**2. Emotional intelligence and leadership traits among family physicians**

Emotional intelligence and leadership traits are intimately linked [16–18]. A common thread that weaves these explorations is the idea that leaders with high EI are more effective in management than those with low EI [17, 19]. Leadership traits may be illustrated on an organizational and personal level (**Figure 2**) [16, 20].

EI requires self-discipline, self-efficacy, self-evaluation, and self-criticism, which enhances leadership and job fulfillment [21–23]. What's more, through the enrichment of strong relationships with their patient's and colleagues, any physician may be considered a leader. Therefore, it behooves the physician to foster these aptitudes to deliver excellent care [16]. Moreover, physicians' EI has bearings on their interactions and relationships with patients. Although it is crucial to exhibit competence in medicine, insufficient EI may hinder the ability to fully understand the complexities of a patient's being during their evaluation and treatment. In fact! Compared to physicians with higher EI those will low EI are less likely to foster empathic connections with their patients and appreciate or make out their emotions [23, 24]. EI may facilitate the patient–doctor rapport [22–24]. It shapes judgments concerning patient management, encourages self-control in demanding circumstances, and the avoidance of emotionally charged behaviors and decisions. Physicians who can identify and manage their emotions can remain calm when faced with patients who are under stress, anxious, or trigger the provider in some way. EI will allow the physician to convey their thoughts and feelings empathically and without judgment to the patient, which affords the most advantageous care [25].

EI plays a part in the physicians' ability to acclimate well with other people, optimize team-based care, and respond appropriately to external pressures. Healthcare providers with noticeable levels of EI may drive forward institutional missions. Besides the personal and relational aspect of EI, there may also be administrative benefits. For example, it may lower hospital costs by reducing burnout, medical errors, and litigation [23–25].

Family physicians are indispensable health-care workers who evaluate, treat, and manage acute and chronic diseases, promote health and wellness, and enhance the well-being of patients and communities through the application of the therapeutic relationship. Because family physicians may be a patient's first and potentially only contact with a healthcare provider, the development of EI for primary



**Figure 2.**

*Organizational and personal examples of leadership traits.*

care physicians is essential to the healthcare system. What's more, a high level of EI in family physicians may help in team-based care [22, 25].

A study by Coskun et al. aimed to determine the association of different variables and *trait emotional intelligence* (TEI). TEI consists of four basic factors that include: well-being, self-control, emotionality, and sociability [26]. This was a descriptive population-based study conducted from September 2013 to December 2014. The total population comprised 20,185 family physicians working at family healthcare centers across the seven regions of Turkey [27]. Women scored higher than did men for well-being, emotionality, and global TEI, which reflect similar GME outcomes. For instance, female medical students have exhibited significantly higher EI, empathy, and utilization of emotions than their male counterparts [28]. Society and environment may play a crucial role in the way women construct their personal and business lives. In this study, the sex differences gap was not particularly large, which may point to a shift in societal sex roles. Still, higher EI and leadership skills promote empathic communication, trust, and positive interactions between physicians and patients regardless of sex; therefore, both female and male physicians may benefit from training related to improving EI and leadership. Additionally, significant differences were found in well-being, self-control, and emotionality according to age and health-care experience. There may be a positive correlation between EI and experience, which hints that EI raises as a person advances through their career [24]. It may also be that as people age they are more likely to gravitate toward emotions that give them joy and avoid negative emotions if possible [23, 24]. Inexperienced physicians may struggle to adapt to their new role, thus displaying decreased EI. Fascinatingly, leadership traits of family physicians have not shown to vary significantly based on age or years of experience. Although it may be assumed that advanced age and years of experience would be associated with increased leadership traits, these variables appear to exert an insignificant effect on leadership styles in general [29]. Tenure has no effect on leadership ability either [18]. It may well be that age and experience optimize results with leadership experience.

According to Goleman, the most effective leaders are those who possess emotional intelligence [21]. Emotional understanding, emotional management, empathy, social flexibility, and adaptability are essential for individual growth and development as well as indispensable for societal regulation in the work setting [30]. Whereas low EI may lead to less effective teamwork, diminished work satisfaction, and heightened anxiety among physicians, higher EI preserves good physician–patient relationships, superior teamwork and communication skills, healthier stress management, and top-quality commitment and leadership [18, 20, 23, 31]. Personal well-being, empathy, teamwork, and leadership skills are all staples to a physician's work [17–20].

