Discussion:
Today’s medical students are tomorrow’s doctors, and strong foundations
in both intellectual and emotional intelligence are paramount for
fostering a skillful doctor who is capable of maintaining efficacious
doctor-patient relationships, which would improve therapy by increasing
trust and satisfaction on both sides. (7)
(18) Intellectual and emotional
intelligence can both be improved throughout the educational stages of
university life. High EI is believed to be of importance to the doctor’s
practical life, enabling them to better deal with patients by using
emotions to investigate and reach a correct diagnosis. EI may also
enable doctors to understand different points of view concurrently,
understand their own reactions, and handle stress in an appropriate
manner; newer research additionally focuses on EI as an indicator of a
doctor’s academic and professional success.
(7) (19)
(20) (21)
This study assessed emotional intelligence among medical students and
identified some factors that affect it. Changes and interventions with
which to improve EI were considered. Finally, we established a base for
further studies, e.g. measuring methods to improve EI, identifying its
relationship with physical and mental health, and determining if it is
connected to career success. Moreover, the findings may direct medical
education to emphasize EI learning and to incorporate special technical
courses for improving EI in medical students and doctors.
The results showed a significant difference in EI between basic and
clinical medical students, with EI declining significantly in the second
period. This indicates that as medical students progress from basic to
clinical stage, their awareness of their own feelings and emotions
decreases. This is consistent with the results established in an
exploratory study conducted by the University of Kentucky College of
Medicine, which also found that some subscales of emotional intelligence
(empathic concern and attention to feelings) decreased as students
proceeded through their study. (4) This
decline may be attributed to many factors, including:
- High expectations :
In medical training, the divide between reality and prior expectations
of the student is sometimes profound and disappointing.
(22) During their basic years, many
students have high expectations of clinical training that stem from
movies or medical series (such as The Good Doctor andHouse ). However, as soon as they start their clinical period,
they realize the difference between what they expected and what is
practically applied in hospitals. For example: The unethical behaviors
of some doctors are a huge letdown for students. One study of
3rd and 4th years found that 61%
of students observed unethical behaviors toward patients, and 40% of
students reported feeling guilty for participating in that behavior in
order to please their doctors and get good evaluations.
(4)
- Low self-esteem :
Decreased self-esteem among clinical-stage medical students in
clinical stage stems from embarrassment and self-doubt caused by some
of their doctors, including occasional gender discrimination and
disrespectful treatment, which could be exaggerated and augmented when
students realize that there is a deficit in the rights that protect
students and health care professionals against violence.
(4) Moreover, students may encounter
differences between what they learned about the signs and symptoms of
diseases from books during their basic years and how patients present
in the hospital; many times, not all symptoms can be seen on a
patient. This difference may weaken student self-confidence and their
confidence in what they learned, which may affect their EI.
(23)
- Social environment :
As EI is associated with pro-social behavior, the change in a
student’s social environment between basic and clinical periods is a
potential cause for the decline in their emotional intelligence.
Clinical training includes several rotations, each one in a different
hospital, which usually separates students from their families and
peers. This may create a feeling of loneliness, which may affect their
empathy. The need to adapt at every rotation to a new environment with
different requirements also causes immense stress.
(4)
- Medical challenges :
Medical studies are hard, and the medical environment is a stressful
one. The medical world is rapidly changing, with more demanding
patients and families and increased workloads on doctors
(24) (9)
In addition, the number of students entering medical school increases
every year, which means that getting a satisfying job or residency
program is becoming harder. This puts medical students in a constant
state of fear for their future, especially when they see that the
highly competitive nature of medicine leads many graduates to end up
receiving unpaid residency programs. This constant fear of the future
combines with immense responsibilities and the high expectations of
family members to create a very stressful circumstance for the
student. (4) In addition, the challenge
of balancing medical life, social life, responsibilities, and personal
happiness causes some stress to medical students, which would
potentially decrease their EI. Finally, fear of catching illness or of
facing people in suffering is also overwhelming to some medical
students. (9)
- Humanity vs objectivity :
The conflict between humanity and objectivity that occurs inside
medical students throughout their clinical training would decrease
their productivity. These students encounter patients, witness them
suffering, and may see some die. As they progress through medical
school and continue to face these scenarios, they may become more
cynical and desensitized, potentially starting to see patients as
objects rather than people. This decrease in humanism may be an
important factor in decreasing EI, especially through its effect on
empathy. (4)
(25)
There could be additional factors that might explain the observed
results, which is why we recommend more research be carried out to
address these factors. It is also relevant to note that some studies
have showed that EI does not change throughout the course of medical
studies. (9)
One of the interesting results in the present study is that among
medical students who regret studying medicine, EI scores were lower than
for their peers who do not. This may be attributed to the following:
- Some medical students are forced to study medicine by the desire of
their parents, making them less interested, confident, and productive
and more depressed. Even without that, studying medicine is a hard
decision on its own, and pre-college students are not prepared to
choose properly. (7)
- Generally, medical students initially enjoy studying medicine due to
the similarity of early years with school subjects and to enthusiasm
for college life. As they advance, radical changes in the educational
system make it harder and more difficult to tolerate— i.e.
