Emotional intelligence in first year medical students and its correlates: a study conducted at a faculty of medicine in Sri Lanka

Abstract

Background: Emotional Intelligence (EI) is an important attribute to possess in the practice of medicine, which requires skills such as the ability to adapt to clinical situations appropriately and have favourable interpersonal relations, which in turn may have an effect on the outcome of the patient. Objectives: The objectives of the study were to determine the EI levels of first year medical undergraduates of a selected faculty of medicine in Sri Lanka and to determine whether there is a significant correlation between EI and gender, academic ability, number of siblings, self-motivation to study medicine, perceived levels of family support, socialization and religiosity. Methods: The Genos Emotional Intelligence Assessment Concise Questionnaire, translated to Sinhala, was administered to a cohort of 194 first year medical students. This questionnaire included a supplementary section with personal details and questions on self- motivation to study medicine, perceived level of socialization, religiosity, family support and the Z score at the advance level examination. Data was analysed using SPSS version 22.0. Results and conclusions: The levels of EI of new entrant medical students admitted to a Faculty of Medicine in Sri Lanka was established using the validated Sinhala translation of the Genos Emotional Intelligence Assessment Concise Questionnaire.EI was positively co-related with self- motivation to study medicine, perceived level of socialization and religiosity. There was no significant difference in total EI scores between males and females. Perceived level of family support, number of siblings and academic ability did not correlate significantly with EI.

Full text

DOI: http://doi.org/10.4038/sljm.v27i2.104 Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
4
Received: 11/07/2018 Accepted revised version: 12/11/2018 Published: 22/12/2018
RESEARCH PAPER.
EMOTIONAL INTELLIGENCE IN FIRST YEAR MEDICAL STUDENTS AND
ITS CORRELATES: A STUDY CONDUCTED AT A FACULTY OF MEDICINE
IN SRI LANKA
D. Edussuriya1*, K.N. Marambe2, S.U.B. Tennakoon3, R.M.I.S.D. Rathnayake1, B.G. Premaratne1,
S.K. Ubhayasiri1 and C.U. Wickramasinghe1
1 Department of Forensic Medicine, University of Peradeniya, Sri Lanka
2 Medical Education Unit, University of Peradeniya, Sri Lanka
3 Department of Community Medicine, University of Peradeniya, Sri Lanka
Corresponding author: D. Edussuriya 1*
E-mail: deepthiforensic2000@gmail.com Tel: 0711698916
ORCiD ID https://orcid.org/0000-0002-8262-3978
Abstract
Background: Emotional Intelligence (EI) is an important attribute to possess in the practice
of medicine, which requires skills such as the ability to adapt to clinical situations
appropriately and have favourable interpersonal relations, which in turn may have an effect
on the outcome of the patient.
Objectives: The objectives of the study were to determine the EI levels of first year medical
undergraduates of a selected faculty of medicine in Sri Lanka and to determine whether there
is a significant correlation between EI and gender, academic ability, number of siblings, self-
motivation to study medicine, perceived levels of family support, socialization and
religiosity.
Methods: The Genos Emotional Intelligence Assessment Concise Questionnaire, translated
to Sinhala, was administered to a cohort of 194 first year medical students. This questionnaire
included a supplementary section with personal details and questions on self- motivation to
study medicine, perceived level of socialization, religiosity, family support and the Z score at
the advance level examination. Data was analysed using SPSS version 22.0.
Results and conclusions: The levels of EI of new entrant medical students admitted to a
Faculty of Medicine in Sri Lanka was established using the validated Sinhala translation of
the Genos Emotional Intelligence Assessment Concise Questionnaire.
EI was positively co-related with self- motivation to study medicine, perceived level of
socialization and religiosity. There was no significant difference in total EI scores between
males and females. Perceived level of family support, number of siblings and academic
ability did not correlate significantly with EI.
Keywords: Emotional intelligence, medical students, Genos Emotional Assessment
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY)

Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
5
Introduction
Emotional intelligence (EI) is defined as
“the ability to perceive emotions
accurately, appraise, and express emotion;
the ability to access and/or generate
feelings when they facilitate thought; the
ability to understand emotions and
emotional knowledge, and to regulate
emotions to promote emotional and
intellectual growth”.1 The corporate world
has identified emotional intelligence as a
predictor of academic as well as
professional success.2 It has been reported
that people and college students with good
EI show better social functioning and
interpersonal relationships and peers have
identified them as less antagonistic and
conflictual.3
A comprehensive survey in medicine
states that EI had a positive contribution in
doctor-patient relationships, with better
empathy, teamwork, communication skills,
stress management, organisational
commitment and leadership.4 EI is
important to medical professionals as it is
associated with self-monitoring, which
would not only facilitate adapting to
clinical situations appropriately but also
improve interpersonal relations. This result
both in a favourable outcome for the
patient and also promote the wellbeing of
the practitioner.
EI becomes especially important for
medical undergraduates due to the long
undergraduate period of 5 years and the
relatively high demands of the medical
course. Few studies have suggested that EI
training can help medical students build
leadership qualities and empathy.5,6 A
systematic review of the literature
concludes that EI should be recommended
as a component of the curricula for
developing physician leaders.7 Literature
surveys on emotional intelligence and
medicine, and physician leadership
qualities concludes that EI correlates with
competencies such as increased empathy,
teamwork, communication skills, stress
management, organisational commitment,
collaboration and interaction that modern
medical curricula seek to deliver, and that
leadership can be nurtured by improving
EI.7,8 However, Humphrey-Murto, et al.,
(2014) found that the level of EI at the
stage of admission to medical school could
not reliably predict academic success in
later years.8
Literature on EI in the Sri Lanka context is
sparse. The few studies done on EI have
been conducted among school children9
and in the field of management.10 The
published literature revealed a recent study
of EI among medical students.11
Studies conducted to determine factors that
contribute to a high level of EI have
revealed that there was a positive
meaningful relationship between
Emotional Intelligence and Spiritual
Intelligence.12 Sotodehasl, et al., (2016)
found that there was a positive significant
relationship between EI and academic
achievement, 13 while Ranasinghe et al.,
(2017) revealed that female medical
students had a higher EI than their male
counterparts and that those who engaged
in extracurricular activities and those who
were satisfied regarding their choice to
study medicine, had significantly higher
EI scores..11 This was reinforced by Ren
et al., (2016) who identified that the level
of socialization within the faculty, time
spent with family, arts and community
service correlated with higher empathy
scores which is one aspect of EI.14 Studies
have been conducted to determine
whether family structure and the number
of siblings have any effect on emotional
intelligence of secondary school
students.15 It was revealed that there was
no significant effect of family structure
and number of siblings on emotional
intelligence of students. Even though
Barbar, Christensen & Barchard (2004)
too found that there is no relationship
between family size and emotional

DOI: http://doi.org/10.4038/sljm.v27i2.104 Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
6
intelligence, they found that people
coming from larger families have greater
externally oriented thinking.16 However,
Morand, 1999 supports the hypothesis that
emotional intelligence is positively
correlated with family size.17
Even though selection to Sri Lankan
medical faculties is not based on personal
attributes of students, the literature reveals
the importance of EI for courses like
medicine.4 Given the current environment
of medical education where there is
emphasis on patient-centered practice, the
use of a tool to assess emotional
intelligence of students may be useful.
Furthermore, exploration of the
relationship between EI and factors such
as gender, number of siblings, perceived
level of family support, self-motivation to
study medicine, level of socialization
within the faculty and perception of
religiosity in medical students would help
faculty to identify “at risk students” who
may require support and guidance through
the course.
The objective of the study was to
determine with regard to new entrants at a
faculty of medicine in Sri Lanka, the level
of EI and its association with academic
ability, gender, number of siblings,
perceived level of family support, self-
motivation to study medicine, level of
socialization within the faculty and
perception of religiosity.
Method
Instrument
The validated Sinhala translation of the
Genos Emotional Intelligence Assessment
Concise Questionnaire was used for this
study.18 The questionnaire consists of 31
items designed to measure the frequency
with which an individual displays
emotionally intelligent behaviours across
seven dimensions (seven subscales). These
sub scaled are Emotional Self- Awareness
(ESA), Emotional Expression (EE),
Emotional Awareness of Others (EAO),
Emotional Reasoning (ER), Emotional
Self- Management (ESM), Emotional
Management of Others (EMO), Emotional
Self- Control (ESC). The items are scored
on a five-point Likert scale, from „Almost
Never‟ to „Almost Always‟. A
supplementary questionnaire was prepared
to include demographic data (gender, date
of birth, and number of siblings in the
family), and the rank (all island) at the
selection test for medical school (as an
indicator of academic ability).
Furthermore, student perception of level of
family support, self-motivation to study
medicine, level of socialization within the
faculty and religiosity were assessed by
students response on a five point Likert
scale to the following questions in the
supplementary questionnaire; “I get good
family support to carry out the academic
work”, “I‟m motivated by myself to study
medicine and be a competent medical
professional in the future”, “I think that I
am well socialized within the faculty” and
“I think I‟m a religious person”.
Participants and procedure
The Sinhala version of the Genos
Emotional Intelligence Assessment
Concise Questionnaire with the
supplementary questionnaire was
administered to medical students at the
point of entry to the Faculty of Medicine,
University of Peradeniya, Sri Lanka,
subsequent to obtaining ethical clearance.
Foreign students were excluded from the
study. The students were informed that
participation was purely voluntary in
nature.
The total EI score was calculated by the
sum of the sub categories. The Genos EI
raw scores (subgroup scores and
cumulative score) were correlated to the

Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
7
island rank at the selection test to the
medical faculty, gender, number of
siblings in the family, level of family
support, self-motivation to study medicine,
level of socialization and students‟
perception of religiosity.
Data analysis
The normality of the total EI score was
tested with the Shapiro-Wilks test to
decide if parametric or non-parametric
statistical tests should be used. The
difference of EI scores between males and
females was tested with the Mann-
Whitney u test, which tests the difference
between two normally distributed
continuous variables. Kendall‟s rank
correlation method was used to look for
correlations between total EI and ESA,
EE, EAO, ER, ESM, number of siblings,
A/L rank, motivation, support,
socialization and religiosity as variables
were not normally distributed. The total EI
score was not normally distributed
(Shapiro-Wilks test statistic 0.91,
significance, 0.001). Since variables were
not normally distributed no linear
regression was carried out. Non-linear
regression would not be of value as it is
reserved for categorical variables, but
ordinal regression could have been used
after ordinally categorising EI, but it was
not attempted as EI categorisation was not
practical. Analysis was done using SPSS
version 22.0.
Results
The response rate was 100%. Six point
seven percent (6.7%) of questionnaires
were incompletely filled thus excluded.
Hundred and eighty-four newly recruited
medical students, aged 19 to 21 years, who
had not commenced the academic
programme, participated in the study.
There were 93 males and 91 females.
The total EI score was not normally
distributed (Shapiro-Wilks test statistic
0.91, significance <0.001). There was no
significant difference in total EI scores
between males and females.
Table 1: Level of EI (subgroup and cumulative scores) of the study population
EI
ESA
EE
EAO
ER
ESM
EMO
ESC
Total
Theoretical range
6-20
6-25
6-20
8-25
8-25
4-20
4-20
31-
155
Mean (% from
max score)
16.89
(84.4)
19.36
(77.36)
16.05
(80.24)
20.65
(74.76)
18.96
(82.5)
16.49
(78.15)
15.63
(80)
124.03
Median
17.00
20.00
16.00
21.00
19.00
17.00
16.00
127.50
Median
by sex
Male
17
20
16
20**
19
17
16
126
Female
18
20
17
21**
20
17
16
129
**P values for difference between sexes<0.05 - Mann-Whitney U test

