Peer Coaching as a Faculty Development Tool: A Mixed Methods Evaluation

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.

A novel hospitalist peer observation program to improve educational and operational rounding practices

Academic hospitalists must balance trainee education with operational demands to round efficiently and optimize hospital throughput. Peer observation has been shown to support educator development, however, few hospitalists have formal training to optimize both skill sets. We sought to extend and adapt peer observation programs to equally focus on education and operations-based outcomes. During the 2-year study period, 76 of 98 (78%) eligible faculty participated in a structured, real-time peer observation program. Immediately after observing a peer, 42% of respondents planned to adopt an operations-related rounding behavior. Following program completion, 77% of respondents endorsed the implementation of a new rounding behavior learned from a peer, with a third of these behaviors related to clinical operations. Ninety-five percent of respondents endorsed at least a moderate degree of program satisfaction. High levels of engagement and sustained behavior change following program participation suggest clinical operations are an important addition to peer observation programs and faculty development initiatives.

Peer feedback: A tool to improve PA, NP, and physician collaboration and clinical practice

ABSTRACT

The increasing use of physician associates/assistants (PAs) and NPs on clinical teams creates an opportunity for colleagues to provide feedback that can drive growth and improvement in PA and NP clinical skills. Through a needs assessment, month-long pilot, and buy-in from our academic hospital medicine group, we initiated a peer feedback platform that sought to highlight individual faculty strengths, facilitate thoughtful and constructive feedback, and create effective collaboration among colleagues. Three months after implementation, results indicated that the platform provided important information on clinical skills and identified areas for growth and opportunities for additional training. Peer feedback can also improve working relationships among PAs, NPs, and physicians by highlighting the clinical skill sets and value of all team members.

Teaching family planning to nurse and midwife students: A constructivist grounded theory study

AIM

This study aimed to describe nurse/midwife educators' understanding and enactment of teaching family planning methods with nursing/midwifery students in educational programs in Rwanda. More precisely, the aim of this study was to generate a substantive theory that explains how nurse/midwife educators introduce family planning methods into their teaching practice to facilitate learning among nurse/midwife students in Rwanda.

BACKGROUND

High maternal mortality remains a global health issue. In 2017, approximately 295,000 women worldwide died from complications related to pregnancy or childbirth and 94% of these maternal deaths occurred in low-income countries. Evidence shows that family planning improves maternal health outcomes and significantly contributes to reducing maternal mortality. Low family planning uptake is partly attributed to inadequate education of healthcare providers to provide family planning services.

DESIGN

This study followed the constructivist grounded theory methodology articulated by Kathy Charmaz (2006; 2014).

METHODS

The primary data source was individual semi-structured interviews with 25 nurse/midwife educators recruited from all the schools/faculties/departments of nursing and midwifery in Rwanda, augmented with written documents related to family planning education in nursing/midwifery preservice programs.

RESULTS

The substantive Theory that emerged from the data analysis indicated that the process of teaching family planning in preservice nursing/midwifery education among nurse/midwife educators has three phases: preparing, facilitating and evaluating. Factors that had an impact on the process and actions that nurse/midwife educators undertook to address the challenges related to those factors were identified. The main influential factors that had a significant impact on nurse/midwife educators' ability to teach family planning are contextual factors and personal factors related to the nurse/midwife educators. The contextual factors included the availability of resources, student-teacher ratio, number of students in clinical placements and the time allocated to the family planning unit. The personal factors related to the nurse/midwife educators included knowledge, skills, confidence, attitude, beliefs and moral values toward family planning methods.

CONCLUSION

These study findings generated valuable knowledge that can guide the improvement of teaching family planning in preservice nursing/midwifery programs in Rwanda and other limited-resource countries and contexts. With the insights provided by this study, future research should investigate strategies to overcome highlighted barriers, increase nurse/midwife educators' expertise in teaching family planning and enhance the preparedness of nurse/midwife students on some family planning methods identified in this study.

