1
|
Hill S, Carranco S, LugoMorales A, Rayburn WF. Obstetrician-Gynecologist Hospitalists as Educators. Obstet Gynecol Clin North Am 2024; 51:503-515. [PMID: 39098777 DOI: 10.1016/j.ogc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
The progressive growth of the hospitalist model of practice over the past 20 years has solidified the role of the obstetrics and gynecology (ob/gyn) hospitalists as an essential component of quality inpatient care. The ob/gyn hospitalist as an educator is proving to be an important role in the future of hospitalist practice. The role as an educator has long-term benefits and implications for the standardization of education and evidence-based patient care both in community-based and academic practice settings.
Collapse
Affiliation(s)
- Sheila Hill
- Division of Hospitalist Medicine, Department of Obstetrics & Gynecology, Baylor College of Medicine, Texas Children's Pavilion for Women, 6651 Main Street, Suite 1060, Houston, TX 77030, USA.
| | - Sara Carranco
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Andrea LugoMorales
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX 77030, USA
| | - William F Rayburn
- Department of Obstetrics and Gynecology, Medical University of South Carolina, 268 Calhoun Street, Charleston, SC 29425, USA
| |
Collapse
|
2
|
García Bolado A, Castanedo Vázquez D. Coaching in a Radiology department. RADIOLOGIA 2024; 66:374-380. [PMID: 39089797 DOI: 10.1016/j.rxeng.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/16/2023] [Indexed: 08/04/2024]
Abstract
Coaching is an effective tool that seeks personal reflection as a way for people to find their own solutions. In this article we show our results when applying it in our Radiology Service. The article includes a bibliographic review on its potential applications in Medicine and in Radiology. We specifically reviewed the fields of improving self-care and preventing burnout as well as the teaching field, both for residents in training and for certified radiologists.
Collapse
Affiliation(s)
- A García Bolado
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - D Castanedo Vázquez
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| |
Collapse
|
3
|
Gala P, Ponatshego P, Bogart LM, Youssouf N, Ramotsababa M, Van Pelt AE, Moshomo T, Dintwa E, Seipone K, Ilias M, Tonwe V, Gaolathe T, Hirschhorn LR, Mosepele M. A mixed methods approach identifying facilitators and barriers to guide adaptations to InterCARE strategies: an integrated HIV and hypertension care model in Botswana. Implement Sci Commun 2024; 5:67. [PMID: 38902846 PMCID: PMC11188218 DOI: 10.1186/s43058-024-00603-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 06/09/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Botswana serves as a model of success for HIV with 95% of people living with HIV (PLWH) virally suppressed. Yet, only 19% of PLWH and hypertension have controlled blood pressure. To address this gap, InterCARE, a care model that integrates HIV and hypertension care through a) provider training; b) adapted electronic health record; and c) treatment partners (peer support), was designed. This study presents results from our baseline assessment of the determinants and factors used to guide adaptations to InterCARE implementation strategies prior to a hybrid type 2 effectiveness-implementation study. METHODS This study employed a convergent mixed methods design across two clinics (one rural, one urban) to collect quantitative and qualitative data through facility assessments, 100 stakeholder surveys (20 each PLWH and hypertension, existing HIV treatment partners, clinical healthcare providers (HCPs), and 40 community leaders) and ten stakeholder key informative interviews (KIIs). Data were analyzed using descriptive statistics and deductive qualitative analysis organized by the Consolidated Framework for Implementation Research (CFIR) and compared to identify areas of convergence and divergence. RESULTS Although 90.3% of 290 PLWH and hypertension at the clinics were taking antihypertensive medications, 52.8% had uncontrolled blood pressure. Results from facility assessments, surveys, and KIIs identified key determinants in the CFIR innovation and inner setting domains. Most stakeholders (> 85%) agreed that InterCARE was adaptable, compatible and would be successful at improving blood pressure control in PLWH and hypertension. HCPs agreed that there were insufficient resources (40%), consistent with facility assessments and KIIs which identified limited staffing, inconsistent electricity, and a lack of supplies as key barriers. Adaptations to InterCARE included a task-sharing strategy and expanded treatment partner training and support. CONCLUSIONS Integrating hypertension services into HIV clinics was perceived as more advantageous for PLWH than the current model of hypertension care delivered outside of HIV clinics. Identified barriers were used to adapt InterCARE implementation strategies for more effective intervention delivery. TRIAL REGISTRATION ClinicalTrials.gov, ClinicalTrials.gov Identifier: NCT05414526 . Registered 18 May 2022 - Retrospectively registered.
