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

Tips for developing a coaching program in medical education

This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

Implementation and Outcomes of an Academic Peer Coaching Program for Pediatric Residents

Introduction Academic coaching fosters self-directed learning and is growing in popularity within residency programs. Implementation is often limited by available faculty time and funding. Peer coaching is an emerging alternative but is not well studied. This study aims to demonstrate the acceptability, feasibility, and efficacy of a resident peer coaching program. Methodology In the 2021-2022 academic year, within a large pediatric residency program, we selected and trained senior residents as coaches and interns who opted in as coachees. Coaching dyads began meeting in the fall and worked toward individualized goals throughout the year; control interns participated in routine didactics. Outcomes included Accreditation Council for Graduate Medical Education (ACGME) milestone scores and a self-assessment survey (SAS). Results We enrolled 15/42 (36%) interns as coachees, with the remaining 27 (64%) as controls. Narrative feedback from coaches and coachees was overall positive, and time commitment was feasible for program staff (10-12 hours/month), coaches (three to four hours/month), and coachees (one to two hours/month) with minimal financial needs. Post-intervention, more coachees than controls scored ≥4.0 on ACGME milestones systems-based practice 3 (SBP3; 3/15, 20%, vs. 2/27, 7%), SBP4 (4/15, 27%, vs. 5/27, 19%), and practice-based learning and improvement 1 (4/15, 27%, vs. 3/27, 11%). SAS response rate was 8/15 (53%) for coachees and 5/27 (19%) for controls. More coachees than controls reported baseline difficulty with time management often (3/8, 38%, vs. 1/5, 20%); only coachees improved post-intervention, with 0/8 (0%) having difficulty often versus 2/5 (40%) of controls. Conclusions Resident peer coaching is acceptable and feasible to implement. Coachees reported more improvement in time management than controls, and ACGME milestone scores suggest improved use of evidence-based medicine and interprofessional care coordination among coachees.

Impact of a coaching program on resident perceptions of communication confidence and feedback quality

BACKGROUND

While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback.

METHODS

The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis.

RESULTS

The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas.

CONCLUSIONS

These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.

Improved Patient Outcomes and Pediatric Resident Performance With a Parent and Faculty Communication Coaching Curriculum

Communication skills are an important part of patient care, but an often neglected part of residency training. Longitudinal active coaching of communication has the potential to effectively improve communication curricula. A novel communication coach curriculum was implemented with approximately half of a pediatric residency class. Residents were coached by both a parent and faculty coach on multiple occasions throughout their intern year. Effectiveness was evaluated through self-assessment, direct observation, chart review, and follow-up phone calls with families. This longitudinal communication coach curriculum was well-received and resulted in increased self-awareness of communication skills. Coachable behaviors improved in intervention residents, and their patients spoke more positively of their experiences with communication. Additionally, these patients were less likely to be readmitted than patients cared for by control residents. A longitudinal communication coaching model is a feasible and effective curriculum for pediatric residents.

"It's All About the Trust And Building A Foundation:" Evaluation of a Longitudinal Medical Student Coaching Program

Coaching is increasingly implemented in medical education to support learners' growth, learning, and wellbeing. Data demonstrating the impact of longitudinal coaching programs are needed.

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.

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.

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.

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.

A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills

Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation

PURPOSE

Coaching programs have been implemented in medical education to improve skill development and feedback for trainees. As more faculty take on coaching roles, it is critical to understand how being a coach affects faculty as well as trainees. This study examined the effects of coaching residents on faculty members' relationships, learning, and professional identity formation (PIF), as they move through intersecting communities across landscapes of practice.

METHOD

From July 2020 to January 2021, the authors conducted a mixed-methods study of current and former coaches at 2 institutions with longitudinal pediatric resident coaching programs. They used a concurrent triangulation design in which qualitative and quantitative data were collected simultaneously and integrated during data analysis. A survey explored the impact of coaching on faculty members' learning, relationships, and PIF, and semistructured interviews further examined coaches' experiences. The interview transcripts were analyzed inductively guided by the sensitizing principles of PIF and landscapes of practice.

