|SYMPOSIUM: LEADERSHIP AND TALENT MANAGEMENT IN ACADEMIC MEDICINE
|Year : 2016 | Volume
| Issue : 1 | Page : 57-67
The importance of emotional intelligence to leadership in an Academic Health Center
Thomas J Papadimos1, Angela C Sipes1, Michael R Lyaker1, Claire V Murphy2, Areti Tsavoussis3, Scott M Pappada4
1 Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
2 Department of Pharmacy, Ohio State University Wexner Medical Center, Columbus, OH, USA
3 Public Health Specialist, Private Consultant, Columbus, OH, USA
4 Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus; Aptima Inc., Dayton, OH, USA
|Date of Submission||04-Dec-2015|
|Date of Acceptance||07-Jan-2016|
|Date of Web Publication||2-Jun-2016|
Thomas J Papadimos
Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH 43210
Source of Support: None, Conflict of Interest: None
Emotional Intelligence (EI) was first defined in the 1990s and was quickly adopted by the business community. The role of EI in leadership has come to the forefront and is now recognized as the most important trait/skill set that a leader can possess. In the next decade, there will be many challenges to the leaders of Academic Health Centers (AHCs). Understanding the role of EI and the implementation of its precepts in the personal culture of leaders and the organization will be extremely important. EI theory, its tools for assessment, its studies for validation, and its use for the development of professional curriculum for individuals and organizations will continue to evolve over time. Here, we will define EI and explain its origins and its importance to the success of AHCs. Furthermore, its importance to medical students, residents, and subordinates, its measurement, its juxtaposition to nature versus nurture, and what role simulation may play in increasing the EI skills of members of AHCs will also be addressed.
The following core competencies are addressed in this article: Core competencies addressed include systems-based practice, Interpersonal and communications skills, and Professionalism.
Keywords: Academic medical centers, education, emotional intelligence, leadership
|How to cite this article:|
Papadimos TJ, Sipes AC, Lyaker MR, Murphy CV, Tsavoussis A, Pappada SM. The importance of emotional intelligence to leadership in an Academic Health Center. Int J Acad Med 2016;2:57-67
|How to cite this URL:|
Papadimos TJ, Sipes AC, Lyaker MR, Murphy CV, Tsavoussis A, Pappada SM. The importance of emotional intelligence to leadership in an Academic Health Center. Int J Acad Med [serial online] 2016 [cited 2021 Jul 24];2:57-67. Available from: https://www.ijam-web.org/text.asp?2016/2/1/57/183328
| Introduction|| |
Academic Health Centers (AHCs) are extremely complex health organizations that deal with the tripartite mission of service, research, and teaching. In fact, their operation and mission demand much more of their leaders than the typical large community hospital. For example, the conflicting roles of clinical services, teaching, and research must always be considered. AHCs also have to deal with governance issues between hospital and medical school and the resultant complicated decision process involving the delivery of services in crowded or competitive markets. Furthermore, the concern about the distribution of income among faculty members who produce substantial clinical income versus those specialties that are subsidized will always be a matter of interest to many parties. These concerns are important because many AHCs are located in urban areas where the patients are poorer, more unhealthy, uninsured, or underinsured and require the same high quality and effective services than those that are better insured and more affluent. A preeminent clinical reputation, well-funded research, and being well-published are not enough for a leader of such an enterprise. To manage an AHC successfully, a leader must have the skill set for managing the continual and ongoing tension between professional leaders, academic leaders, and the management team of the institution. There is evidence that unsuccessful AHC leaders struggle at managing relationships in these complex organizations, both personal and professional; they cannot handle disruptive behavior, especially from highly productive clinicians; they have not taken time to study the institution's cultural history with its nuances and peccadillos; and they do not understand that they are there to serve, not to be served (by department chairs).,,,
The practice of medicine is changing significantly. Patients/consumers and government and insurance regulators want costs decreased while maintaining the same or better quality with the same or increased value. This effort in the setting of an AHC requires cooperation among physicians and other health providers (pharmacy, respiratory therapy, nursing, etc.); the practice of medicine becomes an ever increasing “team sport.” However, physicians have traditionally practiced independently, always exhibiting confidence in their abilities, and self-directing their practices. For an AHC to be successful, the time-honored silo-like structure of departments will need to change to a more collaborative model.,, Emotional intelligence (EI) is the key competency to achieve this shift in thinking; it is the linchpin feature of leadership and the effective management of change.,,, The role of EI in leadership has a growing compendium of evidence. Physician leaders who can improve their social interactions will improve their management outcomes. Boyatzis found that in the 2000 managers he studied, 16 distinguishing characteristics were needed for success, and 14 of these important markers were emotional, not cognitive. In addition, Spencer and Spencer studied competencies in 286 organizations and found that 18 of 21 traits associated with successful performance in a company were based on emotion.
“In the highly demanding environment of modern medical practice, positive interpersonal interactions are necessary to optimize clinical and academic productivity.” Here, we will define EI and discuss its origins, its importance to leadership success in an AHC, the view of subordinates in relation to leaders with or without EI, its importance to medical student and resident training, nature versus nurture in relation to EI, measurement of EI, and whether EI can be taught in simulation, in the hope that the readers will appreciate its importance and implement a strategy to incorporate EI into their daily routine of service, research, and teaching, as well as making it an institutional or organizational priority.
| Defining Emotional Intelligence and Its Origins|| |
Since the premise put forth is that leaders high in EI are important to the success of an organization, it would be prudent to define EI and its origins. Decision-making and problem solving in organizations through the use of intuition, feelings, and induction/deduction are essentially EI. It was described in the work of Salovey and Mayer in 1990 wherein they addressed the need to be aware of one's feelings and emotions as well as with whom you interact to use such information to guide actions that facilitate problem-solving. However, it was not until 1995 when Goleman published the book, Emotional Intelligence: Why it can matter more than IQ, the term “EI” became familiar to the public. In 1998, Goleman followed with a text that highlighted the workplace applications of EI.
