Twelve tips for the introduction of emotional intelligence in medical education

Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States

OBJECTIVES

To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients.

METHODS

We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917).

RESULTS

Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)).

CONCLUSION

Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery.

PRACTICE IMPLICATIONS

SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.

The cross-cutting edge: Medical selection and education viewed through the lens of emotional intelligence

CONTEXT

Evidence suggesting the benefits of compassionate, person-centred care, for both patients and physicians is accruing. Medical selection, for example, aims to choose future health professionals that possess the correct attitudes, beliefs and personal attributes to deliver such care. Moreover, once in training, these desirable personal qualities should be developed and maintained, sometimes in the face of adverse health care service conditions. However, advances in selecting for, and developing, these abilities and attributes in health care have been hindered by a lack of clarity regarding how the relevant skills and traits should be defined, measured, developed and maintained in clinicians.

METHODS

In this article, we demonstrate how developments in the emotional intelligence (EI) field can be applied to the challenge of selecting for, and developing, relevant interpersonal care skills in medical students and physicians. The concept of EI itself has been somewhat controversial. However, a more nuanced understanding of EI has evolved in the light of research findings that can be applied to medical selection and education. Specifically, we propose modifications to the existing 'cascading' model of EI. This model identifies, and relates, several key socioemotional skills and traits that could be considered as 'the elementary particles' of EI required to deliver compassionate, person-centred care.

CONCLUSIONS

Our model of EI, which is relevant to care delivery, identifies putative targets for both medical selection and training. Selection for medical school and subsequent clinical education should focus on screening out those with low levels of the traits and abilities less amenable to training. Conversely, medical education should be concerned with developing and maintaining the socioemotional skills, attitudes and behaviours critical to the delivery of compassionate, person-centred care. This is especially important for specialties characterised by high levels of emotional labour and possible resultant compassion fatigue.

Impact of reflective writing skill on emotional quotient

Background

The skill of reflective writing and emotional drivers of behavior is enhanced by boosting the awareness of one's feelings and emotions. Individuals having characteristic activity of reflection have more emotional quotient (EQ). EQ has more significance than intelligence quotient in personal and professional life. This study is conducted to analyze the impact of reflective writing skills on components of EQ among first-year MBBS students and to find out the impact of reflective writing between components of EQ and different levels of reflective writing skills among first-year MBBS students.

Methods

An observational-analytical study was carried out for EQ self-assessment and reflections of first-year MBBS students. A paired t-test was used to check the difference between different segments of EQ. Analysis of reflections was done by modifying the REFLECT rubric method.

Results

There was a significant difference in the motivation component between pre and post-test (p-value = 0.013), whereas no significant difference was observed in other components, viz. self-awareness, empathy, self-control, self-confidence, and social competency. The average total scores among EQ domains compared were more at the level of reflection than habitual and introspection levels.

Conclusion

Along with intelligence quotient, EQ is critical for students' overall development. The average total scores of EQ were higher among the students who had a higher level of reflection. Developing reflective writing skills had an impact on the motivation component of the EQ of the students within a short duration.

'Insight' in medical training: what, why, and how?

The term 'insight' is generically defined in English language as the ability to perceive deeper truths about people and situations. In clinical practice, patient insight is known to have important implications in treatment compliance and clinical outcomes, and can be assessed clinically by looking for the presence of illness awareness, correct attribution of symptoms to underlying condition, and acceptance of treatment. In this article, we suggest that cultivating insight is actually a highly important, yet often overlooked, component of medical training, which may explain why some consistently learn well, communicate effectively, and quickly attain clinical competency, while others struggle throughout their clinical training and may even be difficult to remediate. We herein define 'insight' in the context of medical training as having an astute perception of personal cognitive processes, motivations, emotions, and ability (strengths, weaknesses, and limitations) that should drive self-improvement and effective behavioural regulation. We then describe the utility of cultivating 'insight' in medical training through three lenses of (i) promoting self-regulated, lifelong clinical learning, (ii) improving clinical competencies and person-centred care, and (iii) enhancing physician mental health and well-being. In addition, we review educational pedagogies that are helpful to create a medical eco-system that promotes the cultivation of insight among its trainees and practitioners. Finally, we highlight several tell-tale signs of poor insight and discuss psychological and non-psychological interventions that may help those severely lacking in insight to become more amenable to change and remediation.

