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Associations Between Emotional Intelligence, Empathy And Abe et al. BMC Medical Education (2018) 18:47 https://doi.org/10.1186/s12909-018-1165-7 RESEARCHARTICLE Open Access Associations between emotional intelligence, empathy and personality in Japanese medical students Keiko Abe1,2* , Masayuki Niwa1, Kazuhiko Fujisaki1 and Yasuyuki Suzuki1 Abstract Background: It is known that empathic communication is important for physicians to achieve higher patient satisfaction and health outcomes. Emotional intelligence (EI), empathy and personality in medical students predict students’ individual disposition and their emotional and empathic perceptions. This study aimed to investigate: 1) The association between empathy, EI and personality, and 2) Gender differences in the association between empathy, EI and personality. Method: Participants were 357 1st year medical students from 2008 to 2011 at one medical school in Japan. Students completed self-report questionnaires comprising three validated instruments measuring EI: Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), empathy: Jefferson Scale of Physician Empathy- student version (JSPE) and personality: NEO-Five-Factor Inventory (NEO-FFI), which explores 5 dimensions of personality Neuroticism (N), Extraversion (E), Openness to experience (O), Agreeableness (A), and Conscientiousness (C). Results: Pearson Correlations showed weak association between TEIQue-SF and JSPE. TEIQue-SF and NEO-FFI showed positive correlation for E and C, and strong negative correlation for N and weak positive correlation for A and O. Weak positive correlation between JSPE and the NEO-FFI were observed for E and A. Although effect sizes were small, N, A and empathy were significantly higher in females (unpaired t-test). However, hierarchical multiple-regression analysis when controlling for gender and personality showed no association between EI, empathy and gender. A, TEIQue-SF and N were found to make small contributions in respect of predictions for JSPE. Personality contributed significantly to the prediction of TEIQue-SF. N had the largest independent negative contribution (β = − 0,38). Conclusion: In our study population of 1st year medical students, females had significantly higher N, A and empathy scores than males. Medical students’ N score was strongly negatively associated with EI. Empathy was weakly associated with EI and A. However, when controlling gender and personality in regression analysis, gender did not affect EI and empathy, rather personality is the most important factor. Our findings indicate that N is a major factor that negatively affects EI. It is important to mitigate N using thoughtful training, taking into account students’ personalities, to reduce N. In future studies, we will assess how communication trainings for students might enhance EI. Keywords: Emotional intelligence, Empathy, Personality, Medical student * Correspondence: [email protected] 1Medical Educational Development Center, Gifu University, Gifu, Japan 2College of Nursing, Aichi Medical University, Nagakute, Japan © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Abe et al. BMC Medical Education (2018) 18:47 Page 2 of 9 Background measure of emotion-related self-perceptions [12]. Re- Compassion and empathy during patient-physician com- search has shown that higher EI positively contributes to munication are major components in successful treat- the patient-physician relationship, increased empathy, ment of health problems [1]. Thus, empathic physicians teamwork and communication skills, stress manage- are more likely to produce improved patient-physician ment, organization commitment, leadership and higher relationship, patient trust, satisfaction, compliance and academic performance [16–19]. to achieve better outcomes in clinical practices [2–4]. In EI and empathy have been found to be associated. Em- addition, these patients’ positive outcomes prompt phy- pathy is viewed as an ability to understand and share the sicians to improve their clinical decisions, leading to feelings of another. It is a multi-dimensional construct greater job satisfaction and well-being, and better leader- which includes both cognitive and affective elements. ship skills within their healthcare team [5–7]. As well as Hojat defined empathy in the context of health care as: biomedical knowledge and clinical skills, physician per- “predominantly a cognitive as opposed to affective of formance is strongly influenced by their empathetic and emotional attribute, that involves understanding of the emotional abilities, which in turn may be shaped and in- patient’s pain, experiences, concerns and perspectives fluenced by personality. combined with a capacity to communicate this under- In the USA, the Association of American Medical standing and an intention to help” [20]. Thus, physi- Colleges (AAMC) states in their learning objectives for cians’ empathic attitude is important in patients’ care to medical school education that “physicians must be com- develop trustful patient-physician relationship and re- passionate and empathetic in caring for patients” [8]. duce their concerns. Additionally, for residents, the Accreditation Council for In addition to EI and empathy, personality is another Graduate Medical Education (ACGME) has defined factor influencing the patient-physician relationship and Emotional Intelligence (EI) competency as assessment patient care. Recently, both EI and empathy have been methods of residents’ interpersonal and communication found to be related to personality in medical students skills, professional behaviors and patient care which were 3 and their ability as successful physicians. Costa et al. pro- of 6 core competences for residents [9]. EI competency vided the Five-factor model for describing personality with definitions include 12 abilities: Emotional self-awareness, 5 dimensions, which is called the Big Five: Neuroticism Emotional self-control, Adaptability, Achievement orienta- (N; anxiety, fearfulness and insecurity in relationships), tion, Positive outlook, Empathy, Organizational awareness, Extraversion (E; sociability, positive affect and energetic Coach and mentor, Inspirational leadership, Influence, behavior), Openness to experience (O; having active Conflict management, and Teamwork. ACGME concluded imagination and esthetic sensitivity), Agreeableness (A; that competences of EI and empathy are essential compo- altruistic, affective, and collaborative behaviors), and nents for 21st century physicians [10]. Conscientiousness (C; having self-discipline, persistence, EI is a measure of emotional awareness and ability to and striving for achievement) [21]. O and A have been respond to emotion in oneself and others. EI has two found to be positively correlated with empathy [22]and major concept models, namely ability EI model and trait both A and E to social functioning [23], also E, O, A and and mixed EI models. Ability EI proposed by Mayer and C have been found to be highly positively correlated with Salovey is the ability to perceive and integrate emotion, EI, whereas, high N, a vulnerability factor for stress, nega- as well as to understand and regulate emotion to pro- tively correlated with EI [24–26]. mote personal growth [11]. It is measured by answering While there is clear evidence for an association be- performance-based questions. And trait EI as described tween EI/empathy and improved patient care, there is by Petrides and Furnam [12, 13] and mixed EI as described also evidence that physicians with a high degree of em- by Golemann [14] can be viewed as the set of interrelated pathy are at great risk of stress from emotional fatigue competencies skills, abilities, personal qualities and person- [27]. Because patient-physician relationships include an ality trait. Trait EI measures one’s self-perception of aspect of emotional labor, highly empathetic physicians emotional self-efficacy. Though the measurement of the may be at risk of ‘burn out’, and therefore they need to construct is different, sampling domains overlap. Both recognize this and learn emotional self-control. EI in- models view EI as a multidimensional construct with cludes the ability not only to perceive and understand cognitive and affective elements, including abilities to one’s own and other’s emotions, but it also includes the recognize, deal with and apply emotional information to ability of how to manage emotions [12, 13]. everyday decision-making and behavior [15]. Both EI and empathy have been found to be influ- The measurement of Trait EI called TEIQue (Trail enced by culture and by gender [13, 20]. These Emotional Intelligence Questionnaire) can provide vital differences have been ascribed to communication pat- and consistent cross-situational information about an terns, including nonverbal communication, which may individual’s personality and behavior, as a comprehensive decrease empathic communication, as well as selection Abe et al. BMC Medical Education (2018) 18:47 Page 3 of 9 of individuals
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