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Miller-Kuhlmann R, Sasnal M, Gold CA, Nassar AK, Korndorffer JR, Van Schaik S, Marmor A, Williams S, Blankenburg R, Rassbach CE. Tips for developing a coaching program in medical education. MEDICAL EDUCATION ONLINE 2024; 29:2289262. [PMID: 38051864 PMCID: PMC10783821 DOI: 10.1080/10872981.2023.2289262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.
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Affiliation(s)
| | - Marzena Sasnal
- Center for Research on Education Outcomes, Stanford University, Palo Alto, USA
| | - Carl A. Gold
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, USA
| | | | | | - Sandrijn Van Schaik
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Andrea Marmor
- Department of Pediatrics, University of California at San Francisco, San Francisco, USA
| | - Sarah Williams
- Department of Emergency Medicine, Stanford University, Palo Alto, USA
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Charondo LB, Sheu L, Bakke BM, Hauer KE. 'It's more like checking in with an old friend': A qualitative study of medical students' experiences with longitudinal coaches throughout medical school. MEDICAL TEACHER 2024; 46:808-816. [PMID: 38049978 DOI: 10.1080/0142159x.2023.2284659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE Coaching in medical education facilitates learners' growth and development through feedback, goal-setting and support. This study explored how coaching relationships evolve throughout medical school and the impact of longitudinal coaching relationships on medical students' approach to feedback and goal setting in the clinical years. METHOD In this qualitative study using a constructivist paradigm, authors purposively sampled 15 senior medical students at University of California, San Francisco, to participate in individual semi-structured interviews (October-November 2021). The authors used an inductive approach to thematic analysis. RESULTS The authors identified four themes: First, the student-coach relationship deepened over the course of medical school. Second, students identified factors that sustained and strengthened the student-coach relationship over time: a strong foundation to the relationship, the non-evaluative nature of the relationship, coach supportiveness and responsiveness, and coach knowledge of the institutional landscape. Third, coaches provided individualized advice, assessed trajectory, and guided feedback interpretation. Lastly, students applied skills of soliciting and responding to feedback and creating learning goals, originally learned through coaching experience. CONCLUSIONS Coaching relationships, grounded in trust, evolve to meet students' changing needs as they grow into physicians. Students apply feedback and goal-setting skills learned with the coach in clinical settings with other supervisors.
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Affiliation(s)
| | - Leslie Sheu
- Private Medical, Menlo Park, California, USA
| | - Brian M Bakke
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Hoang K, Grow HM, Rooholamini SN, McPhillips H, Selling SK, Rassbach CE, Blankenburg R. Impact of Longitudinal Coaching on Pediatric Residents' Professional Identity Formation: A Multi-Institution Qualitative Study. Acad Pediatr 2024:S1876-2859(24)00155-4. [PMID: 38729301 DOI: 10.1016/j.acap.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 03/27/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Coaching has emerged in medical education as a strategy for trainees' development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents' professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. METHODS In July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. RESULTS We interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates' PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. CONCLUSIONS Residency coaches have the potential to influence residents' PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.
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Affiliation(s)
- Kim Hoang
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif.
| | - Helene Mollie Grow
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sahar N Rooholamini
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Heather McPhillips
- Department of Pediatrics (HM Grow, SN Rooholamini, and H McPhillips), University of Washington School of Medicine, Seattle
| | - Sarah Kate Selling
- Department of Pediatrics, Stanford University School of Medicine (SK Selling), Calif
| | - Caroline E Rassbach
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics (K Hoang, CE Rassbach, and R Blankenburg), Stanford University School of Medicine, Calif
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Sundy-Boyles K, Jackson K, Pian T, Benedict J, Barnes A, Redman C, Kasick R. Implementation and Outcomes of an Academic Peer Coaching Program for Pediatric Residents. Cureus 2024; 16:e59846. [PMID: 38854301 PMCID: PMC11156810 DOI: 10.7759/cureus.59846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Academic coaching fosters self-directed learning and is growing in popularity within residency programs. Implementation is often limited by available faculty time and funding. Peer coaching is an emerging alternative but is not well studied. This study aims to demonstrate the acceptability, feasibility, and efficacy of a resident peer coaching program. Methodology In the 2021-2022 academic year, within a large pediatric residency program, we selected and trained senior residents as coaches and interns who opted in as coachees. Coaching dyads began meeting in the fall and worked toward individualized goals throughout the year; control interns participated in routine didactics. Outcomes included Accreditation Council for Graduate Medical Education (ACGME) milestone scores and a self-assessment survey (SAS). Results We enrolled 15/42 (36%) interns as coachees, with the remaining 27 (64%) as controls. Narrative feedback from coaches and coachees was overall positive, and time commitment was feasible for program staff (10-12 hours/month), coaches (three to four hours/month), and coachees (one to two hours/month) with minimal financial needs. Post-intervention, more coachees than controls scored ≥4.0 on ACGME milestones systems-based practice 3 (SBP3; 3/15, 20%, vs. 2/27, 7%), SBP4 (4/15, 27%, vs. 5/27, 19%), and practice-based learning and improvement 1 (4/15, 27%, vs. 3/27, 11%). SAS response rate was 8/15 (53%) for coachees and 5/27 (19%) for controls. More coachees than controls reported baseline difficulty with time management often (3/8, 38%, vs. 1/5, 20%); only coachees improved post-intervention, with 0/8 (0%) having difficulty often versus 2/5 (40%) of controls. Conclusions Resident peer coaching is acceptable and feasible to implement. Coachees reported more improvement in time management than controls, and ACGME milestone scores suggest improved use of evidence-based medicine and interprofessional care coordination among coachees.
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Affiliation(s)
- Kristin Sundy-Boyles
- Hospital Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA
| | - Kelsey Jackson
- Hospital Medicine, Nationwide Children's Hospital, Columbus, USA
| | - Timothy Pian
- Pediatric Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Jason Benedict
- Biostatistics, The Ohio State University College of Medicine, Columbus, USA
| | - Alexis Barnes
- Cardiology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Charles Redman
- Hospital Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Rena Kasick
- Hospital Medicine, Nationwide Children's Hospital, Columbus, USA
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Gold CA, Jensen R, Sasnal M, Day HS, Miller-Kuhlmann RK, Blankenburg RL, Rassbach CE, Morris AM, Korndorffer JR, Nassar AK. Impact of a coaching program on resident perceptions of communication confidence and feedback quality. BMC MEDICAL EDUCATION 2024; 24:435. [PMID: 38649901 PMCID: PMC11036561 DOI: 10.1186/s12909-024-05383-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback. METHODS The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis. RESULTS The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas. CONCLUSIONS These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.
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Affiliation(s)
- Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rachel Jensen
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA
| | - Marzena Sasnal
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - Heather S Day
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - Rebecca K Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Arden M Morris
- Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Stanford University School of Medicine, Stanford, CA, USA
| | - James R Korndorffer
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3639, Stanford, CA, 94305, USA.