ChatGPT in research and health professions education: challenges, opportunities, and future directions

ChatGPT was launched by OpenAI in November 2022 and within 2 months it became popular across a wide range of industrial, social, and intellectual contexts including healthcare education. This article reviews the impact of ChatGPT on research and health professions education by identifying the challenges and opportunities in these fields. Additionally, it aims to provide future directions to mitigate the challenges and maximize the benefits of this technology in health professions education. ChatGPT has the potential to revolutionize the field of research and health professions education. However, there is a need to address ethical concerns and limitations such as lack of real-time data, data inaccuracies, biases, plagiarism, and copyright infringement before its implementation. Future research can highlight the ways to mitigate these challenges; establish guidelines and policies; and explore how effectively ChatGPT and other AI tools can be used in the field of research and healthcare professions education.

Using storytelling in undergraduate dental education: Students' experiences of emotional competence training

AIM

The aim of the study was to explore the use of storytelling as a teaching method for emotional competence interventions within undergraduate dental curriculum (dental and dental hygiene students).

MATERIALS AND METHODS

Students participated in five sessions related to emotional competence: one theoretical and four practical. During the latter, divided in small groups, students told individually two stories: a story about a clinical situation in which they had an emotional experience and a story concerning a patient's experience of the same emotion. Each session focused on a single emotion: happiness, fear, anger and shame. A questionnaire was used to collect perceptions about enjoyment, how stories were chosen, what was learned and if the sessions were stimulating in any way. A focus group was organised to collect reflections about the learning environment, process of learning and specific skill set developed during these sessions.

RESULTS

The majority of the students enjoyed listening, telling and preparing the stories. They reported to experience social support and feeling a sense of community during the sessions. The students believed that stories helped them to reflect on their clinical work and to regulate their emotional experiences more efficiently in clinical situations. Regarding the learning environment, the dental students pointed out the distinctiveness and dissimilarities between the dental and dental hygiene students, but also expressed that they had a desire to learn more about the other student group.

CONCLUSION

Storytelling used as part of an emotional competence course appears to have benefits for students' reflection about their role as dental health professionals. This teaching method was well-perceived by the students included in this study.

Emotional intelligence is more important than the learning environment in improving critical thinking

PURPOSE

To examine the association of critical thinking (CT) and emotional intelligence (EI) versus CT and learning environment (LE) in order to investigate which has the greatest influence EI or LE.

MATERIALS AND METHODS

A cross-sectional study was conducted with 340 s-year healthcare university students in two nursing and one medical schools from three universities in Greece, between October and December 2020. Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence Questionnaire-Short Form were administered. Hierarchical multiple linear regression analysis, with five steps, was used to compare the associations of CT and EI to CT and LE.

RESULTS

Participants' mean age (years) was 20.9 (6.6 SD); 82.6% female; 86.8% studying nursing. Students mean scores were moderate to high for CT disposition (44.7 ± 4.68). The general characteristics (age, gender, and school) were not significantly associated with CT (p > 0.05). However, CT was positively associated with LE (UCB = 0.064 & p < 0.001) and EI (UCB = 1.522 & p < 0.001). Moreover, CT seems to be associated in a higher degree (R² change adj = 0.036 & p < 0.001) with emotional intelligence (UCB = 1.522) than with learning environment (UCB = 0.064).

CONCLUSIONS

Our findings suggest a different more optimal pathway for educators to improve the CT of their students through EI and not with LE as believed till now. By focusing on improving EI, educators may help their students become critical thinkers, who will provide better quality of care.

Emotional intelligence weakly predicts academic success in medical programs: a multilevel meta-analysis and systematic review

BACKGROUND

Emotional intelligence (EI) is a predictive factor of academic success in undergraduate Doctor of Medicine (MD) programs. Although some research suggests a positive association between EI and academic success in MD programs, other research reports neither an association nor a negative correlation between the two variables. The current study aimed to resolve these contradictory findings by conducting a systematic review and a meta-analysis using research from 2005 to 2022.

