Faculty Coaching Research Articles

Differences in coaching in single- versus dual-console robotic cases: a mixed-methods study.

A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes.We sought to evaluate how intraoperative coaching and resident autonomy differ based on the use of a single- versus dual-console robot. Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty coaching based on the Wisconsin Surgical Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework. Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments). Qualitative analysis highlights that despite similar survey-based faculty ratings across domains, coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.

'Rules of engagement': Does competition drive engagement in faculty development.

Faculty development (FD) is integral to the implementation of educational programmes. However, attracting new faculty is challenging. Competition is a motivator for learning at an undergraduate level; however, incorporating competition to engage faculty in continued FD has not been explored. In the context of a new strategy to embed in situ simulation in postgraduate education across our healthcare group, and drawing on motivational theory, we asked 'does competition drive engagement in new FD initiatives?' We conducted semi-structured interviews with nine healthcare professionals (HCPs) who had participated in an in situ simulation 'SimStars' competition. Guided by thematic analysis and borrowing from constructivist grounded theory, we explored participants' motivations for entering a competition, their experiences of competition throughout their education and how this process impacted on their engagement in FD. Three overarching concepts arose and challenged our understanding of the role of competition as a motivator: (1) 'Competition is a necessary evil'; (2) 'It really is the taking part that counts'; and (3) 'Teamwork makes the dream work'. In contrast to previously published work, our results suggest participants view competition negatively and as a means to career progression. However, the opportunity to work as part of an (interprofessional) team towards a goal, and to develop a new skill (i.e. the process), was more motivating for participants than 'winning' a competition. Competition may not provide a motivation for HCPs to engage in FD and may be a barrier. Providing collaboration opportunities, faculty coaching and the chance to develop new skills could enhance engagement.

Course Design for Leadership Learning in an Experiential Program

Background: Leadership development is commonly named as an outcome for experiential learning (EL) programs. Some programs have shown success at inculcating individual leadership traits. However, it is not clear whether there is a relationship between certain kinds of experiential pedagogy and specific leadership concepts or styles, such as industrial and postindustrial leadership and other concepts. Purpose: The researchers identify course-design factors associated with leadership-learning outcomes in an interdisciplinary EL program called Vertically Integrated Projects. Method: From five courses across disciplines, faculty were interviewed and syllabi and student reflections were analyzed for concepts of leadership and course designs. Findings: Students showed the most evidence of leadership learning when at least two of the three factors were present: (i) flexible and cooperative course structures; (ii) conceptual instruction; and (iii) faculty coaching. Leadership practice is distinguished from leadership learning. Implications: Leadership educators recommend conceptual instruction prior to experiential learning; the findings support supplementing that instruction with a flexible, cooperative course design to encourage leadership learning. More research is needed on the relationship between “vertical” experiences, in which advanced students mentor junior students in courses of any size, and leadership development.

Faculty Coaching and Faculty Needs in Korean Universities

Faculty Coaching and Faculty Needs in Korean Universities

Putting the “learning” in “pre-learning”: effects of a self-directed study hall on skill acquisition in a simulation-based central line insertion course

BackgroundOpportunities to practice procedural skills in the clinical learning environment are decreasing, and faculty time to coach skills is limited, even in simulation-based training. Self-directed learning with hands-on practice early in a procedural skill course might help maximize the benefit of later faculty coaching and clinical experience. However, it may also lead to well-learned errors if learners lack critical guidance. The present study sought to investigate the effects of a hands-on, self-directed “study hall” for central line insertion among first-year residents.MethodsLearner cohorts before vs. after introduction of the study hall (n = 49) were compared on their pre- and post-test performance of key procedural behaviors that were comparable across cohorts, with all learners receiving traditional instructor-led training between tests.ResultsStudy hall participants spent a median of 116 min in hands-on practice (range 57–175). They scored higher at pre-test (44% vs. 27%, p = .00; Cohen’s d = 0.95) and at post-test (80% vs. 72%, p = .02; Cohen’s d = 0.69). A dose–response relationship was found, such that 2 h of study hall were roughly equivalent to the performance improvement seen with four clinical observations or supervised insertions of central lines.ConclusionsSelf-directed, hands-on “study hall” supported improved procedural skill learning in the context of limited faculty availability. Potential additional benefits make the approach worth further experimentation and evaluation.

The Ohio State University Dream Team: Innovation for Well-being fellowship and coaching program.