The term “EI” has been advanced to describe the use of personal attributes which enhance social and professional relationships. The four areas that encompass EI are (1) self-awareness, i.e., emotional self-awareness; (2) self-regulation/self-management; (3) social awareness (of the organization and empathy for persons); and (4) relationship management, i.e. coaching, mentoring, inspiring, and facilitating teamwork.,,
Self-awareness is a mainstay of EI. One must understand and be aware of emotions (self and other) and the effect of life experiences on all individuals of concern. An individual has to be capable of taking criticism/feedback and incorporating it into his/her “self.” An individual must be able to apply distance and perspective to emotions. Above all, the presence of emotional extremes, as well as the variety of emotions, have to be recognized. The individual must foster an appropriate reaction, thereby delaying a destructive response to an individual relationship or that of a team (see self-regulation below). Understanding biases and prejudices in one's self are of paramount importance.
Self-regulation means that an individual can manage his/her emotions under any and every circumstance. Suppressing all emotion is not the aim, but controlling a response in any particular situation is important. “Self-regulation is perhaps the most important skill to master. Impulsivity in response to a situation, driven by anger or strong emotion, has derailed many. Pessimism paralyzes and inhibits forward motion.”
Self-regulation also means self-management. It may be the most important of the four skills mentioned here. “Those with strong self-management organize thoughts and actions, produce high-quality work, and are adaptable. They exhibit high levels of integrity. They are able to remain optimistic in the face of failure and rejection, viewing the setback as additional data on which to set a future course.”
Social awareness is also important. Humans live in communities and interact with many individuals on a regular basis, with both those that are known to them and those who are strangers. Furthermore, organizations may interact with other organizations; therefore, politics and social dynamics come into play. When interactions occur between people, certain hints or clues about their feelings are relayed through body language, their eyes, inflections in their voice, etc. Over 80% of communication between individuals comes from nonverbal clues.,, Socially aware individuals can connect the “dots” and understand the scenario in which they are playing. Being able to read an individual or a situation is very important to successful relationships and negotiations.
Relationship management means going beyond the cues, verbal and nonverbal; it requires an ability to understand and work with varying viewpoints and struggles that occur between individuals and between organizations. Individuals who act as mentors or coaches elevate their subordinates. If an individual is leading a team, he/she must make sure that he/she is aware of the needs of the team members, whether it is teaching them, encouraging them, or just finding out their state of mind and what is necessary to “feed” their soul. A leader should acknowledge the success of others and help them flourish.
| The Association of Emotional Intelligence With Success in Academic Health Centers|| |
In the upcoming years, AHCs will undergo many challenges in relation to reimbursement, patient satisfaction, recruitment, and retention that will affect their abilities to fulfill their mission. AHCs have been undergoing a rapid, complicated, and confusing transformation. In the early 2000s, AHCs entered a new era. “This new order in health care, one governed by commercialism and free competition, presents academic medical centers and university physicians with unique challenges.” Medical school and AHCs have entered into a time when they have had to innovate, adapt, and accept the changes and political will of insurers and the government to survive, let alone thrive.
While well-trained in scientific skills and clinical skills, physicians are not well-trained to assume leadership roles. They rarely have competencies of communication, teamwork, change management, and EI in their social, personal, and managerial repertoire. In a study that interviewed department chairs on their perspectives, Lobas found that:
“EI and its concomitant skills are the most essential competencies for leaders to succeed in academic institutions. The 10 chairs emphatically state that this ability was fundamental to their success and its absence the cause of their failures. They suggested that the absence of EI often resulted in the demise of chairs and contributed to the high turnover among their colleagues.”
Outside of the field of medicine, it has been common knowledge for a considerable time that EI is not only associated with but also directly related to profit, productivity, and performance; and that more than 90% of the competencies needed for success fall into the realm of EI.,,,
In an outstanding 2011 review of EI by Brackett et al., workplace performance and its relation to EI was addressed succinctly. They underscored the point that EI contributes to successful workplace performance. It affects employee/colleague interactions, how the individuals in the organization deal with stress and conflict, and of course, job performance and satisfaction. These authors further state that “EI has been associated with the extent to which managers conduct themselves in ways that are supportive of the goals of the organizations, according to the ratings of their supervisors.”
It is of interest that Day et al. recently contacted members and fellows of the United Kingdom Faculty of Public Health and asked them to nominate “Public Health Superheroes.” This study explored the concept of how to ensure effective public health leadership in the future. For instance, policy decisions that needed effective intervention included tobacco, alcohol, firearms, and even Ebola/Public Health Emergencies of International Concern. These authors describe the need for leaders, “who are a paradoxical blend of personal humility and professional will and make the right decisions happen.” They go on to identify five talents public health leaders need to be effective: mentoring-nurturing, shaping-organizing, networking-connecting, knowing-interpreting, and advocating-impacting. None of this can happen without effective EI skills.
