Residents as Medical Coaches

Abstract

Objectives: With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role.

Design: We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding.

Participants: We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs.

Setting: Our study was done in a large tertiary teaching hospital.

Results: Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching.

Conclusions: Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills.

Keywords: Coaching; Competency-based medical education; Residency education; Residents as teachers.