Longitudinal Coaching Research Articles

Impact of Longitudinal Coaching on Pediatric Residents’ Professional Identity Formation: A Multi-Institution Qualitative Study

ObjectiveCoaching has emerged in medical education as a strategy for trainees’ development and has been endorsed by the Coalition for Physician Accountability and the American Medical Association. However, there is a lack of literature on how coaching impacts residents’ professional identity formation (PIF). The purpose of this study was to explore how longitudinal clinical coaching impacted the professional identity of residency graduates. MethodsIn July to November 2020, we conducted an Institutional Review Board-approved qualitative study with semistructured interviews of residency graduates from 2 pediatric programs who participated in a longitudinal coaching program. We inductively analyzed the transcripts using thematic analysis, guided by the sensitizing principles of PIF. We did a member check to enhance trustworthiness. ResultsWe interviewed 34 residency graduates from 2 institutions and identified 4 themes on how coaches influenced residency graduates’ PIF by 1) the presence of a trusting relationship; 2) creating trust and sense of belonging through longitudinal encounters, supportive reflection, and formative feedback; 3) integrating clinical skill, career interests, and work-life integration; and 4) reflecting on their own personal and professional identities. Residency graduates highlighted coaching strategies that coaches, coaching programs, and residents themselves can take to promote resident PIF during residency. ConclusionsResidency coaches have the potential to influence residents’ PIF through their longitudinal relationship grounded in trust. Coaching strategies can be used to enhance resident clinical and professional development during residency training.

‘It’s more like checking in with an old friend’: A qualitative study of medical students’ experiences with longitudinal coaches throughout medical school

Purpose Coaching in medical education facilitates learners’ growth and development through feedback, goal-setting and support. This study explored how coaching relationships evolve throughout medical school and the impact of longitudinal coaching relationships on medical students’ approach to feedback and goal setting in the clinical years. Method In this qualitative study using a constructivist paradigm, authors purposively sampled 15 senior medical students at University of California, San Francisco, to participate in individual semi-structured interviews (October–November 2021). The authors used an inductive approach to thematic analysis. Results The authors identified four themes: First, the student-coach relationship deepened over the course of medical school. Second, students identified factors that sustained and strengthened the student-coach relationship over time: a strong foundation to the relationship, the non-evaluative nature of the relationship, coach supportiveness and responsiveness, and coach knowledge of the institutional landscape. Third, coaches provided individualized advice, assessed trajectory, and guided feedback interpretation. Lastly, students applied skills of soliciting and responding to feedback and creating learning goals, originally learned through coaching experience. Conclusions Coaching relationships, grounded in trust, evolve to meet students’ changing needs as they grow into physicians. Students apply feedback and goal-setting skills learned with the coach in clinical settings with other supervisors.

Examining enablers and barriers to entrustable professional activity acquisition using the theoretical domains framework: A qualitative framework analysis study.

Without a clear understanding of the factors contributing to the effective acquisition of high-quality entrustable professional activity (EPA) assessments, trainees, supervising faculty, and training programs may lack appropriate strategies for successful EPA implementation and utilization. The purpose of this study was to identify barriers and facilitators to acquiring high-quality EPA assessments in Canadian emergency medicine (EM) training programs. We conducted a qualitative framework analysis study utilizing the Theoretical Domains Framework (TDF). Semistructured interviews of EM resident and faculty participants underwent audio recording, deidentification, and line-by-line coding by two authors, being coded to extract themes and subthemes across the domains of the TDF. From 14 interviews (eight faculty and six residents) we identified, within the 14 TDF domains, major themes and subthemes for barriers and facilitators to EPA acquisition for both faculty and residents. The two most cited domains (and their frequencies) among residents and faculty were environmental context and resources (56) and behavioral regulation (48). Example strategies to improving EPA acquisition include orienting residents to the competency-based medical education (CBME) paradigm, recalibrating expectations relating to "low ratings" on EPAs, engaging in continuous faculty development to ensure familiarity and fluency with EPAs, and implementing longitudinal coaching programs between residents and faculty to encourage repetitive longitudinal interactions and high-quality specific feedback. We identified key strategies to support residents, faculty, programs, and institutions in overcoming barriers and improving EPA assessment processes. This is an important step toward ensuring the successful implementation of CBME and the effective operationalization of EPAs within EM training programs.

