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editorial
. 2024 Nov 7;35(1):523–530. doi: 10.1007/s40670-024-02209-3

A Practical Guide for Improving and Evaluating the Components of Emotional Intelligence in Healthcare Students

Antonios Christodoulakis 1,2,✉, George Samonis 3,4, Ioanna Tsiligianni 1
PMCID: PMC11933500  PMID: 40144086

Abstract

Emotional intelligence (EI) is essential for healthcare professionals as it can improve their overall performance at multiple levels. However, healthcare professionals do not adequately improve their EI during their university education. Therefore, in this perspective article, we present a practical guide for teaching and evaluating the components of EI in healthcare students, and the most common challenges/barriers for implementing EI to healthcare education curricula. The guide includes teaching methods and at least one validated questionnaire to improve and evaluate each of the five components of EI as described by Goleman: self-awareness, self-motivation, self-regulation, empathy, and social skill. In conclusion, this guide could help healthcare educators enhance the EI of their students.

Keywords: Emotional intelligence, Improving, Teaching methods, Components, Evaluating

Introduction

In the past, traditional medicine suggested that healthcare professionals (HPs) should maintain an emotional distance from their patients to remain objective [1]. Lately, there has been a significant shift towards a more empathic approach that aims to break down communication barriers, build better relationships, and improve shared decision making between HPs and their patients [2, 3]. Therefore, HPs are now focused on building partnerships through good communication with their patients to improve care, satisfaction, and mutual understanding [3]. However, building such partnerships and communication requires high levels of emotional intelligence (EI), among HPs [4].

Salovey and Mayer were the first to propose the concept of EI and defined it as “the ability to monitor one’s own and others’ feelings and emotions, to discriminate among them, and to use this information to guide one’s thinking and actions” (p. 189) [5]. Goleman expanded on Salovey and Mayer’s [5] theory that EI also has five components: self-awareness, self-motivation, self-regulation, empathy, and social skill [6, 7]. By definition, higher EI is essential for HPs, as it can improve their overall performance at multiple levels [3].

Studies on the EI in healthcare students have emphasized its significance in healthcare education [8]. HPs with higher EI have better social adaptation, team efficacy, and resilience to stress and other environmental pressures [3]. Furthermore, higher levels of EI improve doctor-patient relationships, teamwork, communication skills, stress management, organizational commitment, and leadership [9]. EI has also been associated with higher levels of critical thinking and better handling of emotionally charged situations [4]. Therefore, improving EI is crucial to the well-being and performance of HPs [2]. However, they do not adequately improve their EI during their university education, since relevant issues are not included in the curriculum [10, 11]. Moreover, certain studies propose that healthcare students, despite the rigorous nature of their education, might demonstrate lower levels of emotional intelligence in comparison to students in other fields (i.e., paramedical students) [8, 12]. Consequently, studies have suggested the need to systemize the development of EI in healthcare students [2, 13, 14]. On the other hand, there are still concerns about the inconsistencies in its integration and how to measure it in healthcare education curricula [8].

A guide with teaching methods that develop the EI of healthcare students could help educators, worldwide, optimize and systemize the process. Thus, in this perspective article, we present a practical guide, with teaching methods that target Goleman’s EI components: self-awareness, self-motivation, self-regulation, empathy, and social skill [6, 7]. Moreover, the components are arranged in a logical order, highlighting the most suitable teaching methods for each component, to more effectively develop the EI. Furthermore, in Table 1, we present short descriptions of the suggested teaching methods. Since educators could wish to evaluate the effectiveness of their teaching methods, we also provide some examples of validated questionnaires for each component (Table 2), and potential barriers and challenged for implementing EI in healthcare education curricula. It should be noted that this guide was based from our teaching experiences as healthcare educators.

Table 1.

Short descriptions of the suggested teaching methods for each component of emotional intelligence