There is a little doubt that EI and professionalism go hand-in-hand and that EI is a vital leadership skill.,,,,,,,, A recent systematic review by Mintz and Stoller supported the proposition that EI is endorsed as a strategy for leadership development (although models of EI and leadership development modes vary considerably) and that EI is relevant not just for leaders in AHCs but throughout medical practice and education. These authors further proposed that greater care and focus need to be exercised on “establishing and standardizing the measurement of EI in health care providers.” To further illustrate this need in many AHC settings (and private industry), there are now 360° evaluations. This has become one of the most pronounced innovative disruptions in organizational performance management. Now, employees, managers, etc., are not just graded on performance by their superiors but also by their peers and subordinates. When people were traditionally evaluated by superiors, “Personal success was narrowly defined and corporate cultures focused on shareholder value or for academic medical centers on grants, patient care dollars, and charitable giving. A true understanding of mission, vision, and core values was lacking.” EI is necessary to lead multidisciplinary teams whose members are multigenerational. Sax and Gewertz make the important distinction that while personal insight is important in EI, it is a modification of behavior and not personality that is important to personal EI success, which leads to AHC success in healthcare competition.
The shortcomings and strong points of tests and instruments that are being used in such assessments need to be addressed and evaluated. The best-suited methods of EI testing as part of curriculum must be established. In doing so, an AHC will effectively train future providers at all levels of AHC participation in the many important aspects of EI, thereby not confining it only to top management, but imbedding it also all along the continuum of the provision of healthcare. In addition, simulation may be an acceptable method of propagating awareness of EI, teaching its methods, and defining its association with successful leadership. Nonetheless, there have been no randomized trials to determine whether or not teaching EI leads to enhanced leadership at AHCs or in patient outcomes. More evaluation of methods and creative innovations in EI teaching, measurement, and verification of positive outcomes in the AHC setting need to be pursued.
| Emotional Intelligence and Subordinates|| |
“Human beings of all ages are happiest and able to deploy their talents to best advantage when they are confident that, standing behind them, are one or more trusted persons who will come to their aid should difficulties arise.” By creating a supportive environment in which followers (e.g., subordinates) feel secure, leaders allow their employees the freedom for both emotional and intellectual growth. To provide this sense of security within their organization, leaders must have the skills to negotiate emotions and interpersonal dynamics.
EI is a key to maximize personal job satisfaction and creation of a positive work environment among both leaders and subordinates. A cyclical relationship has been demonstrated between leadership EI and subordinate trust. Good leaders who approach interpersonal relationships with respect, honesty and fairness facilitate mutual trust, which then decreases workplace stress and theoretically improves job performance among employees. It is well-established that an individual's EI, regardless of whether a leader or follower, is predictive of personal job satisfaction and individual performance. Individuals with high EI also have the ability to adjust and utilize their emotions to their advantage to improve their success in interpersonal interactions. This in turn is associated with improved job satisfaction and performance.,,,
Although a follower's EI correlates with both job satisfaction and performance, it does not correlate with employee commitment to the organization or turnover intention unless the job is associated with high emotional effort. Individuals with high EI may find it challenging to be dedicated to an organization if they do not have an emotional tie to their outcomes or feel emotionally motivated by what they accomplish. Therefore, EI may be more important for jobs with higher emotional labor, including most within an AHC.
When evaluating the impact of a leader's EI on employee outcomes, consideration must be given to both the leader's and the employee's individual EI. While an individual's EI consistently correlates with their own job performance, this relationship does not hold true for supervisor EI and employee performance. However, prior studies have found that the quality of the relationship between leaders and their subordinates greatly impacts the leader's evaluation of the employee's performance. It is possible that an employee with high EI may be able to “manage upward” by managing their relationship with their supervisor(s) and indirectly influencing the supervisor(s) perception of their job performance rather than truly impacting their performance. EI of a leader correlates with job satisfaction and organizational citizenship (e.g., extra-role behaviors) but not job performance (e.g., intra-role behavior) of their followers. Moreover, a leader's EI has higher impact on employee outcomes such as job satisfaction among employees with lower EI. Wong and Law suggest that employees with high EI perform at a higher level overall with increased job satisfaction regardless of their leader's EI. However, employees with low EI may lack self-awareness and interpersonal skills and require assistance from their supervisor to recognize the impact of their emotions and to guide the employee to regulate their emotions and their response to the emotions of their peers.
| Emotional Intelligence, Medical Students and Residents|| |
In the recent decades, considerable attention has been devoted to developing the faculties of EI in medical students and residents. Medicine has evolved from an art practiced by highly knowledgeable, autonomous individuals into a profession calling for compassionate clinicians who are skilled communicators and are able to direct teams of multidisciplinary specialists through an environment of growing infrastructure, technology, and organizational complexity. Increasingly, medical training programs are charged with producing physicians capable of providing safe, compassionate, and patient-centered care. Understanding and responding to emotions in themselves and others should allow physicians to improve the doctor–patient relationship, increase patient satisfaction, minimize conflicts with colleagues, and deal with personal stressors and mistakes.,, To this end, medical schools and graduate medical education programs have been exploring options for selecting applicants with advanced communication skills, empathy, compassion, and maturity., In addition, training programs are developing curricula to cultivate qualities of EI in their graduates.,, However, in spite of these efforts, many questions about identifying and developing EI abilities in physicians remain unanswered.
Selecting medical school and residency candidates possessing high EI is an intriguing but complex proposition. It has been proposed that emotionally intelligent individuals would be better able to deal with the stresses of medical education and perform better academically and clinically. Part of the conundrum is the stubborn question of whether EI is a stable personality trait or skill that can be learned, developed, or forgotten. If it is indeed more of a trait, selecting certain traits in medical school applicants may introduce unintended bias into the process. Certain ethnic groups, age groups, and both female and male have been shown to display higher levels of EI in different studies., Furthermore, although most individuals with high EI are “positive, warm, and helpful,” a subset who display high levels of EI in the setting of competitive and uncooperative traits may be predisposed to Machiavellian behavior.
