Educational interventions to improve emotional intelligence of health professions students

Abstract

Emotional intelligence (EI) is an asset in health professionals supporting resilience, job satisfaction, interprofessional collaboration, and improved health outcomes for patients. Emerging research in health professions education shows that self-reflection and peer feedback, simulation, and experiential learning may contribute to the development of EI. The evidence indicates that training should be incorporated longitudinally throughout the educational process with increasing complexity and challenge. Several contextual factors may support success, such as framing the learning activities as opportunities for growth, adequate faculty and instructor training, and establishment of trusting relationships.

Health care is becoming increasingly specialized and complex. Health professionals, including physicians, nurses, rehabilitation specialists, clinical social workers, and other professionals who work in patient care, need to be able to work together effectively and efficiently. An interprofessional approach supports improved patient outcomes and organizational cost savings.¹ Facilitators of interprofessional collaboration include effective communication, conflict management, trusting relationships, and team members who are accountable, compassionate, and empathetic.¹ These skills and traits are aligned with the concept of emotional intelligence (EI).

EI is the ability to recognize and manage one’s own emotions, be attuned to the emotions of others, and use this awareness and self-regulation to effectively manage relationships.² EI is characterized by accurate self-awareness, trustworthiness, achievement orientation, adaptability, optimism, and empathy. People with high EI demonstrate productive behaviors such as actively seeking and providing feedback, managing conflict, and fostering teamwork.³ EI promotes individual success and has been linked to academic and clinical achievement.⁴ Health professionals with higher levels of EI demonstrate better resilience and coping skills, higher rates of job satisfaction, and reduced burnout.⁵ They also demonstrate enhanced caring behaviors, positively impact patient-centered care and patient satisfaction levels, and improve team performance,^4,5 thereby impacting health outcomes for patients.

Despite evidence that EI is associated with a range of desirable outcomes, instruction in emotional awareness, emotional regulation, and relationship management is limited in prelicensure health professions education⁶ and may result in graduates lacking the necessary skills to provide effective interprofessional collaborative care within teams. EI skills are accepted as crucial to leadership training and typically included as part of advanced leadership programs, but EI is not routinely included in the prelicensure curriculum due to extensive requirements, lack of time, and concerns about appropriate timing.^6,7

Skills and behaviors associated with EI can be taught and can be improved. In the health professions, it has been observed that EI increases with age, experience, and training broadly.^4,8 Despite this, the trajectory of EI development throughout the educational process is not yet clear, with some studies showing a decline over time or no association with the level of training.⁸ Studies of EI educational interventions in health professions programs have shown mixed results, with some showing positive results and others showing no change resulting from an intervention (Table 1).^4,8–14 Below are examples of learning activities that have been effective in improving domains of EI.

Table 1.

Sample of variable findings of EI interventions in health professions education

Study	Measurement tool	Findings
Aguilar-Ferrándiz et al, 202411	Trait Meta-Mood Scale 24	Significant change in EI for nursing and physical therapy students, but not occupational therapy students, following coaching to improve EI skills
Gribble et al, 20178	Emotional Quotient Inventory	No significant change overall in EI following clinical placements in occupational therapy, physiotherapy, and speech pathology students, although individual students demonstrated large variability with both positive and negative changes
Gribble et al, 20194	Emotional Quotient Inventory	Significant change in EI in physical, occupational, and speech language pathology students following clinical placement compared with a control group of business students with no clinical training
Pades Jiménez et al, 202312	Trait Meta-Mood Scale 24	No significant differences in EI for physical therapy students who received EI-specific content
Raut & Gupta, 201913	EI scale	Significant increase in EI following a 3-month EI intervention consisting of self-assessment and reflection and peer observation and feedback for undergraduate medical students
Yoong et al, 202314	Trait Meta-Mood Scale 24	Significant improvement in EI for nursing students following participation in 2 palliative care simulations

EI indicates emotional intelligence.

INTERVENTIONS

Self-reflection and peer feedback

One or two 4-hour workshops in the programs of nursing, physical therapy, and psychology were incorporated to address EI development with modeling of EI behaviors and learning activities such as self/peer-assessment and reflection assignments. A questionnaire assessing the ability to reflect on and manage one’s emotions showed a significant difference between scores of students early compared to late in the program in understanding emotional states but not in the ability to express or regulate feelings appropriately.¹² Conversely, participation in an optional program designed to improve EI for medical students in their final year showed a more robust change, with significant improvements in a global EI measure for medical students.¹³ The program consisted of a 3-hour training workshop followed by weekly self-reflections and monthly peer feedback sessions focused on emotions/behavior over 3 months. Additional analysis of high and low scorers at the conclusion of the study found that facilitators to participation in the activities included self-motivation, openness to new things, and ability to choose their peers; the primary barrier to participation was a lack of trust in peers. These examples indicate that self-reflection and peer feedback could be effective strategies for the development of EI in health professions students, although motivation to improve and trusting peer relationships are required and using these activities longitudinally in daily life may be needed to effect change.

