Emotional Intelligence Shapes How Accurately Surgical Residents Judge Their Own Skills

For surgeons in training, knowing what you don’t know may be just as important as technical skill in the operating room. A new multi-institutional study suggests that emotional intelligence, a trait rarely measured in surgical education, may quietly determine how accurately surgical residents perceive their own clinical competence. The findings, published in Global Surgical Education, the journal of the Association for Surgical Education, offer a provocative answer to a question that has long troubled educators: why do some residents judge their abilities with startling accuracy while others see themselves as far better, or worse, than their faculty evaluators do?

The research team, led by Colleen P. Nofi, Ila Sethi, and Vihas Patel of Northwell Health and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, together with collaborators at Good Samaritan Regional Medical Center and Hackensack University Medical Center, designed an exploratory prospective observational cohort study spanning the 2022–2023 academic year. Their central question was deceptively simple: does a resident’s emotional intelligence, commonly abbreviated EI, predict the degree of agreement between how residents rate themselves and how their programs’ Clinical Competency Committees, the faculty panels formally charged with assessing trainee progress, rate them?

To measure emotional intelligence, the investigators used the 33-item Schutte Self-Report Emotional Intelligence Test, a validated instrument rooted in the Salovey and Mayer model of EI as the ability to monitor, discriminate among, and use emotional information. Self-assessment alignment was quantified using the Accreditation Council for Graduate Medical Education’s Milestones 2.0 framework, a competency-based evaluation system that grades residents across specialty-specific subcompetencies. Concordance between resident self-evaluations and Clinical Competency Committee evaluations was captured at two time points, mid-year and end-of-year, allowing the team to track not just whether residents were accurate, but whether their insight improved as the training year unfolded.

The dataset included performance evaluation data from 88 surgical residents whose concordance could be analyzed; of those, 36 also completed the emotional intelligence survey. The headline result was a trend rather than a definitive statistical verdict: residents with medium to high EI scores demonstrated greater concordance with their Clinical Competency Committee evaluations than residents with low EI scores, with a p-value of 0.059, just shy of the conventional threshold for statistical significance. In an exploratory study of this size, the researchers argue, such a near-significant association is meaningful evidence that self-awareness, a core component of emotional intelligence, underpins honest and accurate self-appraisal of surgical competence.

The temporal data added a second, arguably more hopeful, layer to the story. At mid-year, 43 percent of residents showed low concordance between self-assessment and faculty evaluation, while 57 percent showed high concordance. By the end of the academic year, low concordance had fallen to 38 percent and high concordance had climbed to 62 percent. In other words, residents as a group became more accurate judges of their own performance over time, a pattern the authors attribute plausibly to the accumulating effect of ongoing feedback, formal evaluations, and the reflective practice embedded in surgical training.

Perhaps the most unexpected finding concerned program size, a variable rarely scrutinized in competency research. Residents in medium-sized programs achieved strikingly higher concordance, at 86 percent, than those in small programs, at 58 percent, or large programs, at 52 percent, a difference that reached statistical significance with a p-value of 0.029. The authors offer no single explanation, but the pattern invites speculation about the social dynamics of feedback: in mid-sized programs, faculty may know each resident well enough to give calibrated, individualized evaluations, while the smallest programs may suffer from limited evaluator diversity and the largest from anonymity, with residents and faculty interacting too briefly for honest, granular assessment. Notably, neither postgraduate year level nor program type showed any significant association with concordance.

The significance of accurate self-assessment extends well beyond academic bookkeeping. Prior work has repeatedly documented that residents frequently overestimate their abilities relative to faculty judgment, and the milestone framework under which these evaluations occur directly shapes promotion, remediation, and ultimately board certification. A resident who cannot accurately perceive a competency gap may fail to seek the operative experience or study needed to close it, while a program that cannot rely on self-assessment must invest heavily in external surveillance. The new study suggests that emotional intelligence could serve as a screening variable, identifying trainees who need structured support in developing the self-awareness that honest self-evaluation demands.

The findings also sit within a growing body of literature linking emotional intelligence to surgical outcomes. Earlier studies have associated EI with resident well-being, lower burnout, higher job satisfaction, and even technical performance measures such as surgical quality. A 2020 pilot study by Nayar and colleagues reported that emotional intelligence predicted accurate self-assessment of surgical quality, and the present work extends that logic from the individual procedure to the full spectrum of clinical competencies codified by the ACGME. Educational researchers have begun designing interventions, from patient-centered experiences to formal EI coaching curricula, aimed at cultivating these skills deliberately rather than assuming they emerge from clinical exposure alone.

The authors are careful to frame their conclusions within the study’s limits. With only 36 residents completing the EI survey, the cohort was small and the near-significant p-value could shift in either direction with more data; the self-report nature of the Schutte test introduces the possibility that residents with genuinely high self-awareness also rate their EI differently; and the multi-institutional design, while a strength for generalizability, leaves residual confounding from institutional culture and evaluation practices unmeasured. Data privacy constraints prevent open sharing of the underlying dataset. Still, the study’s exploratory design was explicitly intended to generate hypotheses, and its results justify larger, powered trials of EI measurement and training in surgical education.

If confirmed, the implications for training programs are concrete. Programs might incorporate validated EI assessments at entry, use concordance between self- and faculty evaluations as a flag for residents lacking insight, and design feedback structures, particularly in small and large programs, that replicate the calibrated, personal evaluation environment apparently achieved in mid-sized ones. The steady improvement in self-assessment accuracy across the academic year reinforces a message educators have long promoted but rarely quantified: feedback, delivered consistently and received with genuine self-awareness, teaches residents not just how to operate, but how to see themselves as surgeons. In a profession where the cost of misjudging one’s own limits is measured in patient outcomes, cultivating that inner clarity may be one of the most consequential skills a training program can teach.

Subject of Research: The relationship between emotional intelligence and the accuracy of surgical residents' self-assessed clinical competency

Article Title: Emotional intelligence influences surgical resident’s self-perception of competency: an exploratory, multi-institutional study

Article References: Nofi, C. P., Sethi, I., Demyan, L., Koti, S., Hansen, L., Serfin, J., Surick, B., & Patel, V. (2026). Emotional intelligence influences surgical resident’s self-perception of competency: an exploratory, multi-institutional study. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 166. https://doi.org/10.1007/s44186-026-00568-6

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00568-6

Keywords: emotional intelligence, surgical residents, self-assessment, Clinical Competency Committee, ACGME Milestones 2.0, surgical education, competency evaluation, Schutte Self-Report Emotional Intelligence Test, graduate medical education, feedback, self-awareness, Emotional