Emotional Intelligence in Surgical Training: The Five Love Languages Applied

Introduction

Healthcare worker burnout reached crisis proportions during the COVID-19 pandemic and continues to escalate. Additionally, the American College of Surgeons recently reported that 52% of surgeons admitted to burnout, substance use, and/or suicidal ideation.¹ The negative impact on patients is reflected in increased rates of reported medical errors and malpractice suits.² Surgical educators are working to mitigate burnout in training by incorporating programs, such as Enhanced Stress Resilience Training (ESRT), into residency curricula, and the ACGME has added team building and personal wellness to program accreditation requirements.^3,4 Surgical trainees regularly experience some version of an ‘extreme action team’ in which they must cooperate to “perform urgent, unpredictable, interdependent, and highly consequential tasks while simultaneously coping with frequent changes in team composition and training their teams’ novice members.”⁵ Trauma resuscitation, where emergent life and death decisions are made, often with incomplete clinical information, is a prime example.

While numerous factors influence team effectiveness, emotional intelligence is a particularly salient one.⁵ Defined as the “ability to monitor one’s own and others’ feelings…and to use this information to guide one’s thinking and actions,” emotional intelligence is essential to the urgent, often life-changing decisions made in surgery.⁶ Collectively, surgical residents have similar emotional intelligence to non-surgical trainees and the general population, but possess distinct strengths in sociability, emotion management, assertiveness, and social awareness.^7,8 While emotional intelligence is a potentially protective quality, there is limited data regarding its optimization in medical trainees.^1–5,7,8 A 2022 meta-analysis demonstrated that structured seminars within residency curricula are a viable approach.³ Accordingly, contemporary surgical training must embrace an emotional intelligence curriculum focusing on interpersonal and team interactions.⁹

One possible approach is to adapt the popular five ‘love languages’ to surgical training to help integrate emotional intelligence with team communication. The ‘love languages’ have been applied and validated in numerous settings including grade schools, universities, parenting, couples’ therapy, occupational therapy, obstetrics, and endoscopy training.^9–15 Given the demonstrated value in these contexts, surgical trainees’ ‘love languages’ may allow for optimal function as part of an extreme action team. We thus highlight the five languages and how they may manifest within surgical training.

Words of Affirmation

Surgical culture takes a “no news is good news” approach to feedback provision, leaving trainees unaware of both successes and opportunities for improvement. Direct validations of effort build confidence and can cohere a team despite a stressful environment. Furthermore, inviting junior trainees’ input reminds residents that their presence and budding expertise—not only a senior surgeon’s—is respected, desired, and meaningful. Affirmation through peer-to-peer recognition programs has been considered for minimizing burnout in emergency medicine. While this implementation has not significantly improved burnout, it does improve workplace recognition and support.¹⁶ Thus, affirmations may cultivate a supportive environment, even in high-pressure medical fields. However, positive reinforcement must accompany rather than replace performance feedback. Finally, certain trainees may not respond to such affirmations because of an inherent sense of duty rendering any thanks for “doing their job” unnecessary.

Quality Time

Individuals define ‘quality time’ differently. In flexible educational settings, simply asking trainees how they wish to optimize learning may be beneficial. More personalized time with attendings is a common request. For some, dedicated teaching rounds may be a welcome opportunity to spend more individualized educational time together whereas others may see this as an intrusion on clinical duties. By querying trainees’ experiences, faculty can leverage mentorship opportunities without adding to resident workloads.

Gifts

Tangibles, like coffee and snacks, are obvious “rewards” to busy trainees. Unique to surgical residents, however, are opportunities to perform level-appropriate operative cases that challenge both intellect and technical skill. This is perhaps the greatest affirmation due to the inherent, active investment in a trainee. Invitations to participate in research similarly validate trainees’ knowledge and commitment. Despite the additional work, the resultant publications, collaboration, and networking opportunities carry short- and long-term value. These gifts constitute the fundamentals of mentorship and signify a vested interest in trainees’ success.

Acts of Service

If a trainee’s love language is ‘acts of service’, their team will most rapidly flourish when an opportunity for service arises and is followed by recognition. Encouraging the teaching of mastered skills (e.g., coaching medical students through a wound closure) reinforces a resident’s own achievements and nurtures their desire to serve. However, they may have difficulty accepting others’ help, seeing task completion as a test of their ultimate value. As such, they may be prone to time management struggles, thus highlighting the need for optimal balance between education and clinical service.

Physical Touch

While physical touch is an original love language, its application in a learning environment can be fraught with misinterpretation, yielding a general recommendation of avoidance. Some would posit that a handshake and eye contact added to words of affirmation may permit sufficient emotional anchoring such that information, including praise, can be fully received. This ‘language’ is most relevant to patient interactions as its appropriate use is essential to compassionate medical practice. For example, a hand held during anesthesia induction can be welcomed and meaningful. Any physical touch should be brief and consensual.

Summary

Effective communication is inherent to successful extreme action teams with demonstrable improvements in efficiency, safety, and team member satisfaction. Surgical training is emotionally charged work, and optimal resident education and patient outcomes require not only knowledge and technical proficiency, but also resilience, honesty, and emotional intelligence. The admonition of “call me if you need me, need me if you call me” reminds trainees that trust and graduated responsibility are inextricably linked to self-awareness.

However, few strategies have yielded improvement in surgical teams’ interpersonal interactions. The ‘love languages’ offer a framework to optimize team dynamics by acknowledging individuals’ primary motivations. While trainees may not share a ‘love language,’ such gaps may be bridged through mutual understanding of different communication styles. Application of the ‘love languages’ may help promote early trust and mutual respect throughout surgical training.¹⁵