CoachingStrategiestoHelpTrainees’ClinicalSkills

DevelopmentAssociationofPediatricProgramDirectors’Meeting

April6,2017

Stanford• CarrieRassbach,MD• AlyssaBogetz,MSW• LucyLee,MD• CarrieLoutit,MD• DebbieS.Sakai,MD• Nivedita Srinivas,MD• BeckyBlankenburg MD,MPH

SeattleChildren’s• SaharRooholamini,MD,MPH• Maneesh Batra,MD,MPH• MollieGrow,MD,MPH• CelesteQuitiquit,MD• HeatherMcPhillips,MD,MPH

Objectives

• Reviewpurposeandbenefitsofcoaching• Discussskillsandtoolsforsuccessfulcoaching• Practicecoachingwithscenarios• IntroduceCoachingmodelsfromStanfordandSeattleChildren’sResidencyPrograms

• Reviewmythsandmisconceptions

WhatisGoodCoaching?

• Think:Individualreflection—positiveandnegativeCoachbehaviors

• Pair-share

WhatisCoaching?“Coachingphilosophyadherestothenotionthatlearningisneverfinishedandtoreachone’smaximumpotentialrequiresanexternalviewpointtocorrectorenhanceperformance.”

ThreetypesofCoachingrelevanttocoachinginmedicine:1. Coachingforskillenhancement2. Coachingforincreasedperformance3. Coachingfordevelopment

Schwellnus H,CarnahanH.Peer-coachingwithhealthcareprofessionals:Whatisthecurrentstatusoftheliteratureandwhatarethekeycomponentsnecessaryforpeer-coaching?Ascopingreview.MedTeach.2014

WhatarethebenefitsofCoaching?• Improvesclinicians’:– Confidenceintheirclinicalandcommunicationskills– Communicationskills(ie.Motivationalinterviewing)– Self-reportedburnoutscores– Patientsatisfactionscores

• Improvesresidents’:– Perceptionsoffeedback– Reflectiveskills– Goal-settingskills

IntroductiontoCoaching

• WhenshouldCoachingbeused?• Howdoyouassesswhatthelearnerneeds?• HowdoyoubecomeaneffectiveCoach?

RolePlay

6Essentialskillsforeffectivecoaching

1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals

LearnerReflection

Feedback

Furthergoal-setting

ObservationInternalization

andapplication

Residentidentifiesgoals,communicates

withcoach/attending

Skill1:RecognizingthebigpictureofCoaching

Skill2:Establishingasafelearningclimate

● Clarifyroleofcoach● Growrelationshipovertime● Emphasizenon-evaluativefeedback● Beapproachableandavailable● Help,notjudge● Givefeedbackprivately● Facilitategoal-setting● Serveassupport● Cultivatetrust● Ask/learnstrengthsandinsecurities● Focusonskills● Improveconfidence

Skill3: Observing• Directobservationis:

(1) first-handobservationofalearner(2) coupledwithfeedback(3) inareal-lifesetting

• Itcanprovide:(1)reinforcingand/orformativefeedback(2)increasedcredibilityfortheobserver

Directobservation:Miller’sPyramid

Toolstoenhancedirectobservation

• Standardizedtools– Systematizetheprocess– Increaseobjectivity– Serveasamentalprompt,likeachecklist,especiallyforlessexperiencedobservers

• Ideally,toolsareflexibleandallowuserautonomy,expertise

Skill4: FacilitatingreflectionTechnique ExampleAsk “How didyoufeelthatwent?”

‘’Whatwentwell?”“Whatwaschallenging?”“What,ifanything,surprisedyou?”

Tell Providefeedback

Ask “Does thisresonatewithyou?”“Isthissomethingyou’veheardbefore?”“Whatgoalscanweworkontogether?”

Skill5: GivingfeedbackTechnique (“Tell”)• Relatedtolearner’s

goals/reflections• Specific,focused ontask

orbehavior• Timely• Nonjudgmental• Providedinsmallpieces• Mindfultohowlearner

processesfeedback

Example• “Inoticed thatwhenyouwere

speakingwithyourpatient’sfamilyyouused’febrile’and’tachycardic.’Somefamiliesmaynotunderstandwhatthesetermsmean…

• “In thefuture,youmaywanttoconsider…”

• “Iwouldhavesaid...”• “Youcouldhavesaid...”

