Evidence and Strategies for Including Emotional Intelligence in Pharmacy Education

Emotional Intelligence Tools and Assessments

While various emotional intelligence studies have been performed, experts in emotional intelligence research have not agreed on a standardized assessment tool.³ The literature describes several tools for measuring emotional intelligence,^26-40 and these assessments are generally divided by the various model theories of emotional intelligence: ability, trait, and mixed. As these competing views on how to characterize emotional intelligence continue to diverge, it is becoming less likely that any concordance regarding a standardized assessment method for emotional intelligence in health education will be reached.³ Thus, selecting the appropriate assessment tool largely depends on the purpose of the assessment; Appendix 2 provides a detailed summary of some emotional intelligence assessment tools.

When selecting an assessment tool, choosing between ability-based versus trait-based versus mixed measures may be an important first step. Ability-based measures are useful when one wants to assess a student’s ability to identify emotions. However, measures based on the emotional intelligence ability construct have difficulty distinguishing between emotional intelligence skills gleaned from experience versus skills developed independent of prior learning, which prevents one from assessing the impact of curricular interventions on students’ emotional intelligence development. In most cases, ability-based measures cannot be falsified, as there is a right answer to each question, similar to IQ tests, which have the advantage of eliminating self-report bias.³ However, ability-based measures do not predict outcomes; just because a test taker understands an emotion does not mean they will be able to take appropriate action in a given situation. Furthermore, the ability to correctly identify emotions does not necessarily translate into actual behaviors, which limits the utility of ability-based measures in assessing EQ.³ Ability-based emotional intelligence assessments could potentially be used in introductory communications courses, which require foundational understanding of emotions and how they work, and in leadership courses, where students need to have a good theoretical understanding of emotions. Ability-based assessments may also be useful in personnel selection, as they can be good predictors of good managerial skills.

Two prominent ability-based tools are the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT V2.0) and the Genos Emotional Intelligence Inventory (Genos EI). The MSCEIT is the most popular ability-based tool and is available from Multi-Health Systems (MHS) of Toronto, Canada.³⁰ The test is available in adult and youth research versions. MHS scores the test based on the standardization sample and expert criteria, with an option for researchers to develop their own independent norms. The Genos EI is a behavior-based assessment that was created to assess professionals’ typical workplace behavior.³¹ Three versions of Genos EI (ie, short, concise, and full inventories) are available in both self-report and rater-report format. A development report is provided along with scoring, which identifies strengths and opportunities for development and personalized suggestions for emotional intelligence development.

Trait-based measures have the distinct advantage of assessing student emotional intelligence based on typical behavior in the past, which can be a predictor of future performance.³ This can be useful in situations that are intervention based and require students to identify weaknesses prior to training/coaching. Trait-based measures are useful in situations where the researcher needs to measure emotional self-efficacy. However, trait-based measures are prone to self-report bias, which may limit their utility in situations where the test taker may hesitate to report negative traits or may opt for a socially desirable response, such as during admissions or job interviews.³ In addition, trait-based measures rely on test taker self-awareness and good judgment, which is not always a given.

Various trait-based measures exist, such as the Trait Meta-Mood Scale (TMMS) which is largely outdated but widely assessed. It was modified from 30 to 24 self-reported items in multilingual versions rated on a Likert scale of one (strongly disagree) to five (strongly agree) and divided into three subscales that are classified in either the low, middle, or high score range.³² The scale is available online through the American Psychological Association (APA) PsycNet, and is free for members or those with institutional access. The average and interelement correlations both showed a moderately positive relationship for each of the subscales.

Another trait-based measure, the Trait Emotional Intelligence Questionnaire (TEIQue) provides a comprehensive assessment of an individual’s emotional self-efficacy.^26,33 TEIQue conceptualizes emotional intelligence as a personality trait to be viewed in the context of trait emotional intelligence theory. It does not measure emotional intelligence per se, but the scoring represents typical behavior or self-regard. The instrument has strong reliability and is extensively validated.²⁶ The original version can be completed within 30 minutes. Additional adaptations are available, such as the short form (TEIQue-SF) and peer or 360-degree ratings (TEIQue 360°).

