Education Columns

Sonya Dominguez, MD and Terri Wall, PhD

Emotional Intelligence (EI) is a vital concept to the development of sustainable professionals. EI is made up of: knowing one’s emotions (self-awareness), managing emotions, motivating oneself, recognizing emotions in others, and handling relationships.^1,2 Our residency program has committed to cultivating these qualities in our residents using a learning portfolio. By the end of the first year the residents have multiple opportunities to focus on the medical knowledge they gain as well as how the patient’s experience with illness impacts them.

The recent Milestones provide opportunity to identify gaps in our current residency curriculum. Some of the Milestones are more difficult to capture and evaluate and can be done most effectively through resident self examination. Our learning portfolio creates a space in the curriculum to teach EI through reflection of resiliency, professionalism, wellness, and lifelong learning. The milestones help operationalize qualities that residents don’t always realize are essential to their professional development and sustainability.

Residents are constantly faced with powerful moments during their patient and professional encounters, yet do not always have time to process these experiences. This can lead to burnout, false conclusions, and lack of personal growth. Our new learning portfolio is a continuity lecture series concentrated in the first year of residency. We have developed a series of lesson plans, and we allow each resident a turn facilitating the session with the help of a faculty and a behaviorist. The residents have some brief “homework,” which typically involves a reflection document to complete and results in a better understanding of the milestones and core competencies.

The current learning portfolio integrates multi-media tools such as TED Talks, chapters from several books, including 7 Habits of Highly Effective People, How Doctor’s Think, and The Resilient Physician, as well as requires residents to research ACGME competencies, analyze their In-service Training Exam performance, role-play, and discuss work-life balance. For a complete set of lesson plans, see Appendix A. The purpose of the series is to develop a space in the curriculum for reflection and life-long learning and to share victories and struggles with a peer group.

As with any creative curriculum, there are challenges and opportunities for improvement. Attendance has been challenging, as people are sometimes on vacation or on night float. We have made attendance mandatory, but do not have consequences for missed sessions. As the Milestones allow us to capture some of the professionalism and interpersonal communication skills, our hope is that residents will realize the value in completing the lesson plan and achieving the competency. Acquiring buy-in from residents and faculty has been part of the learning curve, and we hope to use the portfolio for discussion with the faculty advisors during resident quarterly evaluations to help with this. We plan to use New Innovations as a central depository for the lesson plans and completion of assignments, as this has been difficult to track. The focus is not solely on the end product and completion of the assignment but instead on the process and reflection that goes into it.

We believe this project will lead to more emotionally intelligent professionals in family medicine. Our vision is to expand the curriculum beyond the first year of residency. Often the senior residents see the value of the reflective writing in hindsight, and engaging them to share this with junior residents will provide more credibility to the process and keep the learning portfolio innovative.

Recommended Readings for Portfolio Group:
Covey S. The 7 Habits of Highly Effective People. New York: Free Press, 1989.
Goleman D. Emotional Intelligence, Why It Can Matter More Than IQ. Bantam Books, 2005.
Groopman J. How Doctors Think. Boston: Houghton Mifflin Company, 2007.
Sotile W, Sotile M. The Resilient Physician: Effective Emotional Management for Doctors and Their Medical Organizations. American Medical Association, 2002.

References

1. Cherry K. What is emotional intelligence? Definitions, history, and measures of emotional intelligence. (2014, June 3) http://psychology.about.com/od/personalitydevelopment/a/emotionalintell.htm.
2. Goleman D. Emotional intelligence, why it can matter more than IQ. Bantam Books, 2005.

Appendix A
1. Learning Portfolio Lesson Plans Introduction to Professionalism
Residents are given an opportunity to define professional characteristics they would like in their own physician, which lends itself to introduce all of the core competencies and their relevance to residency (Milestone Prof 1, level 1)

Written Reflection: Describe the type of doctor you would like to be. What qualities do you already possess and what qualities would you like to work on during residency?

2. Seven Habits of Highly Effective People
Review Concepts and Habits (Milestone Prof 1, Level 1)

Written Reflection: Write your own mission statement by going to http://www.franklincovey.com/msb/.

3. How Doctor’s Think: Introduction and Chapter 1
Residents discuss their reaction to this chapter and discuss their own professional and personal values (Milestone Prof 1, Level 1-3)

Written Reflection: Write briefly about a case involving a missed, nearly missed or delayed diagnosis that you were involved with or witnessed. Be as specific as you can. Try to focus on all of the possible factors that you think contributed to the event.

4. How Doctor’s Think: Chapter 2 and the Epilogue
Residents discuss their reaction to these chapters and discuss their own professional and personal values. (Milestone Prof 3, Level 1-3)

Written Reflection:
     a. How can you help patients ask appropriate questions in order to better understand their diagnoses and treatment options?
     b. If the patient is not asking an important question how can you incorporate the information into the discussion?
     c. How can you help a person with limited cognitive functioning (for whatever reason) be more involved in their health care decisions?
     d. Lastly, pick a diagnosis and come up with 5 questions you would ask your own physician if you were diagnosed with the condition.

5. The Resilient Physician Chapters 1-3
Read the material and do the self-assessments provided in the chapters. During meeting—group discussion of self-assessments and concept of resiliency. (Milestone Prof 4, All Levels)

Written Reflection:
     a. What are your personality factors that contribute to your resiliency/protection against burnout?
     b. What are your personality factors that are a block to your resiliency/contribute to burnout?
     c. What is one thing you can do to prevent burnout and write down a plan to incorporate that item into your life regularly?

6. Time Management
Review Covey’s Time Matrix to help residents plan lifelong learning and how to triage the day to day tasks before them (Milestone Prof 2, Level 1,2)

7. In-Training Exam Review
Residents must review their ITE and develop a personal learning plan to improve their medical knowledge and meet MOC requirements, while reading some test taking tips and reviewing resources available to them (Milestone MK 1, Level 2)

8. Ted Talk: Doctor’s Make Mistakes, Can We Talk about It?
Watch a 20 min TED Talk by Daniel Goldberg and discuss mistakes they have made. (Milestone SBP 2, Level 1 & 2; SBP 4, Level 1 & 2; Prof 4, Level 3 & 4)

Written Reflection: Think about a recent mistake you made or were afraid you made. What lead to the mistake, what could have been different, what could have prevented the mistake? How did you feel about making this mistake and how did you manage those feelings?

9. Communication
Review Covey’s Habit 5 - Seek First to Understand: Demonstrate/role-play active and reflective listening. (Milestone: C2, Level 1,2, 3)

Written Reflection: Describe a time you were communicating with someone and you were more interested in getting your point across then in understanding their point of view. How did the conversation end and how did you feel after the conversation? Now describe a conversation when you were able to truly listen and understand what someone was communicating with you. How did that conversation end and how did you feel about it?

10. Wrap–up Field Trip: Review competencies, Milestones, and concepts of Emotional Intelligence. Written Reflection: Give examples of 2 intern “milestones” that have shaped your experience this year. Write 3 goals for your second year. Celebrate with frozen yogurt!