Coaching Primary Care Clinicians in the Ambulatory Setting: Direct Observation and Deliberate Practice.

Abstract

Clinical coaching programs can improve clinician performance through feedback following direct observation and the promotion of reflection. This study assessed the feasibility and acceptability of a primary care coaching program applied in community-based practices. Using a 31-item behavioral checklist that was iteratively revised, four faculty observed 18 community-based primary care clinicians (15 of whom were physicians) across 36 patient encounters. Each behavior was scored as a binary variable (observed or not observed). After watching them care for patients, each clinician participated in a focused feedback session to discuss strengths and areas for improvement. Behaviors observed with the highest frequency were: reflects compassion (100%), appears to enjoy caring for the patient (100%), leads and follows with open-ended questions (97%), and asks thoughtful and smart questions (95%). Areas for improvement were those behaviors done less commonly: apologizes for running behind schedule (18%), acknowledges computer and/or explains role in patient care (14%), and assesses understanding (teachback; 7%). Most clinicians agreed or strongly agreed that they would like to be coached again in the future (81%), and that the coaching feedback would help them become more effective in primary care practice (94%). Nearly all patients surveyed substantiated that it did not bother them to have another doctor in the room and that it is a good idea to offer coaching to clinicians to help them improve. Coaching busy primary care clinicians is feasible and a valued experience. Focusing on specific observable behaviors can identify clinicians' strengths and opportunities for improvement. Patients are pleased to learn that their clinicians are receiving coaching as part of their professional development.