Component of emotional intelligence Teaching method Short description
Self-awareness Reflective writing Focus on emotional intelligence in medical education: from problem awareness to system-based solutions Students write their perspective of a clinical situation, putting beliefs, actions, and emotions on paper, and evaluate them. The educator can provide feedback to students upon request without criticizing their actions
Case studies with group discussions Present emotionally challenging clinical situations, ask students how they would react, divide students into groups, and encourage them to discuss how they feel and how they would approach such situation
Self-motivation Learning contracts A learning agreement between educator and student that allows students to complete their assignments at their own pace
Self-assessment Using the learning contract as reference, students can assess their progress/completion of assignments
Cooperative learning Small-group activities/assignments that foster critical thinking, effective communication, and self-accountability in students
Self-regulation Flipped classroom Students receive study material before class, afterwards in class, educators use active learning teaching methods (e.g., problem-based learning, group discussions) to help students better understand the material
E-portfolio Encourage students to create a file (portfolio) that includes their objectives/milestones, and accomplishments. By evaluating and comparing among them, students get a sense of progress and accomplishment
Reflective-writing Students can improve their ability to revise and evaluate their progress by writing about it and reflecting on it. Reflective writing can also be used in conjunction with e-portfolios as reference points
Empathy Case studies Present real-life situations with emotional challenges and encourage students to analyze, understand, and reflect on their response to a similar situation
Simulation training Facilitate student empathy towards patients by providing realistic, interactive simulations of case studies within a secure and controlled learning environment
Social skill Interprofessional education Collaborate with educators of other healthcare universities and co-present common subjects; furthermore, assign students from different proffesions to groups and and provide them collaborative tasks to achieve specific learning objectives
Brainstorming sessions Gather students to generate a pool of ideas in a non-judgmental environment
Learning excursions Visit and explore with students’ real-world clinical settings that stimulate their learning by providing real-life examples related to each lesson’s objective
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Table 2.

Example of questionnaires for measuring each component of emotional intelligence

Component of emotional intelligence Name of the questionnaire Authors Year Items Point system Scores’ meaning
Self-awareness Self-Awareness Questionnaire (SAQ) [15] L. Hughes, S. Betka and M. Longarzo 2019 28 5-point (Likert) The sum of the responses of all 28 items provides a score ranging from 28 to 140 with higher scores indicating higher levels of self‐ awareness
Situational Self-Awareness Questionnaire (SSAQ) [16] J. M. Govern and L. A. Marsch 2001 9 7-point (Likert) The total SSAQ score is the sum of the responses of all 9 items providing a range of 9 to 63 with higher scores indicating higher levels of public and private self-awareness
Self-motivation Academic Motivation Scale (AMS) [17] R. J. Vallerandet al 1992 28 7-point (Likert) The total AMS score is the sum of the responses of all 28 items providing a score range of 28 to 196 with higher scores indicating higher levels of academic motivation
Motivated Strategies for Learning Questionnaire (MSLQ) [18] P. R. Pintrich and E. V. De Groot 1990 44 7-point (Likert) The MSLQ assesses college students’ motivational orientations for a college course. The total scores range from 44 to 308 and higher scores indicate higher motivational orientations
Self-regulation Learning Self-Regulation Questionnaire [19] G. C. Williams and E. L. Deci 1996 13 5-point (Likert) The sum of the responses of all 13 items provides a score ranging from 13 to 65 with higher scores indicating higher levels of learning self-regulation
Self-Regulated Learning Questionnaire [20] E. Oz and H. S. Sen 2018 39 5-point (Likert) The sum of the responses of all 39 items provides a score ranging from 39 to 195 with higher scores indicating higher levels of learning self-regulated learning
Empathy Jefferson Scale of Empathy [21] M. Hojat et al 2001 20 7-point (Likert) The sum of the responses of all 20 items provides a score ranging from 20 to 140 with higher scores indicating a more profound empathic orientation in the caregiver-patient relationship
Questionnaire of Cognitive and Affective Empathy [22] R. L. Reniers et al 2011 31 4-point (Likert) The sum of the responses of all 31 items provides a score ranging from 31 to 124 with higher scores indicating higher cognitive and affective empathy
Social skill Social Skills Inventory [23] R. E. Riggio 1986 90 5-point (Likert) The sum of the responses of all 90 items provides a score ranging from 90 to 450 with higher scores indicating higher social competence
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For all questionnaires, the Cronbach alphas were > 0.7, indicating good reliability [24]

Self-awareness

Self-awareness is the cornerstone of developing all other components of EI. It is defined as “a psychological situation in which people know their traits, feelings, and behaviors” (p. 6) [25]. In order to cultivate self-awareness, students should learn to acknowledge how their emotions mould their actions, how these actions impact patients and colleagues, and how physicians’ values, necessities, motives, and attitudes impact their medical practice [26]. Therefore, teaching methods that help students acknowledge their emotions and examine their values could improve their self-awareness, and prospectively the care they will provide.

Reflective writing and case studies with group discussions of clinical experiences are two teaching methods that could help students develop their self-awareness. The reflective writing teaching method translates to students writing down their perspective on a clinical situation, which puts their beliefs, actions, and emotions on paper as an essay [27]. Subsequently, the educator requests from students to self-evaluate their essays as external observers of the situation (what did they do, why, and what would they do differently) [27]. Finally, if the students wish, they could ask the educator to study their essay and provide his/her points of view and/or reflections/suggestions without criticizing the actions of the students. It should be noted that reflective writing can be used in conjunction with case studies or individually [27].