self-study, the enormous amount of subjects and material, and
increased difficulty. (22)
- From a social point of view, a medical student’s time is fully
consumed by their studies; their social life, time with friends, and
even favorite hobbies become sharply limited, affecting the student’s
emotions. These feelings become exaggerated and augmented when they
realize that they are still stuck in the educational phase of life
while their peers move on to new experiences, such as getting married
and becoming independent and financially autonomous through gaining
access to the labor market. (4)
(22)
- Students may feel guilty about the high installments their parents pay
yearly to fund their education, which may forbid other family members
from pursuing college education or require their parents to hold two
or three jobs.
- Students who are satisfied in studying medicine have higher EI.
(26) Moreover, studies emphasize that
students who enjoy studying medicine have higher EI scores.
(27)
We also observed that the mean EI score for students having hobbies and
extracurricular activities is higher than that for students who do not.
A similar finding was reported in another study, demonstrating that
emotional intelligence is influenced positively by performing leisure
activities. (24) Generally speaking,
medical students who have hobbies would also have outstanding skill in
time management. Furthermore, the social interactions they take part in
while performing these hobbies and extracurricular activities enable
these students to better deal with patients in their professional
career. (28)
(29)
Our finding that the overall emotional intelligence scores of men and
women were almost equal is consistent with the literature.
(30) (5)
This would rebut the idea that women are more emotional. However,
another study stated that “women may be better at translating their EI
into clinical care delivery compared to men,” in which light this
finding could be interpreted as women being better in specific aspects
of emotional intelligence and men in other aspects, with the overall
scores being equal. (5) Some literature
has reported that females have higher EI scores than males
(6) (24)
(26) (18)
(7) (27)
(31); to the best of our knowledge, none
has found that males have higher EI.
Our observations that financial and marital status, birth order, place
of residency, hometown, and university attended do not affect student EI
are consistent with the literature. (24)
(5) (27)
Notably, the two universities that participated in the study have
different educational systems. For instance, Al-Quds University follows
the integrated medical curriculum, while Al-Najah University follows the
regional approach. In addition, third-year basic students in Al-Najah
University have a weekly clinical rotation, which is not applied in
Al-Quds University. Nonetheless, students’ EI scores were not
significantly different.
Unexpectedly, having an older brother or sister who is studying medicine
appears not to significantly influence the EI of students. The
expectation was that having an older family member studying
medicine—i.e. one with similar experience—may prepare the student
for the reality of medical school by managing expectations and providing
hints and advice based on experience. (6)
Also surprising was that living with the family and not in student
housing had no significant effect. (7)
Both of these factors were expected to improve EI and prevent its
deterioration during medical studies by providing a supportive
environment to the student both physically and mentally, thereby helping
tolerance of the stressful medical environment.
(27)
In addition, academic performance appears to have no significant
correlation with EI. This may be interpreted as the students being more
aware of the fact that their performance is not necessarily
representative of their capacities. This result supports that having
high IQ does not necessarily go hand in hand with having high EQ.
(17) (18)
However, some studies have reported that academic performance is
significantly affected by EI. (32)
(24) (18)
(7); furthermore, since studying is the
only parameter for success in their schools, concentration on studies
causes students to neglect their social lives.
(9) Hopefully, medical students still
have opportunity to improve their EI; it has been pointed out that
physicians achieve higher EI as they age and gain experience.
(6)
Despite the interesting results of this study, it has some limitations.
First, the study is restricted to the West Bank. Second, it is
cross-sectional and not a cohort study due to limitations of time and
financial support. Our cross-sectional design limits studying causality
of the factors identified as affecting EI, thus prospective follow-up
studies are needed to investigate this causality. Third, the sample was
collected online and consisted of self-reports over a limited duration
of time. Self-ratings of EI may provide an indication of the
respondent’s beliefs about their EI (perceived EI) rather than
reflecting their actual capacity, and tend to be positively biased.
(33) Fourth, the sample size within each
academic year was small, especially for residency (n=18) and internship
(n=35). Fifth is common method variance, which is attributable to the
measurement method rather than to the constructs the measures represent;
this is especially encountered in questionnaire-based cross-sectional
studies on attitude/behavioral constructs, such as the present study.
(34)