RESULTS

Of 43 eligible coaches, 32 (74%) completed the survey, and 18 completed interviews. Four themes emerged from the interviews. (1) Coaches' relationships supported belonging in multiple communities. (2) Coaching enabled multidimensional learning. (3) Relationships served as mechanisms of learning for coaches. (4) Coaches' relationships and learning catalyzed PIF. Furthermore, there was a significant difference in the effects of coaching on career growth by faculty rank ( P = .02). Coaches' strengthened PIF increased a sense of purpose, meaning, and professional fulfillment, and inspired new career directions. Survey data further supported these findings.

CONCLUSIONS

Being a coach deepened faculty members' professional identities through their varied relationships, multidimensional learning, and sense of belonging in intersecting communities. This study introduces a framework to understand the factors mediating coaches' PIF and highlights how investing in coaching leads to important benefits for coaches.

Patient involvement in assessment of postgraduate medical learners: A scoping review

CONTEXT

Competency-based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent.

METHODS

We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment.

RESULTS

We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand-alone group or part of a multi-source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise.

CONCLUSION

Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading-comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way.

Teaching and Assessing Communication Skills in Pediatric Residents: How Do Parents Think We Are Doing?

OBJECTIVE

Curricula designed to teach and assess the communication skills of pediatric residents variably integrates the parent perspective. We compared pediatric residents' communication skills in an objective structured clinical exam (OSCE) case as assessed by Family Faculty (FF), parents of pediatric patients, versus standardized patients (SP).

METHODS

Residents participated in an OSCE case with a SP acting as a patient's parent. We compared resident performance as assessed by FF and SP with a behaviorally-anchored checklist. Items were rated as not done, partly done or well done, with well-done indicating mastery. The residents evaluated the experience.

RESULTS

42 residents consented to study participation. FF assessed a lower percentage of residents as demonstrating skill mastery as compared to SP in 19 of the 23 behaviors. There was a significant difference between FF and SP for Total Mastery Score and Mastery of the Competency Scores in three domains (Respect and Value, Information Sharing and Participation in Care and Decision Making). The majority of residents evaluated the experience favorably.

CONCLUSION

Involving parents of pediatric patients in the instructive and assessment components of a communication curriculum for pediatric residents adds a unique perspective and integrates the true stakeholders in parent-physician communication.

Immersive virtual reality simulated learning environment versus role-play for empathic clinical communication training

Introduction

The use of immersive virtual reality simulated learning environments (VR SLEs) for improving clinical communication can offer desirable qualities including repetition and determinism in a safe environment. The aim of this study was to establish whether the mode of delivery, VR SLE versus clinical role‐play, could have a measurable effect on clinical empathic communication skills for MRI scenarios.

Methods

A split‐cohort study was performed with trainee practitioners (n = 70) and qualified practitioners (n = 9). Participants were randomly assigned to four groups: clinician VR (CVR), clinician role‐play (CRP), trainee VR (TVR), and trainee RP (TRP). Clinical communication skills were assessed using two methods: firstly, a self‐reported measure – the SE‐12 communication questionnaire and, secondly, a training and assessment tool developed by a panel of experts.

Results

Participants in the VR trainee (TVR) and clinician (CVR) groups reported 11% (P < 0.05) and 7.2% (P < 0.05) improvements in communication confidence post training, whereas trainees assigned to the role‐play (TRP) intervention reported a 4.3% (P < 0.05) improvement. Empirical assessment of communication training scores assessing a participant’s ability to select empathic statements showed the TVR group performed 5% better on average than their role‐play counterparts (P < 0.05).