DOI: http://doi.org/10.4038/sljm.v27i2.104 Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
8
EI was positively co-related with self-
motivation to study medicine, perceived
level of socialization and religiosity. The
perceived level of family support, number
of siblings and academic ability did not
correlate significantly with EI.
Discussion
Currently no tests of EI are used in the
selection of students for the undergraduate
program in medicine in Sri Lanka, where
the selection is based purely on academic
merit and on the district quota system. The
present study establishes a base level of EI
for new entrant medical students, with
identification of factors associated with EI.
Table 2: Correlation between EI (subgroup and cumulative score) and island
rank at the selection test to medical faculty, number of siblings, perceived level of
family support, self-motivation to study medicine, perceived level of socialization
and perception of religiosity.
EI
ES
A
EE
EA
O
ER
ES
M
E
M
O
Siblings
A/L rank
Motivati
on
Support
Socializa
tion
Religiosit
y
EI
1.0
0
.57
**
.54**
.57**
.50
**
.52
**
.59
**
.01
-
.02
.21
**
.02
.23
**
.17**
ESA
.57
**
1.0
0
.34**
.38**
.33
**
.35
**
.37
**
.01
-
.03
.21
**
-.01
.15
*
.12*
EE
.54
**
.34
**
1.00
.31**
.29
**
.29
**
.34
**
.07
.07
.09
.01
.18
**
.10
EAO
.57
**
.38
**
.31**
1.00
.37
**
.27
**
.43
**
-.01
.05
.18
**
.07
.15
*
.15*
ER
.50
**
.33
**
.29**
.37**
1.0
.21
**
.40
**
.01
.02
.19
**
.04
.18
**
.12*
ESM
.52
**
.35
**
.29**
.27**
.21
**
1.0
.29
**
-.03
-
.09
.11
-.03
.20
**
.15**
EMO
.59
**
.37
**
.34**
.43**
.40
**
.29
**
1.0
.02
-
.01
.18
**
.00
.13
*
.19**
Siblings
.01
.01
.07
-.01
.01
-
.03
.02
1.00
.05
-
.01
-.13*
.01
-.03
A/L rank
-
.02
-
.03
.07
.05
.02
-
.09
-
.01
.05
1.0
.11
-.01
-
.03
.12*
Motivati
on
.21
**
.21
**
.09
.18**
.19
**
.11
.18
**
-.01
.11
1.0
.07
.08
.11
Support
.02
-
.01
.01
.07
.04
-
.03
.01
-.13*
-
.01
.07
1.00
.02
.01
Socializ
ation
.23
**
.15
*
.18**
.15*
.17
**
.20
**
.13
*
.05
-
.03
.08
.02
1.0
.22**
Religiosi
ty
.17
**
.12
*
.10
.15*
.12
*
.15
**
.19
**
-.03
.12
*
.10
.01
.22
**
1.00
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
9
Many tools have been identified in the
literature for the purpose of assessing EI.
The emotional competence inventory
(ECI), Bar-On Emotional Quotient
Inventory (EQI), and Mayer-salovey-
Caruso Emotional Intelligence Test
(MSCETT) are popular EI measures. The
Genos EI inventory which was designed to
be used in workplace settings (for
recruitment/promotion) has the potential to
be used in coaching, developmental and
educational fields.19 The concise version
of the Genos EI inventory (31items) was
chosen for this study over the complete
version (71 items) as it was assumed that
the response rate and the accuracy of
responses would be higher with the
concise version.
The study revealed a mean EI of 124
(range 54-149) among new entrant medical
students. The scores for the sub scale
Emotional Self- Awareness was highest,
with the lowest score being for Emotional
Reasoning (Table 1). Even though
Ranasinghe et al., 2017 established EI
levels for 2nd, 4th and final year medical
students at the University of Colombo, Sri
Lanka, using the Schutte Self-Report
Emotional Intelligence Test, this study is
the first to establish EI levels of new
entrant medical students in a medical
faculty in Sri Lanka. However, a similar
study using the Genos questionnaire had
been carried out to establish EI levels of
high school students in Sri Lanka, which
reported that highest scores were observed
for Emotional Expression while the lowest
was for Emotional Self- Control.9
Some studies have concluded that EI is
significantly co-related with gender8,20
explaining that females due to biological
factors, cultural influences, and upbringing
may be more emotionally intelligent.
However, this study revealed that there
was no significant difference in overall EI
between males and females, even though
the mean total score and the mean score
for each subscale was higher in females
compared to male students. A significant
difference between males and females was
only noted in the ER subscale (Table 1).
This indicates that females are
significantly better at considering one‟s
own and others‟ emotions when making
decisions, as well as expressing that such
consideration has taken place. This is
consistent with the findings of a similar
study conducted in Australia, even though
the tool used differed.21 Furthermore, a
study on Irish students revealed that
though there was no significant difference
in total EI score between males and
females, females had scored higher in self-
reported empathy, social responsibility22
and regulation of emotions.23 On the other
hand, a study among Sri Lankan high
school students revealed that higher EI
was found among males when compared
to females.9
Even though the Z score would have
enabled better identification of a
relationship between academic
performance and EI, the rank order was
used for this study as the Z scores of
students were seen to be very close with
difficulty in differentiating between
students. Ranasinghe et al., (2017)
concluded that EI was associated with
better academic performance amongst
final year medical students, in Sri Lanka.
However, this study did not reveal a
significant correlation between academic
performance (as assessed by the Advanced
level examination rank) and EI.11
Thererefore the question arises as to
whether it would be useful to assess EI
separately as entrance criteria to certain
courses, especially, those such as
medicine. EI as a selection criterion to
medical school has been studied by
Carrothers, et al., (2000). 24 A pilot study
done by Carrothers et al., (2000) states that
EI identifies applicants who are oriented
towards the social sciences and humanities
and EI scores correlated positively with
the interview assessment designed to test
interpersonal skills.24 Thus further research

