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Medical Education 2011: 45: 835–842
CONTEXT The occupational health literature has long been dominated by stress-related topics. A more contemporary perspective suggests using a positive approach in the form of a health model focused on what is right with people, such as feelings of well-being and satisfaction.
OBJECTIVES Using a positive perspective and multi-source data collection, this study investigated the inter-relationships among emotional intelligence (EI), patient satisfaction, doctor burnout and job satisfaction.
METHODS In this observational study, 110 internists and 2872 out-patients were surveyed in face-to-face interviews.
RESULTS Higher self-rated EI was significantly associated with less burnout (p < 0.001) and higher job satisfaction (p < 0.001). Higher patient satisfaction was correlated with less burnout (p < 0.01). Less burnout was found to be associated with higher job satisfaction (p < 0.001).
CONCLUSIONS This study identified EI as a factor in understanding doctors’ work-related issues. Given the multi-dimensional nature of EI, refinement of the definition of EI and the construct validity of EI as rated by others require further examination.
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Most of the early research on job satisfaction utilised a disease-based model in that it placed a negative focus on what was wrong, including ill health and dissatisfaction in workers. An overview1 of peer-reviewed journals indicated that occupational health research over the past 15 years has continued to be dominated by stress and stress-related topics, such as burnout and depression. This prevailing negative bias is illustrated by the fact that the total number of publications about negative states exceeds those about positive states by a ratio of 14 : 1.2 A more contemporary perspective suggests using a positive approach whereby a health-based model is used to focus on what is right with people, such as present feelings of well-being and satisfaction.3 What are the factors that contribute to the optimal functioning of health care professionals who persist in the face of difficulties? For doctors in daily practice, which factors can enhance the level of patient satisfaction they facilitate, reduce their burnout, and ultimately have an impact on their own job satisfaction? This study refers to one of the important concepts in positive psychology, emotional intelligence (EI), and examines the inter-relationships among EI, patient satisfaction, doctor burnout and doctor job satisfaction.
With regard to the learning and assessment required within the six core competencies defined by the US Accreditation Council for Graduate Medical Education,4 EI is proposed to have the potential to deepen and enrich students’ understanding of competency during medical training.5 Emotional intelligence is defined as ‘the ability to perceive emotion, integrate emotion to facilitate thought, understand emotions, and regulate emotions to promote personal growth’.6 The theory of EI assumes that individuals with high EI have better interpersonal and communication skills. Studies have demonstrated that EI has a positive impact on social relationships7 and job satisfaction.8 Although it has been suggested that EI should be included among the criteria used to select applicants for medical school,9 no association between EI and selection scores10 or specialty choice11 has been found. One study indicated that the nurse-rated EI of a doctor was positively correlated with patient satisfaction.12 Another study indicated that EI had a positive impact on reducing occupational stress among dental undergraduates.13 However, still another study argued that EI could help moderate lower levels of stress, but that the EI effect might be lessened in the presence of an acute stressor.14 In addition, the definition and the measurement of multi-dimensionality merit some consideration. There have been serious academic debates as to whether or not EI is an ability that is distinct from personality traits6,15or whether it is part of a mixed model that combines both.16 Assessments of EI vary by the model adopted and the purpose of the research. From the perspective of a medical educator, viewing EI as an ability allows for a greater likelihood of change than if it were a personality trait.5 Studies6,15,17 that have adopted an ability-based model for EI suggest that EI is a facet of intelligence which is mildly correlated with general mental ability and that it is developmental in nature. This allows it to increase with age and life experiences.
For individual doctors who are required to spend considerable time in intensive involvement with patients and other health professionals, it is important to understand how EI is associated with burnout, a syndrome of emotional exhaustion, depersonalisation and a reduced sense of personal accomplishment.18 Some studies have used a multi-dimensional perspective19 or conservation of resources theory20 to explain the stressors encountered from internal and external sources. Burnout was found to be associated with negative outcomes at both the individual level (e.g. thoughts of dropping out of medical school21 and decreased job satisfaction22) and the organisational level (e.g. diminished productivity, absenteeism, decreased satisfaction with quality of care23). Doctors who achieve higher satisfaction ratings from patients may experience less burnout and higher levels of job satisfaction. The links between EI, patient satisfaction, doctor burnout and doctor job satisfaction are still unclear in the literature. Therefore, the current study was designed to examine the factors associated with job satisfaction using a health-based model.
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The mean ± standard deviation (SD) age of the doctors was 40.78 ± 6.91 years. Most were male (85.4%) and most held a bachelor’s degree in medicine (86.4%). The most common specialty of the doctors was gastroenterology (n = 21). All doctors from the paediatrics, nephrology and neurology departments in the participating hospitals took part in the study. Only one doctor from a rheumatology department participated. Out of 3682 patients, 2872 agreed to participate in the interview (response rate of 78.0%). Of these, 1686 were men (58.7%) and 1186 were women (41.3%). Their mean ± SD age was 45.51 ± 24.50 years. A total of 32.0% of the patients had completed elementary school or less. The majority of participants were recruited from the gastroenterology clinic (19.3%) and the smallest sample from the rheumatology clinic (0.9%; not shown in Table 1). Descriptive analyses of all observed variables are presented in Table 1. As no variable had a t-value > 3.75,29 measures of skewedness and kutosis are omitted.