METHODS

Data were analyzed using a multilevel modeling approach to (a) estimate the overall relationship between EI and academic success in MD programs and (b) determine whether the mean effect size varies according to country (United States vs. non-United States countries), age, EI test, EI task nature (ability-based vs. trait-based), EI subscales, and academic performance criteria (grade point average vs. examinations).

RESULTS

Findings from 20 studies (m = 105; N = 4,227) indicated a positive correlation between EI and academic success (r = .13, 95% CI [.08, - .27], p < .01). Moderator analyses indicated that the mean effect size significantly varied according to EI tests and EI subscales. Moreover, three-level multiple regression analyses showed that between-study variance explained 29.5% of the variability in the mean effect size, whereas within-study variance explained 33.5% of the variability in the mean effect.

CONCLUSIONS

Overall, the current findings show that EI is significantly, albeit weakly, related to academic success in MD programs. Medical researchers and practitioners can therefore focus on integrating EI-related skills into the MD curriculum or target them through professional development training and programs.

Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety-Drivers to Outcomes and Well-being

Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.

Linking Learning Environment and Critical Thinking through Emotional Intelligence: A Cross-Sectional Study of Health Sciences Students

Background: Health sciences educators should increase the critical thinking of their students as this may improve the quality of care. However, this is rarely considered as a critical point in teaching, despite studies identifying factors such as the learning environment and emotional intelligence as increasing critical thinking at an undergraduate level. Thus, there is a need to better explore these factors and investigate interrelations and ways of improving critical thinking, especially in the critical field of healthcare students (nursing and medicine). Objectives: The present study aimed to examine the potential relationships between critical thinking with emotional intelligence and the learning environment. Method: This was a descriptive cross-sectional study with 208 first year health sciences university students of two nursing departments and one medicine department from three universities in Greece. The Critical Thinking Disposition Scale, Dundee Ready Education Environment Measure, and Trait Emotional Intelligence-Short Form questionnaires were used to assess critical thinking, the education environment, and emotional intelligence, respectively. Results: The results demonstrate that critical thinking was positively related to emotional intelligence (β = 0.82, p < 0.001), but not to the learning environment (β = 1.06, p = 0.30). However, a structural equation modeling analysis supported the indirect relationship between the learning environment and critical thinking through emotional intelligence (M = 1.10, CI = 0.13–2.17, p < 0.05). Conclusions: Emotional intelligence may be the underlying mechanism for achieving critical thinking if it is well applied and cultivated in a learning environment. Therefore, universities could modify their curricula and place emotional intelligence at the epicenter of teaching.

Individual Characteristics That Promote or Prevent Psychological Safety and Error Reporting in Healthcare: A Systematic Review

Background

Healthcare errors continue to be a safety issue and an economic burden that causes death, increased length of stays, and emotional trauma to families and the person who commits the error.  Speaking up and error reporting within a safety culture can reduce the incidence of error; however, this is complex and multifaceted.

Aim

This systematic review investigates individual characteristics that support or prevent speaking up behaviors when adverse events occur.  This study further explores how organizational interventions designed to promote error reporting correlate to individual characteristics and perceptions of psychological safety.  .

Methods

A systematic review of peer-reviewed articles in healthcare that contain characteristics of an individual that promote or prevent error reporting was conducted. The search yielded 1233 articles published from 2015 to 2021. From this set, 81 full-text articles were assessed for eligibility and ultimately extracted data from 28 articles evaluated for quality using Joanna Briggs Institute critical appraisal tools©.

Principal Findings

The primary themes for individual character traits, values, and beliefs that influence a person's decision to speak up/report an error include self-confidence and positive perceptions of self, the organization, and leadership. Education, experience and knowledge are sub themes that relate to confidence. The primary individual characteristics that serve as barriers are 1) self-preservation associated with fear and 2) negative perceptions of self, the organization, and leadership.

Conclusion

The results show that an individual's perception of their environment, whether or not it is psychologically safe, may be impacted by personal perceptions that stem from deep-seated personal values. This exposes a crucial need to explore cultural and diversity aspects of healthcare error reporting and how to individualize interventions to reduce fear and promote error reporting.