Educators can use case studies to improve self-awareness by presenting emotionally challenging clinical situations to the class: for example, dehumanization of patients by other HPs, rude behavior by HPs/patients/caretakers, informing patients of bad news, etc. [26]. Afterwards, educators could ask students how they would behave and react to those situations and why. In this step, educators could use reflective writing to help students better understand the situation. Subsequently, educators could divide the class into groups and ask them to discuss how the case made them feel and what they would do differently. Lastly, the educator could ask each group to present their findings to the entire class and wrap it up by giving their own insights/solutions about the situation.

Cultivating self-awareness can empower future HPs to demonstrate greater forbearance towards their patients [26, 28]. This could contribute to reducing discrimination against their patients, particularly towards elderly and impoverished individuals, and stop avoiding “high-risk” patients and procedures [26, 28]. In summary, improving the self-awareness of healthcare students can be advantageous for future HPs, as it can improve their clinical judgment, focus, and patience [26, 28].

Self-motivation

Developing self-motivation is the next component that educators should focus on after self-awareness [25]. According to the Self-determination Theory (SDT), motivation can be distinguished into two types, intrinsic and extrinsic [29]. Intrinsic motivation is observed when one engages in an activity out of genuine interest and is truly self-determined. Extrinsic motivation is observed when one engages in an activity for a particular benefit or because of pressure from others [29]. Intrinsic motivation is considered the desired type of motivation in students and has been shown to be associated with “deep learning,” “better performance,” and “well-being” [29]. Additionally, intrinsic motivation depends on the fulfilment of three basic psychological needs described by SDT [29]. These are the needs for autonomy (the feeling that one is carrying out a task of their own choice and not by force); competence (feel capable of learning the study or course material); and relatedness (feel a connectedness or a sense of belonging with fellow pupils and the teachers) [29]. Consequently, educators who wish to improve the intrinsic self-motivation of their students could use teaching methods that target these needs (autonomy, competence, and relatedness).

In light of the above, some methods that could improve student self-motivation in their studies include learning contracts, self-assessment (with audio/video logs), and cooperative learning [30]. For each method, the educator could observe and intervene by guiding and encouraging the students. First, to improve autonomy, educators could use a learning contract, which means “a negotiated agreement between a teacher and a student, that addresses four elements: needs, expectations, roles, and content” [31]. The contract could give students a sense of autonomy by allowing them to complete their assignments at their own pace and understand their strengths and limitations [32]. Second, to improve competence, educators could encourage students to frequently self-assess their progress using contract goals as a reference point and to obtain a sense of achievement. Third, to improve relatedness, educators could use cooperative learning strategies. These strategies stimulate students to think critically, communicate effectively with peers, and accept responsibility for learning through small-group activities and assignments [33, 34]. For example, these activities could include a review of the literature or a presentation of a case on a clinical topic.

Self-motivation is the fuel that drives HPs to improve [30, 35]. More specifically, HPs with self-motivation can keep up with the latest guidelines, strive to provide the best possible care for their patients, and can even help advance their fields through rigorous research [30, 35]. To summarize, improving the self-motivation of healthcare students will help them become HPs aspiring to become better every day and provide the best possible quality of care.

Self-regulation

Self-regulation refers to “the self-generated thoughts, feelings, and actions that are planned and cyclically adapted to the attainment of personal goals” (p. 14) [36]. In order to promote self-regulation in students, educators could use methods that help students understand, plan, monitor, and evaluate their learning [37].

Expanding on the above, educators could consider implementing the flipped classroom approach to help students plan their learning. This approach entails students receiving learning material prior to class and engaging in active learning activities during class to enhance their comprehension; and thus, students have to plan their schedules accordingly. In addition, educators could encourage their students to create e-portfolios detailing their learning objectives, milestones, and achievements, thus monitoring their learning [38]. In this context, educators can support students by utilizing formative assessment, which involves providing feedback that identifies the gap between a student’s current level and a specific standard [39]. Therefore, educators could incentivize students to monitor, compare, and evaluate their overall individual progress. Finally, for evaluation, educators could use reflective writing and e-portofolios. Educators could instruct students to use reflective writing with e-portfolios, as reference points and reflect on their progress and accomplishments. These reflections could be achieved by revising, updating, and evaluating their e-portfolios; thus, students could develop a stronger sense of self-regulation and accomplishment.