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Dyster T, Santhosh L. Beyond the Procedure Log: Using Individualized Learning Plans to Set Learner-Specific Milestones for Procedural Skills Acquisition. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:381-387. [PMID: 38113441 DOI: 10.1097/acm.0000000000005593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Procedural training for nonsurgical fields, such as internal medicine, is an important component of medical education. However, recent changes to accreditation guidelines have resulted in less formal guidance on procedural competency, not only leading to opportunities for individualizing training but also creating potential problems for trainees and training programs. In this article, the authors use internal medicine as an exemplar to review current strategies for procedural education in nonsurgical fields, including procedural simulation, dedicated procedural rotations, and advanced subspecialty training, and highlight an emerging need for learner-specific terminal milestones in procedural training. Individualized learning plans (ILPs), collections of trainee-specific objectives for learning, are arguably a useful strategy for organizing procedural training. The role of ILPs as a framework to support setting learner-specific terminal milestones, guide skill acquisition, and allocate procedural learning opportunities based on trainees' anticipated career plans is subsequently explored, and how an ILP-based approach might be implemented within the complex educational milieu of a clinical training program is examined. The limitations and pitfalls of an ILP-based approach, including the need for development of coaching programs, are considered. The authors conclude that, despite the limitations of ILPs, when combined with other current strategies for building trainees' procedural competence, these plans may help trainees maximize the educational benefits of their training period and can encourage effective, safer, and equitable allocation of procedural practice opportunities.
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Taff H, Gilkerson L, Osta A, Seo-Lee A, Schwartz A, Chunara Z, McGinn L, Pillai N, Barnes MM. Strengthening Parent - Physician Communication: A Mixed Methods Study on Attuned Communication Training for Pediatric Residents. TEACHING AND LEARNING IN MEDICINE 2023; 35:577-588. [PMID: 35946430 DOI: 10.1080/10401334.2022.2107528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Problem: High-quality communication improves patient satisfaction and clinical outcomes, yet formal communication training in residency is often minimal. Many studies on empathic communication show mixed results and are often hindered and skewed by brief study lengths, insufficiently and ambiguously defined concepts, and limited methods for objective measurements. Intervention: The FAN Curriculum is a unique communication curriculum, based on the conceptual frameworks of patient-centered communication, reflective practice, mindfulness, and attunement using the Facilitating Attuned Interactions (FAN) model. The first part of the FAN Curriculum was delivered as a 3-hour interactive workshop involving didactics, group discussion, and role play with pediatric residents. Residents then completed weekly self-reflections, a follow-up one-hour training to reinforce concepts, and five monthly mentor sessions, all emphasizing reflective practice. Context: This longitudinal, mixed-methods study examined the effects of the FAN Curriculum on residents' empathy levels and ability to communicate with parents in the clinical setting. The study was conducted at two urban, academic, medium-sized pediatric residency programs in Chicago between October 2016 and November 2017. First- and second-year pediatric residents whose continuity clinic site was located at their home institution participated. Residents received training in the use of the FAN Communication Tool using a delayed-start crossover study design. Impact: At five time points, residents and parents completed instruments validated for measuring physician empathy and mindfulness. Post-study interviews were conducted for one institution's residents and mentors and were evaluated using open and focused coding. Participants (n = 23) demonstrated a high degree of use of the FAN Communication Tool six months post-training and a significant rise in self-reported comfort with four of five FAN core processes. One parent-completed survey (Consultation and Relational Empathy, CARE) showed a statistically significant rise of 3.26% in resident relational empathy and collaboration after training (p = 0.02). In qualitative analysis of interviews, residents and mentors found the FAN Communication Tool beneficial, making clinic visits more efficient and collaborative. Both groups noted improvement in the residents' relationship-building skills; residents were able to use enhanced communication skills to better approach challenging encounters and work through parent concerns. Lessons Learned: Family-centered communication training can improve physician-perceived empathy and mindfulness. Effective communication for pediatric residents incorporates an empathic approach, and introduction to this formal curriculum supported their growth in connecting and engaging with children and parents. The FAN Curriculum may provide a useful method for improving resident communication skills with a positive impact on pediatricians' collaboration with patients and families.
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Affiliation(s)
- Heather Taff
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
- VNA Health Care, Aurora, Illinois, USA
| | | | - Amanda Osta
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Alisa Seo-Lee
- Department of Pediatrics, Cook County Health, Chicago, Illinois, USA
| | - Alan Schwartz
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Zobia Chunara
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Lander McGinn
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Nikita Pillai
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Michelle M Barnes
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
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Singh S, Cheung WJ, Dewhirst S, Wood TJ, Landreville JM. The influence of clinical coaching teams on quality of entrustable professional activity assessments. AEM EDUCATION AND TRAINING 2023; 7:e10879. [PMID: 37361186 PMCID: PMC10290210 DOI: 10.1002/aet2.10879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 06/28/2023]
Abstract
Background Coaching is an important component of workplace-based assessment in competency-based medical education. Longitudinal coaching relationships have been proposed to enhance the trainee-supervisor relationship and promote high-quality assessment. Objective The objective of this study was to determine the influence of longitudinal coaching relationships on the quality of entrustable professional activity (EPA) assessments. Methods EPAs (n = 174) completed by emergency medicine (EM) supervisors between July 2020 and June 2021 were extracted and divided into two groups; one group consisted of EPAs completed by supervisors when a longitudinal coaching relationship existed (n = 87) and the other group consisted of EPAs completed by the same supervisors when no coaching relationship existed (n = 87). Three physicians were recruited to rate the EPAs using the Quality of Assessment and Learning (QuAL) score, a previously published measure of EPA quality. An analysis of variance was performed to compare mean QuAL scores between the groups. Linear regression analysis was conducted to examine the relationship between trainee performance (EPA rating) and EPA assessment quality (QuAL score). Results All raters completed the survey. The mean ± SD QuAL score in the coaching relationship group (3.63 ± 0.91) was higher than the no coaching relationship group (3.51 ± 1.10) but the difference was not statistically significant (p = 0.40). Supervisor was a significant predictor of QuAL score (p = 0.012) and supervisor alone accounted for 26% of the variability in QuAL scores (R2 = 0.26). There was no significant relationship between trainee performance and EPA assessment quality. Conclusions The presence of a longitudinal coaching relationship did not influence the quality of EPA assessments.
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Affiliation(s)
| | - Warren J. Cheung
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
- Royal College of Physicians and Surgeons of CanadaOttawaOntarioCanada
| | | | - Timothy J. Wood
- Department of Innovation in Medical EducationUniversity of OttawaOttawaOntarioCanada
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Selling SK, Rooholamini SN, Grow HM, McPhillips H, Hoang K, Blankenburg R, Rassbach C. The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:376-383. [PMID: 36205486 DOI: 10.1097/acm.0000000000005011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice. METHOD From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semistructured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice. RESULTS Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank ( P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings. CONCLUSIONS Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.
