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

Medical students, residents, and medical faculty are generally considered to be highly talented and competitive. According to Fabio and Buzzai, "The most common traits associated with giftedness are: high sensitivity, higher speed of thinking, introversion, high emotional development, elevated creativity, independence, perfectionism and *interpersonal and intrapersonal conflicts* [38]." Physicians, generally, may not be introverted, but much of the description above can apply to them. It is important to note that the literature has indicated that EI, coping style and creativity coexist within a complex relationship, and can affect the health of an individual [38–42]*.*

Fabio et al., show that among key characteristics of individuals who are able to deal with problems and challenges more effectively is the ability to think in a flexible manner, which in turn seems to facilitate innovative solutions to complex tasks, often approached form different viewpoints or angles and featuring more granular details and conceptualizations [38]*.* However, this does not mean that the more talented have greater EI and are more resilient. Fabio et al. show that highly talented individuals may have the propensity to utilize avoidance coping instead of more direct coping approaches or strategies [38]. In other words, CI becomes very important as an adjunct to EI. Coping intelligence has been defined as "efficient individual ways of managing life stress," and can be further defined as, "a broad repertoire of life skills required to solve successfully everyday stress and life adversities in order to achieve desired goals and maintain physical, mental, and social well-being [20]."

A positive coping model emerged recently, championed by Libin [19, 20]. This multi-dimensional positive coping model (MDPCM) provides a framework for an objectivized assessment, Coping IQ [19, 43]. In this model, CI is defined by the quality, functionality, repertoire, and efficiency of cognitive, emotional, and behavioral strategies that individuals resort to when approaching stressful or otherwise difficult circumstances [20]. In brief, the new model categorizes efficient and inefficient coping strategies based on "their functionality or the organization of coping efforts," and not on their modality [20]. Consequently, the MDPCM is characterized by: [a] The primary cross-cutting parameter: organization of the efforts (either efficient or inefficient); [b] The secondary cross-cutting parameter: modality of manifestation (either emotional, cognitive or behavioral); and [c] The cross-cutting tertiary parameter: intensity of efforts (e.g., passive versus active) (**Figure 2**) [20].

Subsequent research showed that: (a) efficient cognitive coping is characterized by cognitive activity that is focused on the resolution of the difficult situation; (b) efficient emotional coping consists of emotional efforts concentrated on the solution to the problem at hand; and (c) efficient behavioral coping is based on behavioral efforts applied toward resolving the difficulties encountered [20]. On the other end of the spectrum, inefficient cognitive coping is defined as: (a) cognitive activity deviating from the difficult situation; (b) inefficient emotional coping that is tied to emotional efforts divergent from resolving the problem at hand; and (c) inefficient behavioral coping consisting of behaviors that deviate from problem-solving [20].

#### **5. Identifying efficient and inefficient coping strategies in trainees**

Due to the high levels of stress experienced by GME trainees, it is paramount to identify issues with CI early and develop potential strategies for improvement. Leaders working in Business and Marketing have identified 2 major coping strategies in most individuals: (a) active coping, an efficient strategy, and (b) avoidance coping, an inefficient strategy [44]. As can be seen in **Figure 2**, active versus passive coping is among the key components of the multi-dimensional positive coping model championed by Libin [19, 20].

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

**Figure 2.**

*The three cross-cutting parameters within the multi-dimensional positive coping model championed by Libin [19, 20].*

In active coping, individuals identify problems or sources of stress, actively work to remove them, and promote positive outcomes [44, 45]. In avoidance coping, or evasive coping behavior, individuals develop mechanisms for avoiding stress and conflict passively, leading to more negative outcomes—lower job satisfaction, lower job performance, higher burnout, and deleterious consequences on health [44, 46]. Avoidance coping has been proven to increase emotional exhaustion, contribute to a decreased sense of personal pride in one's work, and lead to the development of self-endangering work/professional behaviors [44, 47].

Of importance within our current discussion's context, low EI correlates with worry states, greater degrees of psychological stress, and use of avoidance coping strategies [48]. Competence in EI often leads to effective coping strategies in times of stress, with problem-focused coping in particular leading to alleviation of psychological distress [48]. An important measure of a certain individual's ability to properly cope with stress and adversity is resilience [49]. If a trainee exhibits resilience, this is often a good indicator of his or her stress coping ability [48]. Many mind–body training programs for stress reduction focus on mindfulness and resilience training to mitigate stress, anger, anxiety, and depression.