The lived experience of medical training and emotional intelligence

The shifting health care landscape in the United States has surfaced challenges related to increased accountability, interprofessional health care teams, and changes in federal policy-all of which compel physicians to adopt roles beyond clinician such as clinical investigator, team leader, and manager. To address these challenges, leadership development programs across the continuum of medical education aim to develop critical leadership skills and competencies, such as emotional intelligence. Such skills and competencies are largely taught through didactic approaches (e.g., classroom). These approaches often neglect the context of learning. From medical residency to a hospital or clinic, the contextual lived experience is habitually overlooked as a vehicle for developing emotional intelligence. This article highlights lived experience, such as medical residency, as an approach to develop emotional intelligence. First, we address the need for developing emotional intelligence as a leadership skill as well as the suitability of medical residency for such development. Next, we discuss the background of lived experience and emotional intelligence. Lastly, we identify future directions for leveraging lived experiences of medical residency to develop emotional intelligence.

Twelve tips for being an effective clinical skills peer teacher

The vast majority of clinical skills teaching at our medical school in London is delivered through a peer teaching programme, with research demonstrating that medical students unequivocally prefer being taught clinical skills by peer teachers (students) over-qualified physicians. Peer teaching holds a plethora of benefits for both the learner and the teacher; encouraging academic and professional growth for teachers while instilling confidence in tutees through an improved learning atmosphere. Teaching is an essential skill for all physicians, and peer teaching is an invaluable method to cultivate these teaching skills throughout medical education. This article outlines 12 tips on how medical students can be effective and successful clinical skills peer teachers when faced with medical teaching opportunities, whether physically or remotely conducted. We reflect upon our roles as Peer Teacher Leads, overseeing a team of 200 medical student clinical skills peer teachers on behalf of the faculty at our university in London. We are responsible for leadership and quality assurance, holding key input into the organisation, development and delivery of clinical skills teaching. Therefore, we are able to impart unique insight and experience. This practical guidance is gathered from feedback, experience and the wider literature on the topic of peer teaching in clinical skills. We hope that these tips will enable medical student teachers to become more confident and competent in providing worthwhile training to their peers.

COGConnect: A new visual resource for teaching and learning effective consulting

OBJECTIVE

Consultation skills are essential to clinical practice and, when effective, can facilitate diagnoses and improve patient satisfaction. Various models exist to facilitate consultation teaching. These can be prescriptive, a challenge to apply in clinical settings and are often designed for primary care. In redesigning our entire curriculum, we sought to create a new visual, digital, resource for consultation teaching, aligned with statements from the UK Council for Clinical Communication (UKCCC), and suitable for the evolving expectations of patients, clinicians and the UK NHS, in 21st century medicine.

METHODS

We conducted a literature review encompassing teaching methods, NHS Priorities, patients' priorities, lifestyle interventions and practitioner resilience. COGConnect was designed iteratively through consultation with a graphic designer, health psychologists, a range of clinicians, and a consultation expert, and has evolved through extensive use in our new "effective consulting" course in primary and secondary care.

RESULTS

COGConnect is deliberately visual, iterative, bi-directional and multi-phasic. The central image of COGConnect is two persons in connection; the floating cogs suggesting an encounter of different agents who must adapt their cog-connection in terms of speed, direction and dimension. Around this image we place five core values. The consultation phases are represented by ten colourful cogs, with important additions including 'formulating', 'activating' and 'integrating'.

CONCLUSION

COGConnect builds on the strengths of existing frameworks and provides a strong visual resource suitable for digital learning. It offers greater emphasis on explicit clinical reasoning, activation of patient self-care and learning from the interaction. Having become the de facto resource for consultation skills training across primary and secondary care in our institution, the next phase is to develop the COGConnect.info website and a programme of formal evaluation.

Temporal changes in emotional intelligence (EI) among medical undergraduates: a 5-year follow up study

BACKGROUND

Emotional intelligence (EI) is thought to play a significant role in professional and academic success. EI is important for medical personnel to cope with highly stressful circumstances during clinical and academic settings. The present prospective follow-up study intends to evaluate the changes in EI and their correlates among medical undergraduates over a five-year period.

