ORIGINAL RESEARCH Trait Emotional Intelligence and Its Correlates in Oman Medical Specialty Board Residents Salim Al Huseini, MD Mohammed Al Alawi, MD Hamed Al Sinawi, MD Naser Al-Balushi, MD Sachin Jose, PhD Samir Al-Adawi, PhD ABSTRACT Background As part of the globalization of medical education, residency programs in Oman have adopted competency-based standards by the Accreditation Council for Graduate Medical Education International (ACGME-I). Correctly perceiving the emotions of others and managing one’s own emotions are essential to high-quality patient care. Objective We tested the reliability and construct validity of the Trait Emotional Intelligence Questionnaire–Short Form (TEIQueSF), and assessed trait Emotional Intelligence (EI) in Oman Medical Specialty Board (OMSB) residents in multiple specialties. We explored for correlations with trainees’ sociodemographic background data. Methods We conducted a cross-sectional, observational study between February and August 2017. Participants were OMSB residents. We administered the TEIQue-SF and collected sociodemographic data from participants. Multiple linear regression analysis was conducted to identify independent predictors of trait EI. Results The present cohort scored high in the trait EI subscale of Well-being, followed by Sociability, Self-control, and Emotionality. Among sociodemographic factors, female gender and high income were significant predictors of TEIQue-SF’s Wellbeing subscale and high income and living in a rented home were significant predictors of the Sociability subscale. Conclusions This is the first study conducted among medical residents in Oman regarding trait EI and its correlates. Our findings of overall high EI and several socioeconomic predictors echo the literature on the assessment of EI in trainees. The findings add to the evidence of cross-cultural applicability of instruments to measure trait EI, and use assessments of EI in resident selection and education. Introduction In 1999, the Accreditation Council for Graduate Medical Educations (ACGME) defined 6 competencies important to the practice of medicine: professionalism, systems-based practice, interpersonal and communication skills, medical knowledge, patient care, and practice-based learning and improvement.1,2 There is evidence that some of the constituents of these 6 core competencies embrace the construct of trait emotional intelligence (trait EI).3 Trait EI refers to an ability to monitor one’s own and others’ emotions, to discriminate among them, and to use this information to guide one’s thinking and action.4 There is evidence to suggest that for an individual to excel in competencies such as interpersonal and communication skills and professionalism,1 higher trait EI is essential.5 On the other hand, modern medical care is sometimes perceived to be ‘‘dehumanizing,’’ with studies suggesting that physicians are becoming less compassionate or suffering from ‘‘compassion fatigue.’’6 This has been linked to reduced levels of EI in physicians.7 Some have recommended educational interventions to enhance physicians’ ‘‘people skills,’’8,9 and there are indications that EI might help fill this gap.10 The inclusion of the trait EI in health care curricula has been growing in recent years.11,12 Oman’s residency program follows the competency criteria of ACGME International. To date, no studies have explored trait EI and its correlates in Omani trainees. We tested the reliability and construct validity of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) for measuring EI in Oman Medical Specialty Board (OMSB) residents, and to explore a possible association between the 4 dimensions of trait EI and the specialty, year of training, gender, and socioeconomic data. Methods We conducted a cross-sectional, analytical study between February and August 2017. Subjects were residents enrolled in the OMSB training programs. Setting DOI: http://dx.doi.org/10.4300/JGME-D-18-00388 Editor’s Note: The online version of this article contains the Trait Emotional Intelligence Questionnaire–Short Form (TEIQue-SF). 