Collapse
Affiliation(s)
- Pooja Gala
- Department of Medicine, NYU Langone Grossman School of Medicine, New York, NY, USA.
| | - Ponego Ponatshego
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Nabila Youssouf
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mareko Ramotsababa
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
| | - Amelia E Van Pelt
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Thato Moshomo
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Evelyn Dintwa
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
| | - Khumo Seipone
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
| | - Maliha Ilias
- Center for Translation Research and Implementation Science, Department of Health and Human Services, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Veronica Tonwe
- Center for Translation Research and Implementation Science, Department of Health and Human Services, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tendani Gaolathe
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
| |
Collapse
|
4
|
Namatovu JF, Mubuuke AG, Buwembo W, Nakigudde J, Kiguli S. Stakeholder views on continuing professional development for doctors working in public primary care facilities in central Uganda: a qualitative study. Pan Afr Med J 2024; 47:97. [PMID: 38799194 PMCID: PMC11126753 DOI: 10.11604/pamj.2024.47.97.417840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction the primary care workforce in the public sector of Uganda is under the district health system. The doctors in this workforce provide leadership and frontline promotive, preventive, curative, rehabilitative, and palliative care. Their numbers are still low and therefore need effective support through continuing professional development (CPD). Part of the support is influenced by stakeholders whose views on CPD in the district health system are important. This study therefore explored the stakeholders' views on the CPD of doctors working in the district health system in central Uganda. Methods a qualitative exploratory study was done, and data was collected using an interview guide through in-depth interviews among ten purposively selected CPD stakeholders influencing different aspects of CPD activities of doctors working in public general hospitals and health center IVs. The interviews were recorded and transcribed verbatim and manually analyzed using deductive thematic analysis. Results five themes were categorized into; CPD practices, facilitators, benefits, challenges, and suggestions. Each of the themes had subthemes; CPD practices; training, mentorship and apprenticeship, support supervision, and quality improvement projects. Facilitators; internet services, grants, health facility managers, facility-based CPD providers, and regional CPD guidelines. Benefits; motivation, knowledge, teamwork, and renewal of practicing licenses. Challenges; workload, allowances, access, documentation, mindset, quality, structure of public health system, and sustainability. Suggestions; training needs analysis, collaboration, monitoring, e-CPD platforms, CPD resource centers, and individual CPD responsibility. Conclusion the stakeholders' views are an indication that effective CPD is a collaborative effort from both the primary care doctors and those in the leadership of the health care system.
Collapse
Affiliation(s)
| | | | | | - Janet Nakigudde
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Peadiatrics and Child Health, Makerere University, Kampala, Uganda
| |
Collapse
|
5
|
Sternschein R, Hayes MM, Ramani S. Eureka moments: ICU physicians' views on teaching. CLINICAL TEACHER 2024; 21:e13639. [PMID: 37641477 DOI: 10.1111/tct.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Teaching hospitals are fast-paced health care environments where clinical supervisors constantly balance teaching and patient care. Although hospital-based clinicians in acute care settings regularly teach trainees, views regarding their teaching roles and how this relates to professional satisfaction are less well studied. We explored perspectives of physicians who teach trainees in medical intensive care units (MICUs), to understand whether their engagement in teaching has any impact on professional (job) satisfaction. METHODS This qualitative study used focus groups of MICU fellows (postgraduate clinical trainees) and attending physicians (consultants) to explore participants' perceptions of their teaching roles. Focus groups were audiotaped and transcribed; thematic analysis was conducted on de-identified transcripts. FINDINGS Four focus groups were held; two with MICU attendings (n = 13) and two with MICU fellows (n = 12). We identified four key themes: two challenges of teaching (being a chameleon; calibrating learner abilities), one benefit of teaching (facilitating learners' eureka moments) and a call for professional development (peer coaching to enhance teaching skills). DISCUSSION Although teaching in acute clinical environments requires balancing dynamic learner needs and complex patient care needs, participants found it highly rewarding. They called for peer coaching initiatives to enhance professional development as teachers and demonstrate departmental commitment to teaching. CONCLUSION While teaching in acute clinical settings is challenging for many reasons, clinical teachers emphasise that it is very satisfying when learners see the 'light'. Overt institutional support and recognition for clinical teachers along with peer coaching and debriefing may tilt the balance towards the rewards side of the equation and foster professional satisfaction.
Collapse
Affiliation(s)
- Rebecca Sternschein
- Brigham and Women's Hospital Department of Medicine Boston, Boston, Massachusetts, USA
| | - Margaret M Hayes
- Beth Israel Deaconess Medical Center - Internal Medicine Boston, Boston, Massachusetts, USA
| | - Subha Ramani
- Brigham and Women's Hospital Department of Medicine Boston, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Hauer KE, Chang A, van Schaik SM, Lucey C, Cowell T, Teherani A. "It's All About the Trust And Building A Foundation:" Evaluation of a Longitudinal Medical Student Coaching Program. TEACHING AND LEARNING IN MEDICINE 2023; 35:550-564. [PMID: 35996842 DOI: 10.1080/10401334.2022.2111570] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
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.
