Emotional Intelligence and Resilience Training for Postgraduate Doctors
Dr Isra Hassan, Dr Thomas Kitchen and Dr Laura Jackson from
the Royal College of Anaesthetists
Why do doctors need Emotional Intelligence (EI) and Resilience Training?
Developing professionalism is a core expectation of modern health professional education; doctors must manage high levels of demand and responsibility in constantly changing circumstances of high emotion, while at the same time facing increasing public expectations and living up to the standards required for all doctors.
Doctors are however at risk of experiencing situations in which adverse events, high workload, emotional labour and isolation may create a combination of stressors that can undermine professional practice1. Indeed, a recent morale and welfare survey by the Royal College of Anaesthetists identified that 85% of junior anaesthetists are at risk of burnout, with 64% of anaesthetists in training feeling that their job had affected their physical health, and 61% feeling it had a negative effect on their mental health2.
The Boorman Review3 described the importance of prioritizing staff health and well-being in the NHS and the Francis Report4 clearly demonstrated the need to build a more compassionate and caring healthcare environment. It recognised that to build this environment would require change in both organisational structure and professional training. It also acknowledged that the high levels of mental distress within the workforce and the reported high levels of burnout and depression within the medical profession must be addressed. The GMC response was to highlight and promote the importance of a more open, patient-focused culture in healthcare and the need to invest in building a more resilient workforce and positive culture within the NHS.
Emotions and how they are managed are central to building resilience. Emotional self-awareness is the basis for developing understanding and perspectives on ones own emotions as well as the emotions of patients and colleagues. Training in EI aims to build EI and resilience by strengthening a persons awareness of how they communicate with others and of the effect of their communication on the relationship with the other person(s). Furthermore, it aims to build an individuals skills in recognizing, understanding and analysing their own emotions, and learn to take constructive action based on such conscious analysis (rather than act automatically). By improving skills to communicate and manage emotions with awareness, it is possible to increase a doctors’ ability to understand, adapt to and control situations they meet at work, and thus make better decisions; enabling them to become more person-centered in their work; looking after their patients, their teams and themselves.
In addition, research shows that increasing positive emotions5 and a sense of control within the workplace can increase wellbeing and motivation. In turn this may reduce presenteeism and sickness absence. The final outcome being improved workforce productivity and ultimately organisational resilience. Empowering individuals to support this change in culture is key to providing better and safer patient care, to increased job satisfaction and reduced attrition.
Methods for Training
The challenge remains to determine a method of integrating emotional intelligence and resilience training into both postgraduate and undergraduate training in a way that is meaningful and results in sustained changes.
In September 2017, the GMC issued an action plan entitled ‘reviewing our approach to doctors with health concerns’.6 They created new education standards and recommendations including ‘recommendation 6 – building future resilience’. This stated “medical students work with medical schools to ensure that emotional resilience training is a regular and integral part of the medical curriculum. In the context of developing and maintaining resilience, the framework stresses the importance of doctors being more self-aware; monitoring and seeking appropriate advice to maintain their own physical and mental health.”
The field of EI training and resilience has no quick fix. Key skills include learning ways to challenge unrealistic negative beliefs, advancing communication and problem-solving techniques, adopting assertiveness and negotiation skills and improving one’s ability to deal with strong emotions. These techniques require the individual to identify, reflect on and understand their values, emotional triggers and behaviours as observed and experienced in everyday work and life events.
The Haaland Model (developed by Ane Haaland, a social scientist from the University of Oslo) has been developed and implemented successfully with doctors and nurses across nine countries, based on a individual exploratory process. The Model uses individual observation and Reflection-in-Action guided tasks to support experiential learning in the workplace; linking experience to theory and transforming the everyday workplace into a continual learning environment. Individual observations and reflections are then used to support the development of emotional awareness which is based on their own practices and the effects of these on themselves and on others.
What has been done?
Using the Haaland Model and building on the success of a small pilot programme in 2016, supported by Professor Peter Donnelly (Interim Postgraduate Dean, Wales Deanery) and Professor Debbie Cohen OBE (Cardiff University), a second cycle of EI and resilience training for postgraduate doctors has been completed. This course was planned and delivered by Ane Haaland (University of Oslo), Dr Thomas Kitchen and Dr Isra Hassan. The model focused on training participants in self-awareness and emotional intelligence to build resilience. It was extremely well received.
A wider working group continues to deliver a successful EI programme, based on the Haaland Model, with medical undergraduates in Cardiff University. This is now being lead by Prof Cohen and Dr Thomas Kitchen with the support of Dr Steve Riley (Dean of Medical Education, Cardiff University, School of Medicine).
We present the above opinion seeking your support. The further expansion of the programme will enable it to evolve across all specialities and in the short-to-medium term we seek your support with plans to develop a programme focused on supporting the transition period between undergraduate and specialist training during the foundation years. In the longer term we hope to run a further postgraduate programmes with a parallel training course aiming to train up a faculty to build facilitation capacity.
The overall aim would be to further develop an EI and resilience programme established in undergraduate training, progressing to postgraduate training and consultant practice, supported by a spiral curriculum approach.
This would facilitate and bridge the challenges of foundation training and support the ongoing development through and beyond speciality postgraduate training; enabling doctors to strengthen and maintain skills in emotional intelligence and build resilience.
We want to encourage doctors across specialties to feel safe, to share and support each other; building a culture of well being and openness and in doing so challenge the issues around responses to error and mistakes, non-disclosure of illness, staff retention and presentism in the medical profession.
Dr Isra Hassan (Anaesthetic Registrar, Wales Deanery)
Dr Thomas Kitchen (Anaesthetic Registrar, Wales Deanery)
Dr Laura Jackson (Anaesthetic Consultant, Morriston Hospital)
2) Royal College of Anaesthetists (2017). [Online]. Available: https://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/rcoa-morale-and-welfare-survey.
3) Boorman S. NHS Health and Well-being (2009). Final Report. [Online]. Available: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108907.pdf
4) Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Volume 1.London: The Stationery Office, 2013.
5) Goleman, D. Emotional Intelligence why it can matter more than IQ. Bloomsury. 1995.
6)General Medical Council. Action plan-reviewing our approach to doctors with health concerns. September 2017.[Online].Available:https://www.gmcuk.org/Supporting_vulnerable_doctors___action_plan_FINAL.pdf_66514193.pdf