Hanscarl Leuner – Emotional intelligence and emancipation (1966)

Daniel Goleman – Emotional Intelligence (1995)

Peter Salovey and John Mayer – Emotional Intelligence (1990)

Harold Gardner – Frames of Mind: The Theory of Multiple Intelligences (1983)

Wayne Payne – Study of Emotion: Developing Emotional Intelligence; Self- Integration; Relating To Fear, Pain And Desire (1985)

He is one of the quieter residents and typically flies below the radar on shifts.  He is not overly emotional and is one of the more soft-spoken residents.  When he meets with the program director, Lara, he is unaware of the reason.

“Thank you for meeting with me Omar. We need to review your performance over the past few weeks in the emergency department as there were some comments made by patients and nurses about your interactions with them.  Were you aware of any difficult situations over the past few weeks when you were working in the department?” asks the program director.

Omar is not sure how to respond.  “Not really, what kind of comments?”

The program director hands him a piece of paper with the following comments:

Patient Complaint 1

“The resident didn’t listen to me”

Patient Complaint 2

“He didn’t seem very happy to be there and was rude”

Nursing Complaint

“Omar is consistently dismissive of suggestions made by nursing staff and does not communicate his plans effectively.”

How can the theories of Emotional Intelligence help us to understand the current situation?

Emotional intelligence is an umbrella term describing the processes of cognitive awareness and flexibility in human interaction.  At its peak, it refers to a high level of emotional discrimination and the synergistic ability to use that information to respond in an empathic manner.

Emotional Intelligence (EI) was first described in child psychology literature^[1] in 1966 and later popularized in the 1980s when EI or ‘EQ’ (Emotional Quotient) was introduced as a way to explain cognitive ability in contrast to the traditional “IQ”.^[2],[3]  While viewed with skepticism by academic psychologists initially, the framework took hold in popular culture.  Now used by large businesses and leaders to improve the processes and function of their workers, the framework continues to be refined through various models.

Three of those models of emotional intelligence exist; the ability model, the mixed model, and the trait model.^[4],[5],[6]

The ability model, described by Peter Salovey and John Mayer in the late 1980s, addresses four levels of emotional intelligence:

1. perception and expression of emotions accurately,
2. utilization of emotions to facilitate thinking,
3. understanding and analyzing emotions, and
4. regulating and managing emotions appropriately in yourself and others.^[7],[8]

Subject to the largest number of research studies, it has been criticized for poor practical outcomes and correlation with other measures.^[9]  Other models have subsequently shown better predictive value^[10].

The mixed model, described by Daniel Goleman in the 1990s, identifies characteristics of emotional intelligence that drive leadership performance, namely:

• self-awareness,
• self-regulation,
• social skill,
• empathy, and
• motivation

The characteristics are interconnected: for example, as one becomes more self aware, they are better able to regulate their emotions and social skills. The subject is better able to manage stressful situations and interpersonal conflicts, and the subsequent success is self propagating. This model and its author is the basis of the popularity of the EI framework, through his book ‘Emotional Intelligence’ (1995).  This model, and Goleman’s approach in general, has also received a large amount of criticism due to the the lack of a consistent relationship between his pillars of EI and participant performance.  When EI has been studied with general intelligence and personality controlled, It’s effect has been muted^[1]/^[2]

The trait model, described by Konstantino V. Petrides in the 2000s, describes EI as a personality framework and refers to an individual’s perception of their own emotional abilities.^[3],[4] Developed more recently, the trait model elucidates central parts of the mixed model while rejecting the ability model’s behavioral focus.  By focusing on personality traits, the model requires self-assessment and is highly reliant on the self-awareness of individuals to effectively judge a subject’s personality.  In medical students, it has been shown to be more effective as a measure of personality than the ability model.^[5].

The work studying EI in the era of virtual interaction is an embryonic science^[1].  As distance education becomes increasingly prevalent, understanding how EI might manifest in virtual or online communities will be of great importance.  While not directly studied in medicine, multiple studies^[2]/^[3] have shown that EI is relevant to effective leadership in the virtual world.  Strong communication skills where visual cues may not be apparent are more vital to the success of groups.  Work on a new framework of virtual EI is ongoing.

Perceiving emotions: More eye contact leads to more effective communication.