METHODS

Data were collected in 2015 and 2020 at the Faculty of Medicine, University of Colombo, Sri Lanka. EI was assessed using the validated 33-item self-assessment tool, Schutte Self-Report Emotional Intelligence Test (SSEIT). In addition, socio-demographic details, students' involvement in extracurricular-activities during undergraduate life, students' satisfaction regarding the choice of studying medicine and plans to do postgraduate studies were also evaluated. A multiple-regression analysis was conducted among all students using percentage change in EI score as the continuous dependent variable, together with other independent variables (plan to do postgraduate studies, satisfaction in choice of medicine and extracurricular-activities).

RESULTS

Sample size was 170 (response rates-96.6%), with 41.2% males (n = 70). Mean EI scores at baseline among all students was 122.7 ± 11.6, and it had significantly increased at follow-up to 128.9 ± 11.2 (p <  0.001). This significant increase was independently observed in both males (122.1 ± 12.2 vs. 130.0 ± 12.4, p <  0.001) and females (123.1 ± 11.1 vs. 128.2 ± 10.3, p = 0.001). During follow-up, an increase in EI score was observed in students of all religions and ethnicities. Mean EI score also increased in all categories of monthly income, irrespective of the employment status or attainment of higher education of either parent. An increase in mean EI score during follow-up was observed in students irrespective of their engagement in or number of extracurricular-activities, they were involved. In the multiple regression analysis, being satisfied regarding their choice of the medical undergraduate programme (OR:11.75, p = 0.001) was the only significant factor associated with the percentage change in EI score.

CONCLUSION

EI in this group significantly improved over 5-years of follow-up and was independent of gender, religion, ethnicity, socio-economic parameters and academic performance. Satisfaction in the chosen field was a significant predictor of the overall change in EI. Future studies are  needed to identify and measure factors responsible for improvement in EI among medical undergraduates.

Emotional Intelligence: Leadership Essentials for Chest Medicine Professionals

Emotional intelligence (EI) has become widely appreciated as an important leadership attribute, in business, education and, increasingly, in health care. Defined as "the capacity to understand your own and others' emotions and to motivate and develop yourself and others in service of improved work performance and enhanced organizational effectiveness," EI is correlated with a number of success attributes in several sectors; for example, in business, with enhanced business performance and enhanced personal career success, and in health care, with enhanced patient satisfaction, lower burnout, lower litigation risk, and enhanced leadership success. While multiple models of EI have evolved, perhaps the most popular model is framed around four general rubrics with component competencies. The general rubrics are: self-awareness, self-management, social awareness, and relationship management. EI can be measured by using available instruments, and it can be learned and taught. Indeed, teaching EI has become increasingly common in health-care organizations in service of improving health care and health-care leadership. Although more research is needed, ample evidence supports the notion that EI is a critical success element for success as a health-care leader, especially because EI competencies differ markedly from the clinical and scientific skills that are core to being a clinician and/or investigator. This review of EI presents evidence in support of the relevance of EI to health care and health-care leadership, discusses how and when EI can be developed among health-care providers, and considers remaining questions.

Beyond communication training: The MaRIS model for developing medical students' human capabilities and personal resilience

Purpose: Human capabilities in medicine, including communication skills, are increasingly important within the complex, challenging and dynamic landscape of healthcare. Supporting medical students to manage unavoidable role-related stressors adaptively may help mitigate the anguish that is too commonly reported among the profession. We developed a model, "MaRIS", underpinned by contemplative pedagogy, to support medical students to enhance their human capabilities, across all three domains of Bloom's taxonomy, and their personal resilience. It is the first to integrate Mindfulness, affective Reflection, Impactive experiences and a Supportive environment into medical curriculum design. Here, we describe the theoretical basis underpinning MaRIS and present a preliminary study to evaluate its impact on students' subjectively-rated capabilities.Materials and Methods: A questionnaire capturing self-ratings of competence, empathy and resilience, as well as impressions of their experiences, was administered to foundation year medical students before (T0), during (T1) and after delivery (T2).Results: Fifty-five students completed the survey at all time points. Mean scores for all domains increased significantly from T0 to T1 and from T0 to T2. Free-text comments suggest learning impact across the cognitive, psychomotor and affective domains.Conclusions: MaRIS appears to facilitate medical students' establishment of the foundations for building the human capabilities and personal resilience required for professional practice.