Nearly 70% of faculty experience very high levels of stress. Integrative Nurse Coaching (INC) can help by assisting clients in establishing goals and embarking on new lifestyle behaviors that help to decrease perceived stress, achieve work life integration, and enhance life satisfaction. Our goal was to evaluate a faculty coaching and fellowship program to support faculty well-being while developing innovation competency. We employed an INC paradigm to coach five faculty to build confidence and competence in innovation and enhance well-being. We offered monthly group and individual coaching and used a qualitative research thematic analysis to determine themes important for the fellow and group experiences, identify outcomes, and create recommendations for the future. We identified the following themes as outcomes for our program: (1) enhanced connection, comradery, and support; (2) increased confidence and competence in navigating academia; (3) shift from a fixed mindset to an innovation mindset; and (4) increased ability to identify and manage stress and burnout. Fellows also experienced a shift from focusing on individual needs to addressing the needs of the community at the college. Nurse coaching is an effective strategy to address faculty stress and burnout. Additional research is needed to evaluate the Innovation for Well-being faculty fellowship program and its impact on the academic community.

Faculty coaching to support NCLEX-RN success

Declining NCLEX-RN pass rates intensify the need to evaluate interventions to support NCLEX-RN success. This quality improvement project was conducted to analyze data about characteristics of students who received faculty coaching. Coached students (n=167) had a 90% first attempt NCLEX-RN pass rate. Achieving a pass rate of 90% among a cohort of students who tested at risk suggests coaching supports NCLEX-RN success. Students reported benefits from and satisfaction with the coaching.

The Role of Graduate Medical Education in the Fight Against Health Misinformation.

The Role of Graduate Medical Education in the Fight Against Health Misinformation.

Teaching Communication as a Procedure by Utilizing a Mixed-Methods Curriculum: A Pilot Study.

ObjectiveIn this study, we aimed to develop and pilot a mixed-methods curriculum among pediatric subspecialty fellows that combined didactics, role-play, and bedside coaching with a procedure card. We hypothesized that this curriculum would improve fellows’ ability to navigate difficult conversations and would be feasible to implement across training programs.MethodsThis study was conducted from 2019 to 2020. Phase 1 focused on establishing baseline performance. Phase 2 involved the education of participants and faculty. During phase 3, participants communicated difficult news to patients and families using the procedure card as a prompt with the aid of faculty coaching. Six months later, participants' performance was re-evaluated and compared with baseline performance.ResultsA total of 10 out of 17 (60%) participants completed the pilot study. Likert self-efficacy results revealed an improvement in the skill of delivering difficult news (3.0 pre-intervention, 4.1 post-intervention, p=0.0001), conducting a family conference (2.5 pre-intervention, 3.6 post-intervention, p=0.0001), and responding to emotions (3.4 pre-intervention, 4.2 post-intervention, p=0.0003). Investigator assessments showed improvement in fellows’ ability to communicate information clearly (2.5 pre-intervention, 3.9 post-intervention, p=0.0001) and demonstrate empathy (2.7 pre-intervention, 3.3 post-intervention, p=0.005).ConclusionsIn this pilot study, coaching at the bedside with a procedure-card prompt was effective at improving specific self-perceived and observed communication skills. Future research is needed to evaluate modifications to this curriculum to enhance its feasibility.

Resident Rotation Scheduling for Categorical Internal Medicine Residency Program

Residency program, a stage of medical postgraduate education, plays an important role in a physician’s professional competency. Each year a resident rotation schedule has to be created, and residents develop practical skills and receive faculty coaching in different rotations. The creation of rotation schedule is typically a manual process and thus falls into a sub-optimal solution due to many practical criteria such as the issues of burnout, professional development, and quality of care. This study is motivated by a resident rotation scheduling problem of Mayo Clinic Florida Categorical Internal Medicine residency program. By analyzing all requirements and relative importance, an optimization model is developed, aimed at the first draft of the resident rotation schedule. A desktop application is developed to provide program coordinators with a friendly user interface. Using the method and software proposed in this paper allows drafting the optimal resident rotation schedule to be achieved in seconds.

Practical strategies to enhance resident engagement in clinical quality improvement

