A preliminary study of emotional intelligence, empathy and exam performance in first year medical students

Abstract

A group of 156 first year medical students completed measures of emotional intelligence (EI) and physician empathy, and a scale assessing their feelings about a communications skills course component. Females scored significantly higher than males on EI. Exam performance in the autumn term on a course component (Health and Society) covering general issues in medicine was positively and significantly related to EI score but there was no association between EI and exam performance later in the year. High EI students reported more positive feelings about the communication skills exercise. Females scored higher than males on the Health and Society component in autumn, spring and summer exams. Structural equation modelling showed direct effects of gender and EI on autumn term exam performance, but no direct effects other than previous exam performance on spring and summer term performance. EI also partially mediated the effect of gender on autumn term exam performance. These findings provide limited evidence for a link between EI and academic performance for this student group. More extensive work on associations between EI, academic success and adjustment throughout medical training would clearly be of interest.

Introduction

There is considerable interest in establishing whether individual difference measures (other than intelligence) act as predictors of student academic success. A substantial literature devoted to this topic has produced evidence for associations between personality and other traits and success at university. Studies using the five-factor model personality traits of Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A) and Conscientiousness (C) have consistently identified C as a predictor of academic success independent of degree subject (e.g. Chamorro-Premuzic and Furnham, 2003a, Chamorro-Premuzic and Furnham, 2003b, Ferguson et al., 2003, Paunonen and Ashton, 2001); this result is unsurprising given that C includes facets of competence, dutifulness and achievement-striving. The situation for other personality traits is less clear, but there are reasonably consistent findings of negative associations of exam success with N (e.g. Chamorro-Premuzic and Furnham, 2003a, Chamorro-Premuzic and Furnham, 2003b), and positive associations with O (e.g. Farsides and Woodfield, 2003, Phillips et al., 2003). For N, the negative associations with performance are likely to be related to anxiety and stress vulnerability (Chamorro-Premuzic and Furnham, 2003a, Chamorro-Premuzic and Furnham, 2003b). The associations of O with intellectual interest and curiosity, and its positive relationship with IQ have been evoked to explain O/performance associations (Phillips et al., 2003).

In addition to personality, other dispositional predictors of academic success have been identified. A number of studies have shown the importance of coping style, with students showing coping styles classified as active or task-focussed being more academically successful and less likely to drop out (Endler et al., 1994, Shields, 2001, Struthers et al., 2000). Internal locus of control has also been found to be positively associated with academic success (Findley & Cooper, 1983) and academic self-efficacy to be positively associated with both student retention and average grade level (Robbins et al., 2004).

Given the above findings, it seems likely that individual differences in emotional skills and competencies as assessed by measures of emotional intelligence (EI) may also relate to academic success. Some recent work on first year psychology students at a Canadian university (Parker, Summerfeldt, Hogan, & Majeski, 2004) has shown that students who obtained high marks at the end of their first year scored significantly higher on EI than a comparison group who obtained poor grades and were at risk of dropping out. A second study (Parker, Austin, Hogan, Wood, & Bond, 2005) has shown that alexithymia (related to low EI) is a significant predictor of low student success in the first year, with an effect size comparable to that of entry qualifications. A study of first-year students by Schutte et al. (1998) also found a positive association between EI and end-of-year marks. These findings indicate that students with higher levels of interpersonal EI skills (who presumably find it easier to handle the social aspects of starting at university) and intrapersonal EI skills, such as stress management, are better able to handle the transition from school to university; it is not currently clear whether the inter- or intra-personal aspects of EI are more important, or whether both play an equal role in first-year student adjustment. Studies not specifically limited to first-year students have produced mixed results. Of two studies on groups of students enrolled on introductory psychology courses (who would not all necessarily be in their first year at university), one (Newsome, Day, & Catano, 2000) found no association between EI and exam scores whilst the other (O’Connor & Little, 2003) found some weak associations. A study by Barchard (2003) on a group of upper-division students showed significant associations between a number of EI subscales and exam performance, but did not find evidence for EI measures having incremental predicative validity for exam success over cognitive ability and personality. Positive associations between EI and academic performance were also found in a study of postgraduate students by Jaeger (2003).

Taken together, the EI/academic success results to date suggest that more work is needed to establish the conditions (student and course type, method of EI assessment) where EI has some ability to predict academic success. There seems to be a possibility that EI skills may be particularly useful at the point where students are making the transition to the university environment, which typically involves leaving home, less immediate availability of emotional support from parents/family, making new friends and dealing with stressors associated with adjustment to university study, but may become less salient once this transition has been made successfully.

Examining the effects of EI on academic progress in medical students is of particular interest since EI plays a dual role with respect to this group. All the above discussion on the potential contribution of inter- and intra-personal EI to academic success and adjustment apply to medical students. In the UK medicine is studied as an undergraduate degree, so the possible role of EI in relation to first-year student adjustment and progress applies to first-year medical students. In addition, there is an increasing recognition in the medical education literature that EI skills are important for doctors, with much of the discussion being focussed on the need for interpersonal EI/empathy when dealing with patients, although there is also recognition that intrapersonal EI may be relevant to the high-stress working environment which doctors are required to deal with. These considerations have led to some debate on and implementation of EI/empathy training as a medical degree component (e.g. Glick, 1993, McMullen, 2002, Shapiro et al., 2004), and suggestions that EI assessment might be used as part of the selection process for medical students (Carrothers, Gregory, & Gallagher, 2000).

Whilst discussing the issues related to EI in medical students it is also relevant to mention gender effects. Female medical students generally show better academic performance than males (Ferguson, James, & Madely, 2002). Higher scores on EI are often (although not invariably) found in females (e.g. Van Rooy, Alonso, & Viswesvaran, 2005), whilst for empathy females are generally found to have higher scores than males (Hoffman, 1977, Hojat et al., 2001). This raises the possibility that EI and/or empathy levels may be a contributory factor to male/female differences in academic success.

In the present study both an EI scale and a Physician Empathy Scale (Hojat et al., 2001) were completed by a group of first-year medical students. The students also self-reported on their feelings about a communication skills exercise (Talking With Families). Exam results for these students were available for two courses, one with scientific content (Biomedical Science) and one that was more oriented to general issues in medicine (Health and Society). In the light of the above literature review, together with general considerations of the content of medical course sub-components, and of current EI models (as reviewed for example by Matthews, Zeidner, & Roberts, 2003) the following hypotheses were formulated:

• Exam scores would be positively correlated with EI scores, consistent with previous findings for first year students (Parker et al., 2004, Schutte et al., 1998) with a larger effect for Health and Society (which has some EI-relevant content) than for Biomedical Science.

• High EI students would express more positive feelings about the Talking With Families exercise, as this course component taps into interpersonal/social skills which are a subcomponent of EI.

• EI scores and Physician Empathy scores would be positively correlated, since empathy/awareness of the feelings of others is a subcomponent of EI.

• Females would score higher on EI and empathy than males, as found in previous studies (Hoffman, 1977, Hojat et al., 2001, Van Rooy et al., 2005).

• Females would obtain higher exam marks than males, as has been found previously in medical students (Ferguson et al., 2002).