Conclusion

The accuracy of participant's selection of appropriate empathic responses was shown to differ significantly following the training intervention designed to improve interactions with patients that present for an MRI scan. The results may demonstrate the capacity for immersion into an emotional narrative in a VR environment to increase the user’s susceptibility for recalling and selecting empathic terminology.

Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study

BACKGROUND

Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual).

METHODS

We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed.

RESULTS

Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future.

CONCLUSIONS

In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.

A Training Intervention through a 360° Multisource Feedback Model

Physicians and other health sciences professionals need continuous training, not only in technical aspects of their activity but also in nontechnical, transversal competencies with a cost-efficient impact on the proper functioning of healthcare. The objective of this paper is to analyze the behavioral change among health professionals at a large public hospital following a training intervention on a set of core nontechnical competencies: Teamwork, Adaptability-Flexibility, Commitment-Engagement, Results Orientation, and Leadership Skills for Supervisors. The 360° Multisource Feedback (MSF) model was applied using three sources of information: supervisors, co-workers, and the workers themselves (self-assessment). A quasi-experimental pretest–post-test single-group design with two points in time was utilized. The training intervention improved the scores of only one of the trained competencies—the “Results Orientation” competency—although the scores were slightly inflated. Moreover, significant discrepancies were detected between the three sources, with supervisors awarding the highest scores. The magnitude of behavioral change was related to certain sociodemographic and organizational variables. The study was not immune to the ceiling effect, despite control measures aimed at avoiding it. The empirical evidence suggests that the 360° MSF model must be maintained over time to enhance and reinforce an evaluation culture for better patient care.

A Qualitative Exploration of the Intern Experience in Assessing Medical Student Performance

BACKGROUND

Interns play a key role in medical student education, often observing behaviors that others do not. Their role in assessment, however, is less clear. Despite accreditation standards pertaining to residents' assessment skills, they receive little guidance or formal training in it. In order to better prepare residents for their role in medical student assessment, we need to understand their current experience.

OBJECTIVE

We aimed to describe the first-year resident experience assessing students' performance and providing input to faculty for student clinical performance assessments and grades in the inpatient setting.

METHODS

Pediatric interns at Children's National Hospital (CN) from February 2018 to February 2019 were invited to participate in semistructured interviews about their experience assessing students. Constant comparative methodology was used to develop themes. Ten interviews were conducted, at which point thematic saturation was reached.

RESULTS

We identified 4 major themes: 1) Interns feel as though they assess students in meaningful, unique ways. 2) Interns encounter multiple barriers and facilitators to assessing students. 3) Interns voice varying levels of comfort and motivation assessing different areas of student work. 4) Interns see their role in assessment limited to formative rather than summative assessment.

CONCLUSIONS

These findings depict the intern experience with assessment of medical students at a large pediatric residency program and can help inform ways to develop and utilize the assessment skills of interns.

Look Who's Talking: A Survey of Pediatric Program Directors on Communication Skills Education in Pediatric Residency Programs

OBJECTIVE

To determine current practices for communication skills curriculum and assessment in pediatric residency programs and to identify programs' greatest needs regarding communication curricula and assessment.

METHODS

We surveyed pediatric residency program directors about their programs' approach to teaching and assessing residents' communication skills and how satisfied they were with their curricula and assessment of competence. Respondents were asked about their programs' greatest needs for teaching and assessing communication skills.

RESULTS

Response rate was 41% (82/202). Most programs did teach communication skills to residents; only 14% provided no formal training. Programs identified various 1) educational formats for teaching communication skills, 2) curricular content, and 3) assessment methods for determining competence. Many programs were less than satisfied with their curriculum and the accuracy of their assessments. The greatest programmatic need regarding curricula was time, while the greatest need for assessment was a tool.

CONCLUSIONS

While teaching and assessment of communication skills is common in pediatric residency programs, it is inconsistent and variable, and many programs are not satisfied with their current communication training. There is need for development of and access to appropriate and useful curricula as well as a practical tool for assessment which has been evaluated for validity evidence.