The data analyses yielded two main categories and five subcategories as shown in Table 3.
Table 3: Overview of the sub-categories, categories and themes which emerged in the study
Themes
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Main Category
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Subcategory
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Health outcome
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Mental health improvement
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Modifying emotions
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Increasing interest and motivation
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increasing the self confidence
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Reducing mental conflict
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Physical health improvement
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Increasing physical health
|
Learning outcome
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Cognitive facilitation
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Increasing comprehension
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Promoting clinical reasoning
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Professionalism Facilitation
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Promoting orbital ethics
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Promoting interpersonal interactions
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Increasing responsibility
|
Health outcome:
From the students' point of view, one of the most important effects of teaching based on emotional intelligence was the effect on their health.
Mental health improvement:
Mental health improvement was reported among the significant effects of this type of teaching by the interviewees. This section includes modifying emotions, increasing interest and motivation, increasing self-confidence, and reducing mental conflict.
Increased positive and decreased negative emotions were repeatedly reported by the students in clinical wards where professors taught based on emotional intelligence. Examples of reported positive emotions included a sense of serenity, importance, joy, pride, belonging to a group, and usefulness. The most important reason for creating these feelings, as mentioned by the students, was the professor’s attention and empathy toward their feelings as well as his emotional self-control and communication management.
“When the professor introduces both himself and you to the patient, it means that he cares about you. It gives the students a good feeling, as if they are important, too.” (Sn 1, id code 92).
Negative emotions learners felt in the clinical wards included anxiety, confusion, guilt, being abused, forced labor, passivity, and feelings of inferiority. They believed that teaching based on emotional intelligence could prevent these negative emotions.
“They understand us... For example, yesterday I was on a night shift in the hospital and I didn’t sleep a wink, so this morning I was constantly falling asleep. I was one meter away from the professor when I fell asleep for a moment, but she did not humiliate me in front of you (the researcher) and the interns.” (Sn: 3, id code 16).
Increased interest and motivation and lively presence in the round was stated as another advantage of teaching based on emotional intelligence. Learners believed that the professor’s attention to the basics of emotional intelligence in teaching could reduce their physical fatigue and prevent them from getting bored during the round. They attributed this to a) the professors considering students’ emotions and showing empathy with them, b) the professors paying attention to the learners’ physical and scientific needs, c) the professor’s emotional self-management, and d) passion-based leadership.
Professors can also make the round more fruitful by paying attention to the duration of the round, the students’ level in explaining scientific content, the students' physical comfort, assigning responsibility to them, and avoiding repetitive discussions in the round.
“The professor does not review repetitive lessons and we learn quite new things. This does not make us feel bored and we listen to the discussions eagerly.” (Sn: 2 id code: 15).
“Often, the professor motivates the students to try harder by, for example, giving them some topics for presentation.” (Sn: 18-19 id code: 30).
Another point that students mentioned among their useful experiences of teaching based on emotional intelligence was the increase in their self-confidence. Introducing the students to the patient, delegating responsibility to them, confirming their correct actions, and giving them feedback were reported as the main causes of the increase they felt in their self-confidence.
“When we made a correct diagnosis, the teacher encouraged us. It was really sweet for us to see our professor confirmed what was in our mind as a diagnosis and accepted us as a therapist. We gained the confidence to speak up again next time.” (Sn 12 id code48).
Finally, participants suggested reducing mental conflict as a result of attending the round taught under the principles of emotional intelligence. Outside these rounds, the learners experience mental conflict as a result of the contradiction in the behavior and speech of the professors, which consequently leads to the reprimand of the students as they could not meet the professor’s criteria.
In addition, learners introduced honesty, transparency, and professor’s influence as other factors in reducing their mental conflict.
“Medicine is not just learning a science: it is also about dealing with the colleagues, the patients, and their families, even the ward cleaner. If the professor has many advantages but also a little of misbehavior, the lesson will not be easily engraved onto my mind. When I have a heartfelt relationship with a professor and I accept him, the behavior and speech of that professor are subconsciously engraved on my mind.” (Sn 3 id code34, 35).
