1. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Beyond Glad, Mad, Sad: Developing Emotional Intelligence from the Secure Base of the PGY Class Claudia W. Allen, PhD, JD Theodore Siedlecki, Jr., PhD Emma Pace, MD University of Virginia Family Medicine Residency 9/18/15

2. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Disclosures No conflicts or funding to disclose.

3. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Goals and Objectives Participants will gain awareness of Evidence linking EI and effective doctoring; Evidence linking emotional growth and secure attachment; Opportunities to use PGY class attachments to build EI. Participants will take home: Three-year EI curriculum; FMDRL resource on teaching EI.

4. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Daniel Goleman

5. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Why do we care?

6. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin In a systematic review, higher EI was associated with:  A positive doctor–patient relationship (3 studies),  Increased empathy (5 studies),  Teamwork and communication skills (6 studies), and  Stress management, organizational commitment and leadership (3 studies). Arora et al, Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Medical Education. Volume 44, Issue 8, pages 749–764, August 2010.

7. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Do we need to actually teach EI? (Hint: Starbucks thought it was worth it.) The Latte Method “We Listen to the customer, Acknowledge their complaint, Take action by solving the problem, Thank them, and then Explain why the problem occurred.”

8. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin How are we doing? In terms of taking advantage of empathic opportunities, one study found not so well…. Doc, I’m scared. Your blood pressure is a little high. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, Skinner CS, Rodriguez KL, JA T. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007;25:5748–5752.

9. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Our challenge So is the Latte Method the answer? We think we need to have strong EI skills to actually use any method effectively. How do we strengthen EI?

10. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Paired reflection Think of a time when your abilities and emotional capacities were exceedingly challenged; you were very stressed and may have even doubted that you could make it. But you not only made it, you ended up more emotionally mature. Share 1) one way in which you grew emotionally, and 2) one thing that helped you grow.

11. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Themes?

12. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin video https://www.youtube.com/watch?v=D H1m_ZMO7GU https://www.youtube.com/watch?v=D H1m_ZMO7GU

13. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Secure Base Principle

14. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Personal friendships that are “emotional, trusting and intimate” have been associated with both academic learning and emotional growth. Alexakos et al. It’s not just about parent-child attachment.

15. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Our EI curriculum Longitudinal, group-based, from orientation through PGY 3. Orientation PGY 1 PGY 2 PGY 3

16. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Example from Intern Year What: Sharing personal stories about “a time at a crossroads” When: First 2 hrs. of first day of orientation Who: Intern group with core residency faculty Purpose: Build a safe environment for EI activities Practice awareness and labelling of emotions Consider how emotions affected thinking and behavior at a critical time Learn from others, including mentors. Comments:easy way to get to emotional but manageable content sets an authentic tone good modeling from faculty; builds attachment with faculty

17. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin PGY 1 EI activities Orientation: reflective writing and sharing “Where are you on this journey?” Monitor and label own emotions Process complex emotions from new and challenging environment Learn from others’ emotions and experiences 7 month check-in: Highs and Lows Monitor and put into words intense emotions; experience sharing emotions and getting feedback Reflect on emotional experience and how it has affected behaviors, thinking, and relationships Learn from others’ emotional experiences Weekly intern lunch (confidential, led by BF) Monitor own and others’ emotions; put emotions into words; active listening; Process how to navigate new and complex social environment Creating the safe group Flexible focus; ALWAYS happens (“we can count on it”) Signature Strengths survey – take and discuss as a group strengthen awareness of behavioral dispositions and perceived abilities In discussion learn how others perceive you and themselves Consider the group composition and how to use it 55 Word Stories – write and share Process and put into words complex emotional material Learn from others’ emotional experiences BATHE each other - practice skill with each other with actual personal material Investigate and label own and others’ emotions Practice active listening and empathy Using emotional information to help guide own and others’ thinking and behavior Experience sharing emotions with others and getting feedback Personal challenges of “Saying No” Skill Monitor own emotions; Link own emotions with thinking and behavior Establishing Focus Skill – practice with each other with challenging patient material Strengthen awareness of own and others’ emotions Strengthen active listening Practice balancing patients’ emotional and pragmatic needs

18. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Intern Lunch Weekly intern lunch (confidential, led by BF) Monitor own and others’ emotions; put emotions into words; active listening; Process how to navigate new and complex social environment Creating the safe group Flexible focus; ALWAYS happens (“we can count on it”)

19. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin PGY 2 EI activities Reflective writing and sharing “Where are you on this journey?” Monitor and label own emotions Process emotions from complex and challenging environment Learn from others’ emotions and experiences Bi-Weekly Practice Inquiry lunch (led by BF) Monitor and label own and others’ emotions; active listening; Discriminate emotions in a complex situation; consider how emotions of self and others affect thinking and behavior; Myers Briggs survey – take and discuss as a group strengthen awareness of behavioral dispositions and perceived abilities In discussion learn how others perceive you and themselves Consider others’ dispositions and how they interact with yours Motivational Interviewing Skill – practice with each other with personal material Investigate and label own and others’ emotions Practice active listening and empathy Experience sharing emotional material and getting feedback Using emotional information to help guide own and others’ thinking and behavior CBT Skill – practice with each other with real patient material Investigate and label own and others’ emotions Practice active listening and empathy Using emotional information to help guide own and others’ thinking and behavior Glue Sessions– half days blocks a few times a year where the PGY group is free to do whatever they want as long as they all attend.

20. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Practice Inquiry lunch Led by BFs Monitor and label own and others’ emotions; Active listening; Discriminate emotions in a complex situation; Consider how emotions of self and others affect thinking and behavior.

21. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin PGY 3 EI activities Reflective writing and sharing “Where are you on this journey?”/Reading and reflection on letters from PGY 1 and 2 Monitor and label own emotions; consider how emotions have evolved over three years Process emotions from complex and challenging environment Learn from others’ emotions and experiences Bi-Weekly Practice Inquiry lunch (led by BF) Monitor and label own and others’ emotions; active listening; Discriminate emotions in a complex situation; consider how emotions of self and others affect thinking and behavior; Strengths Bombardment Monitor, label and share deep emotions about others Experience emotions associated with flood of positive feedback Strengthen awareness of how others perceive you and themselves Motivational Interviewing Skill – practice with each other with personal material Investigate and label own and others’ emotions Practice active listening and empathy Experience sharing emotional material and getting feedback Using emotional information to help guide own and others’ thinking and behavior CBT Skill – practice with each other with real patient material Investigate and label own and others’ emotions Practice active listening and empathy Using emotional information to help guide own and others’ thinking and behavior Glue sessions – half days blocks a few times a year where the PGY group is free to do whatever they want as long as they all attend.

22. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Strengths Bombardment Monitor, label and share deep emotions about others Experience emotions associated with flood of positive feedback Strengthen awareness of how others perceive you and themselves

23. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Tips from 3 rd year resident, Emma Pace, MD

24. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin How do YOU use your residency groups to teach EI? On an index card, summarize an activity that you do to promote EI in your residents. In groups of 4, share. Have each group summarize one of the ideas for the larger group. Everyone, hand in your card for inclusion in a FMDRL document. Include your name and program for attribution, and your email address if you are willing to be contacted for additional information about your suggested activity.

25. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Final Comments or Questions

26. The 36th Forum for Behavioral Science in Family Medicine Sponsored by The Medical College of Wisconsin Contact Information Claudia Allen, PhD cmw3u@virginia.educmw3u@virginia.edu Ted Siedlecki, PhD ts6c@virginia.eduts6c@virginia.edu Emma Pace, MD ejp3a@virginia.eduejp3a@virginia.edu