Finally, the trait-based Assessing Emotions Scale (AES), also called the Emotional Intelligence Scale, Self-Report Emotional Intelligence Test (SREIT), Schutte Self-Report Emotional Intelligence Test (SSEIT), Schutte Emotional Intelligence Scale, or Schutte Self-Report Inventory (SSRI), is a measure of trait emotional intelligence based on Salovey and Mayer’s original model.^1,34 The assessment is closely associated with the Emotional Quotient Inventory model and relates to the four branch model of EQ.² Individualized reports are not available; instead total scale scores are calculated by reverse coding three items and then summing all items. Scores can range from 33 to 165, with higher scores indicating stronger emotional intelligence. AES has strong markers of reliability.

Mixed-model assessments combine measurements on multiple social-emotional emotional intelligence qualities, including personality, motivation, emotionally based skills, and other areas.²⁷ The benefit of using a mixed assessment is that, instead of using multiple tools, a mixed assessment can assess multiple emotional intelligence qualities in one tool and combine them together into an emotional intelligence percentage (like IQ). Mixed-model emotional intelligence assessments are typically heterogenous and are measured via self-reports and/or rater reports, which makes self-report bias more likely. Despite this potential bias, mixed assessments are becoming more commonly used because they can measure multiple emotional intelligence qualities in a single tool.

The Emotional Quotient Inventory 2.0 (EQ-i 2.0) is a self-reporting instrument based on the mixed model that assesses social and emotional traits and their influence on an individual’s well-being.³⁵ The self-administered instrument is available from MHS Inc and uses short self-statements rated on a five-point Likert scale.²⁷ Various report options are available, including but not limited to a detailed, personalized client report with strategies for action, a development plan, and a higher education report for the student and counselor to help foster academic and life success. However, 15 subscales may make this tool esoteric, too complex to easily recall, and time-consuming. Multiple tests of validity are incorporated into the EQ-i 2.0, including an inconsistency index to assess for randomness in responses and positive- and negative-impression scales to indicate excessive positive or negative responses, respectively. The EQ-i 2.0 instrument shows strong reliability, both internal consistency and test-retest.³⁶ The 360 multirater measure (EQ-360) is available as a complimentary assessment that combines self-assessment with the perceptions of others who know the individual well.

Another mixed model, the Social and Emotional Development Inventory (SED-I) is designed to better understand and improve the developmental path of social and emotional ability for students in higher education.^37,38 This model focuses on a student’s ability to identify emotional cues, process emotional information, and employ emotional knowledge to adapt to social challenges in higher education. Using the SED-I companion tool, students rate how often 48 different statements are true for them using a seven-point scale, ranging from one (“very rarely”) to seven (“very often”). The four factors of the SED model are represented equally, and each factor contains three reverse-scored items. After adjusting for reverse-scored items, factor scores are derived as well as a total score. These scores generate a student’s rank order preference of the four factors to identify areas of social and emotional competence and create developmental learning agendas. The SED-I has excellent reliability for the overall scale and good reliability for the factor scales. Test-retest reliability over a three- to seven-month period was stronger for the factors “influencing change” and “connection to others” than for “self-awareness” and “consideration of others” (r = 0.74, 0.79, 0.36, and 0.53, respectively).

The Personal-Interpersonal Competence Assessment (PICA) is a refinement to the SED-I to better align the operational instrument with the conceptual framework.³⁹ Students rate how often each statement is true for them using a nine-point scale, ranging from one (“never”) to nine (“always”). This assessment model includes the same four factors of the SED with each factor represented equally but without reverse-scored items. Factor scores and a total score are derived as well as a student’s rank order preference of the four factors to identify personal-interpersonal competence, which is the increase in emotional knowledge capacity and social-behavioral options to achieve desirable, sustainable outcomes. The PICA demonstrates strong reliability.