Collapse
Affiliation(s)
- Karen E Hauer
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anna Chang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sandrijn M van Schaik
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Catherine Lucey
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tami Cowell
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Arianne Teherani
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Selling SK, Rooholamini SN, Grow HM, McPhillips H, Hoang K, Blankenburg R, Rassbach C. The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:376-383. [PMID: 36205486 DOI: 10.1097/acm.0000000000005011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Sarah Kate Selling
- S.K. Selling is a medical student, Stanford University School of Medicine, Stanford, California
| | - Sahar N Rooholamini
- S.N. Rooholamini is assistant professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - H Mollie Grow
- H.M. Grow is associate professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Heather McPhillips
- H. McPhillips is professor, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kim Hoang
- K. Hoang is clinical assistant professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca Blankenburg
- R. Blankenburg is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Caroline Rassbach
- C. Rassbach is clinical professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
8
|
Coaching en Radiodiagnóstico. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
|
9
|
Marcus CH, Michelson CD, Luff D, Newman LR. Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1832-1840. [PMID: 35703138 DOI: 10.1097/acm.0000000000004778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Coaching in medical education is increasingly used for trainee development for a variety of skills, including improving trainee teaching skills through resident-as-teacher programs. Faculty who serve as coaches commit significant effort to the coaching role, often without protected time or support. Little is known about faculty motivations to participate in coaching programs or how the coaching experience affects the faculty. This study explored faculty coaches' motivations to participate as coaches in a resident-as-teacher rotation and the impacts they experienced as a result of their participation. METHOD In this qualitative study, authors conducted 14 semistructured interviews in 2019 with faculty coaches from a single resident-as-teacher program in Boston, Massachusetts. Authors analyzed the transcripts using thematic analysis to develop a conceptual framework. RESULTS Faculty coaches' motivations for initial participation included a sense of honor; a sense of duty; perception of competence; interest in promoting medical education; and desire for increased connectedness. These motivations all related to a larger theme of educator identity. Coaches identified 3 main impacts from participation: improvement in their own teaching, personal satisfaction from helping others and seeing improvement in their learners, and increased connectedness. These impacts affirmed the coaches' educator identity and led to ongoing motivation to participate. They also contributed to the coaches' well-being at work. CONCLUSIONS Faculty were initially motivated to participate as coaches in a resident-as-teacher rotation based on their identity as educators. The benefits achieved-improvement in own teaching, personal satisfaction, and increased connectedness-affirmed their educator identity and led to ongoing participation and increased well-being at work. These motivations and impacts are important to consider as future programs are developed and coaches are recruited for programs across undergraduate, graduate, and continuing medical education settings.
Collapse
Affiliation(s)
- Carolyn H Marcus
- C.H. Marcus is an instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Catherine D Michelson
- C.D. Michelson is assistant professor, Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Donna Luff
- D. Luff is assistant professor, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori R Newman
- L.R. Newman is assistant professor, Department of Pediatrics and Department of Education, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
10
|
Luconi F, Montoro R, Lalla L, Teferra M. An Innovative Needs Assessment Approach to Develop Relevant Continuing Professional Development for Psychiatrists. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:106-113. [PMID: 34846721 PMCID: PMC8630991 DOI: 10.1007/s40596-021-01564-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/08/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Gaps in psychiatrists' competence can interfere with the delivery of optimal patient care, particularly when these gaps have not been identified. This study aimed to assess the perceived and unperceived continuing professional development needs of psychiatrists practicing in Quebec, Canada. METHODS The authors sent an online cross-sectional survey (2018) to members of the 'Association des médecins psychiatres du Québec' and collected data on unperceived needs via the critical incident method (focused on managing challenging clinical cases/situations). Data were analyzed using descriptive statistics, chi-squared tests, thematic analysis, and triangulation of data. Two coders independently analyzed qualitative data. RESULTS Of 1150 eligible psychiatrists, 187 (16%) completed the survey. Over half were female (58%), caring for adult patients (60%), and practiced in a university hospital (49%). Top perceived and unperceived learning need areas were neurodevelopmental disorders and psychopharmacology. Three hundred forty-three factors influencing the management of reported challenges were classified as case complexity (53%), patient (22%), environment (19%), and lack of knowledge (4%). Consultation with colleagues (49%) was the most frequently accessed resource for approaching challenging cases. During the previous year and across both self-directed and group learning activities, respondents reported engaging more frequently in in-person than online activities. CONCLUSIONS A comprehensive needs assessment integrating perceived and unperceived needs is the cornerstone for planning relevant continuing professional development. The critical incident method is a useful tool to assess psychiatrists' unperceived needs. Critical reflection after solving complex clinical cases might provide an opportunity to optimize psychiatrists' selection of relevant continuing professional development.
Collapse
Affiliation(s)
- Francesca Luconi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
| | - Richard Montoro
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Leonora Lalla
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Meron Teferra
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
11
|
Elster MJ, O'Sullivan PS, Muller-Juge V, Sheu L, Kaiser SV, Hauer KE. Does being a coach benefit clinician-educators? A mixed methods study of faculty self-efficacy, job satisfaction and burnout. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:45-52. [PMID: 34406613 PMCID: PMC8371581 DOI: 10.1007/s40037-021-00676-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Coaching is a growing clinician-educator role. Self-efficacy is a powerful faculty motivator that is associated positively with job satisfaction and negatively with burnout. This study examines self-efficacy, job satisfaction, and burnout in coaches and other clinician-educators. METHODS We conducted a mixed methods study using a quantitative survey followed by qualitative interviews of faculty at the University of California, San Francisco. Coaches (funded 20% full-time equivalents), faculty with other funded education positions ("funded"), and faculty without funded education positions ("unfunded") completed a 48-item survey addressing self-efficacy (teaching, professional development, and scholarship), job satisfaction, and burnout. Data were analyzed using analysis of variance followed by post-hoc tests and chi-square tests. To elaborate quantitative results, we conducted qualitative interviews of 15 faculty and analyzed data using framework analysis. RESULTS 202 of 384 faculty (52.6%) responded to the survey; 187 complete surveys were analyzed. Teaching self-efficacy was similar across groups. Coaches and funded educators had significantly higher professional development self-efficacy and job satisfaction than unfunded educators. Burnout was more prevalent in coaches and unfunded educators. Qualitative analysis yielded three themes: sources of reward, academic identity, and strategies to mitigate burnout. Educator roles provide reward that enhances self-efficacy and job satisfaction but also generate competing demands. Coaches cited challenges in forming professional identities and working with struggling learners. DISCUSSION The coaching role provides faculty with benefits similar to other funded educator roles, but the particular demands of the coach role may contribute to burnout.
