Coaching in Anesthesiology Residency Programs: A New Frontier

Originally published by our sister publication Anesthesiology News

Emerging from the other side of the COVID-19 pandemic, anesthesiology residency medical education is at a crossroads. The current state of medical education is shaped by the medical culture and the changing demographics of our learners. Coaching promises to be an important developmental tool that may be implemented in anesthesiology residency programs.

Coaching in graduate medical education is an emerging concept. Historically, the roles of mentor and advisor have been utilized to establish the relationship between learner and facilitator. We now know that there are limitations to these roles. These limitations are evident at the individual, institutional and generational levels.¹

The pandemic caused multilevel complexities in anesthesiology residency education. It halted traditional didactics as residents were needed on the wards. Isolation took hold of a once flourishing collegial academic culture. Burnout adversely affected professionalism and empathy. Resident gatherings ceased and were replaced by virtual meetings with artificial contact.

The field of anesthesiology is seeing the negative effects of resident and faculty burnout, a national anesthesia staffing shortage and decreased interest in anesthesiology fellowships. The evolving generational differences of learners are also causing a change in the medical education landscape. As a result, learner personal and professional guidance, in addition to well-being, should take center stage in medical education. The principles of advising, mentoring and coaching should be fully explored and reviewed to enable the learner to embark on a path to academic and personal success, embrace the ideals of self-assessment, ensure a safe learning environment and promote lifelong learning acquisition.^1,2

Anesthesiology residency programs extrapolate data from Accreditation Council for Graduate Medical Education (ACGME) national surveys, Mayo well-being scores and other institutional measures to access program culture, education and help gauge necessary departmental changes. Robust coaching programming offered to anesthesiology residents would likely aid in career planning, support leadership roles, aid in faculty recruitment and retention, and enhance our investment in the next generation of anesthesiologists.

Education and well-being of anesthesiology residents rely on a complex paradigm of relationships. Residents at different points in their training will require different interactions: mentoring, advising or coaching. These three modalities are uniquely different, but all of them serve a purpose to promote education, wellness and career development.^2,3 Each approach has a function and uses a different strategy, and it’s important to recognize when each modality would be most beneficial for the learner.² The facilitator must know how to engage and tailor the sessions to allow for expectations and goals to be meaningful for the learner.²

The Mentor

Historically, mentoring has been the predominant approach to providing guidance by focusing on a longitudinal personal relationship between mentor and mentee. The learner’s long-term goals are the prime motivators of this type of relationship. Discussions, career planning and advice are based on the mentor’s experiences and expertise.^1,2 Mentors typically have expertise in the desired field and impart their wisdom to the learner. A mentor should direct the sessions and ask explicit questions with long-term goals as a compass. The mentor relationship is often an assigned process in residency education. In addition to this formal process, many times organic/informal mentorships also develop. Mentors may be asked by training institutions to give feedback or to report on these sessions for ACGME requirements.^2,3 Typically, anesthesiology programs relied on mentorship as a framework for faculty–resident interactions.

The Advisor

Differing from mentoring, advising typically represents a single, informal session centered on a specific event or question. The advisor directs the session and offers solutions or strategies based on their experiences. The learner can decide if they wish to follow the advice or not. A relationship is not needed for this interaction and follow-up is typically not part of this strategy.² An advisor may have limited knowledge of the learner’s personal/academic strengths and weaknesses, and as a result, the interaction is limited to situational singular advice.¹

The Coach

Academic coaching differs from advising and mentoring in that this relationship is driven by the learner. Coaches do not offer advice or participate in decision making. The coach’s role is to assist the learner in self-discovery and provide a safe template for self-assessment and planning the trajectory of desired paths. Coaches help identify what actions may lead to success or failure. They do not need to have expertise in the medical field, and unlike mentoring and advisor roles, coaches begin with actively listening to the learner and asking probing questions for learner self-realization.² The practice of coaching allows for a consistent and longitudinal relationship. An educational alliance is formed between coach and learner, and keep in mind that trust is the cornerstone of a safe and nonjudgmental interaction. Core characteristics of a successful coaching interaction are shown in the Table.³ Typically, written summary feedback is not provided, unlike in advising or mentoring roles; however, notes may be taken, but confidentiality is important to protect the nature of the relationship. Feedback should be informal and more of a means to gauge development and goal seeking.