Physical health improvement:
Social Emotional awareness and communication management by the professor affect the learners’ health. The professor’s attention to the health and physical fatigue of the students can prevent the development and aggravation of their illness.
“Dr. ..... is the only professor who realizes that you are tired or not. Once I wasn’t feeling good, but no one noticed my problem. I was coughing all the time yet no one told me to go to have a drink. The only thing that matters to the medical personnel is to get over with the job and no one cares about us; this is what has been stuck on the minds of all of us” (Sn 5 id code 1, 2).
Also, another participant argued that:
“In the hospital, we work as a team and the work of one person affects the whole team. For example, if the resident works effectively, both the patient and the professor will teacher benefit; if the resident doesn’t work well, he can’t visit the patient well either. On the other hand, if a student has an infectious disease, he can pass it on to the others. Therefore, careful attention should be paid to his health.” (Sn 8 id code 40).
Learning outcome:
The second important effect of linking emotional intelligence to clinical teaching is students' learning outcomes, which is related to cognitive and professional facilitation.
Cognitive facilitation:
Cognitive facilitation occurs through increased comprehension and improved clinical reasoning. Interviewees acknowledge that clinical teaching with emotional intelligence increases their comprehension by developing accuracy and focus, active listening, increased study time, increased mental curiosity, and engaging in learning activities due to improved patient-student collaboration. Continuous mentoring, attention to the promotion of others, professor’s emotional self-management, attention, and empathy with learner’s emotions help the medical teacher to influence them which in turn increases students’ comprehension. Also, the teacher's attention to the patient's emotions and showing empathy with him increases the patient's participation in education which in turn facilitates learning.
“Our learning depends on several factors: one is that we get to study well and the other is that we are not afraid to ask questions. This is very important. Sometimes the resident thinks that if he asks a question, the professor will assume that he doesn’t know the answer! He may say ‘You are a resident and you do not know this!’ This humiliation does not allow anyone to ask questions.” (Sn 6 id code 64).
Based on the experiences reported by the interviewees, in addition to giving them deep understanding of the materials, teaching based on emotional intelligence affected learners’ clinical reasoning power. The flexibility of the professor in the assignments assigned and the assigning the responsibility of diagnosing and treating the patient to them was considered effective in this regard. It was also considered as an important cause in the reduction of direct supervision of professors allowing them to practice independently in promoting the power of clinical reasoning.
“The professor defends us and believes that as of now we are students who should first learn, and then, when the time comes, they can do the works required in the ward. Instead of forcing myself to report a document for nursing station, now I take the time to analyze the patient.” (Sn 13 id code 46).
Professionalism Facilitation:
The present study showed that adding emotional intelligence to clinical teaching can enhance professionalism in learners by increasing ethics, improving interpersonal interactions, and increasing accountability.
The students believed that the professor’s attention to ethics promoted their ethics. A professor who pays attention to the basics of emotional intelligence in clinical teaching is stronger in influencing his students and is more effective as a role model.
“When the teacher pays attention to the ethical points in dealing with nurses, we learn quite a lot. We learn that we should not brag after receiving our degree that, for example, as a doctor my job is more prestigious than a nurse’s.” (Sn 10, 11 id code25).
Improved interpersonal interactions in the clinical education triad (physician, student, and patient) was another experience reported by the students who participated in a clinical round taught based on emotional intelligence. They believed that the teacher's emotional self-awareness, social awareness, and attention to the needs of others contributed to this improvement.
"If the professor supports me on a tiring day, I will compensate for my falling back the other days when I am energetic and will try harder. This increases the relationship between the student and the professor. When the student-teacher relationship is favorable, everything takes a different color, and this is very important because a better communication between the professor and the learner results in more learning.” (Sn 4 id code 73).
Finally, the participants considered their increased responsibility in learning owing to the professor’s attention to their scientific promotion, provision of appropriate feedback, and attention to their non-scientific needs.
“The first day I was a little late, the doctor waited for me to come and we visited the patient together, although he was not my patient, this was a good experience because the student feels important and this feeling creates responsibility in him.” (Sn 9 id code 59).