Purpose: Identifying areas of student underperformance and providing tailored support are critical to ensuring medical students become competent clinicians. The Student Guidance Program (SGP) at Stanford School of Medicine uses an innovative executive coaching-based remediation model to support academically struggling medical students. It focuses on the dyad relationship, applying executive coaching principles to remediation, and cultivating an affirming student-focused relationship rooted in positive psychology. The program’s goal is to improve clinical skills. Approach: We developed an executive coaching-based model to support struggling students using coaching and remediation principles, 1–5 practices from a survey of peer institutions’ strategies, and input from educational leaders. We identified underperforming students using standardized patient clinical performance exams that assessed domains of history, physical exam, communication, and clinical reasoning skills at 2 timepoints: (1) after completion of the preclerkship curriculum and (2) after one year of required clerkships. SGP completion required either passing a reassessment exam or successful completion of 3 required clerkships. In one-on-one sessions, faculty incorporated an executive coaching framework 4—helping students build self-awareness and acceptance, self-identify contributors to academic difficulties, reflect on their performance, identify desired outcomes, and create an individualized plan that includes “whole-person” care. Tools used included a review of exam performance, role playing, reinforcing organizational frameworks, and feedback. Students were also paired with faculty for direct observation of patient encounters. Between 2017 and 2021, we collected student metrics and program evaluations. A mixed-methods approach was used for evaluations collected confidentially via Qualtrics, which consisted of 23 Likert-style and 8 open-ended questions. We performed descriptive analyses of quantitative data and thematic analyses of qualitative data. Outcomes: Forty-one students (38 unique) participated in SGP: 28 during preclerkships, 13 during clerkships, and 3 in both settings. Mean age upon entry was 27.7 years, with 3 (8%) female, 35 (92%) male, and 12 (32%) students underrepresented in medicine. Median number of sessions per student was 6, ranging from 1 to 33 over an average of 9.5 months; each session lasted 45–90 minutes. Eighty-eight percent of preclerkship students who went on to complete the clerkship clinical performance exam passed. Of the 26 students exiting SGP thus far, 19 students (10 preclerkship, 9 clerkship) completed evaluations (73% response rate). Students rated the SGP experience highly (mean 4.3 out of 5). SGP provided an important opportunity for growth and development (4.4); coaches helped students achieve individualized goals (4.3), were supportive, affirming, and focused on promoting success (4.7); and SGP helped acquire self-reflection skills (4.3), increased motivation (4.3), and increased commitment to pursuing their clinical skills and academic goals (4.3). In open-ended responses, students appreciated having dedicated coaching sessions that included targeted feedback with practice and skill development. Coaches were instrumental in developing learning plans and identifying personalized learning strategies; coaching was “high yield” and students recommended program expansion beyond remediation. Students felt SGP created a positive learning environment and reduced stigma associated with remediation. Students were encouraged to become better clinicians, learned how to incorporate feedback, and used SGP as an opportunity for growth. The challenges with SGP included scheduling, timing, and frequency of coaching sessions. Significance: The results demonstrate that an executive coaching-based approach to remediation improves clinical skills. This model includes a focus on the dyad relationship, executive coaching principles, and an individualized “whole-person” approach in a context-specific learning environment. Student feedback has led to program expansion, including adding 2 new coaches. Our outcomes are promising and support the use of an executive coaching-based model alongside remediation strategies to improve clinical skills. Future areas of inquiry include long-term follow-up of students to assess clinical performance beyond medical school.
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Dec 17, 2022
Richard M Allman 
Open Access