Collapse
Affiliation(s)
- Martha J Elster
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Leslie Sheu
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Sunitha V Kaiser
- Departments of Pediatrics and Clinical Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| |
Collapse
|
12
|
Khrystenko OM, Vykhrushch AV, Fedoniuk LY, Oliinyk NY. PERSONAL VALUES OF FUTURE DOCTORS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2020-2025. [PMID: 36129089 DOI: 10.36740/wlek202208214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To analyse the value priorities of first-year medical students and outline areas of educational work to develop a system of professional values of future doctors who are able to work in circumstances of challenges of the time, as well as military conflicts. PATIENTS AND METHODS Materials and methods: The method of questionnaires involving the students of Ternopil National Medical University from Ukraine and India was used, as well as the method of content analysis of students' creative work. At the final stage of the study, essays written by Ukrainian first-year students on the day of the beginning of the war in Ukraine on February 24, 2022 were analysed. RESULTS Results: The desire to help people was the motive to enter a medical university for the majority of both Ukrainian and international students. Besides, Ukrainians identified civic values that are important in wartime: unity, national consciousness, struggle. In their opinion, the first day of the war determined the splash of anti-values: panic, fear, confusion. However, a similar study conducted ten days after the start of the war showed increase of confidence in victory, the levelling of negative emotions among Ukrainians. Therefore, the issue of the dynamics of values in wartime should be studied more. CONCLUSION Conclusions: Institutions of higher medical education should maintain a high intrinsic motivation of students in their altruistic striving to serve people, and improve the adaptation of first-year students, especially international ones. In wartime, it is necessary to intensify the educational work regarding ethical and spiritual development for strengthening the psychological well-being of students.
Collapse
Affiliation(s)
- Olga M Khrystenko
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| | | | | | - Nadiia Ya Oliinyk
- I. HORBACHEVSKY TERNOPIL NATIONAL MEDICAL UNIVERSITY, TERNOPIL, UKRAINE
| |
Collapse
|
13
|
King EE, Beckmann N. The Hospitalist Peer Coach - Improving Feedback Skills, Professional Goal Achievement, and Camaraderie With the MN-PEACH Project. Acad Pediatr 2021; 21:185-187. [PMID: 32949773 DOI: 10.1016/j.acap.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Erin E King
- Children's MN (EE King and N Beckmann), Minneapolis, Minn; University of MN Pediatrics Residency (EE King), Minneapolis, Minn.
| | | |
Collapse
|
14
|
Using Peer Feedback to Promote Clinical Excellence in Hospital Medicine. J Gen Intern Med 2020; 35:3644-3649. [PMID: 32959350 PMCID: PMC7728945 DOI: 10.1007/s11606-020-06235-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
Hospitalists provide a significant amount of direct clinical care in both academic and community hospitals. Peer feedback is a potentially underutilized and low resource method for improving clinical performance, which lends itself well to the frequent patient care handoffs that occur in the practice of hospital medicine. We review current literature on peer feedback to provide an overview of this performance improvement tool, briefly describe its incorporation into multi-source clinical performance appraisals across disciplines, highlight how peer feedback is currently used in hospital medicine, and present practical steps for hospital medicine programs to implement peer feedback to foster clinical excellence among their clinicians.
Collapse
|
15
|
Valanci-Aroesty S, Alhassan N, Feldman LS, Landry T, Mastropietro V, Fiore J, Lee L, Fried GM, Mueller CL. Implementation and Effectiveness of Coaching for Surgeons in Practice - A Mixed Studies Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:837-853. [PMID: 32057740 DOI: 10.1016/j.jsurg.2020.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/02/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Despite recent changes to medical education, surgical training remains largely based on the apprenticeship model. However, after completing training, there are few structured learning opportunities available for surgeons in practice to refine their skills or acquire new skills. Personalized observation with feedback is rarely a feature of traditional continuing medical education learning. Coaching has recently been proposed as a modality to meet these educational gaps; however, data are limited, and few coaching programs presently exist. The purpose of this study is to summarize the characteristics of coaching programs for surgeons in practice including participant satisfaction, program outcomes, and barriers to implementation, in the published literature. METHODS A mixed studies systematic review was conducted according to PRISMA guidelines to identify all original studies describing or investigating coaching for practicing surgeons up to 06/2019. Quantitative analysis was used to summarize numerical data, and qualitative analysis using grounded theory methodology for descriptive data was used to summarize the results into themes across studies. RESULTS After identification of articles, 27 were included in the final synthesis. Twenty-six articles described execution of a coaching program. Programs varied widely with 18/26 focusing on teaching new skills, and the remainder on refinement of skills. Thematic analysis identified 2 major data categories that guided deeper analysis: outcomes of and barriers to coaching. Of the 16 (62%) programs that reported outcomes of coaching, 42% to 100% of participants reported changes in clinical practice directly associated with coaching. Positive satisfaction after completion of a program was reported by 82% to 100% of participants. Reported barriers to participating in a coaching program emerged along 3 main themes: logistical constraints, surgical culture, and perceived lack of need. CONCLUSIONS Coaching for surgeons in practice is highly rated by participants and often results in clinical practice changes, while cultural and logistical issues were identified as barriers to implementation. A better understanding of these factors is required to guide coaching program development and implementation.