134 OMSB is an autonomous training body located in Muscat, Sultanate of Oman, serving as the sponsoring Journal of Graduate Medical Education Supplement, August 2019 ORIGINAL RESEARCH institution for 17 training programs. In 2017, 597 residents were training in OMSB residency programs. What was known and gap Emotional intelligence (EI) has received attention in the business and medical sectors. EI has not been measured in trainees in an Arab nation. Sampling Method What is new A study of EI in a sample of Omani residents found higher overall EI scores in female trainees, and several sociodemographic predictors of EI and its subscores. Based on the published mean difference and standard deviations in TEIQue-SF subscales,13 the required sample size for a 95% confidence interval, 5% a level, and power of 80%, calculated, was 323, using Epi Info software (Centers for Disease Control and Prevention, Atlanta, GA). Data collection took place during a mandatory OMSB workshop. To ensure the representativeness of the study sample, stratified random sampling was adopted, according to the specialty (approximately 65% medical, 20% surgical, and 15% laboratory), reflecting the demographic distribution of residents in OMSB programs. We used randomization software to select participants. Subjects were contacted via the OMSB e-mail system to explain the study and have them provide signed consent electronically. Those who declined to participate were replaced by other randomly selected trainees. Limitations Single institution study and a majority female sample limit the ability to generalize. Bottom line The findings add to evidence of cross-cultural applicability of instruments to measure EI and its use of these assessments in resident selection and education. a cutoff score of . 0.90. Factor loading . 0.30 of the individual item was included in the equation. Bartlett’s test and the Kaiser-Meyer-Olkin index were performed to gauge the fitness of the data for factor analysis. Linear regression analysis was carried out for the significant variables in the univariate level analysis (ANOVA) to evaluate the predictors of Emotionality, Well-being, and Sociability factors. The independent variables were considered given Study Instrument and Sociodemographic Variable their theoretical relationship with both outcome and We used the TEIQue-SF (provided as supplemental TABLE 1 material),14 a self-administered scale designed to Sociodemographic Characteristics of Residentsa capture personality facets and an individual’s dispoVariable n (%) sition in relation to the emotions. In addition to Gender TEIQue-SF, we collected information on various sociodemographic variables (TABLE 1). Male 101 (32) Ethical approval was granted by the OMSB Female 219 (68) Research Ethics Committee and the College of Age, Mean 6 SD 27.84 6 1.84 Medicine and Health Sciences at Sultan Qaboos Accommodation University, Muscat, Oman. Written informed consent Rent 74 (23) was obtained from all participants. Owned 246 (77) Socioeconomic status Data Analysis Low income We computed descriptive statistics for sociodemographic characteristics and items in the TEIQue-SF. Comparison between groups was conducted using the 2-tailed Student’s t test or one-way analysis of variance (ANOVA). Tukey-post-hoc pairwise comparison was performed to find the statistically significant ANOVA. Correlation analysis was conducted by calculating the Pearson product-moment coefficient. Multiple linear regression analysis was conducted to identify independent predictors of the residents’ trait EI. Significance was set at .05. All statistical analyses were carried out using SPSS Statistics 22 (IBM Corp, Armonk, NY). In order to reduce the probability of type 1 errors in the confirmatory factor analysis of data in the current study, we used the adjusted goodness of fit index with 5 (2) Average income 279 (87) High income 36 (11) Secondary education Bilingual school Government school 21 (7) 299 (93) Level of residency Resident 1 121 (38) Resident 2 105 (33) Resident 3 94 (29) Specialty a Medical 206 (64) Surgical 72 (23) Laboratory 42 (13) N ¼ 320 under the auspices of Oman Medical Specialty Board from 17 different subspecialties in Oman. Journal of Graduate Medical Education Supplement, August 2019 135 ORIGINAL RESEARCH exposure, and their often-observed correlation with Emotionality, Well-being, and Sociability factors in univariate analysis (P ¼ .25). The standardized b coefficients were stated with 95% confidence interval (CI). The goodness of fit in the linear regression model was assessed by the coefficient of determination (R2) Cox and Snell approach.15 Results A total of 320 participants