Higher levels of self-regulation are associated with strategic thinking, better performance under stress, and overall better clinical skills in HPs [40]. Therefore, healthcare educators should target and improve the self-regulation of their students to help them become HPs who will provide the best quality of clinical care.

Empathy

Empathy in a clinical setting can be defined as the ability “to understand the patient’s situation, perspective, and feelings (and their attached meanings) and to communicate that understanding, check its accuracy, and act on that understanding with the patient in a helpful (therapeutic) way” (p. S9) [41]. A viable approach to cultivating empathy could be to incorporate teaching methods that promote reflection of settings through visualization of a problem and discussion of possible solutions [42]. Based on this approach, healthcare educators could leverage case studies and simulation training (preferably high-fidelity) to enhance the empathy of their students. Educators could present students with real-life situations with emotional problems or challenges related to each lesson’s objective. Afterwards, educators could encourage students to analyze the situation, understand the emotions, and think about how they would respond if they were in the same situation. In conjunction with case studies, educators could use simulation training to improve the empathy of students by simulating emotionally challenging situations, since in simulation training, educators create realistic and interactive simulations of real-life situations. Through the use of the previously mentioned case studies, educators can bring the situations to life, hence creating an opportunity for students to empathize with patients in a safe and controlled learning environment. This is especially important for healthcare students who face several challenges and time constraints during clinical practice. It should be noted that the use of simulated patients appears to be more beneficial for more advanced students rather than the early-year ones.

HPs who have cultivated their empathy provide better quality of care. More specifically, patients receiving care from HPs with higher levels of empathy experience improved pain management, reduced anxiety, and greater satisfaction with their care [43]. Thus, healthcare educators should improve the empathy of their students to help them provide compassionate and better quality of care.

Social Skill

The final component of ΕΙ is the social skill [25]. This component encompasses “the skills (i.e., conflict management, teamwork, communication etc.) needed to manage and influence other people’s emotions effectively to manage interactions successfully” (p. 7) [25]. Based on the aforementioned definition of social skill, we propose cooperative learning as the teaching approach to improve it.

There are numerous cooperative learning-based teaching methods [44]. However, to develop the social skills in healthcare students, we recommend interprofessional education, brainstorming, and clinical excursions. Professors from various healthcare universities could promote interprofessional education by jointly teaching shared subjects and assigning collaborative tasks or projects to teams consisting of students from different healthcare disciplines such as medicine, dentistry, nursing, and pharmacy. Simultaneously, educators can encourage students to brainstorm ideas to achieve the objectives. This can be done by instructing the teams/groups to share their thoughts and suggestions freely and spontaneously in an open and non-judgemental environment. Educators can further guide students to evaluate and refine their ideas/suggestions together. Finally, educators can take students outside the classroom to explore real-world clinical settings related to the subject they are studying. These excursions could offer hands-on experiences that allow students to observe, interact, and engage with the environment and people related to their learning objectives. In addition, learning excursions can help students better understand and apply theoretical concepts in practical situations. However, despite their advantages, there are some prerequisites to utilize these methods. For example, the educator should, depending on the task, suggest roles within the groups and time allocation. Additionally, educators could provide a form of reward or reinforcement to engage all students. In doing so, students may cultivate their social skill component of EI more effectively.

HPs with good social skills provide better quality of care to their patients. Better social skills improve communication, which in turn generates trust, favors the therapeutic bond, and improves patient adherence to treatment [45]. Furthermore, HPs with good social skills have a lower number of errors, which in turn leads to fewer conflicts and litigation, and ultimately improves healthcare outcomes [45]. Consequently, it is of paramount importance for healthcare educators to target and improve the social skills of their students.

