Faculty Coaching Approach to Individualized Learning Plans

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). This post is now part of the Faculty Coaching Skills Series , which explores how faculty can apply coaching approaches in medical education.

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.  

The CCC, program coordinator, and others can also provide critical data for the residents to have as they reflect on their goals. 

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.

What do we want them to reflect on? Their career goals to the degree they know them, that communities needs, the data that is given to them by the program, their formative feedback that stands out to them, and their assessment of where they are and who they are becoming. 

By starting with the end in mind, residents can more easily identify the areas they want to focus on their growth. Then by listing those, they can start to formulate 2 growth goals and 1 well-being goal. (I'm not going into the weeks about goals, sub-goals, objectives here - just frame them the way they work best in your brain). And they write those down and bring them to you. 

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. It is a skill, so they may not excel in it to start. 

*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 taking a coach-approach, 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. This actually gives you more practice coaching.

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.

1.  Appreciative Inquiry - I like to start with “What’s going well” before we launch into their ILP. This appreciative inquiry gives the resident a chance to intentionally combat the negativity bias and remember their growth to date, that there are things in their current world to be grateful for and build self-efficacy.
2.  Strengths review – Over the 3 years, they will be adding to their strength reprotoire. You can help facilitate this. Many trainees overlook their strengths or downplay them or feel like it’s not appropriate to talk positive about themselves – those defaults will keep them from recognizing and playing toward their strengths.
3. I like to then, dig a little more on their strengths. What else? What do their patients, staff, colleagues say they do well? What do their friends, family, community contacts say? What does their VIA Character Strengths say (a free validated tool that I have no financial interest in)? 
4. Explore Future Plans. Inquire about their future plans. What makes that type of practice seem like the one they want? What will be fulfilling about it? By asking these questions in a non-judgmental curious way – you will help them draw new connections in their minds.
5. Explore Growth Areas. Ask about their ideas of what to work on for the future. What in particular about those growth areas stand out? “What” and “how” questions may deepen reflections and their insights as you talk.
6.  Optional - Add in Considerations. This maybe a good time to bring up other areas they may have overlooked or left out – that you feel are important, such as:

• Particular CBME Outcome with much growth needed (from the CCC).
• Some specific constructive feedback/evaluations of which they’re aware
• Key needs of their future community/practice plan they may not have thought of

The way to do so as a faculty using coaching skills would be to invite reflection instead of correction. Something along the lines of “These areas you’ve identified seem really supportive of your long-term goals. I’m curious, as a 3^rd year resident who is being mindful of the outcomes you need to meet, what are your thoughts of how 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, and notice whether the resident engages or avoids the topic. If they minimize or ignore it AND it's that important, that’s your cue for a negotiation or nudge (see below).

7.  Goals Continue to explore them 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. Motivation - Ask about the importance of the goal to them and about where they are in their readiness and confidence level. This is motivational interviewing - you know these things. What would help them be more ready, more confident. If it's not important, either how can they make it more important or do they need a different focus?

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. This is them getting to learn what works for them in various situations. You're helping them with a life skill. 

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? There is no Failure here, only learning. I repeat. If they didn't make any progress toward any of their goals, this is not a failure. It's data for learning. Explore without judgment, make refinements for the PDSA cycle. 

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 a resident appearing to overlook or ignore important areas of growth, some of which could impact not only patient care but also potentially their own promotion and graduation.

That’s when I like the term “negotiate.”

At the same time, there may be many factors (more on that next week) that contribute to a resident overlooking important growth areas—some of which could affect not only patient care but also their promotion and graduation.

That’s when I like to think in terms of negotiation or nudge rather than correction.

Negotiation example:
“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 the resident downplays it (“I’m not going to do inpatient medicine after graduation”):
“I appreciate the fact that you’re not going to do inpatient medicine in the future, but it’s key to your graduation that you demonstrate competence in this area. How might improving inpatient decision-making translate into your outpatient practice? What’s the hardest part about it? What ideas do you have to make that better? How do we add that goal to the mix?”

From there, keep the ownership visible:
“Which of two original goals do you want to stay the same, and which should we replace with this one on decision-making; or, maybe we mix blend it in with one of your existing; or perhaps you’d rather work on all three goals at once. What seems best for now?”

If resistance continues, pause and assess: Is this the moment to nudge or to direct?

• What’s the real consequence if this isn’t addressed?

• Can you let the goal rest for now, trusting the seed you planted?

• Or is it urgent enough that the expectation must be set?

When it’s clear the issue needs to be addressed, name that shift transparently:
“As your (name the role/hat switch - advisor, mentor, APD, PD, etc.), I believe we need to make sure this area is visible to the CCC. Let’s shape a SMART goal around that together.”

You still keep the resident engaged, but you’re honest about when the decision moves from optional to required.

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.

Empowerment. 

Rather than needing negotiation, you may notice clues that a resident needs more empowerment.

Two common situations to tune into:

1. “I don’t know.”
This is often a first-order answer, not a final one.
Pause. Let silence do some work—or name what you see:

“I notice you paused. Want a moment to think?”
Then try gentle prompts that return ownership:

• “What if you did know?”
• “What would you guess?”
• “How could you decide?”
• “Remember, this is a PDSA cycle—an experiment.”

2. “What do you think?”
When residents default to your expertise, your advice monster may hear it as a green light to jump in. But this is often a cue for empowerment, not direction. Try:

“I’ll be happy to share my opinion in a minute if you still want it, but first I’m curious, what do you think?”

These moments often arise just from fatigue, uncertainty they're not ready to explore, or lack of rapport. But often, they're afraid to give an answer, what if they're wrong, or they can come from a sense of learned helplessness. You helping empower them can be refreshing. If you miss the clue, it’s easy to slip into fixing mode. If you catch it, you model trust and reinforce their capacity to lead their own learning.

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.