Host: [00:05] Learning Objectives: List two components of communicating effectively with a learner. State two questions you can ask to cultivate a learner's emotional intelligence. Differentiate skills coaching from other types of coaching.
Competencies: Effective communication and cultivation of learners emotional intelligence.
In this module, a faculty member provides communication skills coaching to a resident around delivering bad news to a patient by directly observing the patient-resident interaction and then holding a coaching session to debrief afterwards.
The initial coaching session could be improved as the coach does not recognize the opportunity to tap into the emotional component of the interaction. This is a missed opportunity to practice the competency of effective communication and the one of cultivating emotional intelligence. As you watch the next scenario, notice instances where the coach does more advising than coaching.
Coach: [01:14] So let's talk about how the conversation just went. I know it's a really hard conversation to have, but I think it's important to get better at it— you'll get better at it as you start learning more and having more experiences.
Coach: [01:28] So, whenever I have to give some very bad news and give someone a diagnosis, I think it's a really big responsibility and I take it really seriously. So what I try to do is I try to compartmentalize, and then what I do is have tissues with me so if the patient gets emotional, I can give them the box of tissues, and that also helps us get take a little break in the conversation.
Resident: [01:55] I mean, they are really hard situations and I find it especially difficult to give patients news that they have breast cancer.
Coach: [02:03] Yeah, I noticed that I saw that you want to talk a little bit more about it.
Resident: [02:07] I guess I was trying to use the SPIKES model that they taught us for breaking bad news, you know, where you give them knowledge and information, and you try to address the patient's emotions with empathetic responses— and then you give them some strategies and summaries at the end. But I just got so derailed when she started crying and I didn't know how to address her emotions at all, and then I ended up not even getting to the strategy and summary portion of it.
Coach: [02:34] Yeah, I agree. I saw the same thing as well.
Resident: [02:36] Yeah, and I also started to think that I was messing up one of the most important moments of her life, and it just completely lost my focus after that.
Coach: [02:45] I think you're being a little hard on yourself. You know, I think that this is something that you will get better at as you start to understand and get used to these emotions. Okay, so let's start to talk about some strategies and solutions that can help you change your approaches.
Resident: [03:01] Yeah, I really want to fix my approach. I don't want to keep floundering these situations. I know, I'm really bad at it, and I just want to improve.
Coach: [03:08] I really appreciate your desire to do better and to do your best for the patient. What do you think you're weakest in?
Resident: [03:16] Um, well, I guess I would say it has something to do with being empathetic when breaking the news to these patients. It's just I get really upset, and I know it can come off as an emotional or as if I'm, you know, given them doctor speak, and it's just that I don't want them to see how upset I get.
Coach: [03:34] Yeah, I think that's really important and I know how very hard that is. Something that I observed when the patient froze, is you said, "Do you understand what I'm saying, ma'am?" And I know what that is, that's probably like a teach-back moment, right?
Resident: [03:48] I guess so. Yeah.
Coach: [03:51] When I have these conversations, if I see a patient freeze, I like to say, "Do you need some time to absorb this?" and then I have my tissues ready, so when I bring the tissues out, that seems like a good break in the conversation, and it gives the patient a moment to, you know, probably just relax and feel like they can absorb some of what I've said to them.
Resident: [04:11] Yeah, those seem like good techniques.
Coach: [04:14] So great. It sounds like you have a goal to set going forward. This is a really hard conversation to have, but you're doing really good work.
Resident: [04:24] Thank you.
Host: [04:27] Let's reflect. Overall, the tone of the conversation was supportive, but the coach had some missteps that prevented this from becoming a true coaching conversation. They didn't take the time to check in with the learner to see if they were open to coaching. They also lead with their own feelings and technique, implying that this is what the learner should do as well. Additionally, they missed an opportunity to inquire why breaking bad news around breast cancer is particularly difficult for the learner. They made assumptions about why the learner did what they did.
This learner was an MD of a negative spiral. A good coach could use affirmation reflecting on the learner strengths, progress, and successes to frame future learning goals.
Next, we'll see an example of experience coaching. This coach demonstrates several of the communications of competencies and models an additional competency: cultivate coachee's emotional intelligence.
Observe the coach as they help their learner navigate emotional states and emotional well-being, cultivate positive emotions by asking positive questions, and help them cultivate mindfulness and improve their emotional awareness. They guide the learner towards self-compassion, and model processing emotions, noticing, naming, and experiencing. This exemplar coach understands that there is a strong emotional component to this work and models compassion, while offering more direction than coaches in other domains would.
Coach: [06:00] Hi, how do you feel about having a conversation about how that went right now?
Resident: [06:04] I'm a little overwhelmed, but I do want to take some time to process this and learn how I can stop being so bad at it.
Coach: [06:11] When you know, trying to become better takes a lot of courage, and I can just tell you that I don't really think you're that bad at this. If I reframe this: I think it's your empathy and it's your empathetic nature that sometimes makes it hard to finish an important conversation. Does that sound right to you?
Resident: [06:26] Yeah, that sounds about right.
Coach: [06:29] So let's try tapping into your strengths and also, maybe we can figure out what kind of goals you want to set around this.
Resident: [06:36] Yeah, I think I