Teaching Observation as a Faculty Development Tool in Medical Education: A Scoping Review

INTRODUCTION

Health professions education often includes teaching observation to inform faculty development (FD) and indirectly improve student performance. Although these FD approaches are well received by faculty, they remain underused and/or underreported, with limited opportunities to receive feedback in workplace contexts. The goal of our study was to map the depth and breadth of education literature on the use of observation of teaching as a tool of professional development in medical education.

METHODS

Following the methodology by Arksey and O'Malley, we conducted a scoping review and searched four databases for articles published in English (final searches in April 2022).

RESULTS

Of 2080 articles identified, 45 met the inclusion criteria. All observation activities were associated with one of the following FD approaches: peer observation of teaching (23 articles, 51%), peer coaching (12, 27%), peer review (9, 20%), and the critical friends approach (1, 2%). Thirty-three articles (73%) concerned formative versions of the observation model that took place in clinical settings (21, 47%), and they tended to be a voluntary (27, 60%), one-off (18, 40%), in-person intervention (29, 65%), characterized by limited institutional support (13, 29%). Both barriers and challenges of teaching observation were identified.

DISCUSSION

This review identified several challenges and shortcomings associated with teaching observation, such as inadequate methodological quality of research articles, inconsistent terminology, and limited understanding of the factors that promote long-term sustainability within FD programs. Practical strategies to consider when designing an FD program that incorporates teaching observation are outlined.

Physician Perceptions of Performance Feedback and Impact on Personal Well-Being: A Qualitative Exploration of Patient Satisfaction Feedback in Neurology

BACKGROUND

To understand neurologists' experiences and perspectives on patient satisfaction feedback and its impact on personal well-being and behavior.

METHODS

From May to June 2021, the researchers conducted 19 semistructured interviews with neurologists from a large academic medical center. Clinical Performance Feedback Intervention Theory informed a combined inductive and deductive thematic analysis of the qualitative data, which focused on perceptions of current feedback practices, its impact on physician behavior, and recommendations for improvement.

RESULTS

Participants tended to be female (n = 12/19, 63.2%), aged 30-39 (n = 8/19, 42.1%), white (n = 9/19, 47.4%), and were 10+ years into clinical practice (n = 18/19, 94.7%). Physicians were receptive to feedback overall, but perceptions varied by feedback type. Physicians preferred informal feedback (delivered unprompted directly by patients), given its tendency toward actionability. They disliked formal feedback (derived from anonymous surveys) due to low actionability, bias and validity issues, lack of contextual considerations, delivery through public reports, and links to financial incentives. Nearly all physicians reported formal feedback programs had the potential to negatively affect well-being and were not beneficial to their practice; a few reported adjusting their clinical practice to improve patient satisfaction performance. Five recommendations to improve patient satisfaction feedback programs emerged: Align on feedback intent, acknowledge survey limitations during program administration, increase actionability of feedback through specificity and control, support direct patient-physician feedback and problem resolution, and support empathetic integration of feedback.

CONCLUSION

Understanding physician perceptions of current approaches to patient satisfaction feedback offers the opportunity to shape subsequent collection and distribution methods to improve physician performance and optimize professional fulfillment.

Grace, Inspiration, Fulfillment, Timeless, Soulful (GIFTS): The Why and How of Podcasts for Recognition and Mentoring of Faculty in Medicine

This commentary offers the reader an alternative to mentoring through the use of PODCASTS. By providing the listener with an understanding of the challenges and opportunities for self-reflection and sharing of experiences by the interviewees, we are impacting the listener attitudes and future goals through lessons learned.

Participation in a Resident-as-Teacher Rotation: Motivations of and Impacts on Faculty Coaches

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.

Assessing the feasibility and acceptability of a peer-based communication coaching model among hospital clinicians

Objective

Communication coaching shows promise for improving clinician communication yet few have assessed the feasibility of having peers coach each other. We conducted a proof-of-concept study to test the feasibility and acceptability of a peer-based communication coaching program in an inpatient setting.

Methods

We trained three clinician communication coaches (two physicians and one physician assistant) and randomized half of the 27 clinicians working on the general medicine floor to receive coaching. The coaching involved shadowing and providing feedback on real-time encounters with patients. We collected data on feasibility of providing the coaching, quantitative and qualitative ratings of acceptability of the coaching both from the clinician and the coach perspective, and clinician burnout.

