em\u003e = .05. Least square difference (LSD) post-hoc tests revealed that the years of education among pediatric residents were somewhat higher (\u003cem\u003eMean\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19.2, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.4) than the years of education of internal medicine residents (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18.5, \u003cem\u003eSD\u003c/em\u003e 1.0). We believe that this small difference does not represent a meaningful significance or limitation.\u003c/p\u003e \u003cp\u003eThere were no significant between group differences for age, \u003cem\u003eF\u003c/em\u003e (1,57)\u0026thinsp;=\u0026thinsp;1.88, \u003cem\u003ep\u003c/em\u003e = .18, body mass index (BMI), \u003cem\u003eF\u003c/em\u003e (1,57)\u0026thinsp;=\u0026thinsp;1.32, \u003cem\u003ep\u003c/em\u003e = .26, weekly leisure activity score, \u003cem\u003eF\u003c/em\u003e (1,57) = .03, \u003cem\u003ep\u003c/em\u003e = .87, seniority at work, \u003cem\u003eF\u003c/em\u003e (1,57) = .06, \u003cem\u003ep\u003c/em\u003e = .80, and perceived professional skills, \u003cem\u003eF\u003c/em\u003e (1,57) = .21, \u003cem\u003ep\u003c/em\u003e = .65.\u003c/p\u003e \u003cp\u003eLevene\u0026rsquo;s tests of homogeneity of variance conducted on the verbal and figural DT components revealed non-significant (\u003cem\u003ep\u003c/em\u003e \u0026gt; .05) variance differences between the two groups. Skewness and Kurtosis coefficients were all \u0026lt; |2|. Thus, no adjustments for assumption violations were required for testing the study\u0026rsquo;s hypotheses.\u003c/p\u003e \u003cp\u003eMeans and SDs for verbal and figural DT components by group (e.g., pediatric and internal medicine residents) are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and SDs for creativity dimensions by specialty\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal Divergent Thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.992\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.377\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFigural Divergent Thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVerbal and Figural DT fluency and flexibility were higher among pediatric compared to internal medicine residents (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This difference reached statistical significance for verbal flexibility and figural fluency. Similar trend was observed for Verbal and Figural DT originality, but this difference reached statistical significance only for Figural DT.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo further evaluate the magnitude of the observed differences between pediatric and internal medicine residents, effect sizes were calculated using Cohen\u0026rsquo;s \u003cem\u003ed\u003c/em\u003e. The results indicated medium effect sizes for most divergent thinking indices. Specifically, pediatric residents demonstrated higher verbal fluency (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.53), verbal flexibility (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.71), figural fluency (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.55), figural flexibility (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.59), and figural originality (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.51). A small effect was found for verbal originality (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23). These findings suggest that although some group differences did not reach statistical significance, the overall pattern reflects meaningful advantages for pediatric residents across multiple aspects of divergent thinking, particularly in flexibility-related measures.\u003c/p\u003e \u003cp\u003eTo further explore the effect of gender and gender by specialty on creativity dimensions, two ways ANOVA analysis was performed on all creativity dimensions. Means and SDs for verbal and figural DT by gender and group are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and SDs for creativity dimensions by specialty and gender\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFEMALE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMALE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFEMALE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMALE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal DT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFigural DT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eANOVAs performed on verbal and figural DT dimensions did not revealed main gender effect for any of the creativity dimensions. Close to significant interactional effect of gender by specialty was revealed for Figural DT originality, Wilks\u0026rsquo; λ\u0026thinsp;=\u0026thinsp;.93, \u003cem\u003eF\u003c/em\u003e (1,57)\u0026thinsp;=\u0026thinsp;3.98, p \u0026lt; .05, η\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.07 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Male pediatric residents scored higher on Figural DT originality compared to male internal medicine residents, while there was no difference among female residents from the different groups. Same trend was observed for Figural DT flexibility, but this difference did not reach statistical significance.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEffect sizes (Cohen\u0026rsquo;s d) were computed for all pairwise comparisons across the four gender-by-specialty groups. Results showed that the largest effects emerged for male pediatric residents, who outperformed male internal medicine residents in figural flexibility (d\u0026thinsp;=\u0026thinsp;1.11) and figural originality (d\u0026thinsp;=\u0026thinsp;1.17), indicating very large effects. Moderate-to-large effects also appeared when comparing pediatric and internal medicine residents within both gender groups on flexibility-related measures. In contrast, comparisons between male and female residents within the same specialty revealed mostly small or negligible effects. Overall, the interaction pattern was characterized by substantially higher figural divergent thinking scores among male pediatric residents relative to all other groups, consistent with the statistically significant Specialty \u0026times; Gender interaction found for figural originality.