The coaching program at the University of Oklahoma Health Sciences Center was established in 2018. This innovative program is designed to promote individual resident observation, reflection, and feedback throughout training in order to develop the habits of life-long learning and effective self-reflection.
Most of us can recall a coach that made a difference in our lives, whether it was in sports or the arts. If we stop to think about, a coach would be considered highly ineffective if they never offered feedback for improvement after directly observing one's performance. The notion of an effective coach in sports or music telling one simply to "play more" would be seen as not very helpful. Why then, in medical education is observation and feedback to improve the learner's performance not practiced more frequently? Why is "read more" so frequently seen as the only comment?
Historically, physicians have been taught for generations through the "hidden curriculum" they may not make errors and should not admit weaknesses or knowledge deficits. This is completely false, yet persists to some degree, even today. Here, we ask every incoming new resident to leave that thinking at the door. It is a priority to us to develop all our faculty on how to provide effective feedback; we do this multiple times annually through workshops, grand rounds, and virtual training. Aside from a robust patient base, nothing is more important to the learner than effective feedback and support, but the learner has to be ready to receive the information without feeling attacked or full of shame.
To facilitate this process, our Coaching Program was established in 2018 as an innovative approach intended to help residents reach their full potential, in part by uncoupling the feedback process from formal assessment, and in part through the longitudinal pairing of each resident with a dedicated coach who shapes, supports and develops them over time.
The Coaching program partners faculty coaches with residents utilizing a non-evaluative, "I'm on your side" approach. This approach mitigates the fear and anxiety that often unfortunately accompanies being "directly observed" by supervising faculty that will ultimately deliver the course grade or rotation evaluation for a learner. Our faculty coaches are carefully selected based on positive resident feedback and demonstrated commitment to resident education. The coaches go through rigorous and ongoing training and are provided protected time by the department, illustrating the commitment of the department to our learners.
At the beginning of residency, each resident is assigned a dedicated faculty coach who will be with that resident throughout their entire residency. Coaches will observe clinical encounters, facilitate self-reflection and provide feedback across multiple clinical settings throughout residency to help their resident recognize and achieve their full potential, both personally and professionally. Coaches review rotation evaluations and help their resident recognize themes / patterns that may be emerging across settings. They also help their residents develop habits of life-long learning and effective self-reflection, leading to enhanced insight and improved competency in key clinical skills. Coaches may engage with service attending as needed to help facilitate development of specific skills; for example if a resident is working on communicating effectively with families, the coach may engage with the service attending to specifically observe and give feedback around communication with patients. Finally, coaches also receive and review clinical competency committee milestone (CCC) reports and discuss them bi-annually with their residents, working these assessments into goal setting and Individual Learning Plans for the upcoming 6 months.
It is important to note the coach does not provide information to the CCC or any service attending regarding the performance of the resident during their observed encounters. This work remains private between the coach and resident, so that full trust may be developed and the resident feels safe to explore weaknesses, develop insight, and ultimately become empowered to ask, receive, and provide constructive feedback from and to all team members.
We all share the same goal, after all - our residents becoming the very best pediatricians (and people!) they can be, with clarity and confidence around the next steps in their career. Our coaches help their residents obtain the knowledge, skills and attitude to succeed beyond what they ever thought possible, developed and determined by the individual resident's own unique definition of success.