Results

We found the peer coaching to be feasible and acceptable. Quantitative and qualitative reports support the merit of the coaching; most clinicians who received the coaching reported making changes in their communication. Clinicians in the intervention arm reported less burnout than those who did not receive the coaching.

Conclusions

This proof-of-concept pilot showed that peer coaches can provide communication coaching and that clinicians and coaches viewed the coaching as acceptable and might change communication. The coaching also seems to show promise on burnout. We provide lessons learned and thoughts about how to improve the program.

Innovation

Teaching clinicians to coach each other is innovative. We conducted a pilot that shows promise for feasibility, acceptability of clinicians coaching each other to communicate better, and a signal that it can help improve clinician burnout.

Development and implementation of a formative instructional coaching program using the Teaching Practices Inventory within a health professions program

BACKGROUND

A growing body of literature describes teaching practices that are positively associated with student achievement. Observing, characterizing, and providing feedback on these teaching practices is a necessary, yet significant challenge to improving teaching quality. This study describes the design, implementation, and evaluation of an instructional coaching program created to provide formative feedback to instructors based on their use of evidence-based teaching practices.

METHODS

The program was designed for formative purposes utilizing an instrument adapted from the Teaching Practices Inventory. All faculty were invited to participate in the program on a voluntary basis when the program launched in Fall 2019. Program coaches included any School personnel who completed required training. Two rounds of instrument development were conducted with multiple observers and assessed using Krippendorff's Alpha. The program was evaluated using an anonymous post-session survey.

RESULTS

Interrater reliability of the form improved over two rounds of piloting and no differences were found in scoring between trainees and education professionals. Seventeen observations were completed by nine coaches. Instructors indicated that feedback was practical, timely, specific, and collegial, suggesting that including student perspectives (e.g., focus groups, student course evaluations) in the coaching program might be helpful.

CONCLUSIONS

Creating programs that emphasize and foster the use of evidence-based teaching are critical for health professions education. Additional research is needed to further develop coaching programs that ensure teaching practices in the health professions are optimizing student learning.

Collaborative faculty development transforms evaluation at a school of osteopathic medicine: an exploratory grounded theory study

Background: Faculty development (FD) initiatives for medical educators must keep pace with educators’ expanding roles and responsibilities in the 21st century to effectively support and guide professional growth. Successful initiatives will be comprehensive and systematic, rather than episodic. Our research explores the impact of a collaborative, individualized, and focused FD program. The purpose of this pilot study is: (1) to describe the innovative design and implementation of the incipient FD program at University of the Incarnate Word School of Osteopathic Medicine (UIWSOM), San Antonio, Texas; and (2) to present insights from a preliminary process evaluation of the program’s initial launch to inform and facilitate broadscale implementation.      Methods: We used a longitudinal, holistic approach to redesign the UIWSOM FD program to provide evidence-informed and experiential learning for faculty. We performed a process evaluation of the initial iteration of the FD program using an inductive qualitative research approach. We applied principles of constructivist grounded theory to analyze faculty’s responses collected during semi-structured interviews. Results: Three themes emerged from our analysis: communication, advocacy, and reciprocal learning.  We found that effective communication, advocacy for faculty success, and reciprocal value between faculty and program developers undergirded the core concept of authentic engagement.  Faculty’s perceptions of the quality of engagement of those implementing the program overshadowed the quality of the logistics.  Conclusions: Our pilot study identified authentic engagement as critical to faculty’s positive experience of this new FD initiative.  Practical implications for other health professions schools with similar FD initiatives include consideration of the relational aspects.  Future studies should expand the process evaluation to determine key factors driving perceived program success for other skill domains and amongst clinical faculty, and include a long-range outcome evaluation of the fully implemented program.

Learning by Doing: Design and Evaluation of a Quality Improvement Curriculum for Pediatric Hospitalists

Quality improvement (QI) is a core competency for Pediatric Hospital Medicine (PHM) and required for maintenance of certification, but many hospitalists lack QI training. This project set out to increase a PHM faculty’s QI knowledge and comfort participating in QI projects, while concurrently applying the skills learned to a QI project in the hospital.