Self-Determination Theory

Coaching programs should seek certain goals: to provide a safe place for personal and professional reflection, promote well-being, help learners achieve desired goals, and help learners lay the framework of self-monitoring and lifelong learning. The learner must be accountable and have insight into their own strengths and weaknesses, and must be truthful to self and coach for a successful relationship.² The self-determination theory mandates that an individual’s motivation to learn is driven by three needs: a sense of relatedness, a sense of autonomy and a sense of competence.^5,6 Coaching can help a learner identify and navigate these competencies through motivation, feedback and listening. Lifelong self-monitoring tools and assessment are crucial to professional development. More than ever, anesthesiology residents are looking to faculty to do more than just simply guide. Through coaching we can help strengthen career paths, increase job satisfaction, and ensure the cultivation of leaders and innovators.

Individualized learning is also an emerging concept in medical education. Adult learning theories emphasize self-directed knowledge accumulation, acknowledges the importance of past experiences, and focuses on goal-oriented pathways. It is well known that an individual’s experiences and generational difference impact learning.⁶ A generation is a sum of attributes and collective attitudes, and one could then draw the hypothesis that a particular generation may respond more favorably to a particular strategy: advising, mentoring or coaching.

Millennials

Looking at current resident learners, the majority of anesthesiology residents will be comprised of the millennial generational group. The millennial generation (born 1982-2003) may be predisposed to delayed entry into adulthood ideologies. They are a combination of confidence and optimism, while at the same time can be highly anxious and possessing an increased need for feedback and accolades. Millennials are career-minded with the expectation for rapid advancement and recognition for their work. They desire continuous feedback and their career trajectory may be shaped by such feedback.^4,6 Millennial learners have a strong commitment to community and are motivated by helping others, and will expect a high degree of individuation and access to facilitators/educators. The coaching strategy aligns well with what is known about the millennial learner. The allowance for self-discovery, emotional support, informal feedback and positive reinforcement creates a safe environment for the millennial learner to reach beyond boundaries they may have questioned or felt impassable.

Millennials in graduate medical education will be shaped by their involvement in the COVID-19 pandemic. The emotional impact of the pandemic is still ongoing, and residents have reported feelings of abandonment by their programs, extreme dissatisfaction with working conditions, emotional depletion, burnout, and increased rates of depression and isolation. A robust anesthesiology resident coaching program could address the current climate of resident education and culture.

Customized support can identify individual needs and serve as a development tool.^1,8,9 Professional development techniques preferred by millennials include coaching, feedback and one-on-one sessions. Coaching programs look very different across medical specialties, corporations, not-for-profit programs and large learning institutions. Corporate programs frame the coaching process into steps: learning, development and human performance. Established coaching programs in medical education have not been well defined in the literature.¹ Program goals must be explored and established, and coaches will need to be recruited.

Coaching requires skills that are different from those of mentors or advisors, and individuals should excel in the following: communication skills, understanding the learning plan and environment, be experienced in goal setting, and be adaptable to the process.^9,10 Faculty development is also important to ensure quality coaches and a shared understanding of the program’s goals. Many anesthesiology departments offer faculty development programs. Coaching development could be a positive addition and highlights a department’s investment in its faculty and learners. Coaching programs can be constructed to align with learner needs and can be scheduled at intervals throughout the year. These meetings should include agenda creation, participation in coaching exercises, goal setting and a plan for follow-up.¹¹ The coaching environment can promote not only individual successes, but also program success due to positive culture change. A supportive environment can improve performance, prevent burnout, improve recruitment and increase retention.^12,13 Coaching programs will not only improve anesthesiology resident performance, but also promote much-needed culture shifts in medical education.

