**7. What are the potential benefits of implementing coping intelligence programs in a workplace?**

It is postulated by the authors that the introduction of CI into a workplace, especially one that is focused on the provision of services, may help with both employee coping under stress and with conflict resolution. Going back to our earlier discussion, the importance of CI may emerge in highly stressful situations where the overwhelming perception is that "nothing can be done" [20]. Under such circumstances, emotions may 'take over' and lead to inability to cope effectively with the particular stressor or a set of interrelated stressors. On the other hand, individuals who are able to maintain rational stance during highly stressful situations or circumstances, may be able to 'weather the storm' by either employing their social problem-solving skills or by relying on their attitudes and belief systems [20, 24, 25]. As noted previously, institutions, patients, and GME trainees can benefit from programs that teach effective coping. As shown in published research, if trainees can better 'weather the storm,' there will likely be fewer patient safety events, improved clinical outcomes, and reduced provider burnout [63, 64, 68].

### **8. Efficient versus inefficient coping: importance in life satisfaction**

Research suggests that older individuals employ efficient coping strategies more often than younger groups, likely a reflection of an individual 'coping repertoire' that arises as a result of the cumulative 'life experience' and the associated development of emotional and cognitive mental processes. Of importance, there is evidence to support the viewpoint that low life satisfaction is related to inefficient coping strategies across emotional, cognitive, and behavioral domains [20]. To support this viewpoint, data show a relationship between increase in maladaptive behaviors and high levels of impulsivity [69, 70]. Other important concepts within this general context include social plasticity (e.g., ability to be flexible in social relationships and establishing social contacts) as well as one's adequacy and timely channeling of emotional responses [20].

#### **9. Mentoring to improve coping skills**

Traditional medical education involves the use of mentors since the time of Aristotle. It allows a physician who has navigated the training and practice of

medicine to model and encourage the coping skills previously described. The personal relationship developed within a mentoring relationship has been shown to improve transitions for practicing physicians new to a hospital [71]. The tremendous time and intellectual commitments required to effectively train residents and medical students are, in turn, known to affect the trainees' personal lives, including interpersonal relationships, community activities (and thus support), and even the financial domain. Well-designed mentoring programs should incorporate all of the above-listed topic areas, beginning with the training dedicated to ensuring mentor competency and optimization of mentorship efficacy. Subsequent to this, properly trained mentors may begin to guide their mentees through a series of conversations that provide the opportunity to suggest methods of dealing with the issues of time management, practice management, meaning and purpose in medical practice, as well as bringing to light the topic of coping mechanisms that may be useful to the mentee in regards to the various domains and/or stressors of the modern healthcare environment. Physicians who participated in such well-structured programs reported that despite the time constraints and added work demands, the mentoring process helped them achieve greater professional fulfillment and a sense of personal accomplishment [72].

#### **9.1 Coping intelligence in the context of resiliency**

The concept of resiliency warrants a brief discussion as well. Resiliency has been recognized as a quality beneficial to coping with adversity, and can be defined as the ability to respond to stressful situations in an adaptive and healthy manner [73]. It can also be thought of as the ability to withstand, adapt to, and recover from adversity and stress [74, 75]. Consequently, there is inherently a significant amount of overlap between resiliency and CI. Individuals with high resiliency address challenges and stressful changes in their personal and professional lives with flexibility and retained optimism [49]. Highly resilient individuals also recover from stressful or difficult experiences faster and with greater awareness of their environment and their responses to it [76, 77]. In brief, having resiliency not only enables an individual to be adaptive when confronted with difficulties, but also allows them to learn from the experience and therefore, be better prepared for future stressors. Ultimately, this fosters self-confidence and success in the face of adversity.

The Resiliency Scale was developed in the early 1990's by psychologists Wagnild and Young [78–80]. Early on, it was applied primarily in older patient populations to assess one's ability to adapt more effectively as they aged [81–83]. It sought to quantify and stratify individuals into groups that were at risk for maladaptive coping when faced with change and adversity as they aged. The ultimate goal of such efforts was to devise new interventions to enhance coping skills in individuals with diminished resiliency.

Research is also helping to define the quality of resilience that has been anecdotally recognized in successful GME trainees. For example, some have referred to this trait as "grit" – the previously undesignated characteristic that makes an individual both less likely to experience burnout and better equipped at managing demands of graduate medical training. It is specifically defined as perseverance and passion for long term goals; clearly a valuable quality in GME trainees across all specialties [84]. Higher levels of "grit" have been shown to result in decreased feelings of burnout, depersonalization and emotional exhaustion. It also supports the belief that with determination and hard work, one can be highly successful regardless of innate talent. Finally within the context of this chapter, the substance of "grit" may indeed represent a manifestation of CI.