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Affiliation(s)
- Sarah Kate Selling
- S.K. Selling is a medical student, Stanford University School of Medicine, Stanford, California
| | - Sahar N Rooholamini
- S.N. Rooholamini is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - H Mollie Grow
- H.M. Grow is associate professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Heather McPhillips
- H. McPhillips is professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kim Hoang
- K. Hoang is clinical assistant professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca Blankenburg
- R. Blankenburg is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Caroline Rassbach
- C. Rassbach is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Farrell L, Cuncic C, Hartford W, Hatala R, Ajjawi R. Goal co-construction and dialogue in an internal medicine longitudinal coaching programme. MEDICAL EDUCATION 2023; 57:265-271. [PMID: 36181337 DOI: 10.1111/medu.14942] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/18/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships. METHODS This was a qualitative study using interpretive description methodology. Eight internal medicine coach-resident dyads consented to audiotaping coaching meetings over a 1-year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co-construction as a sensitising concept. RESULTS Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals. CONCLUSIONS In analysing goal development in the coach-resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage-specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co-regulation and reflection on both clinical competencies and professional identity formation.
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Affiliation(s)
- Laura Farrell
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cary Cuncic
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Hartford
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
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Awadallah NS, Jones TS, Christian N, Fainstad T, Nyquist J, Schreiber J, Fung CC, Rumack CM, Nehler M, Jaiswal KR. Proactive Coaching in General Surgery Internship: Incorporating Well-being Practices into Resident Professional Life. JOURNAL OF SURGICAL EDUCATION 2023; 80:177-184. [PMID: 36244927 DOI: 10.1016/j.jsurg.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/20/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Coaching can provide learners with space to reflect on their performance while ensuring well-being and encouraging professional achievement and personal satisfaction outside of traditional mentorship and teaching models. We hypothesized that a proactive coaching program for general surgery interns coupled with individualized learning plans would help build foundational skills necessary for residency success and facilitate the incorporation of well-being practices into resident professional life. Here, we present the development, implementation, and outcomes of a novel well-being coaching program for surgical interns. DESIGN AND SETTING A well-being coaching program was developed and implemented from July 2020 through June 2021 at a single university-based surgical residency program. To assess impact of the coaching program, we designed a mixed-methods study incorporating end-of-program survey results as well as participant narratives from commitment-to-act statements for thematic content. PARTICIPANTS All 32 general surgery interns participated in aspects of the coaching program. RESULTS The end-of-program survey was completed by 19/32 (59%) interns and commitment-to-act statements were completed by 22/32 (69%). The majority (89%) of survey respondents "agreed" or "strongly agreed" that the longitudinal intern coaching program helped them reach goals they had set for themselves this academic year; 15/19 (79%) noted that the coaching experience was effective in promoting well-being practices in their life. Well-being and professional goals were identified as major themes in the end-of-the-year commitment-to-act statements. Statements specifically mentioned resources highlighted and skills taught in our coaching program such as mindfulness techniques, gratitude journals, and self-compassion strategies. CONCLUSIONS Our study illustrates the effectiveness of a coaching pilot program on promoting well-being practices in a university-based general surgery internship and can be a roadmap with proven efficacy and measurable outcomes.
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Affiliation(s)
- Nida S Awadallah
- Department of Family Medicine; Department of Graduate Medical Education; University of Colorado School of Medicine, Aurora, Colorado.
| | - Teresa S Jones
- Department of Graduate Medical Education; Department of General Surgery; University of Colorado School of Medicine, Aurora, Colorado
| | - Nicole Christian
- Department of General Surgery; University of Colorado School of Medicine, Aurora, Colorado
| | - Tyra Fainstad
- Department of Internal Medicine; University of Colorado School of Medicine, Aurora, Colorado
| | - Julie Nyquist
- Department of Medical Education; University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Jacob Schreiber
- Department of Medical Education; University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Cha-Chi Fung
- Department of Medical Education; University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Carol M Rumack
- Department of Graduate Medical Education; Department of Radiology; University of Colorado School of Medicine, Aurora, Colorado
| | - Mark Nehler
- Department of General Surgery; University of Colorado School of Medicine, Aurora, Colorado
| | - Kshama R Jaiswal
- Department of General Surgery; University of Colorado School of Medicine, Aurora, Colorado
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12
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Marcus CH, Michelson CD, Luff D, Newman LR. Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1832-1840. [PMID: 35703138 DOI: 10.1097/acm.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches' motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation. METHOD In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework. RESULTS Faculty coaches' motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches' educator identity and led to ongoing motivation to participate. They also contributed to the coaches' well-being at work. CONCLUSIONS Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved-improvement in own teaching, personal satisfaction, and increased connectedness-affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.
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Affiliation(s)
- Carolyn H Marcus
- C.H. Marcus is an instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine D Michelson
- C.D. Michelson is assistant professor, Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Donna Luff
- D. Luff is assistant professor, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori R Newman
- L.R. Newman is assistant professor, Department of Pediatrics and Department of Education, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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13
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Branzetti J, Commissaris C, Croteau C, Ehmann MR, Gisondi MA, Hopson LR, Lai KYF, Regan L. The Best Laid Plans? A Qualitative Investigation of How Resident Physicians Plan Their Learning. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1691-1698. [PMID: 35612927 DOI: 10.1097/acm.0000000000004751] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Adaptive expertise (AE) has been identified as a critical trait to cultivate in future physicians. The 4-phase master adaptive learner (MAL) conceptual model describes the learning skills and behaviors necessary to develop AE. Though prior work has elucidated skills and behaviors used by MALs in the initial planning phase of learning, most resident learners are not thought to be MALs. In this study, the authors investigated how these majority "typical" learners develop AE by exploring the strategies they used in the planning phase of learning. METHOD Participants were resident physicians at graduate medical education (GME) training programs located at 4 academic medical centers in the United States. Participants participated in semistructured individual interviews in 2021, and interview transcripts were analyzed using constant comparative analysis of grounded theory. RESULTS Fourteen subjects representing 8 specialties were interviewed, generating 152 pages of transcripts for analysis. Three themes were identified: "Typical" learners were challenged by the transition from structured undergraduate medical education learning to less-structured GME learning, lacked necessary skills to easily navigate this transition, and relied on trial and error to develop their learning skills. CONCLUSIONS Participants used trial and error to find learning strategies to help them manage the systemic challenges encountered when transitioning from medical school to residency. The success (or failure) of these efforts was tied to learners' efficacy with the self-regulated learning concepts of agency, metacognitive goal setting, and motivation. A conceptual model is provided to describe the impact of these factors on residents' ability to be adaptive learners, and actionable recommendations are provided to help educators' efforts to foster adaptive learning skills and behaviors. These findings also provided valuable evidence of validity of the MAL model that has thus far been lacking.