Collapse
Affiliation(s)
- Sofia Valanci-Aroesty
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Noura Alhassan
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Tara Landry
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Victoria Mastropietro
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Julio Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Carmen L Mueller
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
16
|
Stone EM, Rutkow L, Bicket MC, Barry CL, Alexander GC, McGinty EE. Implementation and enforcement of state opioid prescribing laws. Drug Alcohol Depend 2020; 213:108107. [PMID: 32554171 PMCID: PMC7371528 DOI: 10.1016/j.drugalcdep.2020.108107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In response to the role overprescribing has played in the U.S. opioid crisis, in the past decade states have enacted four main types of laws to curb opioid prescribing: mandatory prescription drug monitoring program (PDMP) enrollment laws requiring clinicians to register with a PDMP; mandatory PDMP query laws requiring clinicians to check a PDMP prior to prescribing opioids; pill mill laws regulating pain management clinics; and opioid prescribing cap laws limiting the dose/duration of opioid prescriptions. While 47 states now have one or more of these laws in place, little is known about implementation and enforcement strategies, facilitators, and barriers. METHODS From November 2017 to February 2019, we interviewed 114 professionals involved in state opioid prescribing law implementation and enforcement in 20 states and identified common themes. RESULTS Implementation efforts focused on awareness campaigns and targeted training of key front-line implementers. Enforcement strategies included active, complaint-based, and automated strategies. Collaboration across agencies and stakeholders, particularly health agencies and law enforcement, was identified as an important facilitator of implementation and enforcement. Two key interrelated barriers were identified: the complexity of state opioid prescribing laws in terms of which providers, patients, and prescriptions they applied to, and IT infrastructure. CONCLUSION Despite differing approaches, our findings suggest similar barriers to implementation and enforcement across state opioid prescribing laws. Strategies are needed to ease implementation and enforcement of laws that apply only to specific sub-sets of providers, patients, or prescriptions and address issues of access and data utilization of the PDMP.
Collapse
Affiliation(s)
- Elizabeth M. Stone
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management , 624, N. Broadway, Room 509, Baltimore, MD 21205
| | - Lainie Rutkow
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, United States.
| | - Mark C. Bicket
- Johns Hopkins School of Medicine, Department of Anesthesiology and Critical Care Medicine , 600 N. Wolfe Street, Baltimore, MD 21205
| | - Colleen L. Barry
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management , 624 N. Broadway, Room 482, Baltimore, MD 21205
| | - G. Caleb Alexander
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology , 615 N. Wolfe Street, Room W6035, Baltimore, Maryland 21205
| | - Emma E. McGinty
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management , 624 N. Broadway, Room 359, Baltimore, MD 21205
| |
Collapse
|
17
|
Sheu L, Hauer KE, Schreiner K, van Schaik SM, Chang A, O'Brien BC. "A Friendly Place to Grow as an Educator": A Qualitative Study of Community and Relationships Among Medical Student Coaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:293-300. [PMID: 31348059 DOI: 10.1097/acm.0000000000002900] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The rise of coaching programs in medical education sparks questions about ways to support physician coaches in learning new educational practices specific to coaching. How coaches learn from one another is of particular interest considering the potential value of social learning. Using communities of practice as a conceptual framework, the authors examine the sense of community and relationships among coaches in a new medical student coaching program, the value of this community, and the facilitators and barriers influencing community development. METHOD In this qualitative study, investigators conducted 34 interviews with physician coaches at 1 institution over 2 years (2017-2018) and observed 36 coach meetings. Investigators analyzed interview transcripts using thematic analysis and used observation field notes for context and refinement of themes. RESULTS Coaches described a sense of community based on regular interactions; shared commitment to medical education; and new roles with similar experiences, joys, and challenges. They valued the sense of camaraderie and support, learning from one another, and opportunities for professional growth that strengthened their identities as educators and enhanced job satisfaction. Facilitators of community included regular meetings, leadership and administrative support, and informal opportunities to interact outside of meetings. Barriers included time constraints and geographic challenges for coaches at off-site locations. CONCLUSIONS The sense of community among coaches was a valued and beneficial part of their coaching experience. Coaches' interactions and relationships promoted skill acquisition, knowledge transfer, professional development, and career satisfaction. Thus, incorporating support for social learning in coaching programs promotes coach faculty development.
