Facilitated transitions: coaching to improve the medical school to residency continuum

Inequities at the Transition to Obstetrics and Gynecology Residency

OBJECTIVE

Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness.

DESIGN

A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds.

SETTING

Survey administered at time of the in-training examination in 2022.

PARTICIPANTS

All OBGYN residents.

RESULTS

Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01).

CONCLUSIONS

Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.

Facilitating the transition to residency: A resident-as-coach pilot program

BACKGROUND

The transition from medical school to residency is a critical developmental phase; coaching may help students prepare for this role transition.

AIMS

We explored whether near-peer coaching could improve a specific workplace skill prior to residency.

METHODS

A resident-as-coach program was piloted for the medicine sub-internship, an advanced acting internship rotation. Between March and June 2021, 26 students were assigned a resident coach (n = 16). Resident coaches completed one training session, and student-coach dyads met for one coaching session on 'pre-rounding'- gathering patient data before rounds. The program was evaluated through surveys and focus groups.

RESULTS

20/26 students and 14/16 residents completed the survey. 19/20 students identified a pre-rounding challenge and reported increased pre-rounding efficiency; all committed to one actionable step for improvement. All 16 residents felt their coaching skills improved. In focus groups, students valued the program's focus on honing a relevant skill in a safe, near-peer setting. Residents expressed their intent to incorporate coaching into their future work.

CONCLUSIONS

A resident-as-coach model can be effective in preparing students for residency, while concurrently building residents' coaching skills.

Implementing coaching programmes for healthcare professionals-A review of the barriers and facilitators

BACKGROUND

The European Union faces severe and worsening personnel shortages in healthcare. Coaching has emerged as a human-centred strategy to enhance sustainable employment and retention. While the number of efficacy studies on coaching continues to grow, knowledge about the barriers and facilitators to implementing coaching interventions among healthcare professionals (HCPs) remains scarce.

OBJECTIVES

This systematic review aimed to describe common barriers and facilitators to the implementation of coaching interventions for HCPs.

METHODS

In April 2023, five databases were searched for eligible articles. Barriers and facilitators were systematically identified and mapped onto the constructs of the Consolidated Framework for Implementation Research (CFIR). Directed content analysis yielded thematic areas and a reporting frequency.

RESULTS

A total of thirty (n = 30) studies were included in this review, representing twenty-five (n = 25) distinct coaching programmes. Implementation determinants were clustered under two CFIR domains: the Inner Setting (8 facilitators, 5 barriers) and Implementation Process (6 facilitators, 1 barrier). Barriers included (i) limited organisational capacity, (ii) lack of psychological safety, (iii) competing work demands, and (iv) insufficient leadership buy-in, while facilitators were the (i) allocation of protected time for participants and coaches, (ii) promotion through opinion leaders, (iii) embeddedness in existing Continuous Professional Development programmes, and (iv) programme co-creation.

CONCLUSION

The findings of this study provide practical insights to guide the future implementation of coaching interventions at an organisational level. In particular, the identified barriers and facilitators suggest, for optimal efficacy and sustainment, coaching interventions must be implemented within a safe, supportive organisational climate.

Twelve tips for designing and implementing an academic coaching program

Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education.

Bridging the Gap from Student to Doctor: Developing Coaches for the Transition to Residency

BACKGROUND

A lack of educational continuity creates disorienting friction at the onset of residency. Few programs have harnessed the benefits of coaching, which can facilitate self-directed learning, competency development, and professional identity formation, to help ease this transition.

OBJECTIVE

To describe the process of training faculty Bridge Coaches for the Transition to Residency Advantage (TRA) program for interns.

METHODS

Nineteen graduate faculty educators participated in a coaching training course with formative skills assessment as part of a faculty development program starting in January 2020. Surveys (n = 15; 79%) and a focus group (n = 7; 37%) were conducted to explore the perceived impact of the training course on coaching skills, perceptions of coaching, and further program needs during the pilot year of the TRA program.

RESULTS

Faculty had strong skills around establishing trust, authentic listening, and supporting goal-setting. They required more practice around guiding self-discovery and following a coachee-led agenda. Faculty found the training course to be helpful for developing coaching skills. Faculty embraced their new roles as coaches and appreciated having a community of practice with other coaches. Suggestions for improvement included more opportunities to practice and receive feedback on skills and additional structures to further support TRA program encounters with coaches.

CONCLUSIONS

The faculty development program was feasible and had good acceptance among participants. Faculty were well-suited to serve as coaches and valued the coaching mindset. Adequate skills reinforcement and program structure were identified as needs to facilitate a coaching program in graduate medical education.

Selected Skill Sets as Building Blocks for High School-to-Medical School Bridge: Longitudinal Study Among Undergraduate Medical Students

BACKGROUND

The high school-to-medical school education transition is a significant milestone in the students' academic journey, which is characterized by multiple stressors. Although this crucial transition has been repetitively explored, the concept of proactively intervening to support this transition is still novel.