Another mixed-model assessment, popularized by the book Emotional Intelligence 2.0, is the Emotional Intelligence Appraisal assessment, which is intended to increase emotional intelligence through 66 strategies.²⁸ The test aims to increase emotional intelligence from a baseline assessment, after which an online report is generated along with a goal-tracking system (plus automatic reminders) that suggests how to improve emotional intelligence skills. The same authors developed the Emotional Intelligence Appraisal, Me Edition, which is self-administered and consists of 28 items; no certification is required to administer it.²⁸ A report is generated containing composite scores for each of the four domains and a description of what their score means. The Emotional Intelligence Appraisal demonstrates strong reliability.

The mixed-model tool Emotional Competence Inventory (ECI) is a 360-degree tool designed to assess the emotional competencies of individuals and organizations.⁴⁰ It measures 18 competency areas that receive a competency level score; these scores are available in the report and indicate the level that is most characteristic of the participant’s day-to-day work behaviors based on the feedback of others. Overall, the reliability of the ECI is considered good, but the “self” rating reliability is not as strong. Lastly, an overall validity study of the self-scored version of ECI demonstrated good construct, discriminant, and criterion validity.

The Emotional and Social Competency Inventory (ESCI) is a 360-degree survey designed to assess 12 competencies of ability based on the abovementioned ECI.²⁹ The ESCI measures the demonstration of individuals’ behaviors through their perceptions (self-scores) and those of their raters (others’ scores), making it distinct from measures of emotional intelligence that assess ability or personality preferences. ESCI data is scored against a frequency range. Respondents are asked to assess the behaviors captured within each item on a five-point scale ranging from one (“never”) to five (“consistently”), and an ESCI report is generated. Strength is indicated when participants’ scores are ≥ 85% of the scale (a score of 4.3), which means that others perceive them to be demonstrating that competency often or consistently. The ESCI shows participants how others experience their behavior in terms of the consistency with which they demonstrate emotional and social competencies. Over 160 000 ESCI and ECI assessments have been processed, and it has strong indicators of reliability.

Finally, the Emotionally Intelligent Leadership for Students (EILS) Inventory is a self-report assessment of emotionally intelligent leadership in the context of a student environment.³⁵ The goal of the EILS is to serve as a learning tool for high school, college/university, or graduate school students, and it includes three key domains: consciousness of context, consciousness of self, and consciousness of others. The EILS inventory includes 19 statements assessed on a five-point Likert scale, and a score (ranging from eight to 40) is generated for each of the three domains/constructs. Reliability was tested, and each scale achieved a strong level of reliability.

Implementing Emotional Intelligence in Pharmacy Programs

Zeidner and colleagues⁴¹ identified seven characteristics of successfully incorporating emotional intelligence into educational programs: clear objectives and outcomes, educational context of the program, full integration into the curriculum, direct application of emotional intelligence to one’s field, trainer/faculty development, and appropriate evaluation of the program. By incorporating emotional intelligence into the curriculum, rather than having an add-on seminar or workshop on EQ, students are more likely to see emotional intelligence as an integral component of their education and training. Schools should also consider and evaluate the best process for standardized programming, effective teaching and assessment methods, assessment tools, and faculty training. School assessment committees should consider collecting data that shows continuous development of emotional intelligence abilities within both the didactic and experiential curriculum. Curriculum committees should consider identifying courses where emotional intelligence is first introduced and later developed. Skills and laboratory courses that are equipped to measure emotional intelligence development may provide critical data to demonstrate its systematic development. In addition, including emotional intelligence within social and administration courses may provide some applicability of emotional intelligence in leadership development, business and project management, and entrepreneurship. Cocurricular outcomes should also include emotional intelligence as a learning competency, and collaborations with student organizations may allow for a more student-driven process for emotional intelligence inclusion. In addition to the deliberate curriculum, personal development through regular reflection may allow for self-development and a conscious effort by students to work on their emotional intelligence as a lifelong competency rather than an isolated outcome. Institutions should identify faculty members with interest in emotional intelligence and facilitate further training in this arena through resource support and workload allocation; only a well-qualified faculty can systematically incorporate emotional intelligence into the curriculum. When possible, schools should pursue interprofessional collaboration with other programs, such as psychology, education, or other health care professions, to leverage the progress that other programs are making in EQ.