As Table 2 shows, older doctors appeared to have higher levels of job satisfaction (p < 0.01–0.001). Doctor EI was not related to patient satisfaction. Emotional intelligence was found to be correlated with almost all sub-dimensions of burnout (p < 0.01–0.001) and job satisfaction (p < 0.01–0.001). Higher EI was shown to be correlated with less burnout and higher job satisfaction. Patient satisfaction was shown to be negatively correlated with one sub-dimension of burnout (depersonalisation, p < 0.0.01). Finally, less doctor burnout was significantly correlated with higher job satisfaction (p < 0.01–0.001). As Fig. 1 shows, evidence of convergent validity was reflected in the high magnitude of the standardised factor loadings (0.66–0.81) at a significant level (p < 0.001) for all four constructs of EI. Findings that the estimated correlations between the factors were not excessively high (e.g. > 0.85)29 indicate discriminate validity. Higher doctor EI was correlated with less burnout (ϕ = − 0.73, p < 0.001) and higher job satisfaction (ϕ = 0.52, p < 0.001). Doctors who achieved higher levels of patient satisfaction perceived less burnout in themselves (ϕ = − 0.31, p < 0.001). In addition, work-related burnout was negatively associated with job satisfaction (ϕ = − 0.50, p < 0.001). The independent model that tested the hypothesis that all latent variables were uncorrelated was easily rejected (χ2 = 135.85, d.f. = 49, p < 0.001, GFI = 0.83, RMSEA = 0.13). Support was found for the hypothesised model (χ2 = 49.95, d.f. = 43, p = 0.22, GFI = 0.93, RMSEA = 0.04). A chi-squared test (△χ2 = 95.9, d.f. = 6, p < 0.001) indicated a significant improvement in fit for the hypothesised model over the independent model.
Table 2. Correlation matrix of estimated parameters (n = 110)
|Age||1|| || || || || || || || || || || || || |
| SEA||0.10||1|| || || || || || || || || || || || |
| OEA||0.03||0.55†||1|| || || || || || || || || || || |
| UOE||−0.01||0.57†||0.51†||1|| || || || || || || || || || |
| ROE||0.04||0.56†||0.52†||0.61†||1|| || || || || || || || || |
| Total||0.05||0.81†||0.80†||0.81†||0.84†||1|| || || || || || || || |
| PS1||0.02||0.01||0.13||0.09||0.07||0.09||1|| || || || || || || |
| PS2||0.14||0.12||0.17||0.16||0.14||0.18||0.87†||1|| || || || || || |
| EE||− 0.25||− 0.31*||− 0.04||− 0.41†||− 0.32*||− 0.32*||− 0.13||− 0.20||1|| || || || || |
| D||− 0.24||− 0.31*||− 0.24||− 0.32*||− 0.31*||− 0.36†||− 0.26*||− 0.28*||0.47†||1|| || || || |
| RPA||− 0.18||− 0.49†||− 0.39*||− 0.55†||− 0.41†||− 0.56†||− 0.14||− 0.21||0.54†||0.52†||1|| || || |
| JS1||0.32*||0.21||0.18||0.44*||0.32*||0.35†||− 0.16||− 0.06||− 0.43†||− 0.21||− 0.42†||1|| || |
| JS2||0.39†||0.30*||0.26*||0.47†||0.47†||0.46†||− 0.23||− 0.09||− 0.39†||− 0.23*||− 0.43†||0.82†||1|| |
| JS3||0.34†||0.28*||0.27*||0.47†||0.45†||0.45†||− 0.16||− 0.06||− 0.44†||− 0.31*||− 0.40†||0.71†||0.86†||1|
Contributors: H-CW and Y-JC contributed to the conception and design of the study, the acquisition, analysis and interpretation of data, statistical analysis and the drafting of the manuscript. Y-TL contributed to the conception and design of the study, the acquisition, analysis and interpretation of data and statistical analysis. C-MH, C-YY, C-CC and C-KH contributed to the conception and design of the study, and the acquisition of data. Y-JC and C-CC provided administrative, technical or material support. H-CW obtained funding. All authors contributed to the critical revision of the article and approved the final manuscript for submission.
Acknowledgements: the authors would like to thank all the doctors who participated in this study. We also thank H-J Chen md, L Kang md, W-H Chen md, S-C Chi rn, W-W Feng md, L-J Lin md, L-C Hsiao ms, D-S Perng md, Y-T Su md, H-B Wu md, L-C Chang rn and Z-H Feng rn, for assistance with data collection, and H-C Chen md and T-J Yu md for their support and advice on this project.