Collapse
Affiliation(s)
- Leslie Sheu
- L. Sheu is assistant professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K.E. Hauer is associate dean for assessment and professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. K. Schreiner is a medical student, George Washington University School of Medicine, Washington, DC. S.M. van Schaik is Baum Presidential Chair of Experiential Learning and professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. A. Chang is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B.C. O'Brien is associate professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California
| | | | | | | | | | | |
Collapse
|
18
|
Manian FA. The Case for Writing Critical Thinking Reports as a Teaching Strategy on Today's Hospital Wards. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520948879. [PMID: 32875120 PMCID: PMC7436775 DOI: 10.1177/2382120520948879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
I review some of the challenges in teaching medical students and housestaff on today's hospital medicine wards, including increasingly limited time for dedicated teaching. Tapping into the extensive literature of "writing to learn" or "writing-across-the curriculum" in non-medical educational settings ranging from elementary school to college classes, I urge consideration of writing concise critical thinking reports (CTRs) by medical students and housestaff in response to questions raised during patient rounds as a means of enhancing their ward-based learning experience. Several potential reasons for writing CTRs are offered: (1) Nurtures curiosity; (2) Demands self-directed search for and encoding of new knowledge; (3) Emphasizes metacognition and conceptualization crucial to meaningful learning; (4) Provides opportunity for learners to teach and share newly-assimilated material with a broader web-based audience; (5) Encourages the concept of narrow but more in-depth learning related to a specific clinically relevant subject matter; (6) Nudges learners toward clear and succinct writing as an important general skill to develop in their everyday professional activities, including electronic medical record documentation; and (7) Reduces work-related burnout. Barriers to writing CTRs, including lack of general appreciation for explanatory writing as a potential teaching strategy in medical education and allowing sufficient time for medical students and housestaff to engage in this activity among other competing demands, are discussed. Writing CTRs is a potentially powerful pedagogical tool in ward-based learning that deserves consideration and formal evaluation by properly designed studies.
Collapse
Affiliation(s)
- Farrin A Manian
- Farrin A Manian, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 50 Staniford, 503B, Boston, MA 02114, USA.
| |
Collapse
|
19
|
Gonzalo JD, Wolpaw DR, Krok KL, Pfeiffer MP, McCall-Hosenfeld JS. A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program. MEDICAL EDUCATION ONLINE 2019; 24:1591256. [PMID: 30924404 PMCID: PMC6442085 DOI: 10.1080/10872981.2019.1591256] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND 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.
Collapse
Affiliation(s)
- Jed D. Gonzalo
- Medicine and Public Health Sciences and Health Systems Education, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel R. Wolpaw
- Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
| | - Karen L. Krok
- Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P. Pfeiffer
- Medicine, Penn State Hershey Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, USA
| | | |
Collapse
|
20
|
MacKenzie C, Chan TM, Mondoux S. Clinical Improvement Interventions for Residents and Practicing Physicians: A Scoping Review of Coaching and Mentoring for Practice Improvement. AEM EDUCATION AND TRAINING 2019; 3:353-364. [PMID: 31637353 PMCID: PMC6795351 DOI: 10.1002/aet2.10345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Graduate medical education (GME) bodies are beginning to mandate coaching as an integral part of the learning process, in addition to current requirements for mentorship. Once an emergency medicine physician transitions beyond graduate training, there is no requirement and little focus on coaching as a method of improving or maintaining clinical practice. Our objective was to understand and describe the current state of the published literature with regard to the use of coaching and mentorship for both GME and practicing physicians. METHODS We conducted a structured review of the literature through PubMed and Google Scholar and included all articles applying coaching or mentorship modalities to GME trainees or practicing physicians. A Google Form was used for standardized data abstraction. Data were collected pertaining to the settings of intervention, the nature of the intervention, its effect, and its resource requirements. RESULTS A total of 3,546 papers were isolated during the literature review. After exclusion, 186 underwent full-text review by the authors of which 126 articles were included in the final data analysis. Eighty-two articles (65%) pertained to mentorship and 14 (11%) to coaching; the remainder of the articles discussed a combination or variation of these two concepts. Fifty-three (42%) articles were descriptive studies and 35 (28%) were narrative reviews or commentaries. Forty-seven (37%) articles originated from within surgical specialties and coaching was most commonly applied to procedural or manual skills with 22 (17%) instances among all studies. CONCLUSIONS Most literature on coaching and mentorship is descriptive or narrative, and few papers are in the specialty of emergency medicine. Most interventions are limited to single instances of coaching or mentorship without longitudinal application of the intervention. There is an important need to study and publish further evidence on coaching interventions.
Collapse
Affiliation(s)
- Casey MacKenzie
- Michael G. DeGroote School of MedicineDepartment of MedicineMcMaster UniversityHamiltonOntario
| | - Teresa M. Chan
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntario
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonOntario
| | - Shawn Mondoux
- Institute of Health Policy, Management and Evaluation (IHPME)University of TorontoTorontoOntarioCanada
| |
Collapse
|
21
|
Orr CJ, Sonnadara RR. Coaching by design: exploring a new approach to faculty development in a competency-based medical education curriculum. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:229-244. [PMID: 31118862 PMCID: PMC6503815 DOI: 10.2147/amep.s191470] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/23/2019] [Indexed: 05/10/2023]
Abstract
As curricula move from a time-based system to a competency-based medical education system, faculty development will be required. Faculty will be asked to engage in the observation, assessment and feedback of tasks in the form of educational coaching. Faculty development in coaching is necessary, as the processes and tools for coaching learners toward competence are evolving with a novel assessment system. Here, we provide a scoping review of coaching in medical education. Techniques and content that could be included in the curricular design of faculty development programming for coaching (faculty as coach) are discussed based on current educational theory. A novel model of coaching for faculty (faculty as coachee) has been developed and is described by the authors. Its use is proposed for continuing professional development.