For implementing emotional intelligence specifically into pharmacy programs, general areas of applicability come from Standard 4 of the American Council for Pharmacy Education (ACPE) accreditation guidelines, which focuses on personal and professional development. Its key elements are self-awareness, leadership, innovation, and professionalism, all of which have the underpinnings of emotional intelligence.⁴² Additional elements of emotional intelligence that are important for professional identify and practice may include mental health/well-being, clinical performance, and communication. Appendix 3 illustrates example cases for practical applicability of emotional intelligence in pharmacy practice.^{4,7-10,12,14-17,20,21,24,35,36,43-52} Regarding emotional intelligence in the context of professionalism, professionalism is a competency that is continuously challenging to teach.^43,44 The term is nebulous and encompasses a variety of behaviors and values including volunteerism, respect, punctuality, enthusiasm for learning, interprofessional collaboration, patient interaction, and leadership activities, among others. Taylor and colleagues⁴⁵ proposed that to be a professional, one must have both a cognitive knowledge base to understand the situation and a moral base to respond appropriately to the situation. Several techniques are available to improve professionalism, including role modeling, experiential learning, mentorship, and others.⁴⁶ Role modeling can be an excellent way to develop pharmacy professionals, but these situations require the student to observe and understand the moral basis of the behaviors they are expected to emulate. For the observing student, the mentor’s private analysis of every situation may still be a mystery. Therefore, Taylor and colleagues⁴⁵ suggested that emotional intelligence may be the basis for teaching professionalism, as it encompasses several intangible competencies, namely self-awareness, self-control, social awareness, and relationship management, which are key in developing a true professional.

In the context of mental health/well-being, stress can have negative health outcomes, including anxiety, weight gain, and cardiovascular disease.⁴⁷ Doctor of pharmacy students report high levels of stress likely related to a variety of sources, such as academics, family expectations, personal relationships, and uncertainty about the future.⁴⁸ As the transition to professional school can be difficult and stressful for most students, this represents a context in which explicitly developing students’ emotional intelligence may be beneficial. Pau and colleagues¹⁶ found that dental students with high levels of emotional intelligence reported less perceived stress, perhaps due to their ability to regulate their mood, develop relationships that help them cope with hardships, and their ability to empathize with others. Arora and colleagues⁴ found similar results with medical students who were performing surgical tasks. Students with higher emotional intelligence traits had lower self-reported stress and lower objective stress as measured by their elevation in heart rate during surgery. Among nursing students, Por and colleagues¹⁷ also found a positive relationship between EQ, well-being, and problem-focused coping, concluding that the ability to manage emotions can contribute to greater subjective well-being. Schutte found that emotional intelligence can be protective against negative affect and is associated with greater life satisfaction.⁴⁹ The literature suggests that emotional intelligence may contribute to well-being and good mental health among students.^{12,16,17,36,48,50}

Clinical performance is another area where emotional intelligence can be implemented. Experiential education is a crucial part of the Doctor of Pharmacy curriculum and is a necessary element for developing a novice student into a practice-ready graduate. However, like any social situation, experiential education can be fraught with personality conflicts, high workloads, and emotionally draining patient interactions. McCloughen and colleagues¹⁵ discussed the use of emotionally intelligent behaviors in navigating tough interpersonal situations with staff during clinical placement and found that emotional intelligence techniques such as self-reflection, self-regulation, and empathy were key in managing challenging interpersonal situations. In a study measuring emotional intelligence and clinical performance among dental students, Victoroff and colleagues²¹ found that competencies related to self-management (self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism) were a strong predictor of clinical performance as measured by clinical preceptor feedback. While the literature is limited in the arena of emotional intelligence and experiential education, the tenets of EQ, including the management of one’s own and others’ emotions, appear to be necessary for succeeding in clinical practice.