returned complete questionnaires (TEIQue-SF), yielding a response rate of 99%. TABLE 1 presents their sociodemographic characteristics, which reflects the actual distribution of residents across the 3 specialty subtypes. The mean (6 SD) of the trait EI score by factors which are as follows for each subscale: Well-being 4.57 6 0.67; Self-control 4.29 6 0.72; Emotionality 3.75 6 0.70; and Sociability 4.31 6 0.61. The global trait EI of all residents was 4.20 6 0.42. Reliability and Validity of TEIQue-SF The reliability and validity of TEIQue-SF have been established across different populations,16–18 but not with trainees in the Arab world. Internal consistency reliabilities of the 4 factors were as follows: Cronbach a ¼ 0.70 for Emotionality, a ¼ 0.8 for Self-control, a ¼ 0.78 for Well-being, and a ¼ 0.75 for Sociability. Confirmatory factor analysis resulted in 4 factors having an Eigenvalue . 1 and accounting for 68% of the total variance. We confirmed internal consistency and 4 factors as previously reported.19 These factors were congruent with the original scale, Sociability, Emotionality, Self-control, and Well-being. The individual items loaded well on each factor. TABLE 2 shows the univariate analysis of the 4 subscales of the trait EI as well: Well-being, Selfcontrol, Emotionality, and Sociability, correlated with different sociodemographic characteristics. Female gender and high income were associated with the higher mean score on Well-being of trait EI (P ¼.019; P ¼.002) and living in a rented house and high income correlated with Sociability in univariate analysis (mean 6 SD 4.44 6 0.61, P ¼ .043; mean 6 SD 4.00 6 0.44, P ¼ .003, respectively). No association was found between other independent explanatory sociodemographic variables (age, marital status, income, year of residency, specialty, and education level) and any EI subscales. There also was no single independent variable that was associated with the composite EI score. TABLES 3 and 4 show multiple linear regressions we ran to predict EI subscales Well-being and Sociability, which were significant in univariate analysis. 136 Discussion The current study, which is the first of its kind in the region, investigated the level and correlates of EI in OMSB residents using the TEIQue-SF. We also explored the psychometric properties of the generic TEIQue-SF. Our average composite score for the TEIQue-SF was 4.20 6 0.42, lower than the average score for the general population and for surgical residents in a prior study,20 but comparable to a study of family medicine residents.3 Our study did not find any significant difference in trait EI and its subscales among residents in different specialties, years of training, and by marital status and age, which is similar to a study of Iranian students of medical sciences21 and a study of American residents in their senior year.22 Omani residents scored high on indices of Wellbeing, followed by Sociability, Self-control, and Emotionality, respectively, in contrast to a study in which the lowest scores were on the Sociability subscale.23 Our lowest score was Emotionality, and there may be cultural factors in this finding. Omani culture, due to traditional value systems, may be less likely to openly express emotion,24 and there is some propensity in Omani culture to somatize emotionality.25 Future studies could explore whether there are cultural differences in some aspects of trait EI. Prior studies have examined the determinants of the trait EI in medical trainees and practitioners.26–28 In our sample, gender was a strong predictor of high trait EI: women scored significantly higher in trait EI scores than men in the Well-being subscale, echoing the findings of a systematic review of studies on trait EI.1 Female gender and high income also showed strong links to the Well-being subscale, in contrast to studies that found no association between trainees’ (?) gender and overall EI.20,22,29,30 Our findings are consistent with research from Sri Lanka,31 Saudi Arabia,32 Malaysia,33 Iran,21 and India.34 This could be explained by women being better at articulating emotions compared to men.35 In addition, over the last decade, Omani women have academically outnumbered their male colleagues,36 resulting in a ‘‘feminization’’ of health care services in the country.37 Therefore, it is possible that the observed higher EI among female