Using EI as an admissions criterion is also complicated by the many methodologies of measuring the EI. Assessments that rely on self-reporting are susceptible to manipulation by highly motivated applicants in a competitive selection process., Others which analyze behavior observed by a collection of experts have been criticized as “knowledge tests” that rely on perception of emotion and may not correlate with other measures. Tools combining self-reporting with a 360° assessment are available but have not been fully validated. Furthermore, incorporating these scores into an admission process poses the questions of what threshold is sufficient and is there a ceiling effect to higher EI. Not all medical professions require the same levels of EI or as summarized by one reviewer, “medicine needs pathologists as well as psychiatrists.” At present, EI testing has not shown good correlation with other existing selection measures intended to assess interpersonal skills, such as interviews and written tests meant to assess these abilities (e.g., part 2 of the Australian Undergraduate Medicine and Health Sciences Admission Test). Questions regarding EI testing and evidence that EI skills can be enhanced through training have led some to conclude there is insufficient evidence to support EI as a selection criterion.
Given concerns that EI is discouraged by traditional training which selects for individual achievement and blunted by professional socialization, efforts are made to nurture EI skills in medical and premedical training., Undergraduate programs emphasize self-awareness and self-assessment through writing. Later, medical students are taught to work in problem-based learning groups during the first 2 years. To this end, the Accreditation Council for Graduate Medical Education (ACGME) has incorporated competencies reliant on EI into the medical curriculum. Professionalism and interpersonal and communication skills are probably the two competencies most closely associated with EI; however, EI plays a less direct role in most if not all competencies. Explicit EI training for residents has been proposed as a modality for teaching professionalism, which traditionally has been achieved through indirect means such as role modeling (medicine's hidden curriculum). A spiral curriculum that repeatedly introduces trainees to components of EI at different phases and increasingly sophisticated levels has been proposed as an effective method of teaching such a complex set of skills.
One of the major tasks of AHC is to train compassionate physicians and leaders in the medical field. It is a compelling proposition that physicians with higher EI may work together better and establish better relationships with patients, leading to better and more cost-effective care. Although there is some suggestion higher EI may increase patient satisfaction, strengthen the doctor-patient relationship, improve stress management, well-being, teamwork, and academic achievement, the literature suffers from poor standardization and conflicting results. EI, however, provides a useful framework for future research, common vocabulary, and means to classify and quantify the “nontechnical skills” that medical training has historically struggled to address.,,,,,
| Nature Versus Nurture in Relation to Emotional Intelligence|| |
Do we learn EI or is it part of an individual's nature? While much can be taught to those willing to learn, individuals still may, to some extent, be hostage to their biology. Human beings exhibited emotions before being able to recognize emotions. When man first roamed the earth, fleeing a dangerous situation was a genetic reflex (and still is). As the human brain developed, the limbic system and amygdala became the center of emotion and allowed humans a wider range of emotion, especially in view of an enlarging neocortex. Throughout the teenage years and as a young adult, the frontal lobe white matter grows and matures. The prefrontal-basal ganglia white matter and posterior fiber tracts develop into early adult life; however, only tracts between the prefrontal cortex and basal ganglia are responsible for controlling impulses/emotions. These pathways develop, as one ages and matures, into higher levels of impulse control, but they do not develop to the same extent in all individuals, which may be one of the reasons for individual variability in human responses, in addition to one's rearing or social situation. For instance, the neurobiology is so sensitive to development and experiences in early childhood that that there are neuro-biological-developmental alterations in children witnessing domestic violence. In their ensuing posttraumatic stress disorder, there is evidence that their cumulative childhood trauma (and not adulthood trauma) may predict the overall symptom complexity as adults in relation to this disorder. Our development as humans affects our neurobiology as well as social skills.
The evidence demonstrating the neurobiological changes within the children's brains became available with the advances of neuroimaging in the 1990s. The advent of magnetic resonance imaging (MRI), functional MRI positron emission tomography scan, single photon emission computed tomography, magnetic resonance spectroscopy, and diffusion tensor imaging has provided indisputable proof that the changes in brain anatomy and function do occur in relation to experiences., The areas of the brain involved in neurobiological changes for children witnessing domestic violence, for example, include the midbrain, the limbic system, cortex, corpus callosum, and cerebellum.,,, It makes sense that these areas would also contribute to EI. Work by Cisler et al., in a group of women who had early life stress where they mapped the patients' emotional regulation, found that women who did not become depressed had higher prefrontal cortex activity (a sign of resilience, even though they had early life stress). Therefore, not everyone who has childhood difficulties will reflect it in adulthood. Hence, it may be that biology and experience complete an individual's portrait as it pertains to EI. “Although one may feel doomed by biology, it is also clear that brain plasticity allows new neural pathways to form and mature throughout life.” As indicated in other sections of this manuscript, methods of EI may be taught and learned. It may be that some individuals have more fertile ground socially and biologically in the acquisition and expression of EI. However, all individuals in leadership positions in an AHC, as well as those who work in the ranks, must strive to perfect and project their EI skills in the work and academic environment, regardless of their nature or the extent of their nurture.