Leadership, defined as being able to demonstrate responsibility for creating and achieving shared goals, regardless of position,²⁰ is another area where emotional intelligence can be implemented, as emotional intelligence is an important ingredient in effective leadership.^{9,10,20,24,51,52} The Emotionally Intelligent Leadership (EIL) model combines both emotional intelligence and leadership in an effort to highlight the importance of self-management and social aptitude when describing leadership qualities.³⁵ emotional intelligence is key in identifying when to step in as a leader, when to delegate work, when to provide emotional support, and when to step back. While the literature is still limited on emotional intelligence and leadership, it is likely that having a high level of emotional intelligence would be useful for any budding leader.⁵²

EQ is also relevant in professional communication, as such communication not only requires one to relay information in an eloquent and efficient manner but also requires one to use the right language for the right situation, to read the emotions in others, to empathize in a sincere manner, to manage one’s own emotions so as not to escalate a difficult situation. Lust and colleagues¹⁴ argued that emotional intelligence should be incorporated into professional communications coursework so that students are introduced to the various aspects of communication, including empathy, relationship building, and nonverbal cues. Further, Galal and colleagues^7,8 reported that students improved their social-emotional competence through directed feedback in a professional communication skills course.

Overall, any health care professional offering direct patient care or collaborating with other professionals needs competency in EQ-related areas, such as self-awareness, empathy, and self-regulation. The ability to manage one’s emotions, adapt to new circumstances, and manage stress is necessary for all pharmacists and pharmacy students in today’s practice environment. Further, the ACPE standards strongly emphasize the affective domain, especially emotional intelligence abilities like self-awareness.⁴² Yet, several considerations exist for incorporating emotional intelligence into pharmacy programs, such as how to systematically implement such content and which assessments/measurement tools to use.

Future Opportunities for Research

Future research should include strategies for longitudinal and systematic development of emotional intelligence abilities, assessment of emotional intelligence in experiential education, and patient outcomes related to EQ. Cocurricular integration of emotional intelligence training is also an area of possible research. While it is unclear whether any specific teaching modality is superior in providing emotional intelligence training for pharmacy education, simulations or role playing with standardized patients can be useful in developing student emotional intelligence and for providing formative feedback for students.^7,8 Other modalities include book readings, self-reflection, coaching, group discussion, and mentorship. However, more research is needed to identify evidence-based modalities that can be used for emotional intelligence development and to determine whether students’ emotional intelligence training can influence their academic success, build resilience in the face of academic difficulty, increase their ability to provide compassionate and competent patient care, and increase grit and optimism. Additionally, more research is needed on emotional intelligence development in interprofessional education.

In addition, the role of emotional intelligence in stress management and burnout should be areas for future research. While there is some evidence that emotional intelligence has a role in managing perceived stress, more research in this area, especially interventional, will provide some direction as to methods that can improve student well-being and mental health. While the current literature demonstrates that emotional intelligence can be improved, there is a dearth of literature that describes sustained and longitudinal improvements of emotional intelligence across the pharmacy curriculum, especially in experiential education. However, some measures of emotional intelligence have an inherent positive bias toward women (eg, MSCEIT) and are subject to cultural norms.⁵³ Inquiry into how this may impact implementation of emotional intelligence evaluation in pharmacy academia is worthy of further study.

In addition, very little evidence exists for demonstrating the long-term retention of emotional intelligence skills and whether these skills actually translate to clinical practice. Further, the question of whether an emotionally intelligent pharmacist provides better care than one who is less emotionally competent remains unanswered. Data extrapolated from medicine would suggest that higher emotional intelligence is related to better outcomes and higher patient satisfaction, but more research is needed in pharmacy practice.^5,22 Even though emotional intelligence was not theorized by the health professions, it would be ideal to validate emotional intelligence assessment tools for use in the health professions, depending on need of the profession, and to have specific guidance on applicability for the tools overall.