Coaching the Fundamentals: Exploring the Applicability and Usefulness of a Novel Skills-Based Feedback Modality

OBJECTIVE

Receiving and integrating feedback is a key to medical trainee development. To assist trainees seeking improvement through daily formative feedback and deliberate practice, the authors created a new skills-based framework called microskills, derived from the Accreditation Council for Graduate Medical Education (ACMGE) milestones and entrustable professional activities. The authors then explored pediatric resident perceptions around the applicability and usefulness of microskills.

METHODS

The authors conducted 4 qualitative semistructured focus groups of 28 pediatric residents. Focus group prompts asked participants to reflect on microskills as a new feedback modality and microskills in relation to existing feedback and assessment approaches. Focus group transcripts were analyzed through inductive thematic analysis through an iterative process until theoretical saturation was reached.

RESULTS

Participants felt microskills could facilitate skill-building and improvement, allow for consistent, targeted feedback, and establish a practice of coaching. Participants also perceived microskills' future success to be dependent on how the modality is adopted and utilized alongside existing assessment tools.

CONCLUSIONS

Trainees found microskills to be a granular, context-based, coaching tool that could improve skill-building and the feedback process. Microskills' emphasis on feedback and their delineation of clinical skills that can be repeatedly practiced has the potential to provide a roadmap for trainee growth. Though microskills could fill a current need in the medical training landscape, they are not a substitute for existing assessment frameworks.

Integrating video-modeling into counseling skills and techniques course and its impact on counseling self-efficacy

Counselor education requires a comprehensive curriculum including entry-level courses as counseling skills and techniques which foster students’ basic knowledge in counseling and perceived counseling self-efficacy (CSE). Counselor candidates are provided opportunities to observe skills and techniques in practice through video modeling (VM) as one of the most favored teaching methods. The use of VM is not a common method in counselor training in Turkey; therefore, first aim of the current study was to investigate how VM-integrated counseling skills and techniques course affected students’ perceived counseling techniques efficacy and CSE. The second aim was to gain a deeper understanding of the use of VM as a teaching method in this course. A mixed-methods sequential explanatory design was used. The research setting of the current study was the undergraduate counseling skills and techniques course that integrated 10 previously developed short videos about counseling techniques or processes. There were 41 third-year students enrolled in this course who participated in the study (quantitative phase). Seven voluntary students (out of 41) participated in the focus group (qualitative phase). The paired samples t-test was applied to analyze the effectiveness of VM and the content analyses were conducted to examine qualitative data. Results showed that the VM-integrated course increased students’ perceived efficacy in using techniques and general CSE. Results of the focus group were categorized under four themes and provided critical insights to better understand the factors leading to increased self-efficacy. The results of this study were discussed in the light of previous literature on counselor education.

Building a doctor, one skill at a time: Rethinking clinical training through a new skills-based feedback modality

The Accreditation Council for Graduate Medical Education milestones and entrustable professional activities (EPAs) are important assessment approaches but may lack specificity for learners seeking improvement through daily feedback. As in other professions, clinicians grow best when they engage in deliberate practice of well-defined skills in familiar contexts. This growth is augmented by specific, actionable coaching from supervisors. This article proposes a new feedback modality called microskills, which are derived from the psychology, negotiation, and business literature, and are unique in their ability to elicit targeted feedback for trainee development. These microskills are grounded in both clinical and situational contexts, thereby mirroring learners' cognitive schemas and allowing for more natural skill selection and adoption. When taken as a whole, microskills are granular actions that map to larger milestones, competencies, and EPAs. This article outlines the theoretical justification for this new skills-based feedback modality, the methodology behind the creation of clinical microskills, and provides a worked example of microskills for a pediatric resident on a hospital medicine rotation. Ultimately, microskills have the potential to complement milestones and EPAs and inform feedback that is specific, actionable, and relevant to medical learners.

Thematic Mapping in Case Conceptualization: An Introduction to the Special Section

Case conceptualization is an essential clinical activity in which clinicians, in one form or another, gather and synthesize data about their clients in order to formulate clinical pictures and maximize therapeutic gains. However, a myriad of methods of case conceptualization that vary in complexity and theoretical bases currently reflects an almost complete lack of standardization in this most fundamental activity of mental health treatment. The lack of standardization in case conceptualization is especially daunting to trainees and clinicians who are early in their careers. This special section, comprising 5 articles, introduces thematic mapping, a transtheoretical and transdiagnostic method of case conceptualization. The method aims to overcome or minimize many of the problems inherent in current practice. In this first article, we provide a rationale for the special section and lay the groundwork for the subsequent four articles. Overall, we assert that thematic mapping holds promise as a systematic method of case conceptualization.

The Conceptual Framework of Thematic Mapping in Case Conceptualization

This article, the 3rd in a series of 5, introduces the conceptual framework for thematic mapping, a novel approach to case conceptualization. The framework is transtheoretical in that it is not constrained by the tenets or concepts of any one therapeutic orientation and transdiagnostic in that it conceptualizes clients outside the constraints of diagnostic criteria. Thematic mapping comprises 4 components: a definition, foundational principles, defining features, and core concepts. These components of the framework, deemed building blocks, are explained in this article. Like the foundation of any structure, the heuristic value of the method requires that the building blocks have integrity, coherence, and sound anchoring. We assert that the conceptual framework provides a solid foundation, making thematic mapping a potential asset in mental health treatment.

