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Coaching Residents

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On the job coaching of residents seems an effective way to prevent burn-out and to help them adapt to a demanding job. Foreest Medical School ran a pilot in 2007/8 and has now successfully implemented ...

On the job coaching of residents seems an effective way to prevent burn-out and to help them adapt to a demanding job. Foreest Medical School ran a pilot in 2007/8 and has now successfully implemented coaching for residents.

Presented in Prague, at AMEE Congress 2008.

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  • The introduction of the CanMeds model and competence based learning in the past few years not only set out new learning paths for young students. It also appealed to doctors to improve their skills in certain domains. Still, supervisors are not always ready to adopt all new teaching methods. More and more often they become aware of their lack of knowledge in certain domains, like communication, professional or collaboration. Of course, there are the “Teach the Teacher training programmes”, in which supervisors can acquire necessary skills required for their function in the education of residents. These basic skills do not always meet the needs of the resident and the supervisor when confronted with more complicated problems. In the Alkmaar Medical Centre, we share the opinion that dealing with these more complicated personal or professional problems cannot be taken as a primary competence for the supervising medical specialist. Therefore we introduced the concept of a personal coach.
  • The personal coach focuses on three specific CanMed-roles: Being: Communicator Collaborator Professional If there appears a problem in one of these domains, the supervisor or the resident can contact the coach directly to start a tailor made training or coaching.
  • Of course, no one calls our coach with the question “Can you please help our resident to become a better collaborator”. Goals are often more personal, like these examples These issues are mostly brought up by professors, and are linked to the problems they experience with their assistant in their daily work or the educating process.
  • These are the Goals set after intake.
  • Broadly speaking, we work by these steps After the first call, mostly by the teaching specialist, immediate action is taken. Resident and teaching specialist at this point are highly motivated to do something about their problem. Most of the times they have waited until the problem is highly urgent. Also motivation for a coaching process is necessary. The individual intake sessions combined with a session with the teaching specialist and resident together to see their interaction and to give them the opportunity to speak openly about the problems. In most cases an observation on the job is part of the intervention. The coach puts on a white coat and presents herself to patients as a student. The observations and feedback are part of the coaching sessions. These take place once per 3 weeks. The whole process is evaluated. In some cases an external training was necessary. Also role-playing with an actor can be arranged in one of these sessions.
  • After setting goals, perspectives and opportunities an intervention is chosen. As you can see different interventions can be used. Communication training with actor, individual or an external training (at training company, in groups)
  • We got 12 applications Two residents quit before the intake procedure was started. All others continued the full procedure.
  • Back to the CanMeds roles. At first sight, most problems seemed related to communication-problems. After the intake procedure with a professional coach, only 3 issues were categorized as “also communication issues”. All ten issues were mainly related to professional role and 8 of those were also about collaboration skills.
  • As said, 2 residents who initially were meant to start the program never started an intake procedure. As for them we see no changes in job satisfaction. One participant realized the job she was in, wasn’t the job she wanted for live. So she quit her job. In terms of job satisfaction, this is a decrease. When we look at the positive results of the coaching sessions, she was glad to discover this in an “early” stage of her job. And of course we are proud to conclude that 9 residents are now more satisfied with the way they work. These results monitored in the evaluation session that took place with the assistant as well as the educating doctor.
  • We won’t promise you a rose garden. There are some risks. Especially those two were seen. The coach is not a judge or advisor in those processes. He or she should always be alert to stay objective.
  • Gender aspects: do women ask for help more easy and often? And if so, what interventions can “attract” men? Speciality related aspects: do certain specialities (i.e. obstetrics, pediatrics) ask for coaching more often than others (i.e. surgery, psychiatry)? What are the differences in results between individual and group interventions.

Coaching Residents Presentation Transcript

  • 1.
    • Judith Wagter MA, Caroline Buis MSc
    • Marina Eckenhausen MD PhD
  • 2. Challenges in Residency Training The Added Value of Individual Coaching in the Working Place An observational study
  • 3.
      • Background
      • Results
      • Concluding remarks
      • Future studies
    Challenges in Residency Training
  • 4.
      • Background
      • Results
      • Concluding remarks
      • Future studies
    Challenges in Residency Training
  • 5. Challenges in Residency Training
  • 6.
    • communicator
    • collaborator
    • professional
    Tailor made training of roles Challenges in Residency Training
  • 7.
    • “ There are complaints about the way this resident communicates with the nurses.”
    • “ He is often perceived as an arrogant person.”
    • “ She needs to learn how to cope with stress and the workload.”
    • “ I need to learn how to present myself as a medical specialist.”
    ‘ Questions’ at intake Challenges in Residency Training
  • 8.
    • “ I’d like to be more self-secure in discussions with nursing teams.”
    • “ I need to learn how to structure my work and give myself the opportunity to learn in this new job.”
    • “ I need to be more self-secure and I want to be able to remain strong in difficult decisions.”
    Goals set after intake Challenges in Residency Training
  • 9.
    • Intake 3 sessions (0,5hrs. each)
        • Teaching specialist / supervisor
        • Resident
        • Together
    • Intervention
        • Observation & feedback on the job (0,5 day)
        • 3 coaching sessions (3 x 1,5hrs.)
        • Role-playing (if necessary)
    • Evaluation
    Procedure Challenges in Residency Training
  • 10.
    • Diagnosis
    • Miscommunication with patients
    • Conflicts with other professionals
    • Extreme perfectionism
    • Insecurity
    • Adaptation to new job
    • Intervention
    • Guidance in practice
    • Individual coaching
    • Communication training
    • Role-playing with actor
    Diagnosis and interventions Challenges in Residency Training
  • 11.
      • Background
      • Results
      • Concluding remarks
      • Future studies
    Challenges in Residency Training
  • 12. N = 10 Results Challenges in Residency Training Gender Men Women 4 6 Mean coaching period Differs: varied between X months to Y months Specialities Surgery 2 Pediatrics 2 Internal Medicine 2 Other 4
  • 13. N = 10 Issues behind the question Challenges in Residency Training 10 questions were about professional behaviour 8 questions were also about collaboration skills 3 were also communication-issues Professional Collaborator Communicator
  • 14.
    • Participants reported
    • a high satisfaction on working methods used
    • a positive outcome in their function.
    • Word of mouth publicity resulted in an increase of spontaneous enrolments.
    High satisfaction Challenges in Residency Training Results Job satisfaction increased 9 Job satisfaction decreased 1
  • 15.
      • Background
      • Results
      • Concluding remarks
      • Future studies
    Challenges in Residency Training
  • 16.
    • Professional, objective and neutral coach:
    • Observation by coach has no influence on appraisal.
    • Coach is not a role model.
    • Breaks with negative trends in thinking and behaviour. (‘Everything I say will be used against me.’)
    • Skilled in asking, listening and specifying.
    Critical success factors Challenges in Residency Training
  • 17.
    • Coach has to be aware of the risks:
      • Becoming part of a dismissal process
      • Being forced to judge in promotion or degradation process
    Challenges in Residency Training
  • 18.
      • Background
      • Results
      • Conclusions
      • Future studies
    Challenges in Residency Training
  • 19. Future Studies
    • Gender aspects
    • Speciality related aspects
    • Differences between individual and group interventions
    Challenges in Residency Training
  • 20. Challenges in Residency Training