Impact of emotional competence on clinical reasoning: a scoping review

Objectives Given the role of emotions in reasoning, we hypothesised that emotional competence (EC), defined as the ability to identify, understand, express, regulate and use emotions, would increase the quality of physician’s clinical reasoning (CR). The objectives of this study were to map the existing literature on the impact of EC on physician’s CR and to identify any literature gaps.

Design This study is a scoping review.

Data sources We included articles from Medline (via Ovid), Embase and Psychinfo and articles found manually, with no limitations in terms of publication date or location.

Eligibility criteria Inclusion criteria were all physicians and medical students and articles focusing on one or more dimensions of EC (based on the model of Mikolajczak et al) and of CR (based on the framework of Young et al). We excluded non-research articles and articles concerning other health professionals, physicians’ psychiatric disorders or the impact of emotions on well-being, instrument-handling skills or students’ academic learning.

Data extraction and synthesis Data were extracted by two independent reviewers. Results were summarised using descriptive analyses and a narrative synthesis.

Results After removing duplicates, we identified 12 046 articles. Following a review of their titles and abstracts, we assessed 268 articles for eligibility and included 98 in the scoping review. Most studies examined the effects of emotional regulation strategies, empathy and global EC scores on clinical performance. Positive effects of EC on uncertainty management and intuitive reasoning have been well documented, as have its effects on diagnostic and therapeutic performance and the development of CR in the context of life-threatening situations. A smaller number of studies suggest a favourable impact on clinical performance in the surgical context and on the quality of prescriptions. The impact of EC on diagnostic and therapeutic performance outside emergency and intraoperative contexts and on patient outcomes remains uncertain. The effects of EC on CR were most evident under conditions of high acute stress, likely due to the increased cognitive load associated with such conditions.

Conclusions EC has been found to have a positive impact on CR mainly when dealing with uncertainty and life-threatening emergencies. Stress regulation and the resulting reduction in cognitive load appear to be a key modulator of EC’s impact on CR. Further research should focus on the impact of EC on diagnostic and therapeutic performance outside emergency conditions and on patient outcomes.