Case Mis-Conceptualization in Psychological Treatment: An Enduring Clinical Problem

Case conceptualization, an integral component of mental health treatment, aims to facilitate therapeutic gains by formulating a clear picture of a client's psychological presentation. However, despite numerous attempts to improve this clinical activity, it remains unclear how well existing methods achieve their purported purpose. Case formulation is inconsistently defined in the literature and implemented in practice, with many methods varying in complexity, theoretical grounding, and empirical support. In addition, many of the methods demand a precise clinical acumen that is easily influenced by judgmental and inferential errors. These errors occur regardless of clinicians' level of training or amount of clinical experience. Overall, the lack of a consensus definition, a diversity of methods, and susceptibility of clinicians to errors are manifestations of the state of crisis in case conceptualization. This article, the 2nd in a series of 5 on thematic mapping, argues the need for more reliable and valid models of case conceptualization.

Health care provider communication: an empirical model of therapeutic effectiveness

BACKGROUND

Patients who are facing life-threatening and life-limiting cancer almost invariably experience psychological distress. Responding effectively requires therapeutic sensitivity and skill. In this study, we examined therapeutic effectiveness within the setting of cancer-related distress with the objective of understanding its constituent parts.

METHODS

Seventy-eight experienced psychosocial oncology clinicians from 24 health care centers across Canada were invited to participate in 3 focus groups each. In total, 29 focus groups were held over 2 years, during which clinicians articulated the therapeutic factors deemed most helpful in mitigating patient psychosocial distress. The content of each focus group was summarized into major themes and was reviewed with participants to confirm their accuracy. Upon completion of the focus groups, workshops were held in various centers, eliciting participant feedback on an empirical model of therapeutic effectiveness based on the qualitative analysis of focus group data.

RESULTS

Three primary, interrelated therapeutic domains emerged from the data, forming a model of optimal therapeutic effectiveness: 1) personal growth and self-care (domain A), 2) therapeutic approaches (domain B), and 3) creation of a safe space (domain C). Areas of domain overlap were identified and labeled accordingly: domain AB, therapeutic humility; domain BC, therapeutic pacing; and domain AC, therapeutic presence.

CONCLUSIONS

This empirical model provides detailed insights regarding the elements and pedagogy of effective communication and psychosocial care for patients who are experiencing cancer-related distress.

A Person-Centered Approach to Multicultural Counseling Competence

This article examines current and historical trends in psychotherapy research and practice with racial/ethnic minority populations. Initially, research on Derald Sue’s multicultural counseling competencies is provided as a foundation to further examine the evidence regarding effective cultural adaptations to mainstream treatment approaches, such as cognitive-behavior therapy and interpersonal psychotherapy. Next, a brief outline of Carl Rogers’s psychotherapy research tradition is presented, with a focus on both past and present evidence suggesting that person-centered therapy may be effective across diagnoses, as well as cultures. Using psychotherapy evidence from both the latter half of the 20th century and the initial decades of the 21st century, cultural adaptations to previously hypothesized person-centered therapy mechanisms of change are proposed. In particular, this culturally adapted person-centered approach is suggested to provide a competent and effective treatment system for racial/ethnic minority clients and families.

Notes on the Path to Competence

Focusing on the challenges of training counseling psychologists, Ridley and colleagues offer in this issue a review and critique of microskills training, the dominant training model in counseling psychology graduate programs. Recognizing the role of higher order cognitive and affective functions in expert practice, they propose a hierarchical model of considerable complexity. In these comments, the author offers some thoughts about their model in light of the range of roles and interests that competency models serve, the definition of competence, and the idea of metacompetency.

Therapeutic Change

In this rejoinder, the authors respond to the comments, feedback, and suggestions offered by Hatcher, Miville, and Nutt. The authors clarify a possible point of confusion, reaffirm their contention that the crux of sound psychology practice rests on therapists’ ability to facilitate change with their clients, and acknowledge both the progressive development that characterizes the process of becoming a competent counselor and the problem of assuming advanced training alone can compensate for the limitations inherent in the microskills-only approach to training. Next, the authors address the issue of complexity, including their intention to balance the need to provide a coherent, accessible model that does not fall prey to oversimplification. Finally, the authors note key similarities to and differences from the competency benchmarks and invite their colleagues to join them in the rigorous testing needed to validate their model of counseling competence.

Microskills, Trainee Competence, and Therapy Outcomes

This article represents an invited reaction to the series of articles critiquing the microskills approach predominant in most counseling training programs as well as the new model of counseling competence presented in this issue. The authors note that the microskills approach has been a useful and well-researched framework in the field, although they were generally in agreement with the conclusions drawn regarding this approach. These authors suggest that the authors of the series of articles address how their new model intersects with the competency benchmarks model as well as provide feedback concerning the social justice applications of the model.

Counseling Competence

Working from their proposed model of counseling competence, the authors address critical implications and applications of the model. First, they present a 10-parameter juxtaposition of the model of counseling competence and the microskills training model, including points of comparision and contrast. Second, they discuss implications of the model for practice, including guidelines for teaching and an application exercise. Third, they discuss implications of the model for research, including improvements over design flaws and the limited focus that has typified research on microskills training.

Training in Counseling Psychology

This Major Contribution, consisting of four articles, critically evaluates the status of training in counseling psychology, especially at the entry level, and offers a model for moving the field forward. In this first article, we provide a rationale for the contribution, laying the foundation for the subsequent three articles. Specifically, we ask the questions, Do training programs in counseling psychology produce the desired results? and Is the prevailing paradigm of training effective in developing counselor competence? Then we report on the research showing a disappointing relationship among training, experience, and expertise. We conclude by inviting the profession to engage in honest self-reflection about the status and future direction of training in counseling psychology.