BackgroundEngaging residents in meaningful quality improvement (QI) is difficult. Challenges include competing demands, didactics which lack connection to meaningful work, suboptimal experiential learning, unclear accountability, absence of timely and relevant data, and lack of faculty coaches and role models. Various strategies to address these challenges for engagement have been described, but not as a unified approach. This paper describes a bundle of practical strategies to address common challenges to resident engagement in QI, illustrated through the experience of one residency education program.Methods62 categorical residents in the University of Missouri Internal Medicine residency participated in a longitudinal QI curriculum integrated into residency clinic assignments with dedicated QI work sessions and brief just-in-time didactics with mentorship from faculty coaches. Residents completed at least two PDSA (Plan-Do-Study-Act) cycles for their projects. The experience included clear expectations and tools for accountability. Project criteria included importance to patients, residents, and the institution. Residents had access to data related to their own practice. A pre-post survey asked residents to self-assess their level of interest and engagement in QI on a 5-point Likert scale, with 1 = least desired and 5 = most desired result. Data were analyzed by paired t-test.ResultsAll 62 residents participated in the program as members of ten QI teams. 40/62 residents completed both pre- and post-surveys. Items related to self-assessment of QI in clinical work all changed in the desired direction: likelihood of participation (3.7 to 4.1, p = 0.03), frequency of QI use (3.3 to 3.9, p = 0.001), and opinion about using QI in clinical work (3.9 to 4.0, p = 0.21). Resident assessment of QI priority in clinical work did not change.ConclusionsWe implemented a practical strategies bundle to overcome common challenges to successfully engaging residents in clinical quality improvement. These strategies included QI work integrated into routine clinical assignments, just-in-time didactics, experiential learning with clear expectations and strategic project selection, timely and pertinent data from the residents’ own practice, and real-time faculty coaching.

Michigan State University College of Human Medicine.

Michigan State University College of Human Medicine.

"Hot Seat" Simulation to Teach Conflict Management Skills to Residents.

Conflict management is an important leadership skill for residents to develop, yet it is a challenging skill to practice. We developed and evaluated a workshop that teaches conflict resolution skills to physical medicine and rehabilitation residents in a group setting with real-time faculty coaching and peer feedback. A 4-step model for handling work-related conflicts was taught, and then residents practiced their skills during a realistic simulated conflict with a trained actor. A faculty coach supported the participant, and peers gave feedback and suggestions in real time as the scripted conflict unfolded. Immediate post-session survey results were analyzed. Workshops were conducted in 2015, 2017, and 2019. A total of 36 residents participated and completed evaluations out of a possible 40 residents in the cohort (90% participation rate). Post-session surveys showed that 100% of participants agreed the session content was relevant to their training and they would use the skills in the future. Ninety-seven percent (35 of 36) felt prepared to manage conflict following the session. This experiential workshop helped cultivate an appreciation of the importance of conflict management skills in residents' professional development and confidence in their ability to apply a conflict management framework to real-world situations.

Implementation and Impact of a Serious Illness Communication Training for Hematology-Oncology Fellows.

Effective communication between providers and patients with serious illness is critical to ensure that treatment is aligned with patient goals. We developed and tested an implementation strategy for incorporating the previously developed Serious Illness Conversation Guide (SICG), a clinician script, into hematology-oncology fellowship training at a single US academic medical center. Between December 2017 and April 2018, we trained 8 oncology fellows to use and document the SICG. The training included associated communication skills-such as handling emotion and headlining-over 7 didactic sessions. Implementation strategies included training 4 oncology faculty as coaches to re-enforce fellows' skills and an electronic medical record template to document the SICG. We assessed effectiveness using 4 approaches: (1) SICG template use among fellows in the 12months following training, (2) fellow confidence pre- and post-intervention via survey, (3) performance in 2 simulated patient encounters, and (4) semi-structured interviews after 12months. Fellows successfully implemented the SICG in simulated patient encounters, though only 2 of 6 fellows documented any SICG in the clinical practice. Most fellows reported greater confidence in their communication after training. Thematic analysis of interviews revealed the following: (1) positive training experience, (2) improved patient preference elicitation, (3) selected SICG components used in a single encounter, (4) prioritize other clinical duties, (5) importance of emotion handling skills, (6) no faculty coaching receive outside training. Despite acquisition of communication skills, promoting new clinical behaviors remains challenging. More work is needed to identify which implementation strategies are required in this learner population.

Just a Game: the Dangers of Quantifying Medical Student Professionalism.

A medical student on her internal medicine clerkship says her numerical medical professionalism grade was "just a game." Building on this anecdote, we suggest there is good reason to believe that numerical summative assessments of medical student professionalism can, paradoxically, undermine medical student professionalism by sapping internal motivation and converting conversations about core professional values into just another hurdle to residency. We suggest better ways of supporting medical student professional development, including a portfolio comprised of written personal reflection and periodic 360° formative assessment in the context of longitudinal faculty coaching.

Continuity Clinic Practice Feedback Curriculum for Residents: A Model for Ambulatory Education.