Physicians who looked more frequently at patients were more successful in recognizing psychological distress.^[1]  

The primary way we read emotions is non-verbal; <10% is spoken word, ~40% verbal tone, ~50% facial expression.^[2]  Similarly, patient satisfaction was most strongly correlated to emotional expressive nonverbal behavior on the part of the clinician.^[3]

Physicians who were better at expressing their emotions had patients who rated them as listening more and being more caring and sensitive than those doctors who were less good at this.^[4]

Labeling patient’s emotions can help with empathy.^[5]  Starting an interview with a patient who is visibly upset may be best managed by labeling this emotion.  Physicians infrequently use emotional language and a conscious effort may need to be used among physicians.^[6]

Positive and negative emotions are contagious in the group setting and particularly when demonstrated by the leader of a group.^[7]  This can be particularly important in the clinical setting when working in teams; specifically in a resuscitation or crisis event.

1. Mayer, J.D.; Salovey, P.; Caruso, D.L.; Sitarenios, G. (2001). “Emotional intelligence as a standard intelligence”

This paper lays forth the opinion of that the ability model of EI has validity as a form of intelligence. They review the key tenets of intelligence, frameworks of abstract reasoning, as well as emotions, complex mental responses to physical and cognitive stimuli. They discuss criticisms of their work as well as the data and literature that support their work.  In particular, they spend time discussing how there can be objective answers to emotional questions that arise aside from general consensus.

2. Cartwright, Susan, and Constantinos Pappas. “Emotional intelligence, its measurement and implications for the workplace.” International Journal of Management Reviews 10.2 (2008): 149-171.

This article attempts to remove the popular hype that accompanies the theory of EI and find concrete evidence of where it works to improve workplace performance and where it doesn’t.  They begin by discussing the view of emotion in workplace functionality.  It initially was viewed negatively, as constructs that interrupt the inherently rational exercise of business.  They then review the models of EI and how they pertain to the workplace.  Also, they also make note of the common criticism that EI has become commercialized and the number of tools that evaluate it are so innumerable as to make formal research and conclusions about the framework difficult.  There is also concern that many of the measures are reliant on self-assessment, which are prone to error and intentional distortion.  Regardless, the meat of the article is a review of the literature, which reveals positive correlations between EI and workplace performance, leadership effectiveness, openness to change and effectiveness in service encounters.  Similarly, there are also negative correlations between EI and dysfunctional behaviors.

3. Brannick MT, Wahi MM, Arce M, Johnson HA, Nazian S, Goldin SB. Comparison of trait and ability measures of emotional intelligence in medical students. Med Educ. 2009 Nov;43(11):1062-8.

For those who wish to use EI in the health care educational setting, there is a limited but real fund of literature.  This particular study attempts to evaluate if either the ability or trait measures of EI is more highly correlated to conventional personality characteristics (neuroticism, extroversion, openness to new experiences, agreeableness and conscientiousness). It also attempts to study if measures of trait and ability EI correlate to each other. In this study of medical students, it was found that the trait measure of EI (in this case a test known as WLEIS) correlates to the aforementioned personality traits better than the ability measure. The measures of trait and ability EI do not correlate, leading to a concern that while they describe similar phenomena, they may not actually measure the same underlying construct. Finally, the reference list of this article is the best source of studies looking at EI in the field of medical education that could be found.

Lara questions Omar if he recognizes his current body language, and what he is indicating. Omar is embarrassed and admits that he has struggled with social interaction all his life, as that it does not come naturally to him. Omar admits that he wants to improve, and continues to add that he is not interested in seeking a therapist. Omar states that his adviser in medical school attempted multiple times for him to seek mental health treatment, but Omar did not want any associated stigma.

Surprised that mental health was the only suggestion previously offered, Lara asks Omar if he has done any readings on emotional intelligence. Lara then has a heart-to-heart with Omar.

At the conclusion of their discussion, Omar gladly accepts the opportunity to lead a 30 minute talk on emotional intelligence during the residency’s weekly conference. Omar is  expected to review current literature and provide a succinct talk on methods that physicians at all levels can implement.

They also agree to set up weekly assignments to improve his interactions. His first assignment is to maintain eye contact, for at least a short period of time, with every patient encounter. His second week task is to add shaking the patient’s hand upon introducing himself, sitting down next to his patients, and be cognizant about crossing his arms. His final goal is to verbally express emotions.