| Measuring Emotional Intelligence|| |
Contemporary studies show that EI has implications for effective leadership and ideal “clinical and academic productivity.”,, Empirical methods for determining EI have been debated pivoting around situational needs and condensed into two models: ability and mixed models., The mixed model focuses on “abilities and personality traits” appraised through self-reports; comparatively, the ability model focuses on the management and processing of internal and external emotional stimulation assessed through psychological abilities. The ability model could be favored over mixed-model assessments because of innate bias with self-reporting. However, the internal consistency of comprehensive mixed-model assessments such as the EI scale provides an empirical, objective measure from subjective self-appraisals.,
Ability model contenders argue the value of EI becomes apparent in “being able to monitor one's own and other's feelings and emotions…” and guiding “…one's thinking and actions” while Brackett et al. purport “self-report measures are problematic because respondents may not…know how good they are at emotion-based tasks” given differences in experience and abilities such as perception, understanding, and application of emotional information.,,
Mixed-model assessments for the evaluation of EI are subjective in that they are based on the perception and understanding of emotion, skills described by EI that is unequally developed in individuals, but self-report assessments utilize scales ranging from “1 (not at all true) to 4 (exactly true),” allowing adequate estimation of action in real-life scenarios. An adaptation of this scale is used in the Bar-On Emotional Quotient Inventory (EQ-i), which may be proposed as the ideal assessment of EI., Bandura asserts the ratings on mixed-model assessments are related to self-efficacy reports influenced by direct experiences (a determinant of self-efficacy beliefs); Gürol et al. support perceived self-efficacy in leadership also indicating positive correlation with EI., When considering the ideal assessment of EI relating to leadership in AHCs, “…competencies…representing the degree to which an individual has mastered specific skills and abilities…” can be learned. Assessments from the mixed model can identify personal shortcomings in self-efficacy beliefs through interpreting EQ-i responses on how adequately one will handle hypothetical situations.
While test takers could fake answers or “provide socially desirable responses” relative to personal experiences, an AHC keen on improving quality of care could encourage honest, introspective assessments to reveal areas of weak EI to supplement professional development. Kotzé and Venter indicated that with self and peer ratings combined, effective leaders scored “significantly higher on the total EI measure.”, Mixed-model assessments of EI are more holistic because they consider awareness and management of emotions, motivation, empathy, and relationships extending to interpersonal interactions. The EQ-i is the ideal scale because the comprehensive subscales evaluated (understanding one's emotions and ideas, awareness others' feelings, flexibility and adjusting emotions with changing situations, managing stress and emotions, and expressing optimism during adversity) are relevant to daily work in AHCs. The EQ-i is composed of 133 questions taking about 30 min to complete and yields data valuable for designing development programs focused on EI competencies, identifying and understanding personal and others' emotions, and using this knowledge to take action, making EQ-i a comprehensive and effective assessment tool., Nonetheless, tests of EI are evolving, and there are multiple EI evaluation methods coming to market. An organization can select various testing options and pricing [Table 1].
| Simulation and Emotional Intelligence|| |
In today's technology-driven society, simulation-based education and training of healthcare professionals is becoming increasingly routine and probably necessary. This is likely attributed to the fact that simulation offers the unique benefit to train and practice medical interventions and procedures within “life-like” environments, in an era of restricted work hours for trainees. Simulation is quickly being adopted across medicine as an extremely effective means of training and educating healthcare providers. This is occurring primarily because it offers a realistic and risk-free environment in which trainees and healthcare providers can be “pushed to the limits” without any harm coming to a single patient. Through simulation, it is possible to design and refine clinical scenarios of variable complexity. These scenarios serve to tailor and focus training with the end goal being the ultimate acquisition of key knowledge and skills among trainees participating in a simulation session. Simulation thus offers a unique potential to not only train but also test EI.
The ACGME has defined six core competencies that trainees are to have attained by the conclusion of their residency program. These core competencies include (1) patient care, (2) professionalism, (3) systems-based practice, (4) intrapersonal and communication skills, (5) medical knowledge, and (6) practice-based learning and improvement. Previous work has encouraged the incorporation of EI into healthcare training, especially within the context of the six ACGME competencies mentioned previously.
In a recent study, Arora et al. investigated EI and stress among medical students using a surgical simulator. This study was unique in that it focused on simultaneously measuring EI traits and objective physiological responses of stress (by measuring changes in heart rate occurring before, during, and following simulation-based training). Arora et al. demonstrated that simulation may provide an effective platform for training stress-coping strategies. While this study measured EI and stress at the individual level (i.e., emotional self-awareness), simulation could also be used to train, and thereby incorporate, key team-level skills such as social awareness and relationship management into daily practice. In terms of social awareness, repeated participation in simulation-based training will allow trainees to be aware of significant changes in effect occurring among members of their team (e.g., when a team member becomes stressed, fatigued, disengaged, etc.,) that impact clinical performance. In addition, trainees can improve relationship management by developing effective communication and leadership skills.
A key component of simulation-based training is the debriefing of trainees following completion of scenarios. These postscenario debriefing sessions allow instructors and trainees to discuss what went right, what went wrong, and what can be improved upon during future simulation sessions or within real-world clinical settings. Advances in EI technology will assist in providing effective trainee simulations, whereby performances can be tracked and assessed. Technologies implemented within simulation environments (such as simulated electronic health records, patient simulators, and video recording equipment\software) provide data at a high-resolution time-scale integral to the debriefing process and will be invaluable in regard to future efforts in EI education and measurement.
