2019 HSC Section 2 - Practice Management

Emotional Intelligence and Simulation

used the Wong and Law Emotional Intelligence Scale, a 16-item tool based on an ability conceptualization of EI. In one study, the investigators computed physician EI based on both self-rating and nursing director ratings. 34 Data regarding the patient-doctor relationship was collected both from physicians and nursing directors using the 9-item Patient-Doctor Relationship Questionnaire-9. 35 Postoperatively, however, physician EI did not have a significant correlation with the patient-doctor relationship. Emotional Intelligence in Surgery: Unanswered Questions To summarize, studies of EI in surgery have focused on describing the EI levels of sur- gical residents or surgical applicants. As such, there are multiple unanswered ques- tions with regard to EI and surgery. The first is whether EI is predictive of a surgical trainee’s performance. To the authors’ knowledge, no study has examined whether a surgical resident’s EI corresponds to his or her clinical performance by any measure. In one multi-institutional study, researchers recruited residents from anesthesiology residencies at 5 academic institutions to determine if a correlation existed between resident EI and clinical performance as measured by faculty evaluation of the 6 ACGME core competencies. 36 Only 86 of 339 invited residents completed the study, but researchers concluded that several of the EI scores and subscores were statisti- cally significantly correlated with all 6 of the ACGME core competencies with a modest effect size. These scores were measured using the EQ-i instrument and included total EI score, intrapersonal composite score, self-regard, self-actualization, and stress tolerance. There were no statistically significant gender differences in EQ-i total score, composite scale, or content score aside from empathy, although the investigators did not indicate which gender scored higher. Again, descriptive statistics of the residents as a group were not published, but these findings suggest that given a large enough number of participating resident physicians, EI may have predictive validity for resi- dent physician performance. A second unexplored question about EI and surgery is whether targeted EI develop- ment leads to improved clinical performance. There are at least 2 approaches to the selection and design of an EI development program. One could first assess the base- line EI characteristics of surgical residents and then specifically address areas of low development. This strategy embraces the view that well-rounded development would aid clinical performance by arming residents with the skills and confidence in EI stra- tegies they are less comfortable with or inclined to use, in essence increasing the number of tools at their disposal when encountering the diversity of emotionally demanding hospital scenarios. Another approach to selecting EI targets for develop- ment is to determine which areas of EI most correlate with strong clinical performance and then design educational programming intended to augment these particular areas regardless of a group’s baseline EI profile. This method reflects the view that well roundedness in itself may not be essential to superior performance; rather, specific traits are more essential than others in enabling clinical effectiveness. It remains to be seen whether EI development does indeed lead to gains in clinical performance and whether there is an optimal strategy in choosing EI targets. A third frontier in EI research is the role that simulation would have in EI develop- ment, if any. The remainder of this article is devoted to outlining the benefits that simu- lation may bring to EI development, exploring the variety of forms in which simulation might support the development of EI, and reviewing the evidence that simulation may be an effective way to augment EI development with the ultimate goal of improved clinical performance.

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