This study examined the relationship between emotional intelligence (EI) and well-being in 73 surgical residents. The study found that EI scores positively correlated with psychological well-being and negatively correlated with burnout and depression. Regression analyses controlling for demographics found that EI strongly predicted well-being, emotional exhaustion, depersonalization, and depression among residents. The study concluded that EI is a strong predictor of resident well-being, and measuring EI could help identify residents most likely to thrive while interventions to increase EI may optimize resident wellness.

1. Emotional Intelligence as a Predictor of
Resident Well-Being
Dana T Lin, MD, FACS, Cara A Liebert, MD, Jennifer Tran, BS, James N Lau, MD, FACS,
Arghavan Salles, MD, PhD
BACKGROUND: There is increasing recognition that physician wellness is critical; it not only benefits the pro-
vider, but also influences quality and patient care outcomes. Despite this, resident physicians
suffer from a high rate of burnout and personal distress. Individuals with higher emotional
intelligence (EI) are thought to perceive, process, and regulate emotions more effectively,
which can lead to enhanced well-being and less emotional disturbance. This study sought
to understand the relationship between EI and wellness among surgical residents.
STUDY DESIGN: Residents in a single general surgery residency program were surveyed on a voluntary basis.
Emotional intelligence was measured using the Trait Emotional Intelligence
Questionnaire-Short Form. Resident wellness was assessed with the Dupuy Psychological
General Well-Being Index, Maslach Burnout Inventory, and Beck Depression Inventory-
Short Form. Emotional intelligence and wellness parameters were correlated using Pearson
coefficients. Multivariate analysis was performed to identify factors predictive of well-being.
RESULTS: Seventy-three residents participated in the survey (response rate 63%). Emotional intelligence
scores correlated positively with psychological well-being (r ¼ 0.74; p < 0.001) and inversely
with depression (r ¼ À0.69, p < 0.001) and 2 burnout parameters, emotional exhaustion
(r ¼ À0.69; p < 0.001) and depersonalization (r ¼ À0.59; p < 0.001). In regression analyses
controlling for demographic factors such as sex, age, and relationship status, EI was strongly
predictive of well-being (b ¼ 0.76; p < 0.001), emotional exhaustion (b ¼ À0.63; p < 0.001),
depersonalization (b ¼ À0.48; p ¼ 0.002), and depression (b ¼ À0.60; p < 0.001).
CONCLUSIONS: Emotional intelligence is a strong predictor of resident well-being. Prospectively measuring EI
can identify those who are most likely to thrive in surgical residency. Interventions to increase
EI can be effective at optimizing the wellness of residents. (J Am Coll Surg 2016;223:
352e358. 2016 Published by Elsevier Inc. on behalf of the American College of Surgeons.)
There is increasing recognition that the well-being of
physicians is of vital importance. It is critical not only
for the sake of the providers, but also for the patients
they care for. On a personal level, unwell physicians can
experience stress, burnout, depression, relationship diffi-
culties, substance abuse, and even suicidal ideation.
In addition, unwell physicians can more broadly impact
the health care system and patient outcomes negatively.1,2
Such consequences include difficulties in recruitment and
retention, decreased productivity and efficiency, subopti-
mal quality of patient care, reduced patient adherence
and satisfaction, and an increased risk for medical errors.3
Resident physicians are especially vulnerable to psycho-
logical and personal distress, given the intense emotional,
social, cognitive, and physical demands of residency
training. Multiple studies have documented rates of
burnout as high as 75%.4-6
In a recent national survey,
more than half of residents screened positive for depres-
sion, with 8.1% reporting suicidal ideation in the last
12 months.7
A rash of resident suicides in 2014 has
brought the importance of physician mental health and
well-being to the forefront of not only the medical com-
munity, but also the general public.8-10
The concept of emotional intelligence (EI) was intro-
duced in the 1990s by Salovey and Mayer,11
who
described it as a type of social intelligence that captures
Disclosure Information: Nothing to disclose.
Presented orally at the American College of Surgeons 101st
Annual Clinical
Congress, Chicago, IL, October 2015.
Received March 30, 2016; Accepted April 28, 2016.
From the Goodman Surgical Education Center, Department of Surgery,
Stanford School of Medicine, Stanford, CA.