Research surrounding the utilization of physiological-derived measures to characterize changes in affect or functional state continues to grow.,,,, The continued growth of research in this area is likely related to recent advances and increased availability of portable and wireless physiological monitoring technologies. These technologies allow for the continuous real-time measurement and acquisition of physiological data that can be leveraged to provide high-resolution temporal data indicative of changes in affect and functional state. Simulation offers a well-suited and unique environment where trainees can be monitored via these technologies to collect useful data and assessments to support optimization of training. Availability of measurements/data collection during simulation will provide educators/instructors a key resource during postscenario debriefing sessions that will allow them to better train EI among trainees via improving trainee emotional self-awareness, social awareness, and leadership\communication skills. Given the growing body of work demonstrating that EI is a desirable attribute across multiple fields including medicine, it is reasonable to hypothesize that incorporating EI into simulation-based training will translate to real-world improvements in healthcare delivery and patient safety.
Future simulations in EI will not only involve actors being used in live scenarios interacting with medical personnel but also involve three-dimensional (3D) simulation caves where students, residents, and faculty will interact with cartoon/animated visages in digitalized locations (computer-generated locations, hospital, or geographic). A resident or team of residents could be operating in a simulated emergency scenario where stressful interactions between the “players” can be staged and be evaluated. Even 3D scenarios involving active shooters in the hospital can be mimicked with such technology, which can test or provide education in negotiating skills.
| Conclusion|| |
EI is the core attribute of effective leadership at an AHC. The future of AHCs in this time of new regulations and scarce resources depends on the ability of leadership to be self-aware, to regulate their emotions, be socially, politically, and economically aware of their environment, and to manage their relationships with others and with organizations. The myriad of challenges faced by AHC leaders and their organizations over the next decade include International Classification of Diseases 10 coding, meaningful use 2 and 3, pay for performance, retention of staff, increased administrative burdens, rising operational costs, advancing technology, liability, collecting co-pays and deductibles, independence versus employment, simply getting paid, issues with the Health Insurance Portability and Accountability Act, payers dictating care, patients dictating care, and maintenance of certification. Its role in patient satisfaction and patient-centered care also continues to evolve.,,
In today's AHC environment, good personal interactions will enhance performance and productivity. Over time, research in EI will become more focused, and its theoretical basis will undergo revision as will the methods of assessment and the creation of professional courses. More research and validation of EI constructs and precepts will need to occur. As more leaders recognize and understand the importance of EI, its teaching and assessment will become a formal part of AHC culture.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Petersdorf RG. Deans and deaning in a changing world. Acad Med 1997;72:953-8.
Weil TP. Leadership in Academic Health Centers in the US: A review of the role and some recommendations. Health Serv Manage Res 2014;27:22-32.
Lee A, Hoyle E. Who would become a successful dean of faculty of medicine: Academic or clinician or administrator? Med Teach 2002;24:637-41.
Levin R, Bhak K, Moy E, Valente E, Griner PF. Organizational, financial, and environmental factors influencing deans' tenure. Acad Med 1998;73:640-4.
Keyes JA, Alexander H, Jarawan H, Mallon WT, Kirch DG. Have first-time medical school deans been serving longer than we thought? A 50-year analysis. Acad Med 2010;85:1845-9.
Souba W, Way D, Lucey C, Sedmak D, Notestine M. Elephants in academic medicine. Acad Med 2011;86:1492-9.
Gabbard GO. The role of compulsiveness in the normal physician. JAMA 1985;254:2926-9.
Stoller JK. Developing physician-leaders: A call to action. J Gen Intern Med 2009;24:876-8.
Weil TP. Difficulties in consummating a meaningful hospital-physician collaboration. J Med Pract Manage 2012;28:47-50.
Brenner DA. Next-generation academic medicine. J Clin Invest 2012;122:4280-2.
Gill R. Theory and Practice of Leadership. London: Sage Pulbications Ltd.; 2011.
Lobas JG. Leadership in academic medicine: Capabilities and conditions for organizational success. Am J Med 2006;119:617-21.
Bohmer RM. Leading clinicians and clinicians leading. N Engl J Med 2013;368:1468-70.
Brackett MA, Rivers SE, Salovey P. Emotional intelligence: Implications for personal, social, academic, and workplace success. Soc Persnal Psychol Compass 2011;5:88-103.
Boyatzis RE. The Competent Manager: A Model for Effective Performance. New York: John Wiley & Sons; 1982.
Spencer L, Spencer S. Competence at Work. New York: Wiley & Sons; 1993.
Sax HC, Gewertz BL. Understanding emotional intelligence and its role in leadership. In: Kribee MR, Chen H, editors. Leadership in Surgery. Switzerland: Springer; 2015. p. 67-78.
Salovey P, Mayer JD. Emotional intelligence. Imagin Cogn Pers 1990;9:185-211.
Goleman D. Emotional Intelligence: Why it Matters More than IQ Now. New York: Bantam Books; 1995.
Goleman D. Working with Emotional Intelligence. New York: Bantam Books; 1998.
Mayer JD, Caruso DR, Salovey P. Emotional intelligence meets traditional standards for an intelligence. Intelligence 1999;27:267-98.
Zakariasen K, Victoroff KZ. Leaders and emotional intelligence: A view from those who follow. Healthc Manage Forum 2012;25:86-90.
Taylor GJ, Parker JD, Bagby RM. Emotional intelligence and the emotional brain: Points of convergence and implications for psychoanalysis. Psychodyn Psychiatry 1999;27:339.
Souba WW. Academic medicine and the search for meaning and purpose. Acad Med 2002;77:139-44.