Evaluating the Components of Emotional Intelligence

Educators who have implemented the aforementioned teaching methods could also employ questionnaires to evaluate each component of ΕΙ in their students. Depending on the results, educators could adapt their lessons accordingly. Therefore, we have listed two (2) questionnaires for each component of EI, their number of items and what their scores mean, in Table 2. Except for the social skills component, we have found only one questionnaire that is widely used (Social Skills Inventory [23]). Each of the suggested questionnaires has their own advantages and disadvantages in assessing components of emotional intelligence (EI). For example, the Self-Awareness Questionnaire (SAQ) provides a comprehensive evaluation with 28 items on a 5-point Likert scale, allowing for a broad assessment of self-awareness [15]. Its strength lies in its simplicity and moderate item count, which makes it feasible to administer in most educational settings [15]. However, relying on self-reporting could introduce biases, as respondents might overestimate their self-awareness [46]. Similarly, the Situational Self-Awareness Questionnaire (SSAQ) has nine items, making it less time-consuming and focusing on both public and private self-awareness [16]. This shorter format is ideal for educational settings, but the reduced item count may compromise its ability to capture nuanced aspects of self-awareness compared to SAQ [47, 48]. For self-motivation, the Academic Motivation Scale (AMS) [17] and the Motivated Strategies for Learning Questionnaire (MSLQ) [18] provide insights into a student’s motivational orientations with extensive item ranges (28 and 44 items, respectively). Both questionnaires use a detailed 7-point Likert format, but the AMS is designed to be used in academic settings [17], despite being more time-consuming than MSLQ. For self-regulation, we suggest using the Learning Self-Regulation Questionnaire (LSRQ) [19] or the Self-Regulated Learning Questionnaire (SRLQ) [20]. The LSRQ is a practical tool for quick assessments due to its conciseness, but it may not evaluate the full extent of self-regulation. In comparison, the SRLQ, which contains 39 items, offers a more thorough evaluation of self-regulation. However, the questionnaire’s length could result in participant fatigue [47, 48]. Regarding empathy, we suggest either the Jefferson Scale of Empathy (JSE) [21] or the Questionnaire of Cognitive and Affective Empathy (QCAE) [22]. The JSE’s healthcare focus makes it ideal for assessing empathy in medical students. On the other hand, the QCAE’s distinction between cognitive and affective empathy offers a richer analysis, but its longer format (31 items) might make its use more challenging for students. Lastly, for the social component of EI, we suggest the Social Skills Inventory (SSI), with 90 items, which offers a broad view of social competence [23]. Despite its high reliability (Cronbach’s alpha > 0.7), its length could cause respondent fatigue, reducing the accuracy of results [24, 46, 47]. Thus, healthcare educators while utilizing these robust and reliable questionnaires should have in mind their potential drawbacks including bias from self-reporting, time constraints due to extensive item counts, and the cognitive burden placed on participants. Therefore, for more accurate results, it is crucial to consider these limitations when choosing a questionnaire and assessing each component of EI in healthcare students. Nevertheless, healthcare educators could use a questionnaire of their choosing at the beginning and end of the academic year to evaluate their students’ ability on a specific component of EI. Should educators deem it insufficient, they could integrate one of the aforementioned teaching methods into their lessons for improvement. Subsequently, at the conclusion of the academic year, they could conduct a follow-up assessment to determine if there was any improvement; if not, they could also collaborate with other healthcare educators within the same department to incorporate another one of the aforementioned teaching methods and improve that particular component.

Main Barriers and Challenges for Improving EI in Healthcare Education

Implementing curricula that enhance EI in healthcare education presents several significant challenges [49]. One primary challenge is the lack of awareness regarding the importance of EI within the medical community. Despite evidence supporting its benefits, EI is not fully appreciated compared to other professional fields, thus limiting its integration into healthcare training. Moreover, the scarcity of time and resources hampers the development of EI programs. Healthcare students often face demanding schedules, making it challenging to allocate extra hours for EI training. Additionally, there is a shortage of qualified faculty to teach EI-related content. Only a few instructors possess the necessary expertise to effectively incorporate EI skills into their lessons, as many professionals in the field were not trained in EI themselves. Overcoming these barriers necessitates institutional support, increased awareness, and structured programs that can be feasibly implemented within existing time constraints.

Conclusions

In conclusion, this perspective article highlights the various components of EI, and also presents teaching methods to specifically target and improve these components, along with validated scales to measure potential improvements. While there is ongoing debate about whether EI is a trait or a learned ability, or a combination of both, we support the idea that it is indeed a combination of the two. This guide aims to enhance the learned ability aspect of EI by providing valuable insights for healthcare educators to improve the EI of their students more effectively. Moreover, this perspective article could serve as a catalyst for interventional studies that further explore the impact of the described methods on EI. By changing their mindset and approach, healthcare educators have the potential to cultivate future healthcare professionals who will deliver compassionate and high-quality care to all patients.

Acknowledgements

None

Author Contribution

AC’s role was in conception, acquisition, analysis, and interpretation of data and writing original draft. GS’s role was in the conception, acquisition, analysis, and interpretation of data and review–editing of original draft. IT’s role was in the conception, acquisition, analysis, and interpretation of data, review–editing of original draft, and supervision. All authors approved the final version of the article for publication.

Declarations

Ethics Approval

Not applicable. No human subjects were involved.

Informed Consent

NA.

Conflict of Interest

The authors declare no competing interests.

Footnotes

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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