Correspondence address: Dana T Lin, MD, FACS, Goodman Surgical
Education Center, Department of Surgery, Stanford School of Medicine,
300 Pasteur Dr, H3552, Stanford, CA 94305. email: danalin@stanford.edu
352
ª 2016 Published by Elsevier Inc. on behalf of the American College of
Surgeons.
http://dx.doi.org/10.1016/j.jamcollsurg.2016.04.044
ISSN 1072-7515/16

2. an individual’s ability to perceive, process, and regulate
one’s own emotions and the emotions of others. It in-
forms how an individual internally manages emotional
and environmental stressors, as well as how one navigates
relationships with other people. Emotional intelligence
has been associated with less mood deterioration and
emotional reactivity after natural and laboratory
stressors.12
Given the potential for EI to moderate the effect of
stressors on an individual, we hypothesized that those
with higher EI are better equipped to handle the stressors
associated with residency. We therefore sought to explore
the relationship between EI and an individual’s sense of
wellness. Because surgical residencies are often character-
ized as being particularly arduous and demanding,
we elected to study this relationship in the setting of a
surgical residency.
METHODS
Procedure
This study investigated the relationship between EI and
well-being among general surgery residents. Surgery resi-
dents at a single institution during the academic years
2013 to 2014 and 2014 to 2015 (n ¼ 115) were invited
to participate in the study on a voluntary basis at 2
discrete time points (April 2013 and May 2014). Partici-
pants completed an electronic questionnaire composed of
established psychometric instruments evaluating EI,
psychological well-being, burnout, and depression, in
addition to a demographics survey. The following scales
were used: the Trait Emotional Intelligence Question-
naire (TEIQue)-Short Form, Dupuy Psychological Gen-
eral Well-Being Index (PGWBI), Maslach Burnout
Inventory (MBI), and Beck Depression Inventory-Short
Form (BDI-SF). The study protocol was approved by
the Stanford University IRB.
Materials
Trait Emotional Intelligence Questionnaire-Short
Form
Emotional intelligence was assessed using the validated
TEIQue-SF, a trait-based instrument designed to capture
personality facets and dispositions related to emotions.13
The TEIQue-SF is based on the long 153-item version
of the TEIQue and consists of 30 self-report items that
are answered on a 7-point Likert scale based on
how strongly the respondent agrees with the statement
(1 ¼ completely disagree; 7 ¼ completely agree). The
TEIQue was selected for this study from among the avail-
able EI instruments because it possesses the strongest asso-
ciations with mental health.14
Dupuy Psychological General Well-Being Index
Well-being was measured using the Psychological General
Well-Being Index.15,16
The PGWBI consists of 22 items,
rated on a 6-point scale, that assess psychological and
general well-being of respondents. The items are scored
to produce an overall total score for general well-being
that is commonly expressed on a range from 0 to 100.
Maslach Burnout Inventory
Burnout was assessed using the Maslach Burnout Inven-
tory, a scale designed to measure various aspects of
burnout in human service professionals.17
For the MBI,
an individual rates on a 7-point scale how often he
or she feels what is described in the 22-items listed
(1 ¼ never; 7 ¼ every day). It has 3 subscales to evaluate
each domain of burnout: emotional exhaustion, deper-
sonalization, and personal accomplishment. In keeping
with convention, analyses were focused on the deperson-
alization and emotional exhaustion subscales of the MBI,
as they are considered the key hallmarks of professional
burnout.18
Beck Depression Inventory-Short Form
The BDI-SF was used to measure depression.19,20
An
abridged version of the original 21-item BDI, the
BDI-SF features 13 items, each of which consists of
4 alternative statements graded in severity from 0 to 3.
Total score ranges from 0 to 39, and higher scores indi-
cate more depressed mood.
Data analysis
Standard univariate statistics were used to describe the
respondents. Descriptive statistics were computed for
the TEIQue-SF, PGWBI, MBI, and BDI-SF. Compari-
sons between sexes were conducted using a 2-tailed,
independent-samples t-test. Pearson’s product-moment
correlations were then used to examine relationships
between EI and well-being parameters. Multivariate linear
regression was performed to identify independent predic-
tors of the outcomes of psychological well-being, burnout,
and depression. All data were analyzed using SPSS soft-
ware, version 21.0 (SPSS Inc).