AMCs need to develop capacity for innovation, Commonwealth Fund report says. Health Care Strateg Manage 2001;19:10-1.
Pfeffer J, Veiga JF. Putting people first for organizational success. Acad Manage Perspect 1999;13:37-48.
Boyatzis RE, Kolb DA. Performance, learning, and development as modes of growth and adaptation throughout our lives. In Career Frontiers: New Conceptions of Working Lives. Peiperl M, Arthur M, Goffee R, Morris T, editors. Oxford, England: Oxford University Press; 2000. p. 76-98.
McClelland DC. Identifying competencies with behavioral-event interviews. Psychol Sci 1998;9:331-9.
Day M, Shickle D, Smith K, Zakariasen K, Moskol J, Oliver T. Training public health superheroes: Five talents for public health leadership. J Public Health (Oxf) 2014;36:552-61.
Collins JC. Good to Great: Why Some Companies Make the Leap and Others Don't. New York: Random House; 2001.
Lake CL. Professionalism: The creation, promotion, and maintenance of professional behavior. Adv Anesth 2005;23:1-14.
O'Sullivan H, van Mook W, Fewtrell R, Wass V. Integrating professionalism into the curriculum. Med Teach 2012;34:155-7.
Lynch DC, Surdyk PM, Eiser AR. Assessing professionalism: A review of the literature. Med Teach 2004;26:366-73.
O'Sullivan H, McKimm J. Medical leadership and the medical student. Br J Hosp Med (Lond) 2011;72:346-9.
Taylor C, Farver C, Stoller JK. Perspective: Can emotional intelligence training serve as an alternative approach to teaching professionalism to residents? Acad Med 2011;86:1551-4.
Wagner PJ. Does high EI (emotional intelligence) make better doctors? Virtual Mentor 2006;8:477-9.
Chaudry J, Jain A, McKenzie S, Schwartz RW. Physician leadership: The competencies of change. J Surg Educ 2008;65:213-20.
Danielsen R, Cawley J. Compassion and integrity in health professions education. Internet J Allied Health Sci Pract 2007;5:2.
Block D. Professionalism and the physician leader. Physician Exec 2004;30:50-3.
Mintz LJ, Stoller JK. A systematic review of physician leadership and emotional intelligence. J Grad Med Educ 2014;6:21-31.
Cherry MG, Fletcher I, O'Sullivan H, Shaw N. What impact do structured educational sessions to increase emotional intelligence have on medical students? BEME Guide No 17. Med Teach 2012;34:11-9.
Bowlby J. The Making and Breaking of Aflectional Bonds. London: Tavistock; 1979.
Kafetsios K, Athanasiadou M, Dimou N. Leaders' and subordinates' attachment orientations, emotion regulation capabilities and affect at work: A multilevel analysis. Leadersh Q 2014;25:512-27.
Knight JR, Bush HM, Mase WA, Riddell MC, Liu M, Holsinger JW. The impact of emotional intelligence on conditions of trust among leaders at the kentucky department for public health. Front Public Health 2015;3:33.
Kafetsios K, Zampetakis LA. Emotional intelligence and job satisfaction: Testing the mediatory role of positive and negative affect at work. Pers Individ Dif 2008;44:712-22.
Sy T, Tram S, O'Hara LA. Relation of employee and manager emotional intelligence to job satisfaction and performance. J Vocat Behav 2006;68:461-73.
Law KS, Wong CS, Song LJ. The construct and criterion validity of emotional intelligence and its potential utility for management studies. J Appl Psychol 2004;89:483-96.
Wong CS, Law KS. The effects of leader and follower emotional intelligence on performance and attitude: An exploratory study. Leadersh Q 2002;13:243-74.
Cherry MG, Fletcher I, O'Sullivan H, Dornan T. Emotional intelligence in medical education: A critical review. Med Educ 2014;48:468-78.
Varkey P, Peloquin J, Reed D, Lindor K, Harris I. Leadership curriculum in undergraduate medical education: A study of student and faculty perspectives. Med Teach 2009;31:244-50.
Johnson JM, Stern TA. Teaching residents about emotional intelligence and its impact on leadership. Acad Psychiatry 2014;38:510-3.
Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N. Emotional intelligence in medicine: A systematic review through the context of the ACGME competencies. Med Educ 2010;44:749-64.
Fletcher I, Leadbetter P, Curran A, O'Sullivan H. A pilot study assessing emotional intelligence training and communication skills with 3rd
year medical students. Patient Educ Couns 2009;76:376-9.
Carr SE. Emotional intelligence in medical students: Does it correlate with selection measures? Med Educ 2009;43:1069-77.
Carrothers RM, Gregory SW Jr., Gallagher TJ. Measuring emotional intelligence of medical school applicants. Acad Med 2000;75:456-63.
Stoller JK, Taylor CA, Farver CF. Emotional intelligence competencies provide a developmental curriculum for medical training. Med Teach 2013;35:243-7.
Dugan JW, Weatherly RA, Girod DA, Barber CE, Tsue TT. A longitudinal study of emotional intelligence training for otolaryngology residents and faculty. JAMA Otolaryngol Head Neck Surg 2014;140:720-6.
O'Connor PJ, Athota VS. The intervening role of Agreeableness in the relationship between trait emotional intelligence and machiavellianism: Reassessing the potential dark side of EI. Pers Individ Dif 2013;55:750-4.
Ogle JA, Bushnell JA. The appeal of emotional intelligence. Med Educ 2014;48:458-60.
