As I end the physician coaching series to focus on faculty, I want to continue the conversation from last week about faculty taking a coaching approach in their roles. Today, I’ll touch on individualized learning plans (ILP).
The ACGME’s more recent standards for programs to train residents under a Competency-Based Medical Education model require that an ILP “should be formulated by the learner, include personal learning objectives, and identify resources and strategies to achieve them. While the learner should be able to create the initial ILP, the ILP content should be guided by a facilitator (faculty member, associate program director, or program director)“. The STFM and AFMRD task force on CBME has recommended quarterly ILPs for each resident throughout their training toward this end.
The ACGME, ABFM, and STFM CBME Taskforce want us to co-create ILP. The tension here is that ILP are more developmental in nature but we are asked to take a performance-based coaching approach. (Read more about those terms in last week's blog). However, I will lay out the approach that I think works really well.
I think this is a fabulous idea. Seriously, it so aligns completely with well-being, growth mindset, and the development of master adaptive learners (MAL) that it has the potential to spur our training of the next generation of family physicians to be the most engaged, healthiest, and clinically astute in patient care!!It empowers the resident, taps into growing their self-efficacy and really hits all 3 areas of psycholgoical fitness (autonomy, relatedness, and competence). It also accesses higher quality motivation than the traditional carrots and sticks that aren't as useful in complex settings. (I say “potential” because if it becomes “just another checkbox” to mark off during resident-advisor meetings, it could fall very short.)
Okay, controlling my enthusiasm so I can convey my take on how this can work well.
The STFM CBME task force has developed an ILP template that makes it incredibly easy and impactful though many programs have developed their own.
Here are my recommended steps to taking a Coaching Approach with an ILP:
Aspirational pre-work Step by CCC:
While I’m laying out my favorite way of approaching this, one idea that came up during the planning for the pilot with STFM’s CBME task force, was the potential for the CCC to have the assessments mapped to the outcomes and give the opportunities for the most growth to the resident, faculty-coach (who may or may not be the advisor) twice a year in preparation for their next couple of their ILPs.
One easy way the pilot programs are doing this is with the New Innovations and MedHub tools developed specifically for this reason for STFM.
Step 1 Resident
Ideally*, the resident will spend time reflecting and filling out their current plans for their future practice and strengths in advance of the meeting with whoever is serving in the coaching role.
By starting with the end in mind, residents can more easily identify things they need to work on for their future careers. They will extrapolate from the growth areas 2 growth goals and 1 well-being goal.
The learning and power that this step alone can create shouldn’t be underestimated. This is foundational to self-assessment and self-direction – habits that will serve them well over their careers.
*In real world settings, there will be times that a resident either doesn’t fill it out in advance or rushes it just before they come to the meeting. As a faculty-coach, continue to emphasize the importance of learning how to prioritize and carve out time for self-reflection (perhaps give examples of what helps you). And, then give them the option to take the first 5-10 minutes in quiet to really reflect on their own, or to partner together and walk them through it from start to finish.
I piloted this with a resident who I gave the form and specifically said – if you have time to glance over it do, but don’t worry about filling it out. We spent 50 minutes over lunch at a sandwich shop, having a meaningful conversation and getting it all filled out. There is value to be had, even if they don’t get it done in advance.
Step 2 Resident and Faculty Coach Alliance. The resident brings this to a pre-arranged protected time meeting with you to explore. The time and space allotted for this allows the resident to take a break from feeling like they’re on a hamster wheel to really remember what their purpose in being here and build rapport with you. I’ll break this into the steps I recommend.
The way to do so as a faculty using coaching skills would be something along the lines of “These areas you’ve identified seem really supportive of your long-term goals. I’m curious, as a 3rd year resident who is being mindful of the outcomes you need to meet, what are your thoughts of what you need to meet the “Model Professionalism and be trustworthy for patients, peers, and communities” that the CCC has identified as a growth area for you? Listen and ask non-judgmental questions.