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Affiliation(s)
- Jeremy Branzetti
- J. Branzetti is residency director, Emergency Medicine Residency, and assistant professor, Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York; ORCID: https://orcid.org/0000-0002-2397-0566
| | - Carolyn Commissaris
- C. Commissaris is emergency medicine residency assistant program director and clinical instructor, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-7099-4851
| | - Charlotte Croteau
- C. Croteau is a third-year resident, NYU/Bellevue Emergency Medicine Residency, New York, New York
| | - Michael R Ehmann
- M.R. Ehmann is emergency medicine associate residency program director and assistant professor of emergency medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0002-8093-7623
| | - Michael A Gisondi
- M.A. Gisondi is associate professor and vice chair of education, Department of Emergency Medicine, Precision Education and Assessment Research Lab, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6800-3932
| | - Laura R Hopson
- L.R. Hopson is associate chair for education and professor, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: http://orcid.org/0000-0003-1745-0836
| | - Krystal Ya-Fong Lai
- K.Y.-F. Lai is a first-year resident, University of Texas Southwestern Internal Medicine Residency, Dallas, Texas
| | - Linda Regan
- L. Regan is emergency medicine residency program director, vice chair for education, and associate professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0390-4243
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Azevedo Sansoni G, Borzi P, Karki P, Khan Sajid S, Semikhnenko A, Varma A. Satisfaction of Medical Students with Surgical Training: A Survey of Northern Italy. INTERNATIONAL JOURNAL OF MEDICAL STUDENTS 2022. [DOI: 10.5195/ijms.2022.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Medical student satisfaction regarding the inclusion of surgical education into the medical curriculum may vary among learners. In this study, we analyzed the satisfaction of medical students in regard to how surgical topics were taught in Italian schools in 2021 through a survey. The results collected can be used to not only improve the quality of medical education in the future but to help students make informed decisions about their own education.
Methods: An electronic survey was sent out to medical students in their third to sixth years across three medical schools in Northern Italy via their respective institutional secretaries. The questionnaire was available in Italian and English. It included both closed and open-ended questions regarding satisfaction with the teaching of surgical topics in Italian medical universities.
Results: Results were reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Most respondents (87%) preferred to have an increase in surgery-related electives and/or extracurricular courses. Further, 51.2% of respondents expressed an increased interest in surgery after having observed in the Operating Room (OR). The majority of respondents (73.3%) also expressed that the coronavirus disease 2019 (COVID-19) pandemic had negatively impacted the quality of teaching of surgical topics.
Conclusion: In the present survey study, Italian medical students preferred hands-on practice over theoretical lectures for surgical education. The majority of students stipulated that the inclusion of suturing, scrubbing, and good surgical practice workshops along with an increased OR attendance would facilitate a better understanding of surgery.
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15
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Jain PG, McBride ME, Caliendo A, Eppich W. Effects of Longitudinal Coaching on Relationships and Feedback Processes in Pediatric Subspecialty Fellowships-An Interpretive Description Study. J Grad Med Educ 2022; 14:458-465. [PMID: 35991102 PMCID: PMC9380628 DOI: 10.4300/jgme-d-21-00936.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Coaching in graduate medical education provides a facilitative approach to feedback as well as opportunities for residents and fellows to engage with feedback and develop individualized improvement goals. OBJECTIVE To explore the roles and actions of successful coaches in longitudinal coaching relationships and how they enable feedback processes. METHODS Using interpretive description methodology, we performed semi-structured interviews with pediatrics fellows (n=11), faculty coaches (n=9), and program directors (n=2) from 2 pediatric subspecialty fellowship training programs at Ann and Robert H. Lurie Children's Hospital of Chicago. Both training programs had previously implemented longitudinal clinical coaching programs. Interview questions aimed to explore the roles and impacts of coaches within a longitudinal coaching program. Interviews took place in 2019 and 2020. RESULTS We identified 4 major actions to the coaching role in longitudinal coaching relationships: (1) establish the coach-fellow relationship; (2) prepare for the coaching conversation; (3) facilitate feedback dialogue; and (4) serve as the go-to person to raise uncomfortable issues. Additionally, nearly all participants expressed support for a longitudinal coaching program to support fellows' growth and development of personalized learning goals. CONCLUSIONS By fulfilling these 4 key aspects to the coaching role, coaches in longitudinal relationships with coachees enable feedback processes.
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Affiliation(s)
- Priya G. Jain
- Priya G. Jain, MD, MEd, is Assistant Professor, Department of Pediatrics and Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine
| | - Mary E. McBride
- Mary E. McBride, MD, MEd, is Associate Professor, Departments of Pediatrics and Medical Education, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine
| | - Anne Caliendo
- Anne Caliendo, MSEd, is a Researcher, Scientific Careers Research and Development Group, Northwestern University Feinberg School of Medicine
| | - Walter Eppich
- Walter Eppich, MD, PhD, is a Professor, RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Science, Dublin, Ireland
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16
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Selling SK, Kirkey D, Goyal T, Singh A, Gold CA, Hilgenberg SL, Weimer-Elder B, Kuo KW, Rassbach CE. Impact of a relationship-centered care communication curriculum on pediatric residents' practice, perspectives, and opportunities to Develop expertise. PATIENT EDUCATION AND COUNSELING 2022; 105:1290-1297. [PMID: 34538683 DOI: 10.1016/j.pec.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To investigate the impacts of a Relationship-Centered Care (RCC) communication curriculum with coaching on pediatric residents 1) self-reported use of RCC strategies and perspectives, and 2) opportunities to develop adaptive expertise. METHODS Residents (n = 77) completed a 4 h RCC training and shared resultant RCC goals with Coaches (n = 15). Data included resident surveys and reflections immediately post-training, and resident and coach surveys 6-months later. Reported use of RCC strategies were compared over time with paired t-tests. Qualitative data were analyzed using open coding guided by sensitizing principles from the RCC framework and adaptive expertise. RESULTS Pediatric residents reported significant increases (p < 0.001) in use of 4/9 RCC strategies after 6 months: eliciting all concerns, chunking information, checking for understanding, and teach-back. Resident reflections highlighted shifts in perspective around RCC. Training combined with coaching provided opportunities for residents to develop adaptive expertise through adapting and innovating across settings and contexts. CONCLUSION Residents had significant increases in reported use of key RCC strategies after a training combined with coaching and demonstrated opportunities to develop adaptive expertise. PRACTICE IMPLICATIONS Residency programs should include RCC training with an emphasis on the new and challenging strategies and provide opportunities to practice and receive coaching.
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Affiliation(s)
| | - Danielle Kirkey
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Tarini Goyal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Amit Singh
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA.
| | - Sarah L Hilgenberg
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA.
| | | | - Kevin Wu Kuo
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Caroline E Rassbach
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Pu H, Bachrach LK, Blankenburg R. Finding Meaning in Medicine: Pediatric Residents' Perspectives on Humanism. Acad Pediatr 2022; 22:680-688. [PMID: 34902564 DOI: 10.1016/j.acap.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/23/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To explore pediatric residents' perspectives on humanism and how residency impacts humanism formation. METHODS We conducted a qualitative study with pediatric resident focus groups at Stanford. Transcripts were analyzed by two investigators using grounded theory. Subsequent literature review led us to adapt Cruess et al. 2015's professional identity formation framework to describe development of a humanism identity in residency. Member check was done to verify themes and the adapted framework. RESULTS Thirty two pediatric residents participated. Five themes emerged: 1) Empathy, compassion, and respect are foundational elements of humanism. 2) Each resident had a unique view of humanism derived from personal values. 3) Residents felt that the terms excellence and resilience (Gold Foundation IECARES model) did not fit with their own definitions. 4) Residents felt that humanism is a central part of their practice and training. 5) The demands, structure, and culture of residency were often in conflict with promoting humanism in residents. Based on residents' perspectives, we modified the professional identity formation and socialization conceptual framework proposed by Cruess et al. 2015 to reflect humanism identity formation during pediatrics residency. The new framework emphasizes the increased power of the healthcare system and unconscious acquisition on humanism formation in residency as compared to medical school. CONCLUSIONS Residents believe that humanism is a core part of practicing medicine and should be reinforced during residency training. Cruess' professional identity and socialization framework is a tool for a better understanding of the complexity of humanism development in residency.