Youthful physicians with less experience may have lower EI scores compared to older, more experienced ones, which implies that EI may increase throughout training. GME programs that integrate EI and leadership competencies allow for students to attain these skills earlier and perhaps most importantly provides a platform to generate meaningful results [19]. This curriculum needs to be supplemented by coaching, mentorship, or other directives to ensure sustainable change in self-awareness and emotional intelligence among physicians.

#### **3. Coaching emotional intelligence**

The Accreditation Council for Graduate Medical Education (ACGME) mandates that residents be taught and assessed in six general competencies, which include:

#### *Emotional Intelligence and Leadership Development: Implications for Family Medicine… DOI: http://dx.doi.org/10.5772/intechopen.99463*

patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practices [32]. EI has been proposed for teaching interpersonal and communication skills as well as professionalism [33]. EI contains the skill to carry out precise interpretation on the subject of feelings and the aptitude to exercise emotions and emotional knowledge to boost thought [34]. Moreover, abundant positive correlations that link EI with desirable outcomes exist (**Table 1**) [35].

Although much is known about the numerous positive impacts EI may have, there is still much to elucidate in regards to proper implementation, maintenance, and enhancement of EI skills. In a quasi-experimental design, with an intervention and control group composed of one class each of family medicine residents researchers assessed the Emotional and Social Competence Inventory (ESCI), a 360-degree EI self and peer reported survey for 12 EI competencies (**Table 2**) to determine if coaching would enhance emotional intelligence [36].

Unfortunately, there was no significant difference in ESCI scores in the intervention versus control group. Interestingly, teamwork significantly declined. Regrettably, a drop in aspects of EI during training is not unique. Specifically, Wagner et al. found a decline in self-reported medical student EI scores [37]. A deterioration in humanitarianism, enthusiasm and idealism experienced by medical students has also been ascribed to the fall of EI throughout training [38].

Despite the lack of significance, this study was plagued by implementation barriers, which are important to understand. First, no faculty were given protected time for coaching. Second, resident's comments suggested that increasing EI was not a priority for them at this juncture in their training. Third, resident's EI scores were already relatively high; therefore additional time spent may not have been felt to be justified. Finally, there remains a lack of validity of ESCI for the medical community.

It is vital that if EI is to be tested and enhanced in a residency program that it be implemented properly. For example, EI coaching should have built-in protected time. It may be beneficial for residents toward the end of training when they appear to be less stressed and more focused on future goals. Alternatively, in view of its time-intensive make-up, EI training could selectively center on residents with low EI ratings. Post-residency it may be provided as continuing medical education for stress management, remediation of deficiencies, or advanced training.

It should be stressed that EI coaching requires a high level of trainee engagement and commitment. This course may include cognitive behavioral assignments between coaching sessions. An EI training session may include a trainee's initial statement of ideal career goals along with a guided review of EI survey results.


#### **Table 1.**

*Positive outcomes associated with emotional intelligence.*


*\*ESCI norms apply to other ratings only and are based on a North American sample of workers all ages and job levels. Achievement orientation is the highest rated competence in the norms, and self-awareness the lowest [36].*

#### **Table 2.**

*Emotional intelligence competency definitions.*

The coach could then emphasize EI strengths of the trainee while simultaneously employing schemes to build upon areas of improvement for the trainee. The trainee and coach would then set performance goals, negotiate assignments, time frames, frequency of coaching sessions, and add or modify selected goals based upon progress.

EI has been proclaimed fundamental for leaders who are coping with change management [39]. This skill is all the more important as it relates to physicians and the current health care landscape. Even so, much work remains to be done to provide clear-cut proof that investment in EI training is warranted. A reasonable next phase would be to substantiate approaches that consistently boost physician EI. Advantages and disadvantages to implementation are shown (**Table 3**).

Potential research ought to emphasize the elaboration of an expedient reasonably priced 360-degree EI instrument for physicians. Ideally, this would be enhanced by providing established external validity measures that further correlate medical outcomes, patient satisfaction, and physician satisfaction. Multi-institution collaboration may possibly evaluate EI development in distinctive training paradigms and fields of practice. Perhaps longitudinal research will explore EI development post training, specifically in relation to physician impairment or disruptive behavior. If EI tools demonstrate sustained value in the domains of physician selection, education, training, and remediation, they may well become more generalizable and important to the medical community as a whole.


#### **Table 3.**

*Potential advantages and disadvantages to emotional intelligence training.*

*Emotional Intelligence and Leadership Development: Implications for Family Medicine… DOI: http://dx.doi.org/10.5772/intechopen.99463*
