What is Physician Coaching? Tools and Various Formats

We are continuing our blog series, What is physician coaching?  So far, we have covered the definition and discussed what both the coach and the coachee bring to the session.  This week we will review commonly used tools and maybe unpack some of the various formats. 

While coaching is not therapy, and most coaches are not behavioral scientists, there exists an overlap in many of the tools. 

Much of the literature in physician coaching (more to come next week on that) is based on the cognitive behavioral model, more specifically, a positive psychology approach, emphasizing strengths, values, and goals.

There have been three waves of positive psychology, and depending on your coach, much of the coaching will focus on the thought, emotion, and action cycle. (https://www.joyinfamilymedicine.com/blog/optimizing-your-mindset-in-medicine-step-3). And there are tools used from the 3^rd wave of positive psychology – ACT – including becoming the observer, acceptance, mindful presence, values, action, and commitment. The six areas coaching can explore for change and insight are 1. Self  2. Attention. 3. Motivation. 4. Affect. 5. Cognition. 6. Behavior.

Many of the approaches utilize thought awareness and the thought model, the GROW model, appreciative inquiry, increasing emotional intelligence, emotional processing, leveraging strengths, aligning values, self-compassion, gratefulness, mindful presence, acceptance, self-compassion, goal, and vision setting, visioning, and leveraging perspectives from your future and/or past self.

These tools help physicians take back agency in how they experience their day-to-day lives. In the hands of a skilled coach, cognitive remodeling begins verified by EEGs.

the new insights clients express during a session. Much more so than with self-reflection or directive advising alone.

We know there are personality clusters that physicians often demonstrate may not always be adaptive. While those may have been helpful in allowing physicians to overcome the barriers to arrive at their current place, those same tendencies have been reinforced, if not actually initiated, by the process of travailing pre-med, medical school, residency, and fellowship. And combined with the state of our multiple current medical system challenges and shortfalls, it makes for a bleak combination.

Often combining the tools with a coach approach helps the physician realize the costs of those tendencies and how they can shift and move forward in a healthier manner. Thereby, optimizing their potential while preserving their mental, physical, and emotional health.

Okay, so you may be wondering how coaching can be utilized. Let's review the various formats.

Internal vs External.

Internal. Coaches can be employed by the company or program or contracted externally within an organization.

An internal coach can have a formal or an informal role. Informally, the coach utilizes their coaching skills in their day-to-day work though it’s not part of their job description. Formally, they coach as part of their job description (and hopefully have time allotted for it as well – more to come on this next week).

The benefits of an internal coach include having the contextual background and physical presence in the space.

External. External coaching can be offered by a coaching organization, such as Coaching for Institutions or Better Together, both of which I have the honor of coaching within. Also, some EAPs (employee assistance programs) now offer coaching as a benefit. I will say the feedback I’ve heard from physicians on the EAP coaching is mixed. I know some who have had a wonderful experience and many others who haven’t. My opinion in listening to those who have accessed it is that it seems to depend on the coach's level of physician coaching experience.

An external coach can contract as an individual. That is the role I play most of the time.

One of the main benefits of an external coach is a higher level of psychological safety. We covered last week the importance of the coachee being able to lean into vulnerability to optimize the benefits of coaching. With an external coach, there is less of a chance of conflicts of interest. Also, an external coach will not evaluate a trainee or faculty member, and won’t be in social settings with the individual’s colleagues or supervisors.

Venues coaching can take place:

- In-person.

- Remotely, whether through phone or video conferencing. Even before the pandemic, tele- and videoconferencing and phone calls were common.

- Asynchronously via email or apps such as Slack or others.

- Anonymously, where someone writes in for coaching on a topic with some detail, and the coach reflects back and asks questions as if they were speaking with them. This is often then posted in a protected space so others in the group can benefit from the coaching as well.

- By oneself. Self-coaching is a concept in which a person utilizes self-reflection and becomes a curious, compassionate observer of their thoughts, beliefs, emotions, motivations, actions, etc., and looks for various other approaches and perspectives to move toward their goals.

Formats

-Group. This usually involves one coach, or sometimes another co-facilitating coach, with a group of physicians. This can be physicians with something in common, such as their employer, or goals like weight loss. They may or may not know each other.

Benefits of group coaching include shared humanity – knowing you’re not alone in how you’re challenged or frustrated; connection; crowd-sourcing; and exposure to various perspectives. A key benefit also includes hearing someone else be coached (when a 5-10 min 'coach-the-individual' with an audience approach is used, gives a person a little distance between the narrative and themselves. The space can make personal insights and application easier than when they are not wrapped up in the story. Also, when the group comprises physicians who previously did not know each other, there’s a sense of safety in the relative anonymity.

-Team. This involves a smaller group of individuals that work together as a team. The benefits include most of the group coaching and can elevate the team's culture. It also can move the team forward to collaborating optimally.

       Group and team coaching can be done in a variety of manners.

One involves coaching one person for a few minutes while others listen in. In the purist method for groups that may or may not know each other, this can be in a webinar format where no one sees other participants, and the individual being coached, and the coach are the only ones that can be observed.

The other end of the spectrum is more of a coach-facilitated discussion where the participants converse around a topic. The coach chimes in to offer self- and group reflection, framing what is being said, and keeping the focus on the group's stated objective.

-Individualized. One-on-one coaching involves the individual and their coach.

The benefit is more devoted time to the individual and their identified needs. It also offers confidentiality for topics that the individual doesn’t want to unpack in front of others. A set of 1:1 coaching sessions, build on one another to move the individual to their goals over time.

-Hybrid. This is when the coach offers both group and individual coaching to maximize both benefits.

Okay, I hope that was a helpful overview.  In two weeks, we will look at the evidence around physician coaching. Then we will wrap up with how coaching works in academic medicine and the possibilities for the future. 

Next week, I will highlight one physician coach that utilizes group coaching for physicians looking to recover from burnout.  

Have a joy-filled week! Tonya

Learn more about my hybrid coaching program for family medicine residencies.