Does Positive Psychology Coaching Improve Trainee Well-Being? Evidence from a Longitudinal Professional Development Coaching Program in a Cohort of Pediatric Trainees

Introduction: Trainee burnout is common and evidence supporting the effectiveness of well-being interventions for this population is limited. We studied the effect of a longitudinal coaching program grounded in positive psychology on measures of pediatric trainee well-being.

The power of stories: Supporting professional identity transitions through longitudinal coaching.

Farrell details the importance of coaches developing a shared conceptualization of identity and willingingness to cede control of discussion to allow for the emergence of creative and open conversations with coachees.

A Portfolio Coach-Informed Professional Development Framework.

A majority of US medical schools have incorporated faculty coach-supported educational portfolios into the curriculum. Existing research describes coach professional development, competencies, and program perceptions. However, limited research exists on how programs address coach professional development needs. Our sequential objectives were to (1) explore faculty coach professional development experiences within medical student coaching programs and (2) develop a preliminary framework for medical faculty coach professional development. Faculty portfolio coaches who completed 4 years of a longitudinal coaching program were recruited to complete a semi-structured exit interview. Interviews were transcribed using detailed transcription. Two analysts inductively generated a codebook of parent and child codes to identify themes. They compared themes to the professional development model proposed by O'Sullivan and Irby. Of the 25 eligible coaches, 15 completed the interview. Our team organized themes into two broad domains paralleling the established model: program-specific professional development and career-relevant professional development. Four program-specific professional development themes emerged: doing; modeling; relating; and hosting. Three career-relevant professional development themes emerged: advancement; meaning; and understanding. We then applied themes within each domain to propose strategies to optimize coach professional development and develop a framework modeled after O'Sullivan and Irby. To our knowledge, we propose the first portfolio coach-informed framework for professional development. Our work builds on established standards, expert opinion, and research responsible for portfolio coach professional development and competencies. Allied health institutions with portfolio coaching programs can apply the framework for professional development innovation.

Goal co-construction and dialogue in an internal medicine longitudinal coaching programme.

Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships. This was a qualitative study using interpretive description methodology. Eight internal medicine coach-resident dyads consented to audiotaping coaching meetings over a 1-year period. Transcripts from meetings and individual exit interviews were analysed thematically using goal co-construction as a sensitising concept. Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co-construction mainly occurred in how to meet goals, rather than in prioritising goals or co-constructing new goals. In analysing goal development in the coach-resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage-specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co-regulation and reflection on both clinical competencies and professional identity formation.

“It’s All About the Trust And Building A Foundation:” Evaluation of a Longitudinal Medical Student Coaching Program

Problem Coaching is increasingly implemented in medical education to support learners’ growth, learning, and wellbeing. Data demonstrating the impact of longitudinal coaching programs are needed. Intervention We developed and evaluated a comprehensive longitudinal medical student coaching program designed to achieve three aims for students: fostering personal and professional development, advancing physician skills with a growth mindset, and promoting student wellbeing and belonging within an inclusive learning community. We also sought to advance coaches’ development as faculty through satisfying education roles with structured training. Students meet with coaches weekly for the first 17 months of medical school for patient care and health systems skills learning, and at least twice yearly throughout the remainder of medical school for individual progress and planning meetings and small-group discussions about professional identity. Using the developmental evaluation framework, we iteratively evaluated the program over the first five years of implementation with multiple quantitative and qualitative measures of students’ and coaches’ experiences related to the three aims. Context The University of California, San Francisco, School of Medicine, developed a longitudinal coaching program in 2016 for medical students alongside reform of the four-year curriculum. The coaching program addressed unmet student needs for a longitudinal, non-evaluative relationship with a coach to support their development, shape their approach to learning, and promote belonging and community. Impact In surveys and focus groups, students reported high satisfaction with coaching in measures of the three program aims. They appreciated coaches’ availability and guidance for the range of academic, personal, career, and other questions they had throughout medical school. Students endorsed the value of a longitudinal relationship and coaches’ ability to meet their changing needs over time. Students rated coaches’ teaching of foundational clinical skills highly. Students observed coaches learning some clinical skills with them – skills outside a coach’s daily practice. Students also raised some concerns about variability among coaches. Attention to wellbeing and belonging to a learning community were program highlights for students. Coaches benefited from relationships with students and other coaches and welcomed the professional development to equip them to support all student needs. Lessons Learned Students perceive that a comprehensive medical student coaching program can achieve aims to promote their development and provide support. Within a non-evaluative longitudinal coach relationship, students build skills in driving their own learning and improvement. Coaches experience a satisfying yet challenging role. Ongoing faculty development within a coach community and funding for the role seem essential for coaches to fulfill their responsibilities.