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Affiliation(s)
- Helen Pu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
| | - Laura K Bachrach
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Rebecca Blankenburg
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
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18
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Branzetti J, Gisondi MA, Hopson LR, Regan L. Adaptive expertise: The optimal outcome of emergency medicine training. AEM EDUCATION AND TRAINING 2022; 6:e10731. [PMID: 35368500 PMCID: PMC8908303 DOI: 10.1002/aet2.10731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Michael A. Gisondi
- Department of Emergency MedicinePrecision Education and Assessment Research LabStanford University School of MedicineStanfordCaliforniaUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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19
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Regan L, Hopson LR, Gisondi MA, Branzetti J. Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency. BMC MEDICAL EDUCATION 2022; 22:141. [PMID: 35241060 PMCID: PMC8895544 DOI: 10.1186/s12909-022-03200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. METHODS Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. RESULTS We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. CONCLUSIONS Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.
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Affiliation(s)
- Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21093, USA.
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy Branzetti
- Department of Emergency Medicine, New York University School of Medicine, New York City, NY, USA
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20
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Elster MJ, O'Sullivan PS, Muller-Juge V, Sheu L, Kaiser SV, Hauer KE. Does being a coach benefit clinician-educators? A mixed methods study of faculty self-efficacy, job satisfaction and burnout. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:45-52. [PMID: 34406613 PMCID: PMC8371581 DOI: 10.1007/s40037-021-00676-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Coaching is a growing clinician-educator role. Self-efficacy is a powerful faculty motivator that is associated positively with job satisfaction and negatively with burnout. This study examines self-efficacy, job satisfaction, and burnout in coaches and other clinician-educators. METHODS We conducted a mixed methods study using a quantitative survey followed by qualitative interviews of faculty at the University of California, San Francisco. Coaches (funded 20% full-time equivalents), faculty with other funded education positions ("funded"), and faculty without funded education positions ("unfunded") completed a 48-item survey addressing self-efficacy (teaching, professional development, and scholarship), job satisfaction, and burnout. Data were analyzed using analysis of variance followed by post-hoc tests and chi-square tests. To elaborate quantitative results, we conducted qualitative interviews of 15 faculty and analyzed data using framework analysis. RESULTS 202 of 384 faculty (52.6%) responded to the survey; 187 complete surveys were analyzed. Teaching self-efficacy was similar across groups. Coaches and funded educators had significantly higher professional development self-efficacy and job satisfaction than unfunded educators. Burnout was more prevalent in coaches and unfunded educators. Qualitative analysis yielded three themes: sources of reward, academic identity, and strategies to mitigate burnout. Educator roles provide reward that enhances self-efficacy and job satisfaction but also generate competing demands. Coaches cited challenges in forming professional identities and working with struggling learners. DISCUSSION The coaching role provides faculty with benefits similar to other funded educator roles, but the particular demands of the coach role may contribute to burnout.
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Affiliation(s)
- Martha J Elster
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Leslie Sheu
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sunitha V Kaiser
- Departments of Pediatrics and Clinical Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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Sasnal M, Miller-Kuhlmann R, Merrell SB, Beres S, Kipp L, Lee S, Threlkeld Z, Nassar AK, Gold CA. Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study. BMC MEDICAL EDUCATION 2021; 21:513. [PMID: 34583691 PMCID: PMC8478605 DOI: 10.1186/s12909-021-02936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual). METHODS We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed. RESULTS Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future. CONCLUSIONS In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.
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Affiliation(s)
- Marzena Sasnal
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Rebecca Miller-Kuhlmann
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sylvia Bereknyei Merrell
- Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94305, USA
| | - Shannon Beres
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Lucas Kipp
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Sarah Lee
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Zachary Threlkeld
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA
| | - Aussama K Nassar
- Department of Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Carl A Gold
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, 453 Quarry Road, Stanford, CA, 94305, USA.
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Jordan J, Yarris LM, Dorfsman ML, Wolf SJ, Wagner MJ. Coaching educators: Impact of a novel national faculty development program for didactic presentation skills. AEM EDUCATION AND TRAINING 2021; 5:e10637. [PMID: 34471792 PMCID: PMC8325437 DOI: 10.1002/aet2.10637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/26/2021] [Accepted: 06/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Didactic lectures remain common in medical education. Many faculty physicians do not receive formal training on public presentations or leading instructional sessions. Coaching has emerged in medical education with the potential to positively impact skills. We sought to evaluate a novel, national faculty peer-coaching program created to improve lecture presentation skills and foster career development. METHODS This was a mixed-methods study of participant and faculty perceptions after completing the Council of Residency Directors in Emergency Medicine Academy Coaching Program. Participants completed an online evaluative survey consisting of multiple choice and Likert-type items. Program coaches participated in semistructured interviews. Descriptive statistics were reported for survey data. Thematic qualitative analysis by two independent reviewers was performed on interview data. RESULTS During 2012 to 2017, a total of 30 participants and 11 coaches from 37 residency programs across the United States engaged in the program. Twenty-four (80%) participants completed the survey. Eight (73%) coaches participated in semistructured interviews. Data were collected between October and December 2018. The mean ± SD numbers of national presentations participants had given before and after the coaching program were 6.92 ± 7.68 and 16.42 ± 15.43, respectively. Since their coaching, most participants (87.5%) have been invited to give a lecture at another institution. Many participants felt that the program improved their lecture evaluations, public speaking, ability to engage an audience, and professional development. Almost all (92%) would recommend the program to a colleague. The coaches perceived multiple benefits including improved skills, self-reflection, networking, career advancement, and personal fulfillment. Suggestions for improvement included improved administrative processes, more clear expectations, increased marketing, and increased participant and coach engagement. CONCLUSION Participants and coaches perceived multiple benefits from this novel, national faculty coaching program. With identification of the success, challenges, and suggestions for improvement, others may benefit as they develop coaching programs in medical education.