Abbreviations and Acronyms
BDI-SF ¼ Beck Depression Inventory-Short Form
EI ¼ emotional intelligence
MBI ¼ Maslach Burnout Inventory
PGWBS ¼ Psychological General Well-Being Index
TEIQue ¼ Trait Emotional Intelligence Questionnaire
Vol. 223, No. 2, August 2016 Lin et al Emotional Intelligence and Resident Wellness 353

3. RESULTS
Participants
Of the 115 residents invited to participate, a total of 73
residents completed the survey (63% response rate).
Table 1 presents participants’ descriptive data.
Data analysis
Emotional intelligence
On the whole, the participants demonstrated a global
EI score of 5.18 Æ 0.81 (range 2.93 to 7.00). Table 2
details the mean global EI score for the cohort. There
was no significant difference in global EI between men
and women (5.25 Æ 0.83 vs 5.10 Æ 0.88; p ¼ 0.41).
Multivariate linear regression analysis did not reveal any demographic factor (age, sex, ethnicity, marital status,
children, PGY level, or type of resident) as a significant
predictor of global EI.
Wellness measures
Table 2 provides descriptive data for the psychological
well-being, burnout, and depression scales. The residents’
scores on these measures were concerning. Mean PGWBI
score was 69.34 Æ 15.11, which was significantly lower
than that for the general population21
(73.5 Æ 15.4;
p ¼ 0.03). Sixty participants (82%) scored high on either
emotional exhaustion (score of 27 or higher) or deperson-
alization (score of 10 or higher) subscales of the MBI and
thereby met conventional criteria for having at least one
manifestation of professional burnout.18,22
Thirty-six
percent met criteria for having at least mild depression;
12.1% and 7.5% of these residents screened positive for
moderate and severe depression, respectively.23
There was a trend toward higher BDI scores in women
(p ¼ 0.06); there were no significant differences in scores
between men and women for psychological well-being or
any of the burnout parameters (ie emotional exhaustion,
depersonalization, or personal accomplishment).
Relationship of emotional intelligence with
well-being measures
Emotional intelligence scores correlated strongly with
psychological well-being (r ¼ .74; p < 0.001). Significant
inverse correlations were found between EI and emotional
exhaustion (r ¼ À.69; p < 0.001), EI and depersonaliza-
tion (r ¼ À.59; p < 0.001), and EI and depression
(r ¼ À.69; p < 0.001). These relationships are depicted
in Figure 1.
Four separate multivariate linear regressions were
performed to identify independent predictors of the
following outcomes measures: psychological well-being,
depression, emotional exhaustion, and depersonalization.
Demographic factors (ie age, sex, ethnicity, marital status,
Table 1. Summary of Demographic Characteristics (N ¼ 73
Participants)
Demographic characteristic Data
Age, y, mean Æ SD 30.8 Æ 3.22
Sex
Female 31 (42.5)
Male 42 (57.5)
Ethnicity
White 37 (50.7)
Black 1 (1.4)
Hispanic 3 (4.1)
Asian/Pacific Islander 24 (32.9)
Mixed race 4 (5.5)
Unknown 4 (5.5)
Marital status
Single, never married 32 (43.8)
Married 29 (39.7)
Divorced 3 (4.1)
Unknown 9 (12.3)
Have children
Yes 12 (16.4)
No 47 (64.4)
Unknown 14 (19.2)
PGY level
1 34 (46.6)
2 19 (26.0)
3 5 (6.8)
4 5 (6.8)
5 5 (6.8)
Research/professional development 5 (6.8)
Resident type
Categorical general surgery 32 (43.8)
Designated preliminary 31 (42.5)
Undesignated preliminary 10 (13.7)
Data are presented as n (%) unless otherwise noted.
Table 2. Descriptive Data for Emotional Intelligence and
Well-Being Scales
Measure Data
Global Emotional Intelligence (TEIQue-SF) 5.18 Æ 0.81
Well-being (PGWBI) 69.35 Æ 15.12
Burnout (MBI)
Emotional exhaustion 36.70 Æ 12.36
Depersonalization 18.00 Æ 7.44
Personal accomplishment 43.92 Æ 6.92
Depression (BDI-SF) 4.53 Æ 5.23
Data are presented as mean Æ SD.
BDI-SF, Beck Depression Inventory-Short Form; MBI, Maslach Burnout
Inventory; PGWBI, Psychological General Well-Being Index; TEIQue-SF,
Trait Emotional Intelligence Questionnaire-Short Form.