Effects of Longitudinal Coaching on Relationships and Feedback Processes in Pediatric Subspecialty Fellowships-An Interpretive Description Study.

Coaching in graduate medical education provides a facilitative approach to feedback as well as opportunities for residents and fellows to engage with feedback and develop individualized improvement goals. To explore the roles and actions of successful coaches in longitudinal coaching relationships and how they enable feedback processes. Using interpretive description methodology, we performed semi-structured interviews with pediatrics fellows (n=11), faculty coaches (n=9), and program directors (n=2) from 2 pediatric subspecialty fellowship training programs at Ann and Robert H. Lurie Children's Hospital of Chicago. Both training programs had previously implemented longitudinal clinical coaching programs. Interview questions aimed to explore the roles and impacts of coaches within a longitudinal coaching program. Interviews took place in 2019 and 2020. We identified 4 major actions to the coaching role in longitudinal coaching relationships: (1) establish the coach-fellow relationship; (2) prepare for the coaching conversation; (3) facilitate feedback dialogue; and (4) serve as the go-to person to raise uncomfortable issues. Additionally, nearly all participants expressed support for a longitudinal coaching program to support fellows' growth and development of personalized learning goals. By fulfilling these 4 key aspects to the coaching role, coaches in longitudinal relationships with coachees enable feedback processes.

Abstract 49: Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda

Abstract Purpose: As access to cancer care expands in sub-Saharan Africa, it is essential to develop strategies to examine and improve cancer care quality. We designed and implemented a quality improvement (QI) training and mentorship program for clinicians at Butaro Cancer Center of Excellence (BCCOE) in Rwanda to foster a culture of continual improvement. We report our early experience. Methods: The BCCOE QI curriculum was adapted from programs from Dana-Farber Cancer Institute and Partners In Health-Rwanda and included didactic training, mentored QI projects and leadership development. Prior to the program, staff QI needs, experiences and perspectives were assessed through two focus group discussions (FGDs) with 18 participants. Written surveys assessed staff QI self-efficacy and knowledge immediately before and after a one-day training. Three BCCOE clinicians selected as QI mentors received an additional 3-day intensive training and longitudinal coaching by Rwanda- and US-based QI coaches. Mentors worked with clinician colleagues and coaches to identify quality gaps and devise and implement metric-based QI projects. Results: FGD participants expressed eagerness to engage in QI efforts but identified challenges to QI implementation, including insufficient time, staff and financial resources. Forty oncology staff members (70% nurses) participated in one-day didactic trainings; 37 completed pre- and post-surveys. Perceived QI knowledge, confidence applying QI methods, and perception of adequate time for QI improved after the training (p<0.001 for all using paired t-tests). Mean performance on knowledge assessment items increased from 64% to 73% (p=0.001). Mentor-led teams designed and launched projects to: improve cancer staging/documentation before treatment; increase chemotherapy order double-checking; and reduce chemotherapy wait times. Conclusions: BCCOE's QI program has engaged oncology clinicians as QI leaders and participants, building a culture of team-based QI. Didactic training increased staff self-efficacy and knowledge, facilitating successful launch of projects. Future assessments will examine staff experience, attitudes and knowledge after project engagement. Citation Format: Fidele Sebahungu, David Tuyisenge, Lori Buswell, Olivier Habimana, Esperance Benemariya, Fred Mugabo, Aphrodis Ndayisaba, Cyprien Shyirambere, Hubert Tuyishime, Yeonsoo Sara Lee, Catherine Stauber, Jessica Cleveland, Sarah Kadish, Spyridon Potiris, Dan Gunderson, Temidayo Fadelu, Jean Bosco Bigirimana, Anatole Manzi, Lydia Pace. Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 49.

Improving diagnosis by feedback and deliberate practice: one-on-one coaching for diagnostic maturation.

