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Structure and Function in Medical Education: Trend Analysis of Osteopathic Medical Student Emotional Intelligence (EI) Suggests Curricular Modifications May Improve Functional Traits
Singer-Chang, G. [3]
Dong, F. [3]
Nevins, N. [4]
Seffinger, M. [25]
Blumer, J. [12]
Darmani, N. [2]
Helf, S. [5]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e195-e197. doi: Subito , type of study: longitudinal study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

curriculum [229]
emotional intelligence [4]
empathy [50]
longitudinal study [28]
medical students [402]
osteopathic medicine [1540]
USA [1086]

Abstract:

Background: A growing problem, physician burnout is linked to low EI, depression, anxiety, empathy, poor outcomes, and suicide.1, 2 Research suggests it takes root in medical school,3 giving educators a window to alter its course. Researchers have studied the risk factor empathy,4 an aspect of emotional intelligence (EI). EI encompasses empathy and other related traits.5 The authors sought to determine whether osteopathic medical students exhibit EI trends across matriculation, hypothesizing that if trends could be confirmed, solutions could be developed. Based on literature and initial analysis of the classes DO 2014-2016 suggesting declining EI, 2 key traits were identified for further analysis: empathy and self-regard. With grant support from the AOA, data collection continued to further assess these trends across DO 2014-2018. During the course of this longitudinal study, structural changes took place to the clinical curriculum for the classes of DO 2017-2018. These improvements served as an intervention, offering the opportunity to determine whether EI risk factors could be mitigated. Research Question: Are there identifiable trends in osteopathic medical student EI linked to burnout? If so, can risk factors be positively impacted with educational interventions? Significance/Osteopathic Relevance: With the first tenet of osteopathic medicine stating “the person is a unit of body, mind, and spirit,” holistic development for osteopathic medical students is consistent with the osteopathic approach. EI offers a framework to facilitate and measure this. The third tenet recognizes that structure and function are inter-related. While this refers to patient care, the current study offers the ability to explore whether the same may be true for osteopathic medical education. If so, osteopathic medical educators may seek to better align education and practice. Method: The Bar-On Emotional Intelligence Inventory/EQ-i 2.0 by MHS, Inc. was used. It has 133 self-report items and takes 15 minutes to complete online. It yields an overall EI score as well as scores in 5 domains and 15 subscales. It was offered to DO 2014-2018 at 3 junctures: in-coming, midway, and graduation. Students were emailed the link and provided a 2-week window for completion. Due to attrition, incentives were used for second and third admins in the form of enrollment in gift card drawings and extra credit. Changes took place to the clinical curriculum impacting DO 2017-2018 serving as an intervention. These included incorporation of adult learning models to increase student responsibility for their own development; improved communication channels for students and faculty/preceptors; and a streamlined pathway between preclinical education, clinical education, and residency. The third/fourth-year Essentials of Clinical Medicine (ECM) course, a distance learning course that parallels rotations, was restructured to support the acquisition of Entrustable Professional Activities (EPAs), mirroring the framework used in continuing medical education. Students were offered a variety of activities to choose from, giving them autonomy in directing their own learning. The rotations experience was enhanced. While this mainly impacted the third and fourth years, the Office of Clinical Education began interfacing with these classes during their first year. This included frequent contact with class representatives and a Facebook page, which helped give classroom learning context. Students logged their own experiential learning activities, further reinforcing self-responsibility. Data Analysis: Of 1435 students from DO 2014-2018, 238 completed all 3 surveys, yielding a response rate of 17%. Statistical analyses were conducted to identify longitudinal trends using SAS software for Windows version 9.3 (Cary, North Carolina, USA). A time variable with 3 categories including baseline, mid-way, and graduation was created. Repeated measurement analysis of variance analyses were conducted. A plot of the average of the outcomes (y axis) against time periods (x axis) was used. Statistical analyses were 2-sided. P<.05 was considered significant. Results: Per previous study of DO 2014-2016, overall EI, self-regard, and empathy declined across matriculation with a significant drop taking place mid-way. There were no significant upward trends. When overall EI was analyzed for DO 2017-2018 (n=94), the scores went up from 98.8 to 100.0 (average) mid-way, a non-significant increase (P=.2472), to 108.5 at graduation, a significant increase (P<.0001). Self-regard went from 97.8 to 98.0 (P=.9004) from first to second admin, then increased significantly between send and third with a final score of 103.0 (P<.0001). Empathy went from 104.1 to 103.7 mid-way (P=.7245), with a significant increase between second and third (P<.0001) and a final score of 109.3. With all classes combined, overall EI had a significant initial decrease from 99.6 to 97.7 midway (P=.0044) with a significant increase between second and third and a final score of 101.4 (P<.0001). Self-regard had a significant mid-way decrease from 98.3 to 96.6 (P=.0226), then went up significantly to 98.5 (P=.0063). Empathy had a significant mid-way decrease from 103.4 to 101.4 (P=.004) and a significant increase to 103.4 (P=.0079). Independence was found to have contributed most to the significant upward trend in overall EI in the clinical years, rising from 94.6 to 95.7 between first and second admins in a nonsignificant change (P=.1405), then to 99 (P<.0001) in a significant increase between second and third. Conclusion: Results suggest structural changes to medical school curricula may improve EI traits linked to burnout in a subset of students. It is noteworthy that the biggest contributing factor to the increase in overall EI was independence, or “the ability to be self-directed; free from emotional dependency; decision-making, planning, daily tasks are completed autonomously.5” Future studies of burnout may wish to incorporate physician autonomy. Self-regard and empathy are also worth further study. The downward-upward trend suggests that given the right structure, osteopathic medical students can be resilient. The study has limitations. The small response rate makes generalizability difficult; the EI 2.0 is self-reported; participants self-selected; and given the longitudinal nature, other variables may have influenced results. Inter-institutional research is needed to determine whether these trends occur in the broader DO student population.

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