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Affiliation(s)
- Jaime Jordan
- Department of Emergency MedicineUCLA Ronald Reagan Medical CenterLos AngelesCaliforniaUSA
| | - Lalena M. Yarris
- Department of Emergency MedicineOregon Health & Science University in PortlandOregonUSA
| | - Michele L. Dorfsman
- Department of Emergency MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Stephen J. Wolf
- Department of Emergency MedicineDenver Health Medical CenterDenverColoradoUSA
| | - Mary J. Wagner
- Central Michigan University Medical Education PartnersSaginawMichiganUSA
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Zhao R, D’Eon M. Five ways to get a grip on grouped self-assessments of competence for program evaluation. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e90-e96. [PMID: 32821308 PMCID: PMC7417831 DOI: 10.36834/cmej.69276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Self-assessments conducted by individuals when taken together (grouped) provide valid and accurate measures of learning outcomes of the group. This is useful for program evaluation. Grouped self-assessments are simple to understand and construct, easy to implement, relatively accurate, and do not require extensive and complex pre-post testing measures. However, group self-assessments have the potential to be misused. To examine how group self-assessments have been used in medical education, we conducted a search of journal articles published in 2017 and 2018 from eight prominent medical education journals. Twenty-seven (n = 27) articles that used self-assessments for program evaluation were selected for data extraction and analysis. We found three main areas where misuse of self-assessments may have resulted in inaccurate measures of learning outcomes: measures of "confidence" or "comfort", pre-post self-assessments, and the use of ambiguous learning objectives. To prevent future misuse and to build towards more valid and reliable data for program evaluations, we present the following recommendations: measure competence instead of confidence or comfort; use pre-test self-assessments for instructional purposes only (and not for data); ask participants to do the post-intervention self-assessments first followed by retrospective pre-intervention self-assessments afterwards; and use observable, clear, specific learning objectives in the educational intervention that can then be used to create the self-assessment statements.
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Fishman A, Kenett R, Biron-Shental T. Implementing Personal Mentoring in an Obstetrics and Gynecology Residency Program-3-Year Evaluation. MEDICAL SCIENCE EDUCATOR 2020; 30:293-297. [PMID: 34457670 PMCID: PMC8368510 DOI: 10.1007/s40670-019-00902-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To empower residents-in-training through personal mentorship from a senior physician who dedicates time and guidance to their personal development and provides professional and emotional support. METHODS A structured model of personal mentoring for residents was designed and implemented in the Department of Obstetrics & Gynecology. The process was assessed by a special-purpose survey constructed and reviewed by established medical mentors. The survey examined residents' attitudes towards personal aspects associated with their residency. The questionnaires were filled out anonymously before launching and 1 and 3 years after initiating the personal mentoring process. RESULTS The residents' reports showed a distinct trend of increased positive attitudes towards the personal mentoring throughout the process. The residents reported on an improvement in the mentors' availability to address personal aspects within the mentoring relationship (empathy, emotional support in deliberations, career guidance, etc.). The general satisfaction with the residency program improved as well. CONCLUSIONS Mentoring is a significant element in a comprehensive, multi-dimensional process. Integrating personal mentoring into a residency program, with the focus on interpersonal relational characteristics as empathy, availability, open communication, and guidance, led to improvements in residents' professional development and skills. They also received optimal support and guidance in their professional careers and personal deliberations.
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Affiliation(s)
- Ami Fishman
- Department of Obstetrics & Gynecology, Meir Medical Center, 44281 Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Kenett
- Institute for Drug Research, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Tal Biron-Shental
- Department of Obstetrics & Gynecology, Meir Medical Center, 44281 Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wolff M, Morgan H, Jackson J, Skye E, Hammoud M, Ross PT. Academic coaching: Insights from the medical student's perspective. MEDICAL TEACHER 2020; 42:172-177. [PMID: 31630595 DOI: 10.1080/0142159x.2019.1670341] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Purpose: With the growing recognition of the role of coaching in competency-based medical education, many medical education training programs are investing significant resources into developing coaching programs. However, there is a lack of rigorous research on academic coaching programs in medical education and recommended coaching practices are based on expert opinion without incorporating the student perspective. The aim of this study was to investigate factors that affect a students' perception of a successful coaching experience.Materials and method: This was a qualitative study performed in November 2018 at a medical school in the United States with a formal coaching program. Appreciative inquiry was the theoretical framework used to develop the question guide. The authors facilitated two focus groups and then used Colaizzi's phenomenological analysis approach to analyze the transcripts.Results: A total of 21 students participated in the focus groups. The analysis revealed four themes that describe students' perceptions of successful coaching experiences: coach attributes, relational skills, coaching skills, and utilization of coaching. Each of these themes had specific dimensions.Conclusions: The findings from this study illuminate the student stakeholder perspectives on successful coaching relationships, and should be considered when developing a coaching program and faculty development.
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Affiliation(s)
- Margaret Wolff
- Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Helen Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jasmyne Jackson
- Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eric Skye
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maya Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paula T Ross
- RISE and the University of Michigan Medical School, Ann Arbor, MI, USA
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Alston J, Cheung E, Gandell D. Goal-Setting on a Geriatric Medicine Rotation: A Pilot Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120519893989. [PMID: 32064357 PMCID: PMC6993154 DOI: 10.1177/2382120519893989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Formal goal-setting has been shown to enhance performance and improve educational experiences. We initiated a standardized goal-setting intervention for all residents rotating through a Geriatric Medicine rotation. OBJECTIVES This study aims to describe the feasibility of a goal-setting intervention on a geriatric medicine rotation, the resources required, and the barriers to implementation. As well, this study aims to describe the learning goals residents created regarding content and quality. METHODS A pilot goal-setting intervention was initiated. A goal-setting form was provided at the beginning of their rotation and reviewed at the end of the rotation. Residents were invited to complete an anonymous online survey to gather feedback on the initiative. Goals were analysed for content and quality. Feedback from the survey results was incorporated into the goal-setting process. RESULTS Between March and December 2018, 26 of 44 residents completed the goal-setting initiative. Explanations for the poor adherence included limited protected time for faculty and residents to engage in coaching, its voluntary nature, and trainee absence during orientation. Reasons for difficulty in achieving goals included lack of faculty and trainee time and difficulty assisting residents in achieving goals when no clinical opportunities arose. Although only 59% of residents completed the intervention, if goal-setting took place, most of the goals were specific (71 of 77; 92%) and 35 of 77 (45.5%) goals were not related to medical knowledge. CONCLUSIONS This pilot study outlines the successes and barriers of a brief goal-setting intervention during a Geriatric Medicine rotation. Adherence was limited; however, of those who did complete the intervention, the creation of specific goals with a short, structured goal-setting form was possible. To enhance the intervention, goal-setting form completion should be enforced and efforts should be made to engage in mid-rotation check-ins and coaching.
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Affiliation(s)
- Jillian Alston
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Evelyn Cheung
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Dov Gandell
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
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Gonzalo JD, Wolpaw DR, Krok KL, Pfeiffer MP, McCall-Hosenfeld JS. A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program. MEDICAL EDUCATION ONLINE 2019; 24:1591256. [PMID: 30924404 PMCID: PMC6442085 DOI: 10.1080/10872981.2019.1591256] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Resident physicians' achievement of professional competencies requires reflective practice skills and faculty coaching. Graduate medical education programs, however, struggle to operationalize these activities. OBJECTIVE To (1) describe the process and strategies for implementing an Internal Medicine (IM) resident coaching program that evolved in response to challenges, (2) characterize residents' professional learning plans (PLPs) and their alignment with EPAs, and, (3) examine key lessons learned. DESIGN The program began in 2013 and involved all postgraduate years (PGY) residents (n = 60, 100%), and 20 faculty coaches who were all IM trained and practicing in an IM-related specialty. One coach was linked with 3-4 residents for three years. Through 1:1 meetings, resident-coach pairs identified professional challenges ('disorienting dilemmas' or 'worst days'), reviewed successes ('best days'), and co-created professional learning plans. Typed summaries were requested following meetings. Coaches met monthly for professional development and to discuss program challenges/successes, which informed programmatic improvements; additionally, a survey was distributed after three program years. Data were analyzed using quantitative and qualitative methodologies. RESULTS Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work-life balance, career planning, teaching skills, and research/scholarship. The most-frequently mapped topics included: PGY1 - leading and working within interprofessional care teams (EPA 10), research and scholarship, and work-life balance; PGY2 - improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 - lifelong learning (EPA15); career planning was common across all years. CONCLUSIONS Lessons learned included challenges in coordination of observations, identifying disorienting dilemmas, and creating a shared mental model between residents, faculty, and program leadership. The coaching program resulted in professional learning plans aligned with IM EPAs, in addition to other professional development topics. Operationalization of aspects of these results can inform the development of similar programs in residency education.
