Emotional competence and medical decision making in residents performing a simulated life-threatening emergency

Empirical studies
By Léonore Bourgeon, Bruno Debien, Jean-François Ringeval, Véronique Chastres, Anthony Vacher

Life-threatening emergency management is one of the most demanding medical activities, as rapid high-stake decisions must be made on the basis of information that is often partial and/ or uncertain. This situation can generate negative emotions, especially for residents who are still pursuing medical education and who may have to deal with it without any immediate assistance from a senior physician. This study aims to verify whether a high level of Emotional Competence (EC) can improve the performance of residents when managing a life-threatening emergency and, if so, identify the phases of care that benefit from it, and the nature of the EC involved. In a full-scale simulation, 18 military first-year general medicine residents were confronted with the failure of a ventilator connected to an intubated and ventilated patient. Their EC level was assessed using the Trait Emotional Intelligence Questionnaire self-assessment questionnaire, which provides an overall emotional intelligence score and scores for 15, individual facets. Medical performance was assessed using temporal indicators associated with each phase of medical care: Time to detect an unexpected change in the patient’s condition, time to make the correct diagnosis, time to make the relevant decision and time to perform the relevant therapeutic act. Finally, decision strategies were identified from the analysis of audio-video recordings. The results confirmed that the higher the level of EC, the shorter the time taken to stabilize the patient. The higher EC level was linked to a reduction in both time to detect an unexpected change of the patient’s condition and time to make the relevant decision. For most residents, this decision time was spent on identifying the technical failure that caused the patient’s condition to deteriorate whereas the fastest residents made the relevant decision without in-depth searching for this cause which highlights a strategy directly focused on managing patient risk. Finally, emotion perception, assertiveness and stress management are the three emotional competencies that showed a significant link with medical performance, and could be the subject of targeted training for general medicine residents.


  • competence
  • medical decision making
  • life-threatening emergency
  • resident
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