OBJECTIVE

In this study, we investigated the efficacy of a web-based multidimensional resilience building intervention in developing selected soft skills that are believed to drive the learner's success in any learning setting. The association between the students' academic performance over time and their proficiency in selected modules addressing skill sets, including Time Management, Memory and Study, Listening and Taking Notes, and College Transition, was also assessed to test the impact of the intervention on the students' learning.

METHODS

A longitudinal study was conducted on 1 cohort of students of a Bachelor of Medicine, Bachelor of Surgery program (MBBS). The medical students were offered a learning intervention around 4 skill sets during the first year of the 6-year program. Quantitative analyses were conducted using deidentified data, relating to the students' proficiency in the 4 skill sets and to the students' academic performance: grade point average (GPA). Descriptive analyses constituted computing an overall score of skill sets' proficiency (of all 4 selected skill sets). The mean and SD (and percentage of the mean) were also calculated for each skill set component, independently, and for the overall score of skill sets' proficiency. Bivariate Pearson correlations were used to assess the extent to which the academic performance of the students can be explained by the corresponding students' level of proficiency in each skill set component and by all 4 sets together.

RESULTS

Out of the 63 admitted students, 28 participated in the offered intervention. The means and SDs of the annual GPA of the students for years 1 and 2 (GPA range 1-4) were 2.83 (SD 0.74) and 2.83 (SD 0.99), respectively. The mean and SD of the cumulative GPA toward the end of year 2 was 2.92 (SD 0.70). Correlation analysis showed that the overall score of skill sets proficiency was significantly associated with the annual GPA of year 1 (r=0.44; P=.02) but was not associated with their annual GPA of year 2. The cumulative GPA (toward the end of year 2) appeared to be significantly associated with the overall score (r=0.438; P=.02).

CONCLUSIONS

Developing purposefully selected skill sets among medical students holds the potential of facilitating the high school-to-medical school education transition and is likely to improve their academic performance. As the medical student progresses, the acquired skills need to be continuously reinforced and effectively built upon.

SMARTer Goalsetting: A Pilot Innovation for Coaches During the Transition to Residency

PROBLEM

Ability to set goals and work with coaches can support individualized, self-directed learning. Understanding the focus and quality of graduating medical student and first-year resident goals and the influence of coaching on goal-setting can inform efforts to support learners through the transition from medical school to residency.

APPROACH

This observational study examined goal-setting among graduating medical students and first-year residents from April 2021 to March 2022. The medical students set goals while participating in a Transition to Residency elective. The residents in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology set goals through meeting 1:1 with coaches. Raters assessed goals using a 3-point rubric on domains of specific, measurable, attainable, relevant, and timely (i.e., SMART goal framework) and analyzed descriptive statistics, Mann-Whitney U tests, and linear regressions.

OUTCOMES

Among 48 medical students, 30 (62.5%) set 108 goals for early residency. Among 134 residents, 62 (46.3%) entered goals. Residents met with coaches 2.8 times on average (range 0-8 meetings, median = 3). Goal quality was higher in residents than medical students (average score for S: 2.71 vs 2.06, P < .001; M: 2.38 vs 1.66, P < .001; A: 2.92 vs 2.64, P < .001; R: 2.94 vs 2.86, P = .002; T: 1.71 vs 1.31, P < .001). The number of coaching meetings was associated with more specific, measurable goals (specific: F [1, 1.02] = 6.56, P = .01, R2 = .10; measurable: F [1, 1.49] = 4.74, P = .03, R2 = .07).

NEXT STEPS

Learners set realistic, attainable goals through the transition to residency, but the goals could be more specific, measurable, and timely. The residents set SMARTer goals, with coaching improving goal quality. Understanding how best to scaffold coaching and support goal-setting through this transition may improve trainees' self-directed learning and well-being.

Facilitating an Optimal Transition to Residency in Obstetrics and Gynecology

The transition to residency in obstetrics and gynecology is difficult, threatening the well-being of residents as well as their preparedness to care for patients. In addition to essential foundational knowledge and skills, obstetrics and gynecology interns must develop professional identity and a growth mindset toward learning to acquire the self-directed learning skills required of physicians throughout their careers. The transition to residency is a critical opportunity for learning and development. A group of educators and learners from around the country created a preparedness program building on available resources. The result is a national curriculum for improving the transition to obstetrics and gynecology residency on three levels: self-directed learning, facilitated small-group workshops, and coaching. Sharing tools for preparing matched applicants for residency in obstetrics and gynecology ensures adequate residency preparation for all interns, independent of medical school attended. This program aims to address potential threats to equity in the training of our future workforce and to ensure that all obstetrics and gynecology interns are prepared to thrive in residency training.