354 Lin et al Emotional Intelligence and Resident Wellness J Am Coll Surg

4. and whether the respondent had a child), as well as resi-
dent characteristics (PGY level, type of resident), were
accounted for in the models. The TEIQue was also
included as a predictor, as it is generally considered a basic
personality trait that is relatively stable over time,24
which
we hypothesized could potentially affect wellness out-
comes. In the regression models, EI was a strong, and
the only, independent predictor of psychological well-
being (b ¼ 0.76; p < 0.001), depression (b ¼ À0.60;
p < 0.001), emotional exhaustion (b ¼ À0.63; p <
0.001), and depersonalization (b ¼ À0.48; p ¼ 0.002).
DISCUSSION
Residency is an arduous, comprehensive endeavor that
taxes physician trainees mentally, emotionally, socially,
and physically. Of all the medical specialties, surgical res-
idency is one of the most rigorous and lengthy. Yet, there
exists an implicit set of values and expectations within the
culture of surgery that celebrates dedication to work and
patient care over and above all else, even at great cost to
one’s personal needs and well-being. This code also con-
sists of never complaining or showing weakness and keep-
ing emotions and personal problems from interfering with
work.25
Within this context, and in concert with the lack
of priority and emphasis on personal wellness by surgical
training programs, residents are suffering from distress,
burnout, and depression at an alarmingly high rate.6,7
In
the aftermath of 2 resident suicides less than 2 weeks apart
in New York City in August 2014, the issue of physician
wellness and mental health has been a subject of national
concern, not only among the medical community,8,9,26
Figure 1. Correlative relationship between emotional intelligence scores and (A) psychological well-being, (B) emotional exhaustion,
(C) depersonalization, and (D) depression. MBI, Maslach Burnout Inventory, TEIQue-SF, Trait Emotional Intelligence Questionnaire-Short Form.
Vol. 223, No. 2, August 2016 Lin et al Emotional Intelligence and Resident Wellness 355

5. but also the lay public.10,27
This concern is justified, as not
only are the consequences potentially devastating to the
individual at a personal level, but there is also mounting
evidence that physician distress and burnout adversely
affect the quality of patient care and health care organiza-
tions at a broader level.3,4,28,29
Although the problem has been clearly articulated and
its importance well defended, there has been limited
empirical research into the relationship between demo-
graphic characteristics and wellness outcomes. There is
even less research dedicated to identifying significant pre-
dictors of well-being, burnout, and depression, or to the
effectiveness of interventions aimed at optimizing physi-
cian wellness. Several recent reports, including one issued
by the ACGME Council of Review Committee Residents,
have highlighted the need for additional research in this
field.25,26
This study provides data confirming the high preva-
lence of burnout and depression among surgical resi-
dents. The frequency and degree of burnout among
surgical residents are higher than those among residents
in other specialties. In a national survey, Dyrbye and col-
leagues7
reported a burnout rate of 60.3%, with a median
emotional exhaustion score of 24 and depersonalization
score of 10. Their cohort consisted of >1,700 residents
and fellows representing all major medical specialties,
of which 13.1% were surgical trainees. In our study of
only surgical residents, 82% met criteria for burnout; me-
dian scores for emotional exhaustion and depersonaliza-
tion were 35 and 17.5, respectively. This is
substantially higher than the reported burnout rates of
28% to 48% among surgeons in practice, which suggests
that the likelihood and extent of burnout can decrease af-
ter residency.25,30
Possible reasons for this include a more
favorable work environment and lifestyle after residency,
or a greater ability to cope with stress as one matures and
progresses through training. With regard to depression,
36% of surgical residents at our institution screened pos-
itive for at least mild depression. Our data fall within the
range of previously reported depression rates of 22% to
50% among physicians in training, as well as practicing
surgeons.7,30,31
The reality that one-third to one-half of
trainees suffer symptoms of depression cannot be ignored
in light of the recent resident tragedies and the known
fact that male and female physicians have a respective
1.5-fold to 3.8-fold and 3.7-fold to 4.5-fold risk of death
from suicide compared with sex- and age-matched peers
in the general population.25,32
Our data affirm the
growing body of evidence that burnout and depression
are occupational hazards for physicians, particularly for
those in residency, and even more so for the subset
training in surgery.