DOI: http://doi.org/10.4038/sljm.v27i2.104 Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
10
will be necessary to draw conclusion as to
measurement of EI as an ability to test
suitability for selection to medical school.
The literature reveals that siblings
“through their conflicts”, can develop
skills in perspective taking, emotion
understanding, negotiation, persuasion,
and problem solving.25 However, our study
did not reveal any significant association
between the level of EI with the number of
siblings. This finding may be due to the
fact that even a single child might have
faced a certain amount of emotionally
challenging situations outside the family,
such as with peers, which may have
resulted in development of EI.
An Iranian study concluded that there is a
direct significant association between EI
with the socio- economic status and a good
parental relationship.26 A study by Harrod
& Scheer (2005) concluded that EI is
positively co-related with the parent‟s
education and household income. It is
reasonable to assume that emotionally
intelligent medical students may have a
better family environment and support,
which would have influenced them
positively to cope with the stress of the
academic work and peer pressures.27
However, this study failed to reveal a
correlation between EI and the degree of
family support as perceived by the student
(Table 2). It is important to mention that
this study did not specify a level of family
support and assessed only the “student
perception of family support”, which does
not evaluate dimensions of family support
in detail and rigorously to draw reasonable
conclusions.
Selection of students for courses in Sri
Lanka are based on academic merit and the
district quota system and very few students
who are selected for medicine on this basis
reject this selection in favour of other
options. This brings forth the important
question as to whether students are in
reality self-motivated to do medicine or
whether social and family pressure plays a
role in their career choice. Self-
satisfaction over career choice was
positively correlated to EI in several
studies.26,28,29 This study too confirms the
finding – in this study, self-motivation to
study medicine or their satisfaction in
choosing medicine as a career was
positively correlated with the total EI score
(Table 2).
A literature review on the role of EI in
medicine, revealed that teamwork,
communication and interpersonal skills
have a positive co relation with EI 8, which
may be reflected by better socialization
within the faculty, for example by
participating in group/team activities, and
social services. This study showed a
positive correlation between EI and
perceived level of socialisation (Table 2).
Similar to the result of this study, there
was a significant relationship between EI
and perceived positive religious coping
among medical students in the
Mazandaran University in Iran.30
However, some researchers had concluded
that perception of religiosity does not
show a positive effect on EI. 31
Conclusions
EI levels of new entrant medical students
at a Faculty of Medicine in Sri Lanka was
established using the Genos Emotional
Intelligence Assessment Concise
Questionnaire . Emotional intelligence in
new entrant medical students was
positively co-related with the
determination and self- motivation to study
medicine, the perceived level of
socialization within the faculty and the
perceived level of religiosity. There was
no significant difference in overall EI
between males and females. Perceived
level of family support, the number of
siblings and the island rank at the selection

Sri Lanka Journal of Medicine Vol. 27 No.2, 2018
11
test to medical school did not correlate
significantly with EI.
Limitations
The relationship between motivation,
religiosity and socialisation and EI in this
study was assessed using a tool and was
based purely on student perceptions, so the
findings may not be definitive.
Recommendations
A more extensive study on new entrants to
medical faculties in Sri Lanka may reveal
valuable information, which may provide
evidence to evaluate the criteria by which
students are selected to medical schools.
Also identification of factors which have
an impact on EI may help the faculty in
developing mechanisms to improve EI of
medical students, as well as identify
students who may require support.
Furthermore, a longitudinal study to detect
any change in the level of EI of students
following the medical course would reveal
useful information regarding possible
interventions.
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