Clinical Improvement Interventions for Residents and Practicing Physicians: A Scoping Review of Coaching and Mentoring for Practice Improvement

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 fulltext 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.

The Teacher, the Assessor, and the Patient Protector: A Conceptual Model Describing How Context Interfaces With the Supervisory Roles of Academic Emergency Physicians

“…24,39 Existing literature reveals a conceptual tension, as researchers often use "coaching" interchangeably with "supervising" or "teaching." 24,26,40 Our model indicates that coaching may be a separate phenomenon that lies at the intersection of teaching and assessing.…”

“…We were sensitized by Goffman’s dramaturgical approach23 and more recent literature on clinical supervision 11,17,24,25. This approach allowed us to understand how emergency physicians present themselves when they interact with trainees, patients, or other staff in the ED.…”

“…We were sensitized by Goffman's dramaturgical approach 23 and more recent literature on clinical supervision. 11,17,[24][25][26] This approach allowed us to understand how emergency physicians present themselves when they interact with trainees, patients, or other staff in the ED. Given that we were interested in the different roles played by emergency physicians, we employed Goffman's theory of dramaturgy to help structure our first-order analysis of the data.…”

“…To adopt coaching approaches in medicine, we must pay attention to how we define coaching and the responsibilities that come with it 24,39. Existing literature reveals a conceptual tension, as researchers often use “coaching” interchangeably with “supervising” or “teaching.”24,26,40 Our model indicates that coaching may be a separate phenomenon that lies at the intersection of teaching and assessing.…”

“I made a mistake!”: A narrative analysis of experienced physicians' stories of preventable error

“…Therefore, another potential opportunity for future development could be around training physicians to be supportive and empathetic colleagues. Measures in this realm may include training individuals to adopt a coaching framework, 79 creating peer support networks, 80 or finding new ways to process errors in an educational systems‐based approach 66 . Because medicine is a field where professionals are continuously learning, it is important for support around medical errors to not only occur during official training periods such as medical school, residency, and fellowship, but throughout one's career trajectory.…”