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, pediatric residents with children obtained higher mean scores on all Verbal DT dimensions compared with pediatric residents without children; however, none of these differences reached statistical significance. No meaningful differences were observed between the two pediatric groups on any of the Figural DT dimensions. Among internal medicine residents, no differences were found between those with and without children on Verbal DT measures. In contrast, internal medicine residents with children showed higher scores on all Figural DT dimensions compared with those without children, with group differences approaching statistical significance for figural fluency and flexibility. Effect size estimates indicated moderate to large differences in Figural DT among internal medicine residents (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.76\u0026ndash;0.84), while differences among pediatric residents on Verbal DT were in the small-to-moderate range (d\u0026thinsp;=\u0026thinsp;0.62\u0026ndash;0.76) and negligible for Figural DT\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMeans and SDs for creativity dimensions by specialty and parenthood\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"16\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePediatric\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInternal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerbal DT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFigural DT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFluency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlexibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e3.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e4.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1,28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c15\"\u003e \u003cp\u003e1,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c16\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study examined divergent thinking (DT) among pediatric and internal medicine residents, focusing on fluency, flexibility, and originality in both verbal and figural domains. Consistent with our hypotheses, pediatric residents demonstrated higher DT scores than internal medicine residents, with significant group differences observed in verbal flexibility and in all three figural DT measures. These findings align with the conceptualization of DT as a core indicator of creative potential (Runco \u0026amp; Acar, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e) and suggest that the pediatric training environment may provide more frequent affordances for generating multiple, flexible, and original responses.\u003c/p\u003e\n\u003ch3\u003eCreativity as an Outcome of Person–Environment Interaction\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eCreativity as an Outcome of Person\u0026ndash;Environment Interaction\u003c/div\u003e \u003cp\u003eThe higher DT performance among pediatric residents is congruent with sociocultural theories of creativity, which view creative potential as emerging from interactions between individuals and their cultural, social, and environmental contexts (Amabile \u0026amp; Pillemer, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Glăveanu, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Although residents in both specialties undergo similar formal medical education and technical training, their day-to-day practice environments differ substantially. These differences appear to extend beyond clinical content and touch upon the social, communicative, and emotional demands of each specialty.\u003c/p\u003e \u003cp\u003eThe pediatric setting is characterized by imaginative and child-oriented spatial design, playful elements, communication challenges with young children, and frequent use of pretend play to reduce fear and pain (Moore \u0026amp; Russ, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Such environments may foster flexibility, openness, and a broader range of associative thinking\u0026mdash;key components of divergent thought (Runco, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). In contrast, internal medicine often emphasizes protocol-driven decision-making, structured environments, and communication with articulate adult patients (Ibrahim et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003cem\u003e[אם תרצי, אוסיף מקור זה]\u003c/em\u003e, potentially affording fewer opportunities for spontaneous creative adaptation.\u003c/p\u003e \u003cp\u003eThis interpretation is consistent with prior work showing that professional environments vary in their \u0026ldquo;creativity affordances.\u0026rdquo; For example, dancers trained in improvisational genres (e.g., modern or contemporary) scored higher on verbal and figural DT than dancers trained in more structured forms like ballet (Fink \u0026amp; Woschnjak, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). These parallels highlight how environmental constraints and affordances may shape the development of creative cognitive tendencies across professions.\u003c/p\u003e\n\u003ch3\u003eGender Differences and Selection Mechanisms\u003c/h3\u003e\n\u003cp\u003eInterestingly, gender differences played a central role in explaining group disparities. Male pediatric residents demonstrated significantly higher DT scores than male internal medicine residents, whereas such differences did not emerge among female residents. This is notable given that pediatric residency programs in Israel are highly competitive, with 70\u0026ndash;75% of trainees being female. One possible explanation is a selection effect: creative male medical graduates may possess qualities that are particularly valued in competitive pediatric admissions processes, aligning with theories suggesting that creativity confers adaptive advantages in socially complex environments (Simonton, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). While speculative, this interpretation is consistent with research indicating that creative abilities may influence professional pathways and success when environmental demands align with creative strengths (Hennessey \u0026amp; Amabile, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParenthood as a Contributor to Creative Cognitive Processes\u003c/h2\u003e \u003cp\u003eThe study also revealed nuanced associations between parenthood and DT. Among internal medicine residents, those with children demonstrated higher figural DT scores than those without children. While prior work has not systematically examined parenthood as a factor associated with adult creativity, these findings may be understood in light of theories emphasizing experiential, affective, and relational contributors to creativity (Sternberg \u0026amp; Lubart, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Amabile \u0026amp; Pillemer, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Parenting often involves complex emotional regulation, perspective-taking, and rapid adaptation\u0026mdash;processes that may generalize to non-verbal creative tasks. In contrast, among pediatric residents, parenthood was associated with moderately higher verbal DT scores but produced negligible differences in figural DT, suggesting that the pediatric environment itself may overshadow or absorb the influence of parenthood.