Teaching GP trainees to use health coaching in consultations with patients: evaluation of a pilot study

Medical students as health coaches: adding value for patients and students

BACKGROUND

Underlying the global burden of chronic disease are common and modifiable risk factors such as unhealthy diet, physical inactivity and tobacco use. Health coaching is being introduced into healthcare as an effective tool in facilitating behaviour change and addressing lifestyle risk factors in patients. Although some medical schools are training students in health coaching, there is little research on this emerging practice. This qualitative study explores the experience and application of health coaching approaches by third year medical students that have been trained in health coaching.

METHODS

Six focus groups were conducted with medical students (n = 39) who had participated in an experiential health coaching training module and practiced their health coaching skills in primary care settings. Interactive facilitated discussions between students aimed to explore experiences of health coaching, how this related to their ongoing practice, and their perceived impacts of engagement with patients. Data was thematically analysed.

RESULTS

Themes emerged around 'mindset', 'skills', 'application of skills', 'perceived value' and 'context'. Training in health coaching prompted a shift towards a non-judgemental, solution-oriented mindset in which students increasingly accepted the ability of each person to define their needs and identify individually appropriate solutions. Mindset change supported skill development in person-centred communication, active listening, and self-refection. Mindset and skills related to changes in how students conducted patient consultations, their practice of self-refection, and their personal relationships. Perceived value of coaching approaches reinforced mindset. Students described facilitators to their coaching practice, and also tensions due to misalignment between their coaching mindset and ongoing practices in medical education and service delivery.

CONCLUSIONS

Training medical students in health coaching and supporting them to contribute meaningfully through empowering patients in real-world settings can help develop students' professional identity and a non-judgemental, solution-oriented mindset and skills in self-reflection, person-centred care and facilitating health behaviour change.

Training in health coaching skills for health professionals who work with people with progressive neurological conditions: A realist evaluation

Background

Supporting people to self‐manage their long‐term conditions is a UK policy priority. Health coaching is one approach health professionals can use to provide such support. There has been little research done on how to train clinicians in health coaching or how to target training to settings where it may be most effective.

Objective

To develop theories to describe how training health professionals in health coaching works, for whom and in what circumstances, with a focus on those working with people with progressive neurological conditions.

Design

Realist evaluation using mixed methods (participant observation, pre‐ and post‐training questionnaires, and telephone interviews with participants and trainers). Realist data analysis used to develop and refine theories.

Intervention

Two 1‐day face‐to‐face training sessions in health coaching with 11 weeks between first and second days.

Setting and participants

Twenty health‐care professionals who work with people with neurological conditions in the UK, two training facilitators.

Results

Four theories were developed using context‐mechanism‐outcome configurations to describe how training triggers critical reflection; builds knowledge, skills and confidence; how participants evaluate the relevance of the training; and their experiences of implementing the training. Some participants reported a major shift in practice, and others implemented the training in more limited ways.

Discussion

Fully embracing the role of coach is difficult for health professionals working in positions and settings where their clinical expertise appears most highly valued.

Conclusions

Training should address the practicality of using coaching approaches within existing roles, while organizations should consider their role in facilitating implementation.

Developing excellent leaders - the role of Executive Coaching for GP specialty trainees

Given an increasingly complex healthcare environment, doctors need to rise to the challenges of leadership. Executive coaching offers innovative and workable means of realising excellence in leadership. Coaching creates an empowering, 'high challenge, high support' environment for significant growth. This study sought to determine general practice (GP) specialty trainee (ST3) knowledge of coaching, views on leadership training, and reflections on the experience of receiving coaching. All GP ST3s in one UK region completed a questionnaire about coaching and developing leadership abilities. Six received professional coaching sessions, followed by a semi-structured interview. Baseline knowledge of coaching was sparse. Trainees felt under-equipped for leadership, but were keen to develop themselves. The short intervention appeared to result in a shift in leadership mind-set in four key areas: courage, passion, impact, and vision. A new enthusiasm was apparent, as well as a willingness and desire to increase leadership responsibilities. This is the first UK study examining professional executive face-to-face coaching as an educational method for doctors. Coaching helps provide leadership 'language' and 'identity'. It appears to 'name' clients as 'leaders' and challenges 'imposter phenomenon'. Coaching provided bespoke, deep, experiential learning, with transferable benefits not otherwise available in the Specialty Training programme.

Clinical trainees' responses to parents who question evidence-based recommendations

OBJECTIVE

We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations.

METHODS

We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions. Outcomes included time spent clarifying values (primary), attitudes and beliefs about the parent (secondary).

RESULTS

132 medical students and pediatric residents enrolled; 119 (90%) completed the study. There were no differences in time participants would spend clarifying values (antibiotics 26±12%; equipoise 28±11%; vaccine-hesitancy 22±11%; p=0.058). Participants in the vaccine-hesitancy group (vs. other groups) would spend less time answering questions (p=0.006). Participants in the antibiotics (vs. equipoise) group perceived the parent as difficult (p=0.0002). Those in the vaccine-hesitancy group (vs. other groups) perceived the parent as difficult, saw less value in the conversation, and had lower respect for the parent's views (all ps<0.0001). Most (76%) wanted additional training navigating these discussions.

CONCLUSION

Clinicians' attitudes may impact conversations when patients question evidence-based recommendations.

PRACTICE IMPLICATIONS

Clinicians should consider ways to discuss evidence and clarify patients' values to optimize health without damaging patient-clinician relationships.

Patient-centred consultations in a dispensary setting: a learning journey

Background

Hospital dispensary consultations usually focus on telling your patients how to take medicines. However, patient views are not always considered. We suggest that the value of a consultation lies in helping patients get the best health outcome from their medicines and this requires more than education. Pharmacy teams need to think differently about the way in which consultations are undertaken in order to improve effectiveness of medicines.

Objectives

To explore development of patient-centred consultations in a hospital dispensary environment using a health coaching approach.

Method

In April 2014, London North West Hospitals NHS Trust Pharmacy Department commissioned a 2-day health coaching course for 18 pharmacists to improve patient focus in consultations. Using learning from the course and knowledge of dispensary processes, a flow chart was created to support management of the three categories of patient. Pharmacy staff trained to tailor their consultation to patient need using a coaching approach, including use of principles of the 4Es (Explore, Educate, Empower, Enable), a pharmacy-based model for short consultation.

Results

Preliminary findings from the new approach included improved staff satisfaction, improved skill mix and positive feedback from patients. The main perceived disadvantage of using the above consultation style was the fear of increasing the time for consultations, however, this appears unfounded. A need for a dedicated counselling area to improve privacy in consultations was identified.

Conclusions

Provision of a patient-centred consultation framework in a dispensary environment, using a coaching approach, has improved focus on patient needs, continuing the journey towards patient-centred care.