residents could be partly reinforced by the increasing participation of women in the health workforce. We also explored the effects of socioeconomic status on trait EI. In Oman, one’s social standing often reflects his or her family origin or tribe, while in Western Europe or North America, one’s education, income, and occupation define socioeconomic status.38 Journal of Graduate Medical Education Supplement, August 2019 2 Univariate Analysis of Trait Emotional Intelligence Subscales and Associations With Different Sociodemographic Characteristics of Study Participants TABLE Well-Being Variable Gender Male 4.44 6 0.68 Female 4.63 6 0.66 Self-Control P Value a .019 Emotionality Sociability (Mean 6 SD) P Value (Mean 6 SD) P Value (Mean 6 SD) 4.3360.77 .54 3.76 6 0.68 .75 4.34 6 0.70 4.2760.70 3.74 6 0.71 P Value .62 4.30 6 0.57 Age Age r ¼ –0.083 .14 r ¼ 0.023 .68 r ¼ 0.039 .48 r ¼ 0.005 .93 Marital status Married 4.60 6 0.79 .86 4.19 6 0.54 .72 3.55 6 0.86 .62 4.50 6 0.58 .57 Single 4.55 6 0.63 Rent 4.53 6 0.66 Owned 4.58 6 0.67 Acccomodation Secondary education Level of residency Specialty 4.32 6 0.73 .59 4.40 6 0.76 3.73 6 0.65 .14 4.26 6 0.71 a .002 3.78 6 0.72 4.32 6 0.57 .45 3.70 6 0.69 4.44 6 0.61 4.27 6 0.61 Low income 4.63 6 0.32 Average income 4.53 6 0.68 4.27 6 0.73 3.74 6 0.69 High income 4.80 6 0.52 4.42 6 0.60 3.76 6 0.77 Public 4.47 6 0.57 Private 4.57 6 0.67 Resident 1 4.59 6 0.67 Resident 2 4.08 6 0.82 Resident 3 4.52 6 0.67 Medical 4.55 6 0.68 Surgical 4.52 6 0.68 4.20 6 0.85 3.61 6 0.73 4.25 6 0.58 Diagnostic 4.74 6 0.56 4.44 6 0.56 3.63 6 0.56 4.29 6 0.57 4.33 6 0.77 .48 4.17 6 0.69 .39 4.28 6 0.74 .52 .45 4.3060.72 3.76 6 0.71 3.69 6 0.71 .003a 4.63 6 0.58 .07 4.34 6 0.56 .81 4.31 6 0.61 .77 4.32 6 0.63 .48 3.83 6 0.47 3.70 6 0.70 .22 4.00 6 0.44 4.28 6 0.60 3.69 6 0.09 4.32 6 0.65 4.29 6 0.70 3.48 6 0.47 .46 3.76 6 0.71 .53 3.75 6 1.53 .20 4.13 6 0.88 .043a 4.29 6 0.56 .50 4.34 6 0.63 .58 Statistically significant. Note: To study the relationship between independent variables and emotional intelligence subscales, 2-tailed Student’s t test or one-way analysis of variance (ANOVA) were used. A Tukey-post-hoc pair wise comparison was performed for a statistically significant ANOVA. Correlation analysis was conducted by calculating the Pearson product-moment coefficient. 137 ORIGINAL RESEARCH Journal of Graduate Medical Education Supplement, August 2019 Socioeconomic status a (Mean 6 SD) ORIGINAL RESEARCH TABLE 3 Multiple Linear Regression Analysis for Predicting WellBeing Factor From Explanatory Independent Sociodemographic Variables of Study Participants References 1. Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N. Emotional intelligence in medicine: a systematic review through the context of the ACGME Variable B SEB b P Value competencies. Med Educ. 2010; 44(8):749–764. doi:10. Intercept 30.453 3.508 1111/j.1365-2923.2010.03709.x. a Gender 1.057 0.487 0.123 .031 2. Joyner BD. 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Salim Al Huseini, MD, is Psychiatric Resident, Oman Medical Specialty Board, Muscat, Oman; Mohammed Al Alawi, MD, is 140 Senior House Officer, Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Hamed Al Sinawi, MD, is Senior Consultant, Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman; Naser AlBalushi, MD, is Psychiatric Resident, Oman Medical Specialty Board, Muscat, Oman; Sachin Jose, PhD, is Senior Statistician, Studies and Research Section, Oman Medical Specialty Board, Oman; and Samir Al-Adawi, PhD, is Professor, Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Oman. Funding: The authors report no external funding source for this study. Conflict of interest: The authors declare they have no competing interests. The authors would like to thank all the residents who participated in the study, the leadership at Oman Medical Specialty Board for their capable and generous contributions to the project, and Sajjeev Antony for his helpful suggestions on an earlier draft of this manuscript. Corresponding author: Samir Al-Adawi, PhD, Sultan Qaboos University, College of Medicine and Health Sciences, Department of Behavioral Medicine, PO Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman, adawi@squ.edu.om Received May 17, 2018; revisions received May 23, 2019, and June 11, 2019; accepted June 18, 2019. Journal of Graduate Medical Education Supplement, August 2019