Faculty Coaching Skills - Part 1

We are continuing to unpack coaching skills for faculty. Two weeks ago, we covered how faculty taking a coaching approach differs from physician coaching. Last week, we walked through a coaching approach for faculty to consider when working with residents on their individualized learning plans (ILP). Today, I hope to offer you an overview of the coaching skills to incorporate as faculty and then dive into the first — Creating a Safe Space.

The great news is that most of you as faculty (physicians, pharm D, behavioral scientists, DPTs, etc.) already have many of the skills needed to take a coaching approach with your residents. As I unpack each skill, I’ll highlight the aspects that may feel new, challenging, or uncomfortable.

Let’s look at an outline of the general skills used in a coaching conversation. (Use your appreciative inquiry lenses to see how many of which you already possess some skills.)

• Create a Safe Space
• Deep Listening
• Develop Awareness
• Partner to Define/Design Progress
• Assist Internalization of Learning
• Assist Accountability Plan

Creating a Safe Space. In creating a coaching-educational alliance, there are cognitive and relational components. The cognitive components define the coaching approach and how it differs from the traditional “telling” approach of you as the expert. They define the goals, roles, and rules. The relational components include rapport building, trust, respect, and caring. Together, these add up to create a safe space.

• Before trainees become accustomed to coaching by their faculty, defining the coaching approach and why you are shifting to it helps the trainee understand the importance. Being asked probing questions by a faculty member who normally takes a directive approach can feel quite invasive. Highlight the key reasons behind a performance-based coaching approach. Here are a few of my favorites:
  • Coaching helps the coachee discover and plan their own best ways forward
  • The process of self-(re)assessment, reflection, and direction builds skills that will endure for their careers, ensuring they can adapt to the rapidly changing healthcare landscape (become master adaptive learners MAL).
  • Coaching reflections often develop the muscle memory to recognize knowledge gaps in real-time. In other words, they don’t neglect the sometimes-subtle questions in their minds while trying to “get through the visit and get an answer.”
  • Coaching empowers them in their educational journey.
  • Coaching helps them evolve their quality of motivation instead of defaulting to the carrots and sticks being the drivers of the educational process

• You retain your faculty hat while using a coaching approach, and the trainees, as coachees.

• Customize and outline the process as it is used in your program. I’ll offer a couple of suggested guidelines:
  • Give them explicit permission to opt- out of a question. “If I ask something that you’re not comfortable answering, just say ‘pass’.”
  • I may offer some suggestions, but they’re just for you to consider and decide if they make sense. If I have something that is a direct request or mandatory, either by me or the program, I’ll make it explicit that it’s not just ‘something to examine’

• Rapport (Trust, Respect, Caring) Building psychological safety is a key part of the alliance.
  • An existing good rapport with a trainee is a helpful foundation. However, if you don’t have one, then coaching can be an approach to improving rapport.
  • At least initially, ask permission to take a coaching approach or at least to trial it. Having a shared willingness to engage in the process is important. As you both become comfortable with the approach, you can then say, “This sounds like a coaching opportunity. What do you think?”
  • It will be helpful in some coaching situations to define what is confidential and what isn’t. This will likely be more important in ILP’s as opposed to feedback coaching conversations. (see last week)
  • The option of opting out of a question if it seems probing can be useful. I often offer that if they’re not open to answering it to me, I give them a few seconds to consider the answers themselves—and maybe write them privately to capture them for further reflection.
  • Suspending your own judgment will naturally affect the way you communicate and strengthen the alliance. You’re human; you will have judgment, but setting it aside as you tune into it is a powerful skill that gives them the freedom to truly explore their thinking and options. You likely have developed this clinically in patient care; now, you’re just transferring it to your trainees.
  • Allow the trainee to drive the agenda. This is empowering in many coaching conversations, especially those on developmental topics. It may also occasionally support skills-based coaching conversations.
  • Make room for asking what’s going well, and relationship building in addition to the coaching topic.

The Resistant (Learner) Coachee. You will encounter residents who appear resistant to being coached, whether or not they seem resistant to other approaches. This can look like reluctance to reflect or answer questions, or they may appear disengaged or even antagonistic.

I’d like to offer you additional perspectives:

• Viewing and/or labeling a resident or fellow as resistant is rarely, if ever, beneficial. Your own mindset is foundational to how you interact with them.
• If you utilize a coaching conversation by building in the key factors above, you’ve given them everything they need to decide how much to disclose to you (i.e. how vulnerable to be).
• Short of that, they still may not feel comfortable for a myriad of reasons:
  • They’re experiencing severe impostor thoughts and feelings, and it doesn’t feel safe to let their mask of perfection slip.
  • They are in a situation where they don’t feel they belong – whether they identify as part of a historically marginalized group or otherwise – you cannot always overcome their experiences to make them feel safe. And honestly, I think most programs have continued growth opportunities in the EDI space.
  • They grew up in a family or culture that makes these conversations feel too personal or familiar and outside of what they consider to be professional standards.
  • They are in a state of learned helplessness, and “I don’t know” feels very real.
  • They’re exhausted. Maybe they are just getting off nights or have had a stretch of 80-hour weeks. Self-reflection takes mental energy.
  • They’re burned out.
  • Their mental health is not doing well.
  • They just don’t yet have the level of rapport with you, despite you doing all the right things.
• Use your curiosity, perspective-taking, and suspension of judgment to meet the trainees where they are – their level of “safe vulnerability”. 

Approaches to consider:

• Naming what you observe can be helpful in uncovering what’s behind the observations. “I noticed when I started asking you questions, you lost eye contact, folded your arms, and gave short answers or said, ‘I don’t know’. I’m curious as to how you are experiencing this conversation?”
• Empower them to create the process. “What would be a more useful way or time to give you feedback?” “How might we better utilize this time to gain you clarity and confidence to make progress in this area?”
• Offer the learning curve and benefits you’ve received personally when self-assessing, reflecting, and discussing with an experienced peer, mentor, or coach.
• Discuss your own experience through impostor moments, or if you are in the 30% who haven’t experienced it, then what you’ve observed in many trainees over the years. Normalize the self-doubt and discomfort that can occur.
• Ask what they need to feel safer to have these conversations.
• Check-in with their bandwidth. “I don’t know” is a common answer for many just learning to self-reflect, but it does take mental energy. Maybe there is a better time – the next morning when they’re fresh instead of at the end of a long day, etc.
• Challenge the I don’t know with space, time, and silence. “What if you did know?” “What if you had to guess?”
• Ask about their support systems and how they know if/when they might consider additional support. I offer an example: “Many physicians find it helpful to periodically perform a PHQ9 and have a plan laid out on what to do at what score.”
• Ask about how they’re carving out time for downtime, rejuvenating activities, self-care, and what else they need in that regard.
• For recurrent, seemingly unproductive ILP coaching conversations (which are more developmental in nature and may cause the most discomfort), you may want to consider allowing them to identify someone they feel more comfortable coaching through the ILP.

That’s all for this week. Next week, we will take on the next coaching skills and highlight where many of the more unnatural approaches will appear. 

Until then, have a joy-filled week!  Tonya