Reflective practice is essential for the ongoing maturation of clinicians and requires regular self-evaluation in association with ongoing mentoring and feedback. Currently, most resident physicians do not have access to educational experiences that fulfill these needs. We present a novel model for structured one-on-one longitudinal coaching using the principles of deliberate practice to improve diagnostic skills. This is an easily implementable educational model that can be replicated inresidencies across the country to improve clinical reasoning. Skills learned through this program have the potential not only to bolster the academic approach to patients but to also directly improve the clinical assessment and care of patients under the trainee's care.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.

You can have both: Coaching to promote clinical competency and professional identity formation.

Coaching is a critical tool to guide student development of clinical competency and formation of professional identity in medicine, two inextricably linked concepts. Because progress toward clinical competence is linked to thinking, acting and feeling like a physician, a coach’s knowledge about a learner’s development of clinical skills is essential to promoting the learner’s professional identity formation. A longitudinal coaching program provides a foundation for the formation of coach-learner relationships built on trust. Trusting relationships can moderate the risk and vulnerability inherent in a hierarchical medical education system and allow coaching conversations to focus on the promotion of self-regulated learning and fostering skills for life-long learning. Herein, we describe a comprehensive, longitudinal clinical coaching program for medical students designed to support learners’ professional identify formation and effectively promote their emerging competence.

Graduating With Honors in Resilience: Creating a Whole New Doctor.

BackgroundAlthough coaching programs have become a prominent piece of graduate medical education, they have yet to become an integral part of undergraduate medical education. A handful of medical schools have utilized longitudinal coaching experiences as a method for professional identity formation, developing emotional intelligence and leadership.ObjectiveWe developed A Whole New Doctor (AWND), a medical student leadership development and coaching program at Georgetown University, with the aim of fostering resilience, leadership, and emotional intelligence at the nascent stage of physician training. To our knowledge, ours is the only program that is largely student-managed and uses certified executive coaches in the medical student population.MethodsCohort 1 of AWND started in October 2016. For each cohort, we hold a kickoff workshop that is highly interactive, fast-paced and covers coaching, complex thinking, reflective writing, and a coaching panel for Q&A. Following the workshop, students work with coaches individually to address self-identified weaknesses, tensions, and areas of conflict. We believe the program’s student-driven nature provides a new structural approach to professional development and leadership programs, offering students a simultaneously reflective and growth-oriented opportunity to develop essential non-technical skills for physician leaders.ResultsOf the 132 students in the program, 107 have worked with one of our coaches (81%). Student testimonials have been uniformly positive with students remarking on an increased sense of presence, improvements in communication, and more specific direction in their careers.ConclusionOur pilot coaching program has received positive feedback from students early in their medical training. It will be important to further scale the program to reach an increasing number of students and quantitatively evaluate participants for the long-term effects of our interventions.

Fostering a Feedback Mindset: A Qualitative Exploration of Medical Students' Feedback Experiences With Longitudinal Coaches.

Feedback is important for medical students' development. Recent conceptualizations of feedback as a dialogue between feedback provider and recipient point to longitudinal relationships as a facilitator of effective feedback discussions. This study illuminates how medical students experience feedback within a longitudinal relationship with a physician coach. In this qualitative study, second-year medical students from the University of California, San Francisco, School of Medicine participated in semistructured interviews that explored their experiences discussing feedback within longitudinal, nonevaluative coaching relationships. Interviews occurred between May and October 2018. Interview questions addressed students' experiences receiving feedback from their coach, how and when they used this feedback, and how their relationship with their coach influenced engagement in feedback discussions. Interviews were analyzed using constructivist grounded theory. Seventeen students participated. The authors identified 3 major themes. First, students' development of a feedback mindset: Over time, students came to view feedback as an invaluable component of their training. Second, setting the stage for feedback: Establishing feedback routines and a low-stakes environment for developing clinical skills were important facilitators of effective feedback discussions. Third, interpreting and acting upon feedback: Students described identifying, receiving, and implementing tailored and individualized feedback in an iterative fashion. As students gained comfort and trust in their coaches' feedback, they reported increasingly engaging in feedback conversations for learning. Through recurring feedback opportunities and iterative feedback discussions with coaches, students came to view feedback as essential for growth and learning. Longitudinal coaching relationships can positively influence how students conceptualize and engage in feedback discussions.

From strategy to action: a qualitative study on salient factors influencing knowledge transfer in project-based experiential learning in healthcare organisations in Kenya

ObjectivesKnowledge transfer is recognised as a key determinant of organisational competitiveness. Existing literature on the transfer of knowledge and skills imply diminutive return on investment in training and development due...

