What is Physician Coaching? Coach and Coachee-Specific Components

We are in the middle of a blog series all about physician coaching. Last week, we reviewed the definition. What it is and what it’s not.  Today, I want to unpack the components of what the coach and the coaches both bring to the session to optimize the power of coaching. In the coming weeks, we will review some of the coaching tools, the variations of coaching, the evidence around coaching in medicine, the ways it’s being utilized in medical training, and the possibilities for the future.  

Let’s start with the coach-specific skills that a coach leverages in a coaching session.

Creates and holds a safe space. This is crucial as psychological safety allows you to really think deeply and share openly. Accessing all the portions of your brain will help you see your best answers. Studies involving functional MRIs demonstrate that coaching, using the components and tools discussed in this series, globally activates the brain, resulting in positive affect and change. 

A safe space includes a non-judgmental approach. A coach provides integrity around confidentiality. Finally, a coaching conversation is not directive. The coach has no agenda. They want you to determine your best path, approach, and result.

Like many in medicine, family physicians regularly practice some of these approaches with their patients, especially when employing motivational interviewing. One difference in motivational interviewing is that as the medical expert, you do have an agenda of wanting your patient to make lifestyle changes. Having an agenda in this setting is wholly appropriate, as this is why they have sought you out.

An example that I like to highlight where most primary care providers exercise all three approaches involves a pregnant woman. We have likely all been given a positive pregnancy result to disclose to a patient about whom we know nothing. Will she be ecstatic, thrilled, worried, disappointed, scared, or angry? We know she may have multiple mixed emotions regardless of whether it was planned, unplanned, desired, or not. We don’t offer judgment or agenda. We don’t make assumptions. And as always, we offer confidentiality.

When it comes to expertise in a coaching session – you, as the client, are the expert of you: your context, circumstances, goals, etc. The coach has expertise in coaching skills and tools. As both parties bring expertise, there is no hierarchy. It is a partnership.

Deep Listening. Listening happens on five levels. First-level is ignoring, not listening at all. Second-level listening is pretend listening. That’s when we give all the normal cues, such as nodding, but we really aren’t listening. Many times we are thinking about what we want to say instead. Third-level listening is only tuning in to the bits that interest you. I find myself doing that when listening to podcasts. Forth-level of listening is attentive listening. We are tuned into what is being said. And fifth-level listening is going to that deeper level – where we are listening to truly understand.

Having someone entirely devoting time to deeply listen and understand you is so impactful.

Develops Awareness. A coach helps develop your awareness. This is primarily done through reflection and questions. Questions are utilized, not to satisfy their own curiosity, but to help you think more broadly or deeply. They also increase your awareness by reflecting on things you’ve said or things they are noticing. Sometimes it brings more meaning to hear your words reflected back. It could be tone or posture changes. It may be seeing some parallels in various situations. They may see what appears to be contradictions. Pointing this out allows you the opportunity to get clear for yourself. They also use framing and reframing and offer perspectives up to see what your take is of it.

Facilitate Growth and Action. When the foundational skills above are employed, it often leads to a natural progression of growth and action. Other times, a more directed line of questioning is needed to progress and decide the session's application. 

There are many more skills that a coach brings to a session but these are the most fundamental.

The important client-specific components that you, as the coachee, bring are:  

Time and Focus. First and foremost, you bring your most valuable asset – yourself. It’s an investment of your precious resources - time and attention. The ROI is phenomenal.

Agenda. Since the coach wants you to get your best answers, you set the agenda. It can be things that align with the longer-term aspirations, those outcomes you want from coaching. It can be anything that is most pressing for you at that moment. And to be honest, if you don’t have time to think through, the coaching session is still valuable. You can co-create the session. Sometimes a few minutes of reflective questioning will lead you to what will be most important to work on that session.  Whether the physician coach calls themselves a leadership coach, an executive coach, a life coach, a health and wellness coach, or an academic coach 🙋🏼‍♀️, they have the skill set to coach around the topics that are most important to you. And, if you happen to have a rare occasion that the coach isn’t comfortable with something you desire coaching around, they will be open and honest with you about that. All facets of life are woven together and impact each other. As a coach, we just start with one end of the thread you hand us and follow where it leads.

Authenticity. The more open, honest, and transparent you are, the more you will gain from the process. Vulnerability doesn’t feel comfortable but is the currency of growth at times. Lean into it up to the point that it still feels safe.  

Self-Reflection and Open-Mind. The ability to pause and self-reflect is a process that will make coaching more helpful. Doing so with an open and growth mindset allows you to discover what you appreciate and want you want to change as you move toward your goals.

Action Planning. You discover and decide what actions you implement based on your session. While a coach partners with you in setting it up in a way that feels best to you and is more likely to be successful, your ideas and plans are the valuable takeaways here. Again, these, more often than not, appear naturally as a result of doing the above work.

As physicians, we are often wired to just move on to action without laying the foundation of the reflection and mindset work.  But once it’s laid, it becomes apparent which actions you want to take, and they will be more achievable.

Accountability. There are 2 schools of thought. Most executive coaches spend a fair amount of time on action planning and accountability. The benefit of them emphasizing accountability is that you know that each time you meet with your coach, they will ask you how you followed through on your plans, which can be useful. It also allows the coach to help you determine what derailed your plans to help you develop a better strategy.

The other school of thought is that a coaching relationship is temporal, especially in academic settings. By relying on a coach, the coachee may not develop a reliable method of accountability going forward. Therefore, the coach as the sole accountability partner may not be the best approach for long-term accountability. And, as perfectionist-tendency busy high-achievers that don’t want to disappoint anyone, it could be easy to postpone coaching sessions if the individual hasn’t yet followed through on the plan.

My approach is to leave it up to the client whether they want me to play a role in the accountability for the duration of our relationship or not. If so, part of the goals can be how they will find accountability once I no longer coach them.  And, we agree that a lack of following through with the plan cannot lead them to avoid the next coaching call. I remind them, there is no judgment from me.

Okay, that covers the foundational components of what the coach and coachee bring to a session. Next week we will review commonly used tools and maybe unpack some of the variations. 

Until then, have a joy-filled week!  Tonya

Although I primarily partner with family medicine residency programs to coach faculty and residents, I will work with individuals whose program isn't quite ready to have an external coach. Set up a call to discuss.