Collapse
Affiliation(s)
- Christine J Orr
- Discipline of Medicine, Memorial University of Newfoundland, St. John’s Newfoundland and Labrador, Canada
- Correspondence: Christine J OrrDivision of Endocrinology, Health Sciences Centre, Rm. 4325A, St. John’s, NLA1B 3V6, CanadaTel +1 709 864 6525Fax +1 709 777 6273Email
| | | |
Collapse
|
22
|
Papadakis S, Cole AG, Reid RD, Assi R, Gharib M, Tulloch HE, Mullen KA, Wells G, Pipe AL. From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates. Ann Fam Med 2018; 16:498-506. [PMID: 30420364 PMCID: PMC6231943 DOI: 10.1370/afm.2312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians. METHODS In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (Ask, Advise, Assist, Arrange) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up. RESULTS Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for Ask (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), Assist (AOR = 1.64; 95% CI, 1.08-2.49), and Arrange (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for Advise was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; P = .02). No differences were documented between groups for cessation outcomes. CONCLUSIONS Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.
Collapse
Affiliation(s)
- Sophia Papadakis
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinic of Social and Family Medicine, University of Crete, Rethymnon, Crete, Greece
| | - Adam G Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Roxane Assi
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marie Gharib
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
23
|
Lovell B. What do we know about coaching in medical education? A literature review. MEDICAL EDUCATION 2018; 52:376-390. [PMID: 29226349 DOI: 10.1111/medu.13482] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 05/26/2023]
Abstract
CONTEXT Coaching has been employed successfully in the competitive sports, professional music, and business and corporate worlds. It is now emerging as a training modality in medical education. OBJECTIVES This paper reviews the current evidence on coaching strategies for doctors and medical students. METHODS An applied literature search was conducted in PubMed, MEDLINE and Web of Science. Predetermined definitions of coaching interventions and their evaluations were used to narrow 993 papers down to 21, which were included in the final review. The 21 papers were critiqued with reference to validated scoring metrics. RESULTS There are many papers discussing the merits of coaching in the world of medicine, but few evaluations of coaching interventions. Existing coaching methodologies can be broadly summarised into three categories: coaching for doctor/student well-being and resilience; coaching for improved non-technical skills, and coaching for technical skills. Identification of suitable papers for inclusion is complicated by theoretical uncertainty regarding coaching: many papers use the term as a synonym for teaching or mentoring. The strongest evidence for coaching lies in the teaching of technical skills. CONCLUSIONS There is weak- to medium-strength evidence to support coaching as a method of improving doctor well-being and enhancing non-technical skills, although the evidence base is limited as a whole. This review identifies strong evidence to support coaching as a method to improve technical skills. There is great scope for further studies investigating the power of coaching in medical students and doctors.
Collapse
Affiliation(s)
- Ben Lovell
- Department of Acute Medicine, University College London Hospitals National Health Service (NHS) Foundation Trust, London, UK
| |
Collapse
|
24
|
Rassbach CE, Blankenburg R. A Novel Pediatric Residency Coaching Program: Outcomes After One Year. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:430-434. [PMID: 28700460 DOI: 10.1097/acm.0000000000001825] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PROBLEM The ACGME requires all residency programs to assess residents on specialty-specific milestones. Optimal assessment of competence is through direct observation of performance in clinical settings, which is challenging to implement. APPROACH The authors developed the Stanford Pediatric Residency Coaching Program to improve residents' clinical skill development, reflective practice, feedback, and goal setting, and to improve learner assessment. All residents are assigned a dedicated faculty coach who coaches them throughout their training in various settings in an iterative process. Each coaching session consists of four parts: (1) direct observation, (2) facilitated reflection, (3) feedback from the coach, and (4) goal setting. Coaches document each session and participate in the Clinical Competency Committee. Initial program evaluation (2013 -2014) focused on the program's effect on feedback, reflection, and goal setting. Pre- and postintervention surveys of residents and faculty assessed the quantity and quality of feedback provided to residents and faculty members' confidence in giving feedback. OUTCOMES Review of documented coaching sessions showed that all 82 residents had 3 or more direct observations (range: 3-12). Residents and faculty assessed coaches as providing higher-quality feedback and incorporating more reflection and goal setting than noncoaches. Coaches, compared with noncoaches, demonstrated increased confidence in giving feedback on clinical reasoning, communication skills, and goal setting. Noncoach faculty reported giving equal or more feedback after the coaching program than before. NEXT STEPS Further evaluation is under way to explore how coaching residents can affect patient-level outcomes, and to better understand the benefits and challenges of coaching residents.