Victoroff KZ, Boyatzis RE. What is the relationship between emotional intelligence and dental student clinical performance? J Dent Educ 2013;77:416-26.
Uchino R, Yanagawa F, Weigand B, Orlando JP, Tachvosky TJ, Dave KA, et al
. Focus on emotional intelligence in medical education: From problem awareness to system-based solutions. Int J Acad Med 2015;1:9-20.
Maren S, Quirk GJ. Neuronal signalling of fear memory. Nat Rev Neurosci 2004;5:844-52.
Lenroot RK, Giedd JN. Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev 2006;30:718-29.
Liston C, Watts R, Tottenham N, Davidson MC, Niogi S, Ulug AM, et al.
Frontostriatal microstructure modulates efficient recruitment of cognitive control. Cereb Cortex 2006;16:553-60.
Tsavoussis A, Stawicki SP, Stoicea N, Papadimos TJ. Child-witnessed domestic violence and its adverse effects on brain development: A call for societal self-examination and awareness. Front Public Health 2014;2:178.
Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, et al.
A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress 2009;22:399-408.
English DJ. The extent and consequences of child maltreatment. Future Child 1998;8:39-53.
Iwaniec D. The Emotionally Abused and Neglected Child: Identification, Assessment and Intervention: A Practice Handbook. West Sussex: John Wiley & Sons; 2006.
Carrion VG, Weems CF, Watson C, Eliez S, Menon V, Reiss AL. Converging evidence for abnormalities of the prefrontal cortex and evaluation of midsagittal structures in pediatric posttraumatic stress disorder: An MRI study. Psychiatry Res 2009;172:226-34.
De Bellis MD, Kuchibhatla M. Cerebellar volumes in pediatric maltreatment-related posttraumatic stress disorder. Biol Psychiatry 2006;60:697-703.
Choi J, Jeong B, Polcari A, Rohan ML, Teicher MH. Reduced fractional anisotropy in the visual limbic pathway of young adults witnessing domestic violence in childhood. Neuroimage 2012;59:1071-9.
Tomoda A, Polcari A, Anderson CM, Teicher MH. Reduced visual cortex gray matter volume and thickness in young adults who witnessed domestic violence during childhood. PLoS One 2012;7:e52528.
Cisler JM, James GA, Tripathi S, Mletzko T, Heim C, Hu XP, et al.
Differential functional connectivity within an emotion regulation neural network among individuals resilient and susceptible to the depressogenic effects of early life stress. Psychol Med 2013;43:507-18.
Sharma R. Measuring social and emotional intelligence competencies in the Indian context. Cross Cult Manag 2012;19:30-47.
Zheng D, Witt L, Waite E, David EM, van Driel M, McDonald DP, et al
. Effects of ethical leadership on emotional exhaustion in high moral intensity situations. Leadersh Q 2015;26:732-38.
Brackett MA, Geher G. Measuring emotional intelligence: Paradigmatic diversity and common ground. In: Ciarrochi J, Forgas JP, Mayer JD, editors. Emotional Intelligence in Everyday life. New York: Psychology Press; 2006. p. 27-50.
Gürol A, Özercan MG, Yalçın H. A comparative analysis of pre-service teachers' perceptions of self efficacy and emotional intelligence. Procedia Soc Behav Sci 2010;2:3246-51.
Vahedi M, Nikdel H. Emotional intelligence, parental involvement and academic achievement. Procedia Soc Behav Sci 2011;30:331-5.
Chan DW. Perceived emotional intelligence and self-efficacy among Chinese secondary school teachers in Hong Kong. Pers Individ Dif 2004;36:1781-95.
Kotzé M, Venter I. Differences in emotional intelligence between effective and ineffective leaders in the public sector: An empirical study. Int Rev Adm Sci 2011;77:397-427.
Yazici H, Seyis S, Altun F. Emotional intelligence and self-efficacy beliefs as predictors of academic achievement among high school students. Procedia Soc Behav Sci 2011;15:2319-23.
McKinley SK, Phitayakorn R. Emotional Intelligence and Simulation. Surg Clin North Am 2015;95:855-67.
Arora S, Russ S, Petrides KV, Sirimanna P, Aggarwal R, Darzi A, et al.
Emotional intelligence and stress in medical students performing surgical tasks. Acad Med 2011;86:1311-7.
Brookings JB, Wilson GF, Swain CR. Psychophysiological responses to changes in workload during simulated air traffic control. Biol Psychol 1996;42:361-77.
Vogt J, Adolph L, Ayan T, Udovic A, Kastner M. Stress in modern air traffic control systems and potential influences on memory. Hum Factors Aerosp Saf 2002;2:355-78.
Gevins A, Smith ME. Neurophysiological measures of cognitive workload during human-computer interaction. Theor Issues Ergon 2003;4:113-31.
Durkee K, Geyer A, Pappada S, Ortiz A, Galster S. Real-time workload assessment as a foundation for human performance augmentation. In: Schmorrow DD, Fidopiastis CM, editors. Las Vegas, NV, USA: Foundations of Augmented Cognition HCI Proceedings; 2014. p. 279-88.
Birks YF, Watt IS. Emotional intelligence and patient-centred care. J R Soc Med 2007;100:368-74.
Wagner PJ, Moseley GC, Grant MM, Gore JR, Owens C. Physicians' emotional intelligence and patient satisfaction. Fam Med 2002;34:750-4.
Weng HC. Does the physician's emotional intelligence matter? Impacts of the physician's emotional intelligence on the trust, patient-physician relationship, and satisfaction. Health Care Manage Rev 2008;33:280-8.