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCreativity in Medical Practice: A Necessary but Underdeveloped Skill\u003c/h3\u003e\n\u003cp\u003eThe findings reinforce longstanding arguments that creativity is an essential component of adaptive expertise in medicine (Ness, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Creative thinking supports diagnostic reasoning, personalized care, communication with diverse patient populations, and innovation in unpredictable or ambiguous situations. Despite this, creativity remains underrepresented in formal medical curricula worldwide, with most creativity-related learning occurring informally through clinical encounters, reflective practices, or individual differences in coping and communication (Ness, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Green et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, while creativity training programs in other disciplines have consistently improved fluency, flexibility, originality, and creative performance (Clapham, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Scott et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), medical training has not widely adopted structured creativity-enhancing interventions. This gap persists despite evidence that artistic and humanities-based activities can enhance observational skills, empathy, and creative insight among medical learners (Haidet et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Root-Bernstein, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; D. \u0026amp; R., 2003). Integrating such approaches into medical education may support the development of cognitive and interpersonal capacities foundational to creative clinical decision-making.\u003c/p\u003e\n\u003ch3\u003eTheoretical Integration\u003c/h3\u003e\n\u003cp\u003eThe current study supports multi-level theoretical models of creativity that integrate:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ecognitive components\u003c/b\u003e, such as divergent thinking (Guilford, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1967\u003c/span\u003e; Runco \u0026amp; Acar, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003esocial-environmental influences\u003c/b\u003e, such as freedom, autonomy, and playful environments (Hennessey \u0026amp; Amabile, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Davies et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2013\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ecultural frameworks\u003c/b\u003e, emphasizing relational and dialogical processes (Glăveanu, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2010\u003c/span\u003e);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003elife experiences\u003c/b\u003e that enrich creative cognition (Simonton, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe emerging pattern suggests that creativity among medical residents is not merely an individual trait but the product of an interaction between professional culture, everyday clinical demands, environment design, and personal background.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Medical Education\u003c/h2\u003e \u003cp\u003eThese findings highlight opportunities to strengthen creativity in medical training:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFormal creativity curricula\u003c/strong\u003e \u003cp\u003eEvidence-based creativity training programs\u0026mdash;adapted from business and design fields\u0026mdash;could enhance DT and problem-solving skills among medical trainees (Clapham, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Scott et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eArts and humanities integration\u003c/strong\u003e \u003cp\u003ePrograms involving narrative writing, visual arts, improvisation, and creative making have demonstrated benefits for reflective capacity, empathy, and creative insight (Green et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Haidet et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEnvironment design\u003c/strong\u003e \u003cp\u003ePediatric settings exemplify how physical spaces can foster playfulness, flexibility, and patient-centered innovation. Applying similar principles\u0026mdash;colour, space, interaction, sensory cues\u0026mdash;elsewhere in medicine may support creative thinking.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCultivating adaptive expertise\u003c/strong\u003e \u003cp\u003eEncouraging residents to navigate uncertainty, question assumptions, and explore multiple solutions reflects the skills necessary for innovation and resilience in modern healthcare (Ness, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFaculty development\u003c/strong\u003e \u003cp\u003eSupervisors and program directors should be trained to recognize, encourage, and model creative problem-solving behaviours.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations warrant consideration. First, the cross-sectional design precludes causal inference regarding whether creativity influenced specialty choice or was shaped by residency training. Longitudinal studies are needed to trace creative development over time. Second, the sample was drawn from a single medical center, limiting generalizability across cultures, healthcare systems, or residency structures. Third, although DT tasks are validated measures of creative potential, they do not directly assess real-world creative performance (Runco \u0026amp; Acar, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Fourth, parenthood was measured categorically without accounting for children\u0026rsquo;s ages or engagement in caregiving, which may vary widely. Finally, self-selection biases may influence residency choice, particularly among male pediatric residents, limiting conclusions about environmental determinants.