Collapse
Affiliation(s)
- Caroline E Rassbach
- C.E. Rassbach is clinical associate professor, associate residency program director, and coaching director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: https://orcid.org/0000-0002-9221-1643. R. Blankenburg is clinical associate professor, associate chair for education, and residency program director, Department of Pediatrics, Stanford School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-1938-6113
| | | |
Collapse
|
25
|
Goodwin JS, Salameh H, Zhou J, Singh S, Kuo YF, Nattinger AB. Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population. JAMA Intern Med 2018; 178:196-203. [PMID: 29279886 PMCID: PMC5801052 DOI: 10.1001/jamainternmed.2017.7049] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Substantial numbers of hospitalists are fresh graduates of residency training programs. Current data about the effect of hospitalist years of experience on patient outcomes are lacking. OBJECTIVE To describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. DESIGN, SETTING, AND PARTICIPANTS We used a 5% sample of national Medicare data of patient and hospital characteristics to build a multilevel logistic regression model to predict mortality as a function of years of experience of the hospitalists. We created 2 cohorts. The first was a cross-sectional cohort of 21 612 hospitalists working between July 1, 2013, and June 30, 2014, with a 5-year look-back period to assess their years of prior experience as a hospitalist, and the second was a longitudinal cohort of 3860 hospitalists in their first year of practice between July 1, 2008, and June 30, 2011, who continued practicing hospital medicine for at least 4 years. MAIN OUTCOMES AND MEASURES Thirty-day postadmission mortality adjusted for patient and hospital characteristics in a 3-level logistic regression model. Hospital mortality was a secondary outcome. RESULTS Among 21 612 hospitalists caring for Medicare inpatients from July 1, 2013, to June 30, 2014, 5445 (25%) had 1 year of experience or less, while 11 596 (54%) had 4 years of experience or more. We then identified 3860 physicians in their first year as hospitalists who continued to practice as hospitalists for 4 years. There was a significant association between hospitalist experience and mortality. Observed 30-day mortality was 10.50% for patients of first-year hospitalists vs 9.97% for patients of hospitalists in their second year. The mortality odds for patients of second-year hospitalists were 0.90 (95% CI, 0.84-0.96) compared with patients of first-year hospitalists. Observed hospital mortality was 3.33% for patients cared for by first-year hospitalists vs 2.96% for second-year hospitalists. (odds ratio, 0.84; 95% CI, 0.75-0.95). For both 30-day and hospital mortality, there was little change in odds of mortality between the second year and subsequent years of experience. CONCLUSIONS AND RELEVANCE Patients cared for by hospitalists in their first year of practice experience higher mortality. Early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
Collapse
Affiliation(s)
- James S Goodwin
- Department of Medicine, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Habeeb Salameh
- Department of Medicine, University of Texas Medical Branch, Galveston
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | | | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
26
|
Larsen DP, Naismith RT, Margolis M. High-Frequency Learning Goals: Using Self-Regulated Learning to Influence Day-to-Day Practice in Clinical Education. TEACHING AND LEARNING IN MEDICINE 2017; 29:93-100. [PMID: 27813672 DOI: 10.1080/10401334.2016.1230501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PROBLEM Although self-regulated learning (SRL) is considered a fundamental skill that must be developed in physician training, many programs of SRL utilize learning goals that are generated only at the beginning of learning experiences or are widely spaced apart in time. These goals are often not formally shared with those actually working with the learner in the clinical setting. INTERVENTION We developed a program of written, student-generated weekly learning goals in which students focused on processes of becoming better doctors for their patients. These goals were shared at the beginning of each week with students' clinical teams for feedback and incorporation into the work. CONTEXT The weekly learning goals program was developed and implemented as part of a required 3rd-year neurology clerkship. At the end of each 4-week clerkship, students were asked to evaluate the program through an anonymous electronic survey utilizing quantitative and open-ended qualitative questions. OUTCOME Seventy-six of 82 students completed the evaluation survey (93% response rate). Eighty-six percent reported that the weekly learning goals increased their awareness of their thoughts and actions. Seventy-eight percent reported that the learning goals helped to improve their clinical performance to some degree, and 57% reported that the learning goals increased their focus on patient care. Students described a greater sense of focus on self-assessment and accountability from their goals. Students often commented that engagement from attendings and residents regarding their goals was a key element for successful learning from their goals. LESSONS LEARNED Student-generated weekly learning goals on a neurology clerkship appear to be an effective method to operationalize SRL. For most students, the frequency of the goals allowed for close self-monitoring, and the act of sharing goals with the team opened a new avenue for dialogue between students and their supervisors.
Collapse
Affiliation(s)
- Douglas P Larsen
- a Department of Neurology , Washington University in St. Louis School of Medicine , St. Louis , Missouri , USA
| | - Robert T Naismith
- a Department of Neurology , Washington University in St. Louis School of Medicine , St. Louis , Missouri , USA
| | - Mathew Margolis
- b Washington University in St. Louis School of Medicine , St. Louis , Missouri , USA
| |
Collapse
|
27
|
Sklar DP. Teaching the Diagnostic Process as a Model to Improve Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1-4. [PMID: 28027090 DOI: 10.1097/acm.0000000000001481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
28
|
Sklar DP. Moving From Faculty Development to Faculty Identity, Growth, and Empowerment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1585-1587. [PMID: 29408839 DOI: 10.1097/acm.0000000000001447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|