Emotional Intelligence in the Surgical Workplace

Why do certain medical students, residents and attendings outperform their peers? What competencies can surgeons develop besides technical ones? Emotional intelligence (EI or EQ) describes the ability to perceive, understand and manage one’s own and another person’s emotions [1]. The business world has long recognized EI as being meaningful and equally, if not more, important to success than technical and analytical skills. In this article, I aim to introduce the concept of EI and to demonstrate its relevance for surgeons in clinical practice, education and research.

Psychologist and author Daniel Goleman popularized EI in the 1990s and found that successful Fortune 500 leaders were distinguished by high EI [2]. Individuals with high EI seemed to perform better on the job and were more effective leaders. In addition, greater mental health and less burnout were reported. Goleman defined EI by five components: motivation, empathy, self-awareness, self-control and social skills (MESSS).

I have found this rubric useful in understanding why certain surgeons (and anyone, for that matter) seem to be better leaders, mentors and role models. Motivated surgeons with high EI seem driven by a passion to achieve for the sake of achievement. They are motivated more by intrinsic desires to learn, explore and teach than extrinsic goals like money and prestige. Empathetic surgeons have the best bedside manner: these surgeons sit eye-level with patients and take time to learn about their fears and goals. Surgeons with self-awareness are honest, sometimes in a self-deprecating way, with the strengths, weaknesses and emotional states of themselves and others. This quality is perhaps the most important in determining EI and hardest to learn or teach. Surgeons with self-control do not let their emotions dictate their behavior and instruments tend to stay on the Mayo stand. Surgeons with social skills are able to build rapport among diverse groups to achieve common goals. In retrospect, variations in these five qualities may explain how leaders are chosen and why we gravitate towards certain individuals (and away from others).

Studies in the healthcare industry have suggested that high EI can lead to improved doctor–patient relationships, empathy, teamwork and communication skills [3]. Components of EI like empathy have been furthermore linked to higher patient satisfaction scores [4]. Surprisingly few studies have focused on EI in the surgical workplace and more research is needed. Two single-institution studies found that EI scores were above and below-average for general surgery and orthopedic residents, respectively, when compared to national norms [5, 6]. A multi-institutional study observed differences in EI profiles by specialty among surgery, pediatric and pathology residents [7]. In another study [8], general surgery applicants to Stanford took EI tests and their EI scores were compared with their final rank. Of the 10 top-ranked candidates, 6 were among the top 10 for EI; non-ranked candidates had the lowest EI. For all the table-banging occurring behind closed doors, admission committees may actually be judging non-cognitive characteristics like EI. Similarly, ACGME core competencies overlap with EI components [3] and perhaps we should also be characterizing medical students, residents, and even faculty members by EI in performance evaluations.

If EI can be measured, then is it modifiable? Evidence would suggest yes. At the very least, EI increases with age and time (i.e., maturity). In a study of internal medicine residents, EI improved after one academic year which correlated with better performance and lower burnout scores [9]. A study of Taiwanese physicians also demonstrated that EI increased over time [10]. What remains unclear is how to modify EI with specific, targeted interventions. Goleman described a Wall Street executive who sought to improve his EI (specifically: empathy) and employed a personal coach [2]. His coach videotaped meetings, gave detailed critiques and ultimately improved his EI after several months. In this situation, modifying EI required: (i) personal commitment, (ii) significant time investment and (iii) an individualized teaching plan. Innovative approaches like coaching are finding a place in the surgical workplace but have mostly focused on improving technical competence. Future research should also investigate the role of coaching in improving emotional competence.

So what’s the catch to EI? Is it too good to be true? Noteworthy figures like Martin Luther King, Jr. and Winston Churchill undoubtedly had high EIs and accomplished great deeds. But EI has a dark side. Case in point: Adolf Hitler. Individuals can become so good at understanding other people’s emotions that they can manipulate them to act against their own best interests. In fact, EI has been associated with the Dark Triad traits of narcissism, Machiavellianism and psychopathy [11]. A person can be highly motivated, empathetic, self-aware, self-controlled and socially skilled but have completely nefarious, self-serving objectives. EI is “morally neutral” and can therefore be used for good or bad. While the idea of a “dark intelligence” seems lifted straight from Star Wars, I take solace that our profession fundamentally seeks to do good and EI could be used to better achieve those goals.

EI is important for surgeons and trainees to recognize, understand and develop. The surgical workplace is physically, mentally and emotionally challenging and our ability to navigate through those waters affects patients, co-workers and ourselves. As a testament to its increasing relevance in our surgical workplace, EI will be featured at the 2015 ACS Clinical Congress in a panel session (PS411 The Surgeon and Emotional Intelligence: It’s Real and Relevant | Thursday Oct 8^th @ W-375A 9:45-11:15am). Hope to see folks there!

References

1. Colman, A.M., A dictionary of psychology. 3rd ed. Oxford paperback reference. 2009, Oxford ; New York: Oxford University Press. xi, 882 p.
2. Goleman, D., What makes a leader? Harv Bus Rev, 1998. 76(6): p. 93-102.
3. Arora, S., et al., Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Med Educ, 2010. 44(8): p. 749-64.
4. Weng, H.C., et al., The effect of surgeon empathy and emotional intelligence on patient satisfaction. Adv Health Sci Educ Theory Pract, 2011. 16(5): p. 591-600.
5. Chan, K., B. Petrisor, and M. Bhandari, Emotional intelligence in orthopedic surgery residents. Can J Surg, 2014. 57(2): p. 89-93.
6. Jensen, A.R., et al., The emotional intelligence of surgical residents: a descriptive study. Am J Surg, 2008. 195(1): p. 5-10.
7. McKinley, S.K., et al., A multi-institutional study of the emotional intelligence of resident physicians. Am J Surg, 2015. 209(1): p. 26-33.
8. Lin, D.T., A. Kannappan, and J.N. Lau, The assessment of emotional intelligence among candidates interviewing for general surgery residency. J Surg Educ, 2013. 70(4): p. 514-21.
9. Satterfield, J., S. Swenson, and M. Rabow, Emotional Intelligence in Internal Medicine Residents: Educational Implications for Clinical Performance and Burnout. Ann Behav Sci Med Educ, 2009. 14(2): p. 65-68.
10. Weng, H.C., et al., Doctors’ emotional intelligence and the patient-doctor relationship. Med Educ, 2008. 42(7): p. 703-11.
11. Petrides, K.V., et al., Trait emotional intelligence and the dark triad traits of personality. Twin Res Hum Genet, 2011. 14(1): p. 35-41.