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.

Fostering medical students' lifelong learning skills with adashboard, coaching and learning planning.

IntroductionTo develop lifelong learning skills, students need feedback, access to performance data, and coaching. A new medical curriculum incorporated infrastructural supports based on self-regulated learning theory and the Master Adaptive Learner framework to engage students in reflection and learning planning. This study examines students’ experience with a performance dashboard, longitudinal coaching, and structured time for goal-setting.MethodsFocus groups with first-year medical students explored performance dashboard usage, coaching and learning planning. We analyzed findings using thematic analysis. Results informed development of a 29-item survey rated strongly disagree (1) to strongly agree (5) to investigate experience with the dashboard, coaching and learning goals program. The survey was distributed to one first-year medical student class. We performed descriptive statistics and factor analysis.ResultsIn three focus groups with 21 participants, students endorsed using the dashboard to access performance information but had trouble interpreting and integrating information. They valued coaches as sources of advice but varied in their perceptions of the value of discussing learning planning. Of 152 students, 114 (75%) completed the survey. Exploratory factor analysis yielded 5 factors explaining 57% of the variance: learning goals development (α = 0.88; mean 3.25 (standard deviation 0.91)), dashboard usage (α = 0.82; 3.36 (0.64)), coaching (α = 0.71; 3.72 (0.64)), employment of learning strategies (α = 0.81; 3.67 (0.79)), and reflection (α = 0.63; 3.68 (0.64)).DiscussionThe student performance dashboard provides efficient feedback access, yet students’ use of this information to guide learning is variable. These results can inform other programs seeking to foster lifelong learning skills.Electronic supplementary materialThe online version of this article (10.1007/s40037-018-0449-2) contains supplementary material, which is available to authorized users.

Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

ObjectivesTo gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors...

Differentiated coaching: developmental needs of coachees

Purpose– The purpose of this paper is to focus on teacher coachees’ perceptions of why some coaching goals (selected by coaches or coachees) were more achievable than others and how this knowledge might advance a coaching culture that has the potential for sustainable improvements to teaching and learning.Design/methodology/approach– As educators, the authors took a constructivist approach to grounded theory because the authors believe learning is socially constructed. The relationship between coach and coachees is underpinned by their constructed meanings and co-constructed learning. constructivist grounded theory (Charmaz, 1996) requires researchers not to start with a theory or hypothesis but to engage with data in a manner (coding, categorising, theorising) that allows for a theoretical understanding to emerge. In total, 22 teacher coachees from one school participated in this research. They were asked to complete an online questionnaire about their coaching experiences, speculating about why some goals (related to improving student reading, writing, speaking and listening, and math) were more achievable than others. One of the researchers had been a coach in the school, but not at the time of the research. Nonetheless online questionnaires were used as they offered teacher coachees anonymity to share their lived experiences (Charmaz, 2006). This data collection method also assisted in limiting accidental leading by an interviewer (Charmaz, 2006).Findings– The investigation into longitudinal coaching (one to six years) indicated how coachees positioned themselves or peers, when reflecting on and seeking to establish why some coaching goals were more achievable than others. Coachees clustered around one of the following themes: Pragmatic I, Pragmatic We, Student Driven, Team Driven, Data Driven, Research Driven. Theorising within and across themes highlighted that while coachees shared the same concerns, they differed in terms of how much they each focused on them. This allowed the authors to gauge the intensity of the concern (dominate, moderate or slight) for each participant. Notwithstanding the overlap, the seventh theme (temporality) serendipitously aligned with their exposure to coaching. Differentiated models of coaching appears to be a way to establish a coaching culture as multiple models could be responsive to divergent coachees’ learning needs. In doing so it is more likely to support sustainable improvements in teaching and learning.Research limitations/implications– The sample size (n=22) was appropriate for an in-depth analysis which allowed an understanding of coaching from the coachees’ first-hand experiences although it does limit generalisability. Another limitation is that coachees were not asked about teaching experience, hence the relationship between years of teaching and coaching exposure was not analysed. This is something that the authors feel now needs to be included in further research. Implications of the findings are that instructional coaches within schools may need to be more cognisant of the developmental stages and therefore differentiated needs of teacher coachees. This is particularly so if the aim is to promote sustainable pedagogical improvement.Originality/value– This is a case study of the effects of longitudinal coaching (one to six years) in a school where all teachers are involved in being coached.