Elam, Carol L. EdD
Dr. Elam is assistant dean for admissions and director of medical education research, University of Kentucky College of Medicine, Lexington, Kentucky.
Admission officers seek ways to improve their assessments of noncognitive characteristics to enhance their selection processes. But what are noncognitive characteristics? Asked to define them, we might say personal qualities or interpersonal abilities, and often our definitions are not specific. Social science researchers' efforts to define terms clearly and develop useful measures can be applied in medical education settings and used to improve assessment of noncognitive characteristics in admission decisions. In their article “Measuring Emotional Intelligence in Medical School Applicants,” elsewhere in this issue, Carrothers, Gregory, and Gallagher report such an effort. They seek to apply a relatively new social science concept, emotional intelligence, to the interview assessment of medical school applicants.1
Emotional intelligence was defined a decade ago by Salovey and Mayer as a type of social intelligence that involves the ability to monitor one's own and others' emotions, to discriminate among them, and to use the information to guide one's thinking and actions.2 In a later article, Mayer and Salovey noted that the scope of emotional intelligence includes the “verbal and nonverbal appraisal and expression of emotion, the regulation of emotion in the self and others, and the utilization of emotional content in problem solving.”3
The principles of emotional intelligence provide an appealing set of constructs to expect from physicians and other health care providers. In fact, some nursing faculty contend that emotional intelligence should be incorporated into the nursing curricula as expected outcome competencies.4 And why not expect emotional intelligence in physicians as well? Having the ability to read and manage emotions would seem to be an important skill in interacting with patients. Given time pressure in managed care environments, the ability to assess and discriminate among patients' emotional responses and to use that information to guide thinking and actions could be important in establishing a doctor-patient relationship. Accurately reading the emotional responses of patients could also bear upon quality and accuracy when eliciting the chief complaint and completing patient histories. Emotional intelligence may also relate to patients' compliance with treatment regimens by helping physicians understand patients' affective responses to treatment recommendations. By improving the quality of the doctor-patient interaction, emotional intelligence could raise the relative level of satisfaction that patients find in the care they receive. The potential for improved outcomes obtained by applying emotional intelligence may not be limited to the doctor-patient relationship. Greater emotional intelligence could also improve health care by improving interactions and relations among members of the health care team. Further, the ability to monitor one's own emotional responses could be an important dimension in helping physicians to gauge their work-related stress and burnout and take steps to lessen their impact.
On the surface, emotional intelligence appears to be a relevant, if not critical, ability in the patient care environment. While it seems to be an important construct in the development of relationships, the impact of having strong emotional intelligence has not been empirically tested in the health care setting. Similarly, emotional intelligence appears to be an important set of abilities to expect from medical school applicants. The work of Carrothers and his colleagues is important in that they are the first researchers to apply this construct to the admission process and to develop a measure of emotional intelligence for use in the selection of applicants. Because emotional intelligence has not been previously assessed in applicants, it is necessary to operationalize the construct, and identify the unique abilities that involve the processing of emotional or affective information using reliable and valid measures. Efforts must be made to demonstrate how emotional intelligence differs from such commonly assessed factors in the medical school admission process as communication skills and verbal reasoning.
So what is emotional intelligence and how should we go about measuring it? In a 1998 study, Davies, Stankov, and Roberts sought to investigate the relations among measures of emotional intelligence, traditional human cognitive abilities, and personality.5 The authors administered a comprehensive set of instruments to 531 participants in their study. The Trait-Meta Mood Scale and the EQ Test, which are self-report measures, were used to assess emotional intelligence of the study participants.6,7 Objective measures of emotional perception, personality, cognitive ability, social intelligence, fluid intelligence, and crystallized intelligence were administered to the study participants as measures of personality and human abilities that were related to emotional intelligence. In reporting their results, Davies and colleagues found that the self-report measures of emotional intelligence were highly associated with well-established personality traits such as empathy and extroversion. They also found that objective measures of emotional intelligence had low reliability. To that end, they recommended the development of improved objective measures. Based on the results of their study, they concluded that “little remains of emotional intelligence that is unique and is psychometrically sound.”
The study presented by Carrothers, Gregory, and Gallagher incorporates the use of a semantic differential scale in the interview setting so that interviewers can “directly assess the interviewee's competency in personal and interpersonal skills.” The authors note that their scale was founded upon the precepts of emotional intelligence. Instrument items are categorized into five dimensions: maturity, compassion, morality, sociability, and calm disposition. Interviewers completed the 34-item semantic differential instrument on applicants following their medical school interviews. Although the interview is generally regarded by admission officers as being the mechanism for assessing noncognitive skills, it can be questioned whether interviewers have the ability to judge emotional intelligence in this context. In trying to assess emotional intelligence, could interviewers also be reacting to extroversion, verbal expressiveness, or empathy of applicants in assigning their ratings? Are attributes associated with communication ability and interpersonal skills the foundation of emotional intelligence?
Self-help books such as Weisinger's recent Emotional Intelligence at Work suggest that emotional intelligence can be enhanced by learning and practicing the skills and capabilities that make up emotional intelligence.8 He outlines the learnable skills as the ability to perceive, appraise, and express emotion accurately, the ability to access and generate feelings on demand when they can facilitate understanding of yourself and other persons, the ability to understand emotions and the knowledge that derives from them, and the ability to regulate emotions to promote emotional and intellectual growth. Are any of these skills currently taught in medical school interviewing, behavioral science, or physical diagnosis courses addressing the doctor-patient interaction? If so, are we teaching communication skills or emotional intelligence? Are these skills the same? If not, how do communication skills and emotional intelligence skills differ? As we seek to refine our definition of emotional intelligence, what can we learn from the literature on health communication skills?
Emotional intelligence is an appealing concept. On the surface, it seems to make sense. Some people do appear to be more in touch with their own emotions than others are. Some people are better at reading, interpreting, and addressing the emotions of others. Are these differences the result of differences in mental abilities or differences in behavioral preferences? As is the case with other noncognitive characteristics, we need to continue to clarify the definition of emotional intelligence and we need to develop reliable and valid measures of this construct. In working to improve the admission process, we must continue to find new ways and improve old ways of assessing the personal qualities and interpersonal abilities of our applicants.
1. Carrothers RM, Gregory Jr, SW, Gallagher TJ. Measuring Emotional Intelligence of Medical School Applicants. Acad Med. 2000;75:456–63.
2. Salovey P, Mayer JD. Emotional intelligence. Imagination Cogn Pers. 1990;9:185–211.
3. Mayer JD, Salovey P. The intelligence of emotional intelligence. Intelligence. 1993;17:433–42.
4. Bellack JP. Emotional intelligence: a missing ingredient? J Nurs Educ. 1999;38:3–4.
5. Davies M, Stankov L, Roberts RD. Emotional intelligence: in search of an elusive construct. J Pers Soc Psychol. 1998;75:989–1015.
7. Salovey P, Mayer JD, Goldman SL, Turvey C, Palfai TP. Emotional attention, clarity, and repair: exploring emotional intelligence using the Trait Meta-Mood Scale. In: Pennebaker JW (ed). Emotion, Disclosure, and Health. Washington, DC: American Psychological Association, 1995:125–54.
8. Weisinger H. Emotional Intelligence at Work. San Francisco, CA: Jossey-Bass, 1998.