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Affiliation(s)
- Jed D. Gonzalo
- Medicine and Public Health Sciences and Health Systems Education, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R. Wolpaw
- Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Karen L. Krok
- Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P. Pfeiffer
- Medicine, Penn State Hershey Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
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Goyal T, Hasty BN, Bereknyei Merrell S, Gold CA. Education Research: Understanding barriers to goals of care communication for neurology trainees. Neurology 2019; 93:362-366. [DOI: 10.1212/wnl.0000000000007975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo describe the perspectives of neurology residents regarding barriers to effective goals of care discussions and to identify residents' current and desired educational strategies to improve goals of care communication.MethodsAll neurology residents at our institution were invited to voluntarily participate in focus groups. Residents were organized into 3 focus groups by year of training. Moderators asked residents open-ended questions about current goals of care communication practice and ideas for improving the frequency and effectiveness of goals of care discussions. All responses were audiorecorded, transcribed, and de-identified. Transcripts of the focus groups were independently read and coded by members of the research team. We performed thematic analysis to identify and systematize relationships across coded data.ResultsTwenty out of 29 neurology residents participated in the focus groups. We identified 3 overarching domains impeding goals of care communication: patient factors, resident factors, and systems factors. Residents proposed specific desired strategies to address these 3 domains with the goal of improving the frequency and efficacy of goals of care communication. The desired strategies included receiving feedback from patients and families, developing resident-focused educational opportunities through direct observation and coaching, and systems changes by documenting goals of care discussions.ConclusionsNeurology residents identify multiple barriers to effective goals of care communication and propose specific desired strategies for improvement. This detailed input from residents will be incorporated into future curricular interventions to improve confidence and skill in leading goals of care discussions.
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The Effect of Faculty Coaching on Resident Attitudes, Confidence, and Patient-Rated Communication: A Multi-Institutional Randomized Controlled Trial. Acad Pediatr 2019; 19:186-194. [PMID: 30368034 DOI: 10.1016/j.acap.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 03/03/2018] [Accepted: 10/17/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Despite a national focus on physician-patient communication, there is a paucity of literature on how patient and family feedback (PFF) can be used as a tool to help residents learn communication skills. The purpose of this study was to assess the effect of coaching on residents' attitudes towards PFF, self-confidence in communication, and patient-rated communication skills. METHODS This was an institutional review board-approved, randomized-controlled trial with pediatric residents at 3 institutions from 2015 to 2016. Pre- and postintervention, residents completed a self-assessment of their attitudes and self-confidence in communication. PFF was collected for each resident using the Communication Assessment Tool, which has been validated in other medical disciplines. Intervention group residents reviewed their baseline PFF with a faculty coach; control group residents reviewed their PFF independently. RESULTS In total, 114 residents completed the study, 57 in each arm. Intervention group residents were significantly more likely to ask for PFF compared with control group residents (mean change 0.36 vs -0.11, P = .01). There were no other significant differences in resident attitudes, confidence, or patient-rated communication between groups. Both groups had increased self-confidence over time and with increasing postgraduate year level. Patient ratings of resident communication did not differ over time or between groups. CONCLUSIONS Residents who reviewed PFF with a faculty coach were significantly more likely to report they would ask patients for feedback than residents who reviewed PFF independently, suggesting review of feedback with a coach may enhance appreciation of patient feedback. Although self-confidence improved over time in both groups, patient ratings of resident communication skills were not significantly different over time or between groups.
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Jordan J, Dorfsman ML, Wagner MJ, Wolf SJ. The Council of Emergency Medicine Residency Directors Academy for Scholarship Coaching Program: Addressing the Needs of Academic Emergency Medicine Educators. West J Emerg Med 2019; 20:105-110. [PMID: 30643611 PMCID: PMC6324694 DOI: 10.5811/westjem.2018.9.39416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/14/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction Didactic lectures remain fundamental in academic medicine; however, many faculty physicians do not receive formal training in instructional delivery. In order to design a program to instill and enhance lecture skills in academic emergency medicine (EM) physicians we must first understand the gap between the current and ideal states. Methods In 2012 the Council of Emergency Medicine Residency Directors (CORD) Academy for Scholarship designed a novel coaching program to improve teaching skills and foster career development for medical educators based on literature review and known teaching observation programs. In order to inform the refinement of the program, we performed a needs assessment of participants. Participants’ needs and prior teaching experiences were gathered from self-reflection forms completed prior to engaging in the coaching program. Two independent reviewers qualitatively analyzed data using a thematic approach. Results We analyzed data from 12 self-reflection forms. Thematic saturation was reached after nine forms. Overall inter-rater agreement was 91.5%. We categorized emerging themes into three domains: participant strengths and weaknesses; prior feedback with attempts to improve; and areas of desired mentorship. Several overlapping themes and subthemes emerged including factors pertaining to the lecturer, the audience/learner, and the content/delivery. Conclusion This study identified several areas of need from EM educators regarding lecture skills. These results may inform faculty development efforts in this area. The authors employed a three-phase, novel, national coaching program to meet these needs.
