Where philosophy meets culture: exploring how coaches conceptualise their roles

Abstract

Context Although conceptually attractive, coaching in medicine remains ill‐defined, with little examination of the transferability of coaching principles from other fields. Here we explore how coaching is enacted both within and outside of medicine; we aim to understand both the elements required for coaching to be useful and the factors that may influence its translation to the medical education context. Methods In this constructivist grounded theory study, we interviewed 24 individuals across three groups: physicians who consider themselves coaches in clinical learning settings (n = 8), physicians with experience as sports, arts or business coaches (n = 10), and sports coaches without medical backgrounds (n = 6). Data collection and analysis were conducted iteratively using constant comparison to identify themes and explore their relationships. Results We identified a shared philosophy of coaching, comprising three core elements that our participants endorsed regardless of the coaching context: (i) mutual engagement, with a shared orientation towards growth and development; (ii) ongoing reflection involving both learners and coaches, and (iii) an embrace of failure as a catalyst for learning. Enacting these features appeared to be influenced by culture, which affected how coaching was defined and developed, how the coaching role was positioned within the learning context, and how comfortably vulnerability could be expressed. Participants struggled to clearly define the coaching role in medicine, instead acknowledging that the lines between educational roles were often blurred. Further, the embrace of failure appeared challenging in medicine, where showing vulnerability was perceived as difficult for both learners and teachers. Conclusions Medical education's embrace of coaching should be informed by an understanding of both coach and learner behaviours that need to be encouraged and trained, and the cultural and organisational supports that are required to foster success.

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

“…Many definitions for coaching are put forward in the literature, and all have very similar elements. Common elements of various nonclinical coaching frameworks include interactions between coach and learner that occur over several observations and time and depend on a trusted respect‐based bond; direct contemporaneous observation of practice in the clinical environment; clearly defined and specific areas of analysis and improvement; creation of a cycle of continuous skill/performance improvement in the learner (rather than reach a finite endpoint); encouragement of critical self‐reflection and collaborative goal‐setting; and feedback and reflections that are timely, specific, actionable, and task‐directed .…”

“…In the period of data collection and analysis for this article, the definition of coaching in the medical context has changed. While experts such as Watling had previously posted a definition of medical coaching on his academic website, subsequent publications have identified that coaching suffers from a lack of clear definition in the medical literature. As a result, there is some confusion in the field as to what the terms coaching and mentorship mean to us in medicine .…”

“…While experts such as Watling had previously posted a definition of medical coaching on his academic website, subsequent publications have identified that coaching suffers from a lack of clear definition in the medical literature. As a result, there is some confusion in the field as to what the terms coaching and mentorship mean to us in medicine . While we must acknowledge that mentorship has had a substantive impact on a number of academic outcomes (e.g., career satisfaction, academic productivity, funding), the use of mentorship in the clinical sphere blurs substantively with the more recent literature on coaching—and hence it is important to bear in mind how this concept might overlap in the clinical environment.…”

“…For instance, the Royal College of Physicians and Surgeons of Canada has recently adopted the new “Competency By Design” (CBD) framework, which involves a heavy emphasis on providing all CBD residents with individualized educational planning via assistance from academic coaches . This push likely comes from the observation that coaching is seen to be learner‐centered and has proven its effectiveness in other domains …”

Bringing meaning to coaching in medical education

“…In this issue, two papers focus on coaching in medical education. In their paper, Watling and LaDonna warn us that ‘If we embrace coaching uncritically, we may find that it fails to serve our distinct educational needs as effectively as we may hope’. The authors therefore sought to give meaning to the ‘medical coach’ by comparing this to more traditional coaching archetypes.…”