We found that EI was a significant predictor of academic performance in overall continuous assessments and final examination amongst first- and final-year medical students in a Malaysian university. This result could indicate the significant presence of a direct EI effect on academic performance in medical education. The EI influence on academic performance seemed mainly due to students’ ability to accurately perceive emotions and to their ability to understand emotional causes. This knowledge would enable the students with higher EI to have more adaptive life-styles, be more attuned to the signals of others and themselves, and better understand the causes of their and others’ emotions [11, 39]. The lack of correlation between EI and the first-year FE could be due to the fact that FE is simply the end-of-Package 6 examination, compared to an accumulation of five examinations in the CA or the more extensive FE in the final year. It was also possible that the first-year medical students were experiencing less negative emotion or that the stress and strain of study were somehow buffered by the positive feeling coming from the fact of them being admitted into a medical school. In addition, higher EI would not have been as necessary in the first-year students who might be less concerned with study because studying medicine was not their own intention or who had been overly disappointed with teacher’s quality (see Table 1) . In final-year medical students, the weak correlation of EI and CA was probably due to the students’ familiarity with the learning activity of postings rotation through the different surgical and medical specialties and thus less emotion-laden in facing the end-of-posting CA. In addition, the final-year medical students would have become more mature and experienced from their previous clinical years of facing small end-of-posting examinations. Therefore, the influence of EI in facing CA would be less apparent compared to when facing the FE which involves more tests and spans over several days .
The total EI score was related mainly to the final-year medical students’ academic performance but not to the performance of first-year students. This result might be due to the fact that this group was more heterogeneous (see Table 1) as compared to the final-year group. It is possible that the English proficiency might be poorer or more varied in the first-year students leading to inconsistent MSCEIT results. These different levels of English proficiency were observed from our experience in teaching these two groups of students. This study found that the first- and final-year students had generally similar MSCEIT scores except that final year students scored better in Branch 3, Understanding emotion, and more specifically, Task C (Changes). In another study in the United Kingdom that used MSCEIT, a similar observation was reported that older medical students scored significantly higher in the Understanding emotion branch . The other possible explanation would be that it is more emotionally demanding in the final year of study which has its academic curriculum packed with many varied clinical postings and the students are constantly preparing for the final professional examination. In this high emotional period of study, EI could have its effect and impact on academic performance. This EI effect in emotion demanding situation was reported by Joseph who observed that EI positively predicts performance for high emotional labor jobs .
More generally, the small effect size of EI versus the large influence of demographic variables such as ethnicity is an important finding. Although the effect size is small, it was significant beyond gender and ethnicity. Ethnicity, in this study, can also serve as a proxy variable for English language fluency. That is, although the language of instruction in this Malaysian medical school is English, and all students take an English-language proficiency examination as part of the admissions process, students with different ethnic backgrounds likely have differing levels of English-language fluency. Given that the MSCEIT was given in English and uses emotion terms typically not covered in language exams, some of the effects for EI may be due to language rather than emotion ability.
Our findings were in line with the general expectation of a positive relationship between emotional intelligence and academic performance. Austin et al. reported a significant correlation between EI and students’ performance in problem-based learning sessions but no correlation was found between EI and end-of-year examination marks . However, that study employed a self-report EI scale in a sample of 100 end-of-year examination marks from medical students in year 1, 2 and 5, so it is difficult to make meaningful comparisons with our present study. People with higher EI are expected to understand, regulate and manage emotions better both in themselves and others. This would allow people with higher EI to experience more stable and positive emotions. Medical students with positive attitude and emotion towards their course were related to academic achievement . In this study, second year medical students in the US who self-reported to have higher course-related enjoyment had higher scores on The National Board of Medical Examiners (NBME) shelf examination (β = 0.31) in contrast to their classmates who were reported to have course-related anxiety and boredom (β = − 0.36 and - 0.27, respectively) . Furguson et al. reported that medical students in Nottingham who scored high on emotional stability (assessed by the big five personality domains) performed better on three out of eight pre-clinical assessments under their study . Jaeger et al. reported that for students in a general management graduate-level course, greater levels of emotional intelligence (using a self-report measure) correlated with academic performance (final project grade comprised a paper and oral presentation) even when controlling for traditional markers of intelligence . This study had also provided evidence that EI training incorporated within the curriculum could improve the students’ EI to the extent of having a positive effect on the academic performance.
The present study reported a positive impact of emotional intelligence on academic performance among Asian medical students with a multicultural background. With the report of high levels of stress and anxiety among the medical students and the positive effect of EI on academic performance in this and other studies , future prospective and intervention studies with emotional training programs are needed to confirm these findings [45, 46]. More work is also necessary to find factors underlying academic performance which have the potential to be trained. The effect of such training might not only improve the students’ academic performance, in terms of examination marks, but also their experience of the teaching and learning activities . Doctors with more developed emotional intelligence skills could also provide more quality patient-centred care , cope better with their highly demanding professional career and perhaps lead a more fulfilled and happier life as an individual [7, 8, 49].
This study was one of the few that employed an ability-based measure of emotional intelligence instead of self-report surveys. Our results add to growing research showing influence of EI, in ability-type EI measures, on academic performance in an undergraduate medical program. However, there were several limitations of this study. The first limitation is the sample size within each academic year. Second, selection bias could play a role, as in any voluntary study; those non-participating students could be less motivated or discouraged with their already poor academic achievement. Third, the EI measure was administered in English and not all subjects were native English speakers. The effect of English proficiency on the MSCEIT and academic performance in this study cannot be ascertained. As this confounding effect of English proficiency is more likely in the first-year medical students, future work could include the students’ Malaysian University English Test (MUET) results that they are required to sit for in the first semester in the first year. Some of the items in the MSCEIT use scenarios surrounding family or personal issues which could be unfamiliar to the students. Since the objective of this study was to examine the effect of EI in undergraduate medical students on academic performance, we did not report the contribution of general intelligence towards the examination results and the relationship of general intelligence and EI. Admission into medical schools is competitive in Malaysia as well as elsewhere; where only the high achievers from the pre-university or matriculation programs are admitted. Thus, it was believed that there would be a limited range of general intelligence among the medical students at this university. Because of the more demanding medical degree program with reports of increasing prevalence of emotional disorders among medical students [38, 50–54], the results reported here are hoped to draw attention to the effect of EI on academic performance. Future work could examine the relationship of general intelligence and EI, and their combined effect on the academic performance in medical education.