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePediatric residents demonstrated higher divergent thinking than internal medicine residents, particularly in the figural domain and predominantly among male residents. These findings underscore the contribution of environmental affordances, interpersonal demands, and specialty-specific culture to the development of creative cognitive tendencies in medicine. Parenthood also showed specialty-dependent associations with DT, suggesting that life experiences outside clinical training may shape creative potential. Together, the results highlight creativity as an important yet underdeveloped competency in medical practice and emphasize the need to integrate structured creativity training and supportive environments into medical education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Review Board (IRB) of Meir Medical Center. All participants provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eSBZ conceptualized and designed the study, supervised data collection, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eDN contributed to study design, statistical analysis, and manuscript revision.\u003c/p\u003e\n\u003cp\u003eAE contributed to interpretation of data and critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe authors thank the medical residents who participated in this study for their time and engagement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eAcar, S., \u0026amp; Runco, M. 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(2011).\u003c/strong\u003e Creative self-efficacy. \u003cem\u003eJournal of Applied Psychology, 96\u003c/em\u003e(1), 113\u0026ndash;123. https://doi.org/10.1037/a0020956\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWallach, M. A., \u0026amp; Kogan, N. (1965).\u003c/strong\u003e \u003cem\u003eModes of thinking in young children.\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9020913/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9020913/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCreativity is increasingly recognized as an essential component of adaptive expertise in contemporary medical practice, supporting clinicians\u0026rsquo; ability to navigate diagnostic uncertainty, communicate effectively with diverse patient populations, and respond flexibly to complex clinical situations. Divergent thinking (DT)\u0026mdash;the ability to generate multiple, flexible, and original ideas\u0026mdash;is considered a key cognitive indicator of creative potential. Although creativity is highly relevant to medicine, particularly in patient-centered fields, empirical research on how medical specialties may foster or constrain DT remains limited. Pediatric medicine, which frequently involves multimodal communication, imaginative engagement, and management of ambiguous behaviors or non-verbal cues, may provide richer opportunities for developing creative cognitive processes than the more structured, protocol-driven environment typical of internal medicine. In addition, life-context factors such as gender and parenthood may also influence creative cognition, yet their contribution within medical training has rarely been assessed.\u003c/p\u003e \u003cp\u003eThis study examined whether residents in pediatrics differ from those in internal medicine in verbal and figural DT, and whether gender or parenthood explains additional variability. Fifty-eight residents (30 pediatrics; 28 internal medicine) from a major academic medical center completed validated verbal and figural DT tasks from the Runco Creative Assessment Battery. Fluency, flexibility, and originality were scored for each domain. Group differences were analyzed using MANOVAs, univariate ANOVAs, and two-way ANOVAs, and effect sizes were calculated.\u003c/p\u003e \u003cp\u003e Pediatric residents demonstrated higher DT scores across most indices, with statistically significant differences in verbal flexibility and in all figural DT measures. Effect sizes were medium in magnitude, indicating meaningful cognitive differences between specialties even when some comparisons did not reach statistical significance. A significant interaction emerged for figural originality, wherein male pediatric residents scored higher than male internal medicine residents, while no such differences were observed among female residents. Parenthood showed a specialty-specific pattern: among internal medicine residents, those with children scored higher on figural DT, whereas no substantial differences were found among pediatric residents.\u003c/p\u003e \u003cp\u003eThese findings suggest that specialty environments, communication demands, and clinical interaction patterns may shape creative cognitive tendencies during residency. The results highlight creativity as an important yet underdeveloped competency in medical education and support integrating creativity-enhancing training and more flexible, supportive learning environments into residency programs.\u003c/p\u003e","manuscriptTitle":"Divergent Thinking Among Medical Residents: A Comparison Between Pediatrics and Internal Medicine","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 16:38:59","doi":"10.21203/rs.3.rs-9020913/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-03T10:42:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T19:53:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T10:16:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T10:07:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-03T13:44:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83664970-fdbc-4941-926f-d8e695877863","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T16:39:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 16:38:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9020913","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9020913","identity":"rs-9020913","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}