Emotional Intelligence and the ACGME Competencies Behavioral Science

Emotional Intelligence and the ACGME Competencies Behavioral Science Forum Chicago: September 27, 2007 Anita Webb, Ph. D & Joane Baumer, MD JPS Health Network in Fort Worth, TX

GOAL Familiarity with emotional intelligence as a model for addressing several ACGME Core Competencies

Our Objectives • • • Define “Emotional Intelligence” (EI). Explain how EI relates to Core Competencies. Describe one strategy to measure EI. Consider how EI could be helpful in residency. Describe an EI research project in our residency.

Format • • • Self-administered quiz Power. Point presentation Discussion of uses of EI in residency Implications of EI Score the quiz Wrap-up

Key Points • • • 1. Some of the ACGME Competencies can be difficult to measure and to teach. 2. We need tools for non-cognitive Competencies. 3. Tools are available from other disciplines. 4. EI tools can help faculty re: core competencies. 5. EI skills can help residents survive training.

Status of EI • • Well researched and understood by social scientists and academicians Well accepted by business community Growing acceptance in diverse settings Unknown by majority of healthcare community

Historical Context • • IQ tests • “Intelligence Quotient” Two kinds of intelligence • Verbal • Math

Types of Genius

Eight Intelligences Gardner, H. (1983). Frames of mind: The theory of multiple intelligences • • • Linguistic Logical/math Visual/spatial Musical Kinesthetic Naturalistic • • Intrapersonal Interpersonal

Emotional Intelligence • Blends two of the multiple intelligences • Intrapersonal: Reflective skills • Interpersonal: Social skills

One Definition of EI • • • “The capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships. ” • (Goleman 1995)

Definitions (cont. ) • • “How well we handle ourselves and each other” “Works well and plays well with others” • All I really need to know I learned in kindergarten (H/O)

EI Popularity • Goleman, D (1995). Emotional intelligence • New York Times bestseller list for over a year • “International phenomenon” • 5 million sold worldwide

Research • • • Military: Army War College, Air Force recruiters Academic: • Administrators, teachers, coaches, students First responders: Fire fighters, paramedics Clinical: Psychotherapy Church: Parishioner satisfaction Business: Show me the $!

Academic Community: S. E. L. • • Social and Emotional Learning: Worldwide • Preschool through grade 12 Meta-analysis of 668 studies showed increased: • Confidence, empathy, self-control • Achievement test scores and GPA • Attendance • Positive behaviors • Safer environment • (Durlak 2005)

Postgraduate Training • • • Weatherford School of Management for M. B. A. • (at Case Western Reserve University) • Longitudinal research 1990 to present • Showed increased: Empathy, initiative, self confidence, leadership, developing others, etc. • And at follow-up years later (Boyatzis 1995) Chicago School of Professional Psychology: Ph. D Harvard Medical School

“Residency” Research • • • Fifth year medical students (first year of clinical training) pediatrics ward in large hospital in Israel • 10 group sessions over 5 weeks = 15 hours Counseling Ed faculty taught openness, empathy • Role play, discussion, patient interviews “Significant and lasting” increase in “supporting behavior” versus decrease in control group • (Kramer 1989)

Business (cont. ) • • Worldwide research • Variety of organizations Positive results for: • Productivity and profits • Leadership success • Department/team success • Employee success • Life success

Research (cont. ) • • • Work behaviors: e. g. citizenship Morale, job satisfaction, commitment, retention Work/family harmony Customer relations, customer satisfaction Coworker relationships, processes, teams Collaborative solutions, negotiation • (reviewed in Matthews et al Science of EI 2007)

“The Conceptual Age” • • Computers are replacing left-brained skills Creating a new era in the global economy Success will require creativity, empathy, intuition A whole new mind: Why right-brainers will rule the world. Pink, D (2005) • A business book

The Brain: Basis of EI • • • “Social Neuroscience” f. MRI studies Studies the “social brain” Widely dispersed neural circuitry Especially the “social superhighway”

“Social Superhighway” • • Operates automatically as we interact Orbitofrontal cortex and amygdala

Social Intelligence (October 2006)

“Brain Looping” • “Whenever we connect face to face or voice to voice or skin to skin our social brains interlock. ”

“Neural Wi. Fi” • • • “Wired to connect” • Neural bridge creates brain-to-brain linkage “Emotional contagion” • Emotions can pass from person to person • Without anyone consciously noticing • Initiated by strongest “e-motor” Contexts: Social, business, sports, etc. • Role of boss, teacher, coach, etc?

Wi. Fi Neurons • • • Spindle cells • Snap social decisions: Best Oscillators • In synch, producing resonance Mirror neurons • Imitation: Basis of learning • Empathy: Feel their pain!

Developing EI • • • Learned automatically via social interactions Primacy of “Parent-child loop” EI “naturally” increases with age

Neuroplasticity • • • Social interactions shape/reshape our brain Relationships have subtle, lifelong impact Likewise, reparative possibilities

EI and Health • • Relationships can buffer or intensify illness E. g. emotional support and heart disease

Relationship Illness? • • “Toxic relationships are as major a risk factor for disease and death as are: • smoking, • high blood pressure or cholesterol, • obesity, and physical inactivity. ” • [via cortisol] • (Goleman 2006 p. 224) Especially criticism, especially unanswered

Relationships (cont. ) • • • f. MRI study of social rejection/exclusion Activated anterior cingulate cortex Physical pain region Esp. if social support is weak Health disparities?