There is an unmet need for formal curricula to deliver practice feedback training to residents. We developed a curriculum to help residents receive and interpret individual practice feedback data and to engage them in quality improvement efforts. We created a framework based on resident attribution, effective metric selection, faculty coaching, peer and site comparisons, and resident-driven goals. The curriculum used electronic health record-generated resident-level data and disease-specific ambulatory didactics to help motivate quality improvement efforts. It was rolled out to 144 internal medicine residents practicing at 1 of 4 primary care clinic sites from July 2016 to June 2017. Resident attitudes and behaviors were tracked with presurveys and postsurveys, completed by 126 (88%) and 85 (59%) residents, respectively. Data log-ins and completion of educational activities were monitored. Group-level performance data were tracked using run charts. Survey results demonstrated significant improvements on a 5-point Likert scale in residents' self-reported ability to receive (from a mean of 2.0 to 3.3, P < .001) and to interpret and understand (mean of 2.4 to 3.2, P < .001) their practice performance data. There was also an increased likelihood they would report that their practice had seen improvements in patient care (13% versus 35%, P < .001). Run charts demonstrated no change in patient outcome metrics. A learner-centered longitudinal curriculum on ambulatory patient panels can help residents develop competency in receiving, interpreting, and effectively applying individualized practice performance data.

Metasynthesis of Preservice Professional Preparation and Teacher Education Research Studies

Results from a metasynthesis of the relationships between 14 different types of preservice teacher preparation practices and teaching quality, preschool to university student performance, and university student and beginning teacher belief appraisals are reported. Each type of preservice practice (e.g., course-based student learning) included different kinds of instructional methods (e.g., problem-based learning, inquiry-based learning, and project-based learning). The metasynthesis included 118 meta-analyses and 12 surveys of more than three million study participants. Findings clearly indicated that active university student and beginning teacher involvement in mastering the use of instructional practices and both knowledge and skill acquisition by far stood out as the most important preservice teacher preparation practices. These included extended student teaching experiences, simulated instructional practices and microteaching, faculty coaching and mentoring, clinical supervision, different types of cooperative learning practices, and course-based active student learning methods. The pattern of results helped identify high leverage and high impact teacher preparation practices. Implications for future research and improving teacher preparation are described.

A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program

ABSTRACTBackground: 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.

The Effect of Faculty Coaching on Resident Attitudes, Confidence, and Patient-Rated Communication: A Multi-Institutional Randomized Controlled Trial

ObjectiveDespite 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. MethodsThis 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. ResultsIn 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. ConclusionsResidents 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.

Coaching the Coach: A Program for Development of Faculty Portfolio Coaches

ABSTRACTProblem: Faculty coaching is recognized as an essential element for effective use of portfolios in undergraduate medical education, yet best practices for training these coaches are uncertain. Intervention: New portfolio coaches participated in a multifaceted training program that included orienting modules, a 7.5-hr training workshop featuring analysis of reflective writing, an Observed Structured Teaching Exercise (OSTE), and subsequent longitudinal coaches’ meetings for timely task training. Four desired coaching skills were emphasized in the initial training: creating a safe environment, explicitly using performance data, asking questions that elicit reflection, and guiding the student to develop future goals and plans. We collected and analyzed several outcomes: (a) coaches’ self-assessment at key intervals, (b) open-ended written responses to three coaching vignettes, (c) video recordings of the OSTE, and (d) subsequent student evaluation of the coach. In an attempt to capture learning from the workshop, both the responses to written vignettes and the video-recorded encounters were coded for presence or absence of the four desired skills. Context: Our portfolio and coaching program was instituted as part of a major undergraduate medical education reform. A new cohort of 25 coaches is enrolled with each matriculating student class, and each coach is assigned to work individually with 8–10 students, forming a coaching relationship that continues over 4 years. Coaches are compensated at 5% full-time equivalent. Outcome: On coach self-assessment, the majority of coaches reported significant improvement in their perceived ability to assess a student's level of reflection, enhance reflection, use performance data, and guide a student to develop goals and plans. After two semesters, coach perception of improved abilities persisted. Students rated coaches as excellent (82%), reporting that coaches created safe environments (99%), promoted insight (92%), and aided in goal setting (97%). Written responses to vignettes before the OSTE found that several coaches omitted desired behaviors; however, posttraining responses showed no discernable pattern of learning. Coding of the OSTE, in contrast, documented that all coaches demonstrated all four of the desired skills. Lessons Learned: Although coaches reported learning related to key skills, learning was not apparent when responses to written vignettes were examined. In contrast, skills were demonstrated in the OSTE, perhaps due to the added structured tasks as well as anticipation of feedback. In conclusion, this portfolio coach training program achieved its desired aim of providing students with portfolio coaches who demonstrated the desired skills, as reported by both coaches and students.