#KeyLIMEPodcast 301: Waiting for Goffman: Coaching, Identity, and the Coming Cultural Transformation

Jason presents to us another paper on identity by Sawatsky et al from the Mayo Clinic. [See Episode 254 for the first] The authors, a team which also includes medical sociologist Fred Hafferty, set out to describe how coaching can promote professional identity formation in #meded. What they really deliver is a powerful argument about the importance of assessment for learning in a CBME world. Listen to the KeyLIME co-hosts discuss here.

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KeyLIME Session 301

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Reference

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Sawatsky et. al., Coaching Versus Competency to Facilitate Professional Identity Formation Acad Med. 2020 Oct;95(10):1511-1514.

Reviewer

Jason R. Frank (@drjfrank)

Background

When you were training, how did you feel about being observed by a supervisor? Did you feel secure in your career, confident in your development, and welcome the feedback of someone who has already made mistakes and learned from them? Or did you cringe at the potential for criticism and risk to your career if you showed any weakness or vulnerability? Was your world filled with assessment for learning or assessment of learning? Or worse, was the learning environment oriented to “search and destroy” those who clearly do not belong? Is it any different today?

How can we have a modern assessment system that is truly dedicated to the development of bright young health professionals to be the best they can be for their patients? How can we embed a growth mindset in institutions and all its individual members of our communities? Are our trainees condemned to putting on a show for assessments to survive?

Purpose

This week we return to another great paper by Sawatsky et al (including medical sociologist Fred Hafferty) from the Mayo Clinic. The authors set out to describe how coaching can promote professional identity formation in meded. What they really deliver is a powerful argument about the importance of assessment for learning in a CBME world.

Key Points on the Methods

This is a conceptual piece. The authors explore the problem of assessment tensions in the meded environment using a case scenario of a trainee who models vulnerability and admitting when she does not know things but subsequently is crushed when her career advancement is denied. They then explore published conceptual frameworks of professional identity formation, programmatic assessment, growth mindset, coaching, communities of practice and Goffman’s theory of impression management.

The opening case is almost melodramatic for effect. The subsequent arguments bring in diverse literature to make a call for the changes in meded that the authors think are needed.

Key Outcomes

There are 2 almost independent theses in this paper…
1. The first makes the case for the use of coaching methods in #meded to systematically promote professional identity formation (PIF). PIF is identified as an “ideal goal of meded”. The works of Jarvis-Selinger, Cruess et al, Wenger, and Kegan are reviewed to operationalize PIF as “the development of professional values, actions, and aspirations” in individuals and a “socialization process” in a community. The coaching scholarship of Watling & Ladonna, and others is reviewed to show that coaching is an ideal set of methodologies to enhance PIF.
2. The second theme is a call to action to resolve the problem of assessment being perceived as a punishment in #meded. With the expansion of CBME worldwide, the HPE community is moving to implement programmatic assessment, envisioned by scholars such van der Vleuten, Scheele, Holmboe, Warm, and others to involve frequent low-stakes direct observations, coaching, and the growth mindset. The major flaw is that, in our current learning environments, assessments are perceived as primarily of learning, not for learning¸ and potentially punishing in nature. True PIF and powerful learning will not ensue if we do not address this.

Key Conclusions

The authors conclude…

  1. Coaching is ideally suited to promoting the kinds of learning that are important for professional identity formation, and
  2. Meded as a community needs to resolve the perceived major challenge of trainee vulnerability in the frequent assessments required by CBME systems.

Spare Keys – other take home points for clinician educators

  1. This paper is in a genre of conceptual pieces that synthesize previous ideas and propose new paradigms and ways forward. These can have a major impact in #meded but are not always given respect in academic reward systems (i.e., “just an editorial”).
  2. There has been a lot of work on coaching in #meded recently, including a series of important papers by Watling and LaDonna. This is still a source of some debate and discourse.
  3. Assessment is a perennial major topic of #meded scholarship. This paper articulates many of the recent themes and controversies.

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