Skill6: Helpinglearnerssetgoals• AdultLearningTheory:

– Adultslearnbestwhentheyareactivelyengagedandself-directtheirownlearninggoalsandactivities

– Adultsmustreflectontheirexperiences– Theroleoftheteacher(akacoach)istoengagethelearner’sneeds

• Inadditiontohelpingsetgoals,thecoachcanhelpthelearnerrefinethemtoensuretheyareappropriateforthelearner’sindividualneedsandactionable

I-SMARTgoalsImportant(tothelearner)SpecificMeasurableAccountableRealisticTimeline

SkillsPracticeScenarios

6EssentialSkillsforEffectiveCoaching

1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals

TwomodelsofresidencyCoachingPrograms

Man-to-Man Zone

TheStanfordPediatricResidencyCoachingProgram

2013-present

StanfordPediatricResidencyCoachingProgramGoals

• Toimproveresidents’clinicalskillsin:• CriticalThinking(includingaskingquestionsandseekingevidencetodrivedecision-making)• Physicalexamination• Communication• Professionalism

StanfordCoachingProgram• 10FacultyCoaches• 10-11residents/Coach• Longitudinaldirect

observationsinmultiplesettings:inpatient,outpatient,throughtrainingyears

• ReviewILPs• ServeonCCC

• Focusoncoreclinicalskills• Coachingsessions:– Goal-directedobservation– Reflection– Feedback– Goal-setting

DirectObservations• PGY1s:–History-taking– Physicalexam– Presentations–ClinicalReasoning–Communication–Handoffs–Documentation

• PGY2sandPGY3s:– Teaching–Precepting–CareConferences–Givingbadnews

LearnerReflection

Feedback

Furthergoal-setting

ObservationInternalization

andapplication

Residentidentifiesgoals,communicates

withcoach/attending

StanfordPediatricResidencyCoachingModel

RassbachC,Blankenburg R.ANovelPediatricResidencyCoachingProgram:OutcomesAfterOneYear.Academicmedicine,inpress.

FacultyDevelopment

Feasibility

• CoachingsessionsbyResidentYear(N=82residents)

• 82/82residentshadatleast3coachingsessions• 659sessions;average=82/Coach(range57-108)

Residentyear Median Interquartilerange

Goal

PGY1 11 8-12 10PGY2 7 6-9 7PGY3 5.5 4.75-7 5-7

0

10

20

30

40

50

60

70

80

90

100

Skill Reflection Goal-setting

Coachvs.OtherFaculty'sSkillandUseofReflectionandGoal-SettinginGivingFeedback

Resident:evalofcoach

Coach:self-eval

Resident:evalofnon-Coach

Non-Coach:self-eval

0"

0.5"

1"

1.5"

2"

2.5"

3"

3.5"

4"

COACH:"PE"

Non3COACH:"PE"

COACH:"Assessment"

Non3COACH:"Assessm

ent"

COACH:"Comm

unica<on"

Non3COACH:"Communica<on"

COACH:"Goal3se?

ng"

Non3COACH:"Goal3se?ng"

Level"of"C

onfid

ence"(1

34"sc

ale)"

Confidence"in"Giving"Feedback"in"the"Following"Domains"!

2013" 2014"

EffectofCoachingProgramonCoachandNon-CoachCoreFaculty

* * *

p<0.01 p<0.01p<0.01 p=0.062

UW/SeattleChildren’sPediatricResidencyCoachingProgram

CCCCoaches2017-2018

EmilyRuedinger

JanieHallstrand

TroyJohnston

ElenaGriego

MayaJones

RonKaplan

ReidFarris

DeryaCaglar

JulianneBishop

SaraVora

ErinAlbers

DougOpel

KariGillenwater

JimmyBeck

DougDiekema

DavidBreland

LyndaKen

TaraWenger

Model

• 18coaches• 6-7residents/coach– allinoneclass• Combinedintocoachteams withaPD/APD:allresidencylevels(R1,R2,R3)represented

• Meetatleasttwiceperyearwitheachresident

• ServeontheCCC

Roles

• Observetheirassignedmenteesandotherresidentsintheirclinicaldomain(“zone”)

• Reviewevaluationsandgivesummativeclinicalfeedback

• HelpresidentsdevelopandtrackILPgoals• Usefacultyevaluationstomapmilestones• Bonus:wellness,careermentoring

CoachFeedback

• Briefsurveyofcoaches,50%responserate• Allrespondents(n=9)likedtheDOTform,foundithelpful&perceivedresidentsdidtoo

• Biggestbarrierstocompletionweretime,coordinationwithresidents

• Areasforimprovement:moreintegratedtimetomeetwithresidents,morestructureforeachmeeting

FuturePlans:CCCPODS

Credit:LilianHoR3andWei-JenHsiehR3Pod=5CCCcoaches andtheir6-7residents(R1s,R2s,R3s)inadditiontoanAPDandchiefresident.

PodProposal:newfeatures

• Includeachiefresidentwitheachpod• Focusonpeermentoringthroughmoresocialeventswithpodsintegratedacrossclasses

• UtilizeIntern,R2,R3retreatsasstrategictouchpointswithcoaches/pods

• Incorporatestructuredapproachtolearningskills:“milestoneofthemonth”

Touchpointsthroughouttheyear:

summer fall winter spring

Myths,Misconceptions,andQuandaries

• Cost• Time• Feedbackinperson• FormativeFeedbackvs.Evaluationvs.Both

CoachinginMedicineToolkit

Summary:6Essentialskillsforeffectivecoaching

1) RecognizingthebigpictureofCoaching2) Establishingasafelearningclimate3) Observing4) Facilitatingreflection5) Givingfeedback6) Helpinglearnerssetgoals

Thankyou!

And

Questions?