Preparing Future Physicians for the 21st Century
By Susan F. Franks, PhD, David Farmer, PhD, and Janet Lieto, DO
The University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic MedicineDepartment of Family Medicine and Osteopathic Manipulative Medicine, Department of Medical Education
Now more than ever, the most satisfying aspect of care—interacting with and helping patients—is overshadowed by the complexities of the modern-day practice of medicine. Your day may be more focused on interacting, coordinating, and making decisions with numerous ancillary people and various entities and stakeholders than the person before you who is seeking care. Coordinating your team and the administration of your practice demands independence, leadership, communication, and organizational skills. As the practice of medicine has evolved, you have progressively faced cumbersome EMRs, nuanced billing and coding expectancies, misinformation that patients get from the Internet, and varying organizational expectations. The on-going evolution of practicing medicine places further demands on the skills of flexibility and stress tolerance.
But perhaps the most subtle transformation in medicine is the increased necessity of creating and maintaining interpersonal relationships. The traditional circle and hierarchical approach of running a practice in the past has transformed into collaborative partnerships with patients, families, colleagues, consultants, administrators, and other key stakeholders. At times you are required to be a team leader, at times a team member. You must still attend to patients and provide expert counsel and education, all the while dealing with interruptions, personal agendas, and a vast array of different communication and personality styles. All your responsibilities are expected to be fulfilled with confidence, respect, professionalism, and above all, treatment effectiveness and a gracious attitude of sharing in successful outcomes, but while still bearing the burden of responsibility when things fall short. You must approach each day with an appropriate balance of assertiveness and impulse control, objectivity and optimism, and emotional expression and empathy.
The twenty-first century physician is immersed in a continually evolving interprofessional, team-based environment where medicine is delivered under an often-fragmented system of care.1 The traditional patient-physician dyad has expanded to encompass a wider net of individuals, all of whom must be integrated to meet clinical outcomes, patient satisfaction, and fiscal demands. Added to this is the increasing awareness of inequities in medical care, an explosion of public access to medical information and misinformation, cost-control strategies, and the politicization of medicine, adding enormous complexities to the primary task of simply caring for the patient sitting before you.
Never has the practice of medicine and the expectations of the people involved in every aspect of it been more dependent on the social and emotional skills of the physician than they are today. This is a world that the doctors of the future must be prepared to enter. A world where cognitive intelligence is not the only predictor of success. A world that depends on the emotional intelligence of the physician for the system to function effectively.
What is Emotional Intelligence?
Emotional intelligence (EI) is a set of social and emotional skills that collectively establish how well we perceive and express ourselves, develop and maintain social relationships, cope with challenges, and use emotional information in an effective and meaningful way.2 EI skills are also associated with the development of empathy, self-awareness, motivation, emotional control, and effective communication.3,4 Compared to people with low EI skills, individuals with high EI perceive, understand, and manage emotions better, are less likely to engage in problematic behavior, and have more positive social interactions.5 Individuals with high EI skills also report lower perceived stress, are highly adaptable, and are more successful in leadership.6
Never has the practice of medicine and the expectations of the people involved in every aspect of it been more dependent on the social and emotional skills of the physician than THEY ARE today.
