By: Karen E. Hauer (@KarenHauer4), Anna Chang (@AnnaChangUCSF) and James Frank (@UCSFPCCMFellows)
Coaching programs are increasingly common in medical education training, and coaching is critical to the success of competency-based education (CBE).1 Coaching is the secret sauce that enables learners to understand and embrace their responsibilities, with faculty support, to drive their own progress toward meeting all program outcome expectations, monitor their learning progress, and set learning goals. Coaches who guide students’ journey develop skills and approaches that transfer to their other roles. In this blog post, we reflect on the ways that coaching enhances learning and the learning culture for both students and coaches within a competency-based education curriculum. These reflections are based on the literature and on our own experience with a medical student coaching program, now in its sixth year.
Students engage in feedback and gain agency over their learning through coaching
A longitudinal relationship between the learner and coach shapes learning and approaches to feedback. Grounded in trust, the relationship enables student and coach to regularly engage in feedback dialogue. In our setting, students learn the language of growth, development, practice and goal setting with the coach.2 In turn, the coach develops deep knowledge of the learner’s abilities and goals and creates a psychologically safe environment to encourage receptiveness to feedback based on trust. The provision of supportive feedback from a trusted coach enhances learner confidence and graduated autonomy.3 These repeated feedback dialogues prompt students to seek and implement feedback as a central tool for their learning.2
The nature and approach of the coaching relationship promotes learner self-awareness, learner-driven priorities, and allowance for learner-directed growth. Skills of effective coaching include elucidation of learner strengths, learner self-reflection and self-assessment with input from the coach. The coach then provides individualized, specific guidance for the learner to build on personal strengths in working toward goals their individual goals. Repeating cycles of this process fosters agency in learning.4 In our coaching program, increased learner agency through coaching has facilitated a culture of student-driven, individualized learning in the context of a diverse class of students who bring a range of backgrounds and prior experiences. For example, medical students perceive their longitudinal coaching relationship as valuable to their efforts at clinical skills acquisition and career exploration.5 Coaching has provided greater opportunity for students to gain insight into individual growth edges while empowering them make informed choices around prioritizing learning goals, considering elective opportunities, and working to balance all of the demands on their time.
Coaching shapes coaches’ approach to their multiple roles
Coaching enhances professional development, career satisfaction, learning, and wellness.5,6 In our own longitudinal medical student coaching program, coaches, who are all physician clinician educators, find tremendous value in belonging to a network of physician educators from diverse backgrounds and clinical specialties, gaining professional skills in areas lacking from one’s own training (e.g. new or enhanced clinical skills, quality improvement strategies, or anti-oppressive language). Coaches value the multiple venues, including coach meetings, faculty development sessions, and 1:1 interactions with other coaches and school leadership, for brainstorming, debriefing, and collecting best practices to support their student coaches. Many of our coaches rise to new clinical or education leadership positions in part because of skills gained during the coaching role. A physician educator who is a coach can also apply coaching skills to support motivation and enhance self-efficacy in their care of patients with chronic illnesses.7 These experiences demonstrate how participating as a coach equips the coach to address emerging challenges in health professions education today.
Coaching shapes institutional culture
Coaching, as a central principle of longitudinal health professions education communities, can be the first step towards the creation of an institutional culture of lifelong learning for learners, coaches, and colleagues. As a strategy, coaching challenges both learners and coaches to grow with every interaction, starting at a point unique to each person’s level of experience and expertise.5 A regularly revisited personal development plan for learner or coach serves as a framework for advancing each individual along their own trajectory as master adaptive learners.8 Student and coach can identify their areas of focus with assessment data and critical reflection, refined with feedback conversations within the context of trusted coaching relationships.4 This safe learning environment, when multiplied, forms the basis for learning communities that embrace continuous improvement in today’s complex landscapes of practice.
Coaches and learners exist in a complex web of intersecting communities and bring effective coaching strategies across silos.6 Multiplied throughout our health care and educational institutions, the coaching mindset may give us the tools to begin to build community and heal the multitude of fracture lines that threaten the wellness and sustainability of our health care workforce, one conversation at a time.
About the authors:
Karen E. Hauer MD PhD is Associate Dean for Competency Assessment and Professional Standards and Professor of Medicine at the University of California, San Francisco (UCSF).
Anna Chang MD is Professor of Medicine in the Division of Geriatrics at the University of California, San Francisco (UCSF).
James Frank MD is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of California, San Francisco (UCSF).
References:
1.Lomis K, Richardson D. Coaching: the lever to realize the full potential of CBME. ICE Blog, June 9 2022.
2. Bakke BM, L Sheu, KE Hauer. Fostering a feedback mindset: a qualitative exploration of medical students’ feedback experiences with longitudinal coaches. Acad Med. 2020;95(7):1057-65.
3. Atkinson A, CJ Watling, PLP Brand. Feedback and coaching. Eur J Pediatr. 2022;181(2):441-446.
4. Armson H, JM Lockyer, M Zetkulic, KD Konings, J Sargeant. Identifying coaching skills to improve feedback use in postgraduate medical education. Med Educ. 2019;53(5):477-493.
5. Hauer KE, A Chang, SM van Schaik, C Lucey, T Cowell, A Teherani. “It’s all about the trust and building a foundation:” evaluation of a longitudinal medical student coaching program. Teach Learn Med. 2022:1-15.
6. Sheu L, KE Hauer, K Schreiner, SM van Schaik, A Chang, BC O’Brien. “A friendly place to grow as an educator”: a qualitative study of community and relationships among medical student coaches. Acad Med. 2020;95(2):293–300.
7. Wolff M, NM A Deiorio, AM Juve, J Richardson, G Gazelle, M Moore, SA Santen, MM Hammound. Beyond advising and mentoring: Competencies for coaching in medical education. Med Teach. 2021;43(10):1210-1213.
8. Cutrer WB, B Miller, MV Pusic, G Mejicano, RS Mangrulkar, LD Gruppern, RE Hawkins, SE Skochelak, DE Moore. Fostering the development of master adaptive learners: a conceptual model to guide skill acquisition in medical education. Acad Med. 2017;92(1):70-75.
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