7. Goals Continue to explore the more deeply – what will the goals do for them and their patients and their future practice? How do we make it more SMART (specific, measurable, achievable, relevant, and timebound – walk them through each letter and assist as needed)? What, if anything, could be changed to make it more inclusive or equitable? (the new I and E in SMARTIE)?
8. Obstacles & Strategies Ask about the obstacles they anticipate and the strategies they can employ to overcome them. Ask about how their strengths and resources they identify can help
9. Experiment Helping them see this as a low risk experiment lessens the implicit, inherent perfectionism that arises. What’s the first step, how will you reassess, what things might you tweak?
10. Accountability What works in ways of holding themselves accountable? What other ways may they consider for this specific goal? What role, if any, would they like you to play? You may share what all things you’ve tried and what you’ve learned about yourself along the way, understanding they may need something different.
11. Internalize the Learning During the course of your conversation, your resident has likely developed new ideas, insights, perspectives or remembered things they’d forgotten like their strengths or resources or successes – help them internalize it simply by asking their takeaways.
12. Next ILP Reflection. Finally, on the follow-up ILP, have the resident explore the last three months of progress on their SMARTIE goals/objectives—What went well? What helped that part go well? What didn’t? What did you learn? What do you want to do differently going forward?
Both Contributing. Taking the coaching approach with your faculty expertise, hopefully, the conversation above will be back-and-forth with both of you contributing and not just you making recommendations and giving your opinion. This is how they develop the skills of the MAL.
I encourage you to hold off on frank advice unless asked—and even then, maybe delay it: “I’ll be happy to tell you my opinion, but first, let’s explore what seems best to you.” You will often be wowed by the answers they come up with. Even after their initial default “I don’t know.” Pause and give them space to think. Often, their answers are so much better than our advice. This approach is empowering and allows them to build confidence in experimenting with ideas that may be a better fit for them.
Negotiation. At the same time, there may be many factors (more on that next week) that contribute to the resident ignoring important areas of growth that will not only impact patients but also potentially their own promotion and graduation.
That’s when I like the term “negotiate.” “I really like that you’re thinking through how to improve your women’s health procedures for your future practice and to get your notes done on time. At the same time, I don’t want the feedback from your recent inpatient medicine experiences to get lost. The evaluations state you are relying on the attendings’ recommendations rather than formulating your plan independently. What are your thoughts about that? What’s driving it? How do we incorporate that in here? “(If resident downplays it since they’re not going to practice inpatient following graduation). “I appreciate the fact that you’re not going to do inpatient medicine in the future, but it is key to your graduation that you demonstrate competence in this area. How might improving in inpatient decision-making translate into enhancing your planned outpatient practice? What’s the hardest thing about it? What ideas do you have to make that better? How do we add that goal to the mix?” (Not sure) “You pick one of the two original goals and replace the other for now with this one on decision making; or, maybe figure out how we mix it in with one of the others; or, perhaps you want to work on three goals at once? Or maybe you see another option? What seems like the best for now?” (If continues to be resistant, here’s your decision point based on your experience as faculty. Is now the time that it “needs” to take place? What’s the real consequence if doesn’t? Can you let them leave their goals as is and know you’ve planted a seed, or is it more urgent?) “Well, as your (advisor, mentor, faculty-coach, APD, PD, etc) I really think we need to have this addressed so that the CCC can see you are committed to working on this area of concern. Let’s make a SMART goal around that.“
Remediation. A word about remediation plans, performance improvement plans, whatever term you prefer/use. If you look at the ACGME remediation toolkit (which I feel is excellent), you will see that many of the approaches are coach-skill based approaches with many good coaching frameworks.
You likely will need more negotiating in these situations since outcomes are more consequential for the learner – but I still encourage you to allow them to develop these skills via reflection instead of becoming directive too early in the process. Many will surprise you.
That’s all for this week. Next week, we will begin to highlight the skills, many of which you already have, to take the coaching approach.
Until then, have a joy-filled week! Tonya
If you are looking for an external coach for faculty development or to work with groups and individuals of residents, take a look at what I offer residency programs.
50% Complete
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.