The Dream of Possibility: My Idea of Ideal Coaching within GME.

In a follow-up to the What is Physician Coaching? blog series, I thought I’d take a minute to write out what I felt is the ideal way for physician coaching to be used in graduate medical education (I explored the possibilities a couple of weeks ago). Dr. Michele Chestovich, a fellow family physician and coach, challenged me with this question after we concluded a recording for her podcast, Re-mind Yourself. (When this blog was published, the episode hadn't been released).

I’ve been mulling it over, and here is what I believe and hope for GME as it pertains to coaching (I've bolded the most important items from my experience and vantage point):

1. All GME faculty learn basic coaching skills and learn when to take a coach approach (as opposed to the usual advisor, mentor, sponsor, or traditional educator approach) for particular situations, individuals, and settings.
   1. This is crucial to ensure that all 149,000+ trainees have access to the benefits of coaching at important developmental points.
   2. Read more here and here.
2. Class-specific trainee and core faculty (including leadership) receive proactive team coaching monthly or quarterly supplanting a faculty or resident meeting.
   1. This approach will open up possibilities and lead to better cohesion, shared vision, connection, collaboration, and synergy.
   2. I see pros and cons for the coach in this context as being internal vs. external, and as such have no strong opinion.
3. In family medicine residencies, Behavioral Scientists fill the role of the BH faculty requirement and partner with the external coach to bring contextual understanding and direction while the coach continues to highlight the value the BH faculty offers to the individuals and leadership.
   1. Psychologists have been off and on the chopping block for several years because they are undervalued. See additional thoughts on this below.
   2. There is a strategic alliance that comes about by pairing the BH team with a an external coach.
4. Every resident, fellow, and faculty have an identified external coach (one they don’t rotate with, supervise, and aren’t supervised by) with whom they have an ongoing relationship that they meet on day 1 (set up as an opt-out) to establish familiarity and decrease barriers to reaching out. They regularly meet one-on-one (privately) at least trimesterly, with prn meetings as determined by the individual.
5. University and sponsoring institution decision-makers meet regularly with the DIO, Chairs, and PDs within their system in a quarterly team coaching session. Everyone’s opinion is heard and valued.
6. There is an institution (or hub for a network of residencies) in which there are remediation coaches with the skills and experience that each trainee and/or faculty in difficulty receive the best practices in coaching them to flourish as a physician. This could be both referral based from PD/CCC and individual initiated. 
7. Annually, there is an open forum/town hall where the DIO and Institutional leaders are transparent with situations and plans; individual trainees and faculty can bring forth discussion points.
   1. The landscape of sponsoring institutions is evolving and often involves non-academic leaders and or even private equity firms who do not have a full grasp on GME as set out by the ACGME and ABFM.
   2. Having a shared understanding of the educational processes, shared vision of the GME programs, and shared goals of what investing in GME returns are crucial. A coach skilled in team facilitation could optimize this.
8. Universities and Sponsoring institutions see the investment in coaching as valueable and necessary to operate GME at its highest potential.
9. Medical and ancillary staff and leaders for hospitals and clinics have a leader trained in coaching to facilitate regular meetings and foster a culture of excellence, team, and appropriate expectations and interactions with trainees. 
   1. Since the trainees are already learning the importance of team, collaboration, and respect as outlined above, this approach will decrease the now common occurrences for using incident reports as retaliation. And form more productive ways of communication between trainees, the program, and medical and ancillary staff. 

There is much more to say about my view of behavioral health faculty that are well-skilled for graduate medical education than could fit in the outline above. I want to unpack them here just a bit more:

Psychologists, and other trained behavioral scientists, are the best people to fulfill the ABFM requirement that Family Medicine Residencies have a faculty member designated as the behavioral health faculty leader. Yes, amazing family physicians are filling this role and doing a good job at it. However, a psychologist brings a robust value beyond the limited items leadership assumes that they do. At the Alaska FMR program, as an example, our BH team:

1. Integrate a behavioral health component to our patient-centered medical home, including group visits, warm hand-offs, co-visits with PCP, and individual therapy sessions.
2. Give valuable input on EMR templates for such things as ADHD, Depression, Anxiety, and Autism screening.
3. Train residents in patient communication, interactions, motivational interviewing, agenda setting, boundaries, difficult conversations, cultural humility, implicit bias, etc.
4. Plan and execute a special month called Transcultural Medicine in which the interns' and seniors' only patient care responsibilities are in their continuity clinic – the rest of the month is dedicated to expanding their understanding of community, culture, and themselves as they relate to these larger ideas.
5. Observe, evaluate, and coach residents on patient interactions.
6. Train and oversee clinical social work and psychology students at all levels by partnering with the local university as they work with our patient population.
7. Obtain grants and IRBs to study and add value to the knowledge of medical and mental health care.
8. Train residents in the psychological aspects of their patients’ care.
9. Coordinate psychiatry and behavioral health rotations/training/didactics.
10. Offer well-being support to the residents, they are present physically and are skilled listeners and encourages. (Though they don’t become their therapists.)
11. Connect trainees to vetted community mental health resources and help them confidentially navigate access to that care and being excused from rotation for such.
12. Offer self-care instruction, stress mitigation which include psychological and emotional fitness skills.
13. Facilitate Balint groups.
14. Step up to interject important perspectives in emotionally charged meetings with residents and/or faculty.
15. Help develop remediation plans for residents in difficulty.
16. Offer trainees contextual support to navigate the ins and outs of the local personalities and systems.
17. Help trainees navigate inter-professional issues such as mindful communication and team-based care.
18. Bring a valuable perspective to the CCC and so much more.

This is where a strategic alliance occurs. Not all trainees and faculty need therapy but most would benefit greatly in their well-being and their professional fulfillment by having a therapeutic, confidential relationship with a coach. However, that does not supplant the need for psychologists or other behavioral scientists. First, they do not usually have a formal private coaching relationship with the residents and faculty. Second, they do so much more to bring full health to all involved. Institutions and residency programs must continue to fight for and invest in a robust behavioral health team led by psychologists to improve patient care, resident education, and resident and faculty well-being. This is one of the wonderful things about Family Medicine Residency programs. 

End of rant. Thank you for listening.

My next blog series is going to be a surprise (to you and me. 😂) Stay tuned. I’d love to hear what you’re interested in reading - whether about coaching, psychological flexibility, flourishing inside and outside of practice, and academic medicine for family physicians. Message me.

Have a joy-filled week – Tonya

As we embark on a new academic year, now is the perfect time to meet with me to discuss how we can partner in bringing coaching to your family medicine residency program.