*Facing Adversity during Graduate Medical Training: The Concept of 'Coping Intelligence' DOI: http://dx.doi.org/10.5772/intechopen.99698*

Several instruments now exist to measure resiliency, expanding on the initial work of Wagnild and Young. Of special importance to our discussion is the Academic Resilience Scale (ARS-30) [85]. Created in 2016 by Cassidy, the ARS-30 aims to measure the participants' mood and attitudes toward adversity in education, focusing on three key factors – perseverance, reflecting and adaptive help-seeking, as well as negative affect and emotional response [85]. These factors further delineate and quantify resiliency as key characteristic of individuals who do not give up when faced with stressors, recover from adversity in a positive manner and maintain optimism. The ARS-30 reinforced the qualities of resiliency and the ability to identify those who will be successful in academics as well as those who would benefit from further, more personalized skill-building. While research is ongoing, the ability to recognize and quantify resiliency may ultimately lead to more effective interventions to avoid burnout, improve CI and finally, facilitate individual and team success amid adversity.

#### **9.2 Empathy and compassion: key components of the overall matrix of coping**

Without a doubt there is a need in medicine to develop both EI and CI to help manage the stress that comes from one's very functioning in an administrative system that may be characterized by at least some priorities that may deviate from the primary role of a physician/trainee – to help the sick and save lives [86–88]. Various administrative tasks and clinical challenges that physicians must successfully navigate may create a highly stressful environment. Without the ability to cope effectively, draw appropriate boundaries, and recognize one's limits, many physicians are unable to successfully reconcile clinical and administrative responsibilities. In this context, one phrase often used by physicians captures the above, "you can only control what you can control." Moreover, it is important that healthcare leaders are aware of, and subsequently embrace critical skillsets that help elevate one's overall leadership effectiveness [89, 90].

High quality, compassionate leadership is critical in today's highly stressful healthcare environment [91–93]. As such, it is crucial for the institutional leadership (at various levels) to bring structure and order to an environment often characterized by controlled chaos within a highly diverse matrix of people, skills, and functions [92, 94, 95]. Hence, in difficult time – regardless of the circumstances – and despite all of the efforts to develop and mature our individual and collective emotional and coping intelligence, physicians must remember their professional oath and responsibility - to do no harm and to help the sick [96, 97]. Our patients depend on our empathy and compassion and balancing our emotions in a system that inherently fosters the emergence of burnout as well as mental and physical exhaustion [6, 11, 29, 64, 98].

Unfortunately, there are growing concerns that among the consequences of relying on CI and/or EI, especially in the context of managing burnout, is increasing apathy and a recognition that the "system is broken." This, in turn, may result in further physician/trainee disengagement and deterioration of the critically important emotional component that is necessary to venture beyond the mindset that providing healthcare is "just a job" or "over when my shift ends." It is therefore critical, as life-long students of EI and CI, that we recognize that our inherent human compassion and empathy must not only be preserved, but also maintained within a framework which fosters an individual's ability to be an effective, empathetic, and emotionally stable physician/trainee [99, 100].

While the topic of burnout, including its avoidance and mitigation, is beyond the scope of this manuscript, there are overlaps across the physical and emotional drivers of burnout. Physicians/trainees may benefit from the knowledge of such

overlaps, including the knowledge of how EI and CI may be beneficial in learning how to better establish and manage critical boundaries that are critical to one's emotional and physical well-being. Mahatma Gandhi once said: "Where there is love there is life" [101]. Nowhere else is such a concept more true than in medicine, but such energies must be kept in balance with the recognition that medicine is a life-long endeavor and to function effectively, for an entire career, a mastery of CI is necessary to successfully manage and contain the growing stressors, professional and personal challenges, and administrative complexities of modern healthcare.

It is also important to recognize that even in the best of circumstances and workplace environments there will be substantial personal and professional career challenges. One must concede that "modern medicine is a business" – and much like most businesses, leadership may change, high (and low) performers will come and go, and economic variables and incentives will be in constant flux [102, 103]. The overall environment can (and likely will) change. At times, this change may be rapid and not always consistent or in alignment with established goals and/or agenda. Having a solid foundation in EI and CI will be invaluable when such changes occur, especially when the positive aspects of our work-life integration or culture, become misaligned [104–107]. Such misalignments will often result in substantial institutional changes – changes in processes, protocols, cultures, team structures and organization – and individuals. You (or key members of your team) might, and potentially will, leave (even if not on their own accord), but a true sign of a solid foundation in CI and EI is to be able to adapt, accept, and navigate such changes when they occur.

**Limitations**: This is a largely exploratory chapter in an area that requires a significant amount of work to better understand all of the intricacies and complexities involved in behavioral responses to burnout and extreme stress. Current literature tends to be more focused on EI, with admittedly insufficient attention to coping as a unique and separate topic. Only with greater appreciation of various factors that contribute to maladaptive coping can we develop better informed and more effective mitigation strategies.

#### **10. Conclusion**

When the professional environment becomes too complex for one to fully understand and manage, social and emotional skills that allow one to function meaningfully under normal conditions may become insufficient. This, in turn, exposes an important gap in our current ability to cope with either momentary or sustained stressors. Under the proposed new paradigm, coping intelligence can be viewed as an extension of emotional intelligence when one's capacity to deal with stress exceeds a certain, highly individualized threshold. In a way, coping intelligence represents a much deeper and more refined form of applied self-awareness and requires much more intensive self-reflection and self-discovery. More research is warranted in this critically important and developing area.
