CoachingStrategiestoHelpTrainees’ClinicalSkills
DevelopmentAssociationofPediatricProgramDirectors’Meeting
April6,2017
Stanford• CarrieRassbach,MD• AlyssaBogetz,MSW• LucyLee,MD• CarrieLoutit,MD• DebbieS.Sakai,MD• Nivedita Srinivas,MD• BeckyBlankenburg MD,MPH
SeattleChildren’s• SaharRooholamini,MD,MPH• Maneesh Batra,MD,MPH• MollieGrow,MD,MPH• CelesteQuitiquit,MD• HeatherMcPhillips,MD,MPH
Objectives
• Reviewpurposeandbenefitsofcoaching• Discussskillsandtoolsforsuccessfulcoaching• Practicecoachingwithscenarios• IntroduceCoachingmodelsfromStanfordandSeattleChildren’sResidencyPrograms
• Reviewmythsandmisconceptions
WhatisGoodCoaching?
• Think:Individualreflection—positiveandnegativeCoachbehaviors
• Pair-share
WhatisCoaching?“Coachingphilosophyadherestothenotionthatlearningisneverfinishedandtoreachone’smaximumpotentialrequiresanexternalviewpointtocorrectorenhanceperformance.”
ThreetypesofCoachingrelevanttocoachinginmedicine:1. Coachingforskillenhancement2. Coachingforincreasedperformance3. Coachingfordevelopment
Schwellnus H,CarnahanH.Peer-coachingwithhealthcareprofessionals:Whatisthecurrentstatusoftheliteratureandwhatarethekeycomponentsnecessaryforpeer-coaching?Ascopingreview.MedTeach.2014
WhatarethebenefitsofCoaching?• Improvesclinicians’:– Confidenceintheirclinicalandcommunicationskills– Communicationskills(ie.Motivationalinterviewing)– Self-reportedburnoutscores– Patientsatisfactionscores
• Improvesresidents’:– Perceptionsoffeedback– Reflectiveskills– Goal-settingskills
IntroductiontoCoaching
• WhenshouldCoachingbeused?• Howdoyouassesswhatthelearnerneeds?• HowdoyoubecomeaneffectiveCoach?
RolePlay
6Essentialskillsforeffectivecoaching
1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals
LearnerReflection
Feedback
Furthergoal-setting
ObservationInternalization
andapplication
Residentidentifiesgoals,communicates
withcoach/attending
Skill1:RecognizingthebigpictureofCoaching
Skill2:Establishingasafelearningclimate
● Clarifyroleofcoach● Growrelationshipovertime● Emphasizenon-evaluativefeedback● Beapproachableandavailable● Help,notjudge● Givefeedbackprivately● Facilitategoal-setting● Serveassupport● Cultivatetrust● Ask/learnstrengthsandinsecurities● Focusonskills● Improveconfidence
Skill3: Observing• Directobservationis:
(1) first-handobservationofalearner(2) coupledwithfeedback(3) inareal-lifesetting
• Itcanprovide:(1)reinforcingand/orformativefeedback(2)increasedcredibilityfortheobserver
Directobservation:Miller’sPyramid
Toolstoenhancedirectobservation
• Standardizedtools– Systematizetheprocess– Increaseobjectivity– Serveasamentalprompt,likeachecklist,especiallyforlessexperiencedobservers
• Ideally,toolsareflexibleandallowuserautonomy,expertise
Skill4: FacilitatingreflectionTechnique ExampleAsk “How didyoufeelthatwent?”
‘’Whatwentwell?”“Whatwaschallenging?”“What,ifanything,surprisedyou?”
Tell Providefeedback
Ask “Does thisresonatewithyou?”“Isthissomethingyou’veheardbefore?”“Whatgoalscanweworkontogether?”
Skill5: GivingfeedbackTechnique (“Tell”)• Relatedtolearner’s
goals/reflections• Specific,focused ontask
orbehavior• Timely• Nonjudgmental• Providedinsmallpieces• Mindfultohowlearner
processesfeedback
Example• “Inoticed thatwhenyouwere
speakingwithyourpatient’sfamilyyouused’febrile’and’tachycardic.’Somefamiliesmaynotunderstandwhatthesetermsmean…
• “In thefuture,youmaywanttoconsider…”
• “Iwouldhavesaid...”• “Youcouldhavesaid...”