Our study also offers deeper insight into the relation-
ship between EI and the following wellness measures: psy-
chological well-being, burnout, and depression. Among
the various demographic and personal variables that can
potentially inform and influence resident wellness, EI
emerged as the only significant predictor of psychological
well-being, burnout, and depression. Emotional intelli-
gence is a construct that captures a variety of noncognitive
attributes that help individuals perceive and regulate emo-
tions and, in turn, cope effectively with emotive situations,
such as environmental stressors or interpersonal relation-
ships. A comprehensive meta-analysis by Martins and col-
leagues14
has demonstrated EI to be a predictor of both
mental and physical health in diverse test populations.
Available evidence suggests that EI can be seen as a factor
that protects individuals against mental health conditions,
such as depression and burnout.33-38
The few studies
related to EI and well-being among physicians have
focused on burnout and have similarly demonstrated an
inverse correlation between burnout and EI.39-41
Although
the mechanism by which EI influences these outcomes is
not entirely understood, some studies have shown higher
EI scores to be associated with significantly lower reactivity
to stress at both psychological and biological levels.12
Sub-
jects with high EI appear to secrete less salivary cortisol un-
der conditions of stress than those with low EI.42
One
study showed that although higher EI individuals
exhibited higher mean heart rates (experienced higher
levels of stress) when encountering stressful stimuli, they
also recovered faster than their peers with lower EI.43
Emotional intelligence can also affect behavioral responses
to stress; those with lower EI are more likely to adopt mal-
adaptive coping strategies and engage in self-harm
behaviors.37
That EI is a significant predictor of wellness outcomes
has practical implications. First, prospectively measuring
EI can enable program directors to discern which individ-
uals are at greatest risk for adverse wellness outcomes and
which are likely to thrive in surgical residency. Second, in-
terventions aiming to enhance EI can also result in greater
wellness among resident physicians. Although EI is gener-
ally thought to be relatively stable over time, some studies
suggest that EI can increase with age or be modified
through intensive training.44,45
Satterfield and colleagues40
reported an increase in the EI of internal medicine resi-
dents during the course of a single academic year; howev-
er, it is unclear what factors were responsible for the
change, whether it be normal maturation, medical
training, support groups, or targeted training on commu-
nication skills. Several studies have demonstrated a signif-
icant and sustained increase in EI after subjects completed
a robust EI training curriculum.46,47
These findings,
356 Lin et al Emotional Intelligence and Resident Wellness J Am Coll Surg

6. combined with ours, suggest that interventions directed at
increasing or optimizing EI might, in turn, improve the
wellness of residents. It should be noted that Webb and
colleagues48
attempted to measure the effect of formal
EI coaching in family medicine residents by implement-
ing training sessions by a certified EI coach. This interven-
tion was unsuccessful due to a lack of protected time for
the residents, rendering the authors unable to assess its
effect. This example emphasizes the importance of
designing and implementing programs in such a way as
to ensure full participation of the residents to attain the
maximal effect.
This study has several limitations. One limitation is
the overall response rate of 63% and relatively small
sample size. As participation was voluntary, it is
possible that the results might be biased by self-
selection. Also limiting generalizability is that partici-
pants were recruited from a single academic surgical
training program; study findings might not be represen-
tative of trainees of other specialties or institutions.
Among the study cohort, junior residents well outnum-
bered senior residents, reflecting the PGY composition
of the program. There was, however, strong participa-
tion of the residents in PGY levels 3 to 5 with a survey
completion rate of 83% for each upper class.
It is imperative to address physician wellness, not
only for the sake of the individual practitioners, but
also for that of the health care organizations to which
they belong and the patients they serve. Our findings
suggest that interventions and curricula designed to in-
crease EI can help lessen the prevalence and degree of
burnout and depression among physicians. Future
research endeavors to better generalize our findings
could start with broadening the test population to
include attending surgeons and physicians from other
specialties. The relationship between physician EI and
clinical performance and patient outcomes should be
also more fully explored. Implementing and measuring
the effect of an EI intervention on individual EI score,
well-being parameters, and clinical outcomes can yield
justification for investing in initiatives that cultivate
the EI of physicians.
Author Contributions
Study conception and design: Lin, Liebert, Lau, Salles
Acquisition of data: Lin, Liebert, Tran, Salles
Analysis and interpretation of data: Lin, Tran, Lau, Salles
Drafting of manuscript: Lin, Lau, Salles
Critical revision: Lin, Liebert, Tran, Lau, Salles
Acknowledgment: The authors would like to acknowledge
Ralph Greco, MD, and Claudia Mueller, MD, for their
collaboration and support as faculty champions of the
Balance in Life program, which promotes wellness among
the general surgery residents at Stanford.
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