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Affiliation(s)
- Jaime Jordan
- University of California, Los Angeles, Ronald Reagan Medical Center, Department of Emergency Medicine, Los Angeles, California.,David Geffen School of Medicine at University of California Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - Michele L Dorfsman
- University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania
| | - Mary Jo Wagner
- Central Michigan University Medical Education Partners, Department of Emergency Medicine, Saginaw, Michigan.,Central Michigan University College of Medicine, Department of Emergency Medicine, Mt. Pleasant, Michigan
| | - Stephen J Wolf
- Denver Health Medical Center, Department of Emergency Medicine, Denver, Colorado.,University of Colorado School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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LeBeau L, Morgan C, Heath D, Pazdernik VK. Assessing Competency in Family Medicine Residents Using the Osteopathic Manipulative Medicine Mini-Clinical Evaluation Exercise. J Osteopath Med 2019; 119:2721358. [PMID: 30644522 DOI: 10.7556/jaoa.2019.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT The Mini-Clinical Evaluation Exercise (Mini-CEX) is one example of a direct observation tool used for workplace-based skills assessment. The Mini-CEX has been validated as a useful formative evaluation tool in graduate medical education. However, no Mini-CEX has been reported in the literature that specifically assesses the osteopathic manipulative medicine (OMM) skills of family medicine residents. Therefore, the authors created and studied an OMM Mini-CEX to fill this skills assessment gap. OBJECTIVE To determine whether the OMM Mini-CEX is perceived as an effective evaluation tool for assessing the OMM core competencies of family medicine residents. METHODS Faculty and residents of The Wright Center for Graduate Medical Education National Family Medicine Residency program participated in the study. Each resident was evaluated at least once using the OMM Mini-CEX. Surveys were used to assess faculty and resident perceptions of the usefulness and effectiveness of the OMM Mini-CEX for assessing OMM competencies. RESULTS Eighty-one responses were received during 2 survey cycles within a 7-month period. The internal consistency of the survey responses had a high reliability (Cronbach α=0.93). Considering respondents who agreed that they had a clear understanding of the general purpose of a Mini-CEX, the perceived effectiveness score for the OMM Mini-CEX was higher among those who agreed that a Mini-CEX was a useful part of training than among those who disagreed or were unsure of its usefulness (median score, 4.0 vs 3.4, respectively; P=.047). CONCLUSIONS The results suggest the OMM Mini-CEX can be a useful direct observation evaluation tool to assess OMM core competencies in family medicine residents. Additional research is needed to determine its perceived effectiveness in other clinical specialties and in undergraduate medical education.
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Kinnear B, Warm EJ, Hauer KE. Twelve tips to maximize the value of a clinical competency committee in postgraduate medical education. MEDICAL TEACHER 2018; 40:1110-1115. [PMID: 29944025 DOI: 10.1080/0142159x.2018.1474191] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Medical education has shifted to a competency-based paradigm, leading to calls for improved learner assessment methods and validity evidence for how assessment data are interpreted. Clinical competency committees (CCCs) use the collective input of multiple people to improve the validity and reliability of decisions made and actions taken based on assessment data. Significant heterogeneity in CCC structure and function exists across postgraduate medical education programs and specialties, and while there is no "one-size-fits-all" approach, there are ways to maximize value for learners and programs. This paper collates available evidence and the authors' experiences to provide practical tips on CCC purpose, membership, processes, and outputs. These tips can benefit programs looking to start a CCC and those that are improving their current CCC processes.
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Affiliation(s)
- Benjamin Kinnear
- a Internal Medicine and Pediatrics , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Eric J Warm
- b Richard W. Vilter Professor of Medicine , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Karen E Hauer
- c Medicine , University of California, San Francisco School of Medicine , San Francisco , CA , USA
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Collins K, Hopkins A, Shilkofski NA, Levine RB, Hernandez RG. Difficult Patient Encounters: Assessing Pediatric Residents' Communication Skills Training Needs. Cureus 2018; 10:e3340. [PMID: 30473973 PMCID: PMC6248659 DOI: 10.7759/cureus.3340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Difficult patient encounters (DPEs) are common and can lead to frustration and dissatisfaction among healthcare providers. Pediatric resident physician experiences with DPEs and curricula for enhancing necessary communication skills have not been well described. Materials and methods We used a cross-sectional survey research design for our needs assessment on resident experiences with DPEs. Thirty-three pediatric residents completed this anonymous survey. The survey assessed residents’ experiences with and self-efficacy regarding DPEs. Descriptive statistics were used to analyze the quantitative data. Additionally, two authors independently coded free response data to include in the narrative description of the survey results. Results These survey results include the views of 92% of the residents in the program (33/36). Residents reported a greater frequency of difficult encounters in the inpatient setting than the outpatient setting. The majority of residents rated their communication skills during DPEs as “fair” or “good” (70%, 23/33). Residents tended to have lower confidence when discussing chronic pain, managing parental insistence on a plan, and breaking bad news. They generally reported higher levels of anxiety for scenarios involving angry patients and families, families insisting on a plan, and when breaking bad news. Residents cited many challenges, including working with angry and demanding families. Additionally, residents described difficulty with managing discordant opinions between the family and the healthcare team regarding the care plan. Residents expressed a preference for learning how to manage challenging patient encounters using clinical experiences. Simulation, discussion, and observation of role models also rated highly as educational methods for increasing skills, while most residents rated lectures as the least important means of training skills for these difficult encounters. Discussion We found that pediatric residents experience difficult encounters frequently, especially in the inpatient setting. Individual residents vary in their confidence and anxiety levels with different types of difficult encounters and may benefit from not only general communication skills training, but also from targeted training to equip them for the particular contexts they find most challenging. Residents value interactive structured learning activities, including discussion and simulation. Residents most consistently value the opportunity to lead challenging conversations in the clinical setting, especially when followed by effective debriefing and feedback by trained faculty preceptors. Conclusions Next steps include creating a “Difficult Encounters” communication skills curriculum informed by this needs assessment, which aim to enhance patient care as well as increase resident self-efficacy. In addition to the curriculum development for residents, it may be helpful to initiate faculty development on how to supervise resident-led difficult conversations and provide effective debriefing and feedback to promote resident growth.
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Affiliation(s)
- Kimberly Collins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Akshata Hopkins
- General Pediatrics, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - Nicole A Shilkofski
- General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Rachel B Levine
- Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Graddy R. Coaching Residents in the Ambulatory Setting: Faculty Direct Observation and Resident Reflection. J Grad Med Educ 2018; 10:449-454. [PMID: 30154978 PMCID: PMC6108367 DOI: 10.4300/jgme-17-00788.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/23/2018] [Accepted: 05/31/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Direct observation can be valuable for learners' skill development in graduate medical education, but it is done infrequently. Information on how to optimize trainee learning from, and best practices of, direct observation interventions in the ambulatory setting is limited. OBJECTIVE We explored the impact of a focused outpatient direct observation and coaching intervention on internal medicine residents. METHODS Using a behavior checklist based on tenets of clinical excellence, 2 faculty preceptors observed outpatient primary care visits with 96% (46 of 48) of the internal medicine residents in 2017. Residents self-assessed their performance after the visit using the same checklist. Next, a focused coaching feedback session, emphasizing reflection, was structured to highlight areas of discrepancy between resident self-assessment and coach observation (blind spots), and residents were asked to identify goals for practice improvement. RESULTS Common blind spots in resident self-assessment related to collaborating with patients while using the electronic health record (48%, 21 of 44), hand washing (43%, 20 of 46), and asking thoughtful questions (40%, 18 of 45). At 1-month follow-up, 93% (43 of 46) of responding residents reported change in practice toward goals often or sometimes. All residents reported that the intervention felt comfortable, and 98% (45 of 46) noted that it helped them identify new behaviors to incorporate into clinical practice. CONCLUSIONS Structured episodes of direct observation and coaching in the outpatient setting, with a behavior checklist, appear acceptable and useful for internal medicine residents' learning and development.
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Artino AR, Durning SJ, Sklar DP. Guidelines for Reporting Survey-Based Research Submitted to Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:337-340. [PMID: 29485492 DOI: 10.1097/acm.0000000000002094] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Anthony R Artino
- Assistant editor for AM Last Pages Deputy editor for research Editor-in-chief
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