Simulation

A chronological, four-part palliative care simulation scheduled in two sessions a week apart for nursing students with activities focused on building empathy, navigating difficult conversations, managing conflict, and providing bereavement support resulted in significant improvements in EI across domains of emotional perception, understanding, and regulation.¹⁴ In a study of nursing students in their final clinical placement looking to understand the impact of simulation on the transfer of clinical judgment skills to the clinical practice setting, one theme that emerged was the impact of EI learning; students reported that the challenge of the simulation prepared them to make decisions in stressful circumstances.¹⁵ These examples demonstrate that simulation may be a valuable tool, especially in the domains of self-awareness and self-regulation of emotion. Simulation provides a challenging, emotionally charged space with time to effectively process these emotions with facilitated guidance and may transfer to the clinical setting.

Experiential learning

Clinical placements may have a significant role in the development of EI. In a study in occupational therapy, physical therapy, and speech and language pathology students, learners demonstrated a significant change over time compared with a control group of business students who did not have clinical placements as part of their curriculum.⁴ Improvement was not universal, though, with some students showing a decline, which may indicate that the role of the clinical supervisor is important in facilitating growth.⁴ This idea is supported by qualitative data from students who identified several clinical instructor factors that contribute to their EI development, including modeling EI behaviors, providing a supportive environment, giving specific feedback and help for improvement, and discussing emotions relevant to clinical encounters.⁶

RECOMMENDATIONS FOR EDUCATORS

Although the literature on EI training in health professions students is limited, the evidence is beginning to provide direction on what learning activities, settings, and other contextual considerations may be effective in promoting EI in health professions education.

The two learning activities frequently used to improve EI are self-reflection and external feedback from peers, faculty, or clinical instructors. Self-reflection allows students to develop improved awareness of their own emotions and behavioral responses to various situations and increases awareness of how others are feeling. Feedback from others provides students additional insights into how they are perceived. Improved understanding of external self-awareness can be used to identify coping strategies for managing emotionally difficult situations, improve relationships, positively influence others, and increase team effectiveness. Self-reflection and external feedback are most successful in improving EI when several contextual factors are accounted for.

1. Self-motivation. Framing self-reflection and feedback as opportunities for growth is important, as students who are motivated for growth and open to new things benefit the most from these activities. Students who initially reported feeling apprehensive about giving and receiving peer feedback felt more confident when they came to understand that the activities served as opportunities for self-improvement and a way to help their peers.¹³

2. Skilled instructors. Faculty and instructors in the clinical setting should be actively involved in their own self-reflection and feedback loops and should model desired behaviors. Students reported that observation of a clinical instructor with high EI is effective in supporting their EI growth.⁵ Students not only require feedback on their practical skills and clinical reasoning but also need time to process their feelings, emotional perspectives, and how these may be impacting their actions. Instructors who can effectively facilitate this process can help improve EI for their students. Faculty and clinical instructors should have training in providing feedback. Students reported that having clinical instructors who provide feedback that is specific and noncritical is helpful for their EI growth.⁵

3. Trusting relationships. Students reported that participation in peer feedback is facilitated by choice of partner and that lack of trust is a barrier to participation in peer feedback activities.¹³ Qualitative learner data showed that positive experiences for growth on clinical placement occurred when students had a trusting relationship with their supervisor.⁵ Fostering educational communities where trusting relationships can flourish is important for successful EI interventions. This may include allowing space for people to get to know one another personally and setting cultural norms for behavior around respect and accountability. Students should be provided training in giving and receiving feedback in ways that will promote trust and facilitate success.

Once the contextual factors underpinning the learning activities of self-reflection and external feedback have been considered, the setting and timing should be considered. As with clinical skills, EI skills should be continually developed over one’s professional career. As such, training for EI skills should be initiated early, built throughout the curriculum, and encouraged as a lifelong process (Figure 1). Self-reflection and feedback should first be implemented within the classroom setting and then progress to more emotionally difficult situations. Simulation as a next step can provide a more challenging learning experience in a safe environment with time for faculty-guided debriefing. As a final step in the formal education process, EI learning activities should be implemented with structured support in the clinical setting where authentic experiences provide increased demand with real-life stressors and conflict.

Figure 1.

Building emotional intelligence skills in health professions education.

In conclusion, high EI is desirable in health professionals, as it has significant individual, patient, and team benefits. As EI has been shown to be important in supporting optimal interprofessional teamwork, patient outcomes, and fulfilling careers, the development of EI in health professions education students should be a priority. Training for EI skills should be initiated early in the educational continuum and continued longitudinally, with increasing challenge for maximum growth. To ensure success, several foundational contextual factors should be considered, such as framing the learning activities as opportunities for growth, training faculty and clinical instructors, and fostering a culture that builds trusting relationships.

DISCLOSURE STATEMENT

The authors report no funding or conflicts of interest.