Measuring EI • • • Tools available for different settings Emotional Competence Inventory (ECI) • Developed for the work setting (1998) • Revised 2007: ESCI (“S” = “social”) Comprehensive: 360 degree evaluation Ease of use: Computerized Validated in hundreds of studies globally Expensive: Free for researchers

ESCI Developers • http: //ei. haygroup. com

Four EI “Abilities” SELF OTHER Awareness Management Relationship management

12 Competencies [Definitions on page 4 of handout] • • I. Self-Awareness • 1. Emotional Self-Awareness II. Self-Management • 2. Emotional Self-Control • 3. Adaptability • 4. Achievement Orientation • 5. Positive Outlook

Competencies: Social • III. Social Awareness • • • 6. Empathy 7. Organizational Awareness IV. Relationship Management • • • 8. Coach and Mentor 9. Inspirational Leadership 10. Influence 11. Conflict Management 12. Teamwork

EI Training for Adults? • • • Not as easy to learn EI • Biologically based Need to re-wire the brain • Limbic system Emotional learning • Experiential

Training Research: Summary “Our experts concur that EI can be taught in differing real-life contexts. ” (Matthews et al Science of EI 2007)

Training (cont. ) • • Basis is self-awareness • Via self-reflection Strategies (examples) • Mindfulness/meditation • Sensitivity training • Spiritual education • Psychotherapy • EI Coaching

EI Coaching: Basics • • Requires accreditation training. Trigger the process of reflection. • Emphasize their “vision” and strengths. Experiential tasks are especially helpful. • Safe environment to practice. Feedback and support.

EI and Medicine • • • “Emotional care is often a blind spot for medicine” New curriculum for “empathy” in medical schools EI project with med school surgeon-administrators

Family Medicine • “The biopsychosocial model 25 years later” • Self-awareness, Self-calibration • Empathic curiosity • Educating emotions • Informed intuition • Therapeutic relationship • Active cultivation of trust • Communication to foster dialogue • Borrell-Carrio, Suchman, Epstein [all MDs]. Annals of Family Medicine Nov. /Dec. 2004.

EI in Residency • • ACGME Core Competencies “Survival skills” for residency

ACGME Competencies • • EI goal is evidence-based curriculum for: • Patient care: “Compassionate” • Interpersonal and communication skills • Professionalism: Ethics, “sensitivity” Need residency research • Validated tools • Validated training strategy

JPS FMRP: EI Research Project • • Measure EI at end of intern year • June 2008 (Class of 2010) • ESCI surveys: Self and Other Individual EI coaching in R-2 year • By faculty psychologist (ESCI accredited) Post-test at end of R-2 Control group: A previous class • EI testing but no coaching

Control Group • • • Class of 2008 • Surveyed in June 2007 as R-2 s • IRB approved: Voluntary Individual results are confidential • Data reported as GROUP scores only • Individuals invited to review own results Status: 65% of surveys returned

External Validity • • Correlate EI scores with FM faculty predictions of resident’s future success. • “How would you rate this resident as a future Family Physician? ” Faculty rated each participant May 2007

Resident Survival Skills • • • Emotional self-control Organizational awareness Conflict management Leadership Teamwork Other?

Work Hours Debate • • • “To create training programs that deliver safe and excellent patient care, High-quality medical education, And sufficient sleep for residents, Residency directors will need to implement far-reaching reforms to reduce workload and intensity and to impart professional standards That emphasize working as a team. ” • (Fried in Okie, NEJM June 28, 2007, p. 2667)

EI Teamwork: “The Biggest Challenge” “Teaching residents that their conscientiousness is best expressed by ensuring that their patients will be well cared for by colleagues while they are off duty, rather than by working to exhaustion. ” • (Okie, NEJM June 28, 2007, p. 2667)

EI Leadership Skills • • • STFM presentations 2006 (Austin, San Francisco) Paul Wenner, Ph. D and Joseph Blonski, MD “Developing Effective Leaders in Family Medicine Using Emotional Intelligence”

Summary: EI Basics • Knowing your feelings • • Managing your emotional life • • and channeling your impulses to pursue your goals. Empathy--reading other people's emotions • • without being hijacked by it--not being paralyzed by depression or worry, or swept away by anger. Persisting in the face of setbacks • • and using them to make life decisions you can live without their having to tell you what they are feeling. Handling feelings in relationships • with skill and harmony -- being able to articulate the unspoken pulse of a group, for example.

Key Points • • • 1. Some of the ACGME Competencies can be difficult to measure and to teach. 2. We need tools for non-cognitive Competencies. 3. Tools are available from other disciplines. 4. EI tools can help faculty re: core competencies. 5. EI skills can help residents during training.

www. eiconsortium. org Collaborative reservoir of EI information e - Journal Issues and Recent Developments in Emotional Intelligence

Bibliography • • Boyatzis RE, Cowan SS, Kolb DA (1995). Innovations in professional education: Steps on a journey to learning. San Francisco: Jossey-Bass. Durlak JA, Weissberg RP. “A major meta-analysis of positive youth development programs”. Presented at the annual meeting of the American Psychological Association, Washington DC, August 2005. Kramer D, Ber R, Moore M (1989). Increasing empathy among medical students. Medical Education 23, 168 -173. Matthews G, Zeidner M, Roberts RD (2007). The science of emotional intelligence: Knowns and unknowns. NY, NY: Oxford University Press.

THE END Small groups to discuss “Implications”