Several models of EI have been introduced, but all are founded on four related fundamental skills: self-awareness, self-management, social awareness, and social management.7 To best manage your behavior, you must first be aware of your emotional states. People with low self-awareness may have difficulty distinguishing between the nuances of feelings, for example the difference between irritability and anger. They may display emotions that are out of proportion to the situation and have difficulty recognizing that their response may not be appropriate. This places them at risk of not being able to maintain mutually respectful relationships, tolerate frustration, be a collaborative member of a team, or create an environment of psychological safety expected from a good leader. Interestingly, 95 percent of people believe that they are emotionally self-aware, but only 10–15 percent are.8 In contrast to earlier beliefs, we now know that the skills of EI can be taught and improved.9
Emotional Intelligence in Medical Education
Many students entering medical school do not have mature development in interpersonal and communication skills (ICS), particularly in dealing with patients and interprofessional relationships. Competency in ICS is woven throughout Entrustable Professional Activities (EPAs) that are being taught in medical schools. As teamwork becomes increasingly important in medical care and decision-making, physicians of the future need to be poised to collaborate so they can achieve the best patient outcomes. Teams with high EI can create a shared vision and achieve results through mutual trust that is fostered through empathy, flexibility, and other key social and self-regulation skills. Furthermore, EI has been found to predict psychological well-being, life satisfaction, and success in collaborations and interpersonal relationships. It enhances higher level thinking through the development of advanced cognitive strategies used to understand and respond to others, thereby improving diagnostic and therapeutic decision making.3,10 Alarmingly, when unattended, EI may diminish throughout medical training, contributing to reduced resiliency and the increased number of residents entering the profession feeling burned out.11,12 EI is now more widely considered to be an essential skill set for medical student development.13
At the Texas College of Osteopathic Medicine (TCOM), we promote the progressive development of emotional and social self-awareness by having medical students reflect on their EI skills and establish targets for growth. They work with an accountability partner to identify progress and areas needing improvement. It is often during clerkships that the social, emotional, and behavioral skills associated with EI are most observable and can provide a deeper understanding of why a student might be experiencing difficulties. Preceptors and residents give feedback on professionalism, teamwork, and interpersonal communication, helping students explore their use of EI skills. For example, a student who is overoptimistic may miss preceptor comments and clues indicating a need for improvement. They are then caught off guard at the summative performance evaluation when they rate lower than they anticipated. Progressive guidance in targeted EI skill growth can help students manage pertinent skills effectively.
TCOM’s Integrated Emotional Intelligence Curriculum
In the TCOM curriculum, we integrate educational activities to improve the skills of EI. We start with a baseline assessment during the first week of their Medical Practice class using a well-established self-report assessment of EI called the EQi-2.0.®14 A student’s results are explained, and the student is introduced to the basics of EI and given a framework that emphasizes how EI skills are applied to patient care, teamwork, leadership, and personal well-being.
Activities to develop EI are strategically integrated into our Medical Practice course curriculum, which teaches students to gather health information and perform appropriate physical examinations, acquire competency in Osteopathic Manipulative Medicine, and apply knowledge and skills to patient encounters. Topics begin with a focus on self-care and the use of the EI skills of flexibility, optimism, and stress tolerance to aid in adjustment to the rigors of medical school. Students later examine the role of emotional self-awareness, self-expression, and empathy as applied through standardized patient encounters. As students engage in small-group learning, EI skills of teamwork and leadership are introduced, and students rotate leading their team. In one particularly cogent activity, students each select a respected faculty physician as a model of emotionally intelligent leadership.
When students approach Year 2 board exams, we advance their stress management skills toward peak performance, and they evaluate their balance of optimism and reality. In the Professional Identity and Health Systems Practice Course, EI aids students in the development of professional identity and in management of that identity as they contemplate how they will fit into the healthcare system as an osteopathic medical student, a resident, an attending, and a life-long learner. EI is reassessed prior to the clerkship year to identify their progress and areas in need of further improvement. It is then revisited in the Family Medicine Clerkship, with a focus on patient care and interprofessional collaboration. Throughout the integrated EI curriculum, evidence-based principles of social learning and cognitive-behavior strategies help promote lasting change.
EI development can help physicians navigate the intra- and interpersonal complexities of the practice of medicine in areas not directly related to technical skill or medical knowledge.13,15 EI is a significant part of clinical competence and is tied to increased patient satisfaction, because it affects a physician’s ability to understand and relate to emotional barriers that patients experience.16,17 In support of the patient, EI can also increase the effectiveness of the healthcare team. In support of the healthcare team, EI can help reduce burnout through the development of resiliency, psychological safety, and mutual support. A focus on personal well-being can include EI development for improved resiliency, personal relationships, and work-life balance. With this understanding of the nature of EI, educational strategies are being utilized to prepare high EI physicians for the challenges of the twenty-first century.
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