More than ever, our role as teachers is critical. We should make ourselves available to residents as early in the process as we can. Starting early and meeting often seems to be where we can have an impact with our most vulnerable residents. We can expand beyond the usual conversation of exams, evaluations, career goals and the obligatory questions about wellness, and try to build a relationship in which they feel safe and heard. A future research query should address the question: “Can a single person fulfill the roles of coach and mentor?” This will become an increasingly important concept in anesthesiology residency programs that are affected by staff shortages and plagued by a culture of burnout. As mentors, we need to be teachers, role models of professionalism and advocates for learners’ well-being. As coaches, we should support self-realization, employ the constructs of psychological safety, and help residents achieve their academic and personal goals. Coaching helps learners to take a self-guided journey to discover their full potential, and there will be times when we must go beyond the structured mentor relationship and practice coaching instead.

Fundamental research could address four questions:

1. How do we structure a program consisting of dual coach–mentoring facilitators?
2. Could an anesthesiology residency coaching program increase faculty recruitment and retention?
3. Would such a program prove to result in increased resident wellness?
4. Would a generational approach to coaching/mentoring result in improved outcomes?

Surprisingly, there is not a large-scale collection of scholarly articles that discuss the ideas of coaching as it pertains to the millennial generation in graduate medical education. It seems that the research in this area is in its infancy and there’s great potential going forward. Anesthesiology is a specialty marked by innovation, emphasis on education and lifelong learning, and betterment of humanity; robust residency coaching programs may likely be a positive predictor of success in those domains in the future.

References

1. Deiorio N, Hammoud M. Coaching in Medical Education. American Medical Association Accelerating Change in Medical Education Coaching Handbook. 2017. https://www.ama-assn.org/system/files/2019-09/coaching-medical-education-faculty-handbook.pdf
2. Marcdante K, Simpson D. Choosing when to advise, coach, or mentor. J Grad Med Educ. 2018;10(2):227-228.
3. Deiorio N, Foster K, Santen S. Coaching a learner in medical education. Acad Med. 2021;96(12):1758.
4. Plochocki J. Several ways Generation Z may shape the medical school landscape. J Med Educ Curric Dev. 2019;6:2382120519884325.
5. Eckleberry-Hunt J, Lick D, Hunt R. Is medical education ready for Generation Z. J Grad Med Educ. 2018;10(4):378-381.
6. Fissel J. Baby boomers, Generation X, and millennials: the attitudes of the 3 generations toward their higher education objectives in Georgia community colleges. 2013. Educ Foundations and Leaderships. Old Dominion University. https://digitalcommons.odu.edu/cgi/viewcontent.cgi?article=1111&context=efl_etds
7. Guthrie K, Meriwether J. Leadership development in digital spaces through mentoring, coaching, and advising. New Dir Stud Leadersh. 2018;2018(158):99-110.
8. Deiorio N, Carney P, Kahl L, et al. Coaching: a new model for academic and career achievement. Med Educ Online. 2016:21:33480.
9. Wolff M, Hammoud M, Santen S, et al. Coaching in undergraduate medical education: a national survey. Med Educ Online. 2020;25(1):1699765.
10. Brooks J, Istas K, Barth B. Becoming a coach: experiences of faculty educators learning to coach medical students. BMC Med Educ. 2020;20(1):208.
11. Gazelle G, Liebschultz J, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015;30(4):508-513.
12. Shaw L, Glowacki-Dudka M. The experience of critical self-reflection by life coaches: a phenomenological study. Coach Int J Theory Res Pract. 2019;12(2):93-109.
13. Wolff M, Morgan H, Jackson J, et al. Academic coaching: insights from the medical students’ perspective. Med Teach. 2020;42(2):172-177.

Nykiel-Bailey is the associate program director of anesthesiology residency and an associate professor of anesthesiology at Washington University in St. Louis School of Medicine.