#KeyLIMEPodcast 217: Fuzzy Coaches & the Fear of Failure

Reference:

Watling CJ, LaDonna KA Where philosophy meets culture: Exploring how coaches conceptualize their roles. Med Educ. 2019 Jan 23. [Epub ahead of print]

Reviewer:

Jason R. Frank (@drjfrank)

Background

Coaches. Coaching. Coachella. Three contemporary poorly understood but popular phenomena. The idea of “coaching” in health professions education is a hot topic right now. “Feedback”, the original, all important meded ingredient, has been much sought after and poorly executed since Ende’s classic JAMA paper. Feedback is sometimes perceived as one individual giving information back to another. Somehow feedback became tired, cold, boring, and useless. Recently, coaching has garnered additional attention, as a number of us have promoted it as a 21^st century reframing of the engagement between a dedicated master clinician and a learner striving to be one. “Coaching” sounds like a more robust conversation, ready for us in a CBME world…But what is it really?

Purpose

The authors from Western University and the University of Ottawa, are skilled at exploring concepts through qualitative lenses. They set out to “explore how coaching is enacted both within and outside medicine”.

Key Points on the Methods

Chris Watling is a master of the novel comparison of educational phenomena within and outside medicine. His previous papers have looked at feedback on the wards and in the dance studio. Kori LaDonna is a skilled qualitative researcher to has looked at multiple concepts in meded. The two team up in this constructivist grounded theory paper to explore coaching. They chose to interview 3 groups of individuals with insights into coaching:

1. physicians who coach clinically
2. physicians who have experience as coaches in sports, arts, or business, and
3. non-medical sports coaches.

As in other papers we have reviewed, they used a constant comparative method to identify themes in the data iteratively. Note that the authors took pains to document their own perspectives in a reflexivity exercise.

Key Outcomes

The authors noted that participants struggled to clearly define coaching in medicine, and they found a “definitional fuzziness” between the concepts of coaching, mentoring, and teaching. While teaching was driven by the teacher and mentoring by the mentee’s needs, coaching was considered to be driven by dynamic engagement with a kind of shared agenda—ie “we are working on this…”

The authors were able to construct a “shared philosophy of coaching”, which participants articulated as unlocking of human potential (a great phrase!). The authors felt this concept had 3 elements. I personally would organize them into 4:

1. mutual engagement
2. orientation towards growth and development,
3. the closely related concept of embracing failure as a catalyst for learning, and
4. ongoing reflection.

Great coaches are not marked by their knowledge or skill per se, but their ability to bring out the best in others. Coaching involved motivating and inspiring, as well as instructing and guiding.

The authors noted that these elements were always implemented by the cultural context in which the coach worked. In particular, failure was a challenging concept in meded, where showing vulnerability was difficult.

Key Conclusions

The authors conclude that medicine needs to inform the use of coaching with a greater understanding of the behaviours needed for success and the organizational environment conducive to a growth mindset.

Spare Keys – other take home points for clinician educators

1. This yet another paper we have reviewed for KeyLIME that demonstrates how terms in meded are variously defined. We still don’t have a lingua franca for health professions education. Editors: please push authors to be clearer.
2. The methods used in this paper are an elegant example of the power of qualitative approaches to elucidate phenomena in meded.
3. My only caution for papers like this is a general one about reflexivity: we need to be careful not to use grounded theory as a way to document our own long-held beliefs. There are recurring themes in this paper, so that makes me hesitate about its findings.
4. Like artists, the work of these authors demonstrates novelty and cleverness, which keeps the reader coming back for more hits.
5. This paper is one of a series by the authors, and demonstrates a nice scholarly arc for a clinician educator.

[Host’s declaration: I suspect I was interviewed for this study. I only realized that after I picked it to review. That probably just makes me even more opinionated about the results!]

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