Skill6: Helpinglearnerssetgoals• AdultLearningTheory:
– Adultslearnbestwhentheyareactivelyengagedandself-directtheirownlearninggoalsandactivities
– Adultsmustreflectontheirexperiences– Theroleoftheteacher(akacoach)istoengagethelearner’sneeds
• Inadditiontohelpingsetgoals,thecoachcanhelpthelearnerrefinethemtoensuretheyareappropriateforthelearner’sindividualneedsandactionable
I-SMARTgoalsImportant(tothelearner)SpecificMeasurableAccountableRealisticTimeline
SkillsPracticeScenarios
6EssentialSkillsforEffectiveCoaching
1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals
TwomodelsofresidencyCoachingPrograms
Man-to-Man Zone
TheStanfordPediatricResidencyCoachingProgram
2013-present
StanfordPediatricResidencyCoachingProgramGoals
• Toimproveresidents’clinicalskillsin:• CriticalThinking(includingaskingquestionsandseekingevidencetodrivedecision-making)• Physicalexamination• Communication• Professionalism
StanfordCoachingProgram• 10FacultyCoaches• 10-11residents/Coach• Longitudinaldirect
observationsinmultiplesettings:inpatient,outpatient,throughtrainingyears
• ReviewILPs• ServeonCCC
• Focusoncoreclinicalskills• Coachingsessions:– Goal-directedobservation– Reflection– Feedback– Goal-setting
DirectObservations• PGY1s:–History-taking– Physicalexam– Presentations–ClinicalReasoning–Communication–Handoffs–Documentation
• PGY2sandPGY3s:– Teaching–Precepting–CareConferences–Givingbadnews
LearnerReflection
Feedback
Furthergoal-setting
ObservationInternalization
andapplication
Residentidentifiesgoals,communicates
withcoach/attending
StanfordPediatricResidencyCoachingModel
RassbachC,Blankenburg R.ANovelPediatricResidencyCoachingProgram:OutcomesAfterOneYear.Academicmedicine,inpress.
FacultyDevelopment
Feasibility
• CoachingsessionsbyResidentYear(N=82residents)
• 82/82residentshadatleast3coachingsessions• 659sessions;average=82/Coach(range57-108)
Residentyear Median Interquartilerange
Goal
PGY1 11 8-12 10PGY2 7 6-9 7PGY3 5.5 4.75-7 5-7
0
10
20
30
40
50
60
70
80
90
100
Skill Reflection Goal-setting
Coachvs.OtherFaculty'sSkillandUseofReflectionandGoal-SettinginGivingFeedback
Resident:evalofcoach
Coach:self-eval
Resident:evalofnon-Coach
Non-Coach:self-eval
0"
0.5"
1"
1.5"
2"
2.5"
3"
3.5"
4"
COACH:"PE"
Non3COACH:"PE"
COACH:"Assessment"
Non3COACH:"Assessm
ent"
COACH:"Comm
unica<on"
Non3COACH:"Communica<on"
COACH:"Goal3se?
ng"
Non3COACH:"Goal3se?ng"
Level"of"C
onfid
ence"(1
34"sc
ale)"
Confidence"in"Giving"Feedback"in"the"Following"Domains"!
2013" 2014"
EffectofCoachingProgramonCoachandNon-CoachCoreFaculty
* * *
p<0.01 p<0.01p<0.01 p=0.062
UW/SeattleChildren’sPediatricResidencyCoachingProgram
CCCCoaches2017-2018
EmilyRuedinger
JanieHallstrand
TroyJohnston
ElenaGriego
MayaJones
RonKaplan
ReidFarris
DeryaCaglar
JulianneBishop
SaraVora
ErinAlbers
DougOpel
KariGillenwater
JimmyBeck
DougDiekema
DavidBreland
LyndaKen
TaraWenger
Model
• 18coaches• 6-7residents/coach– allinoneclass• Combinedintocoachteams withaPD/APD:allresidencylevels(R1,R2,R3)represented
• Meetatleasttwiceperyearwitheachresident
• ServeontheCCC
Roles
• Observetheirassignedmenteesandotherresidentsintheirclinicaldomain(“zone”)
• Reviewevaluationsandgivesummativeclinicalfeedback
• HelpresidentsdevelopandtrackILPgoals• Usefacultyevaluationstomapmilestones• Bonus:wellness,careermentoring
CoachFeedback
• Briefsurveyofcoaches,50%responserate• Allrespondents(n=9)likedtheDOTform,foundithelpful&perceivedresidentsdidtoo
• Biggestbarrierstocompletionweretime,coordinationwithresidents
• Areasforimprovement:moreintegratedtimetomeetwithresidents,morestructureforeachmeeting
FuturePlans:CCCPODS
Credit:LilianHoR3andWei-JenHsiehR3Pod=5CCCcoaches andtheir6-7residents(R1s,R2s,R3s)inadditiontoanAPDandchiefresident.
PodProposal:newfeatures
• Includeachiefresidentwitheachpod• Focusonpeermentoringthroughmoresocialeventswithpodsintegratedacrossclasses
• UtilizeIntern,R2,R3retreatsasstrategictouchpointswithcoaches/pods
• Incorporatestructuredapproachtolearningskills:“milestoneofthemonth”
Touchpointsthroughouttheyear:
summer fall winter spring
Myths,Misconceptions,andQuandaries
• Cost• Time• Feedbackinperson• FormativeFeedbackvs.Evaluationvs.Both
CoachinginMedicineToolkit
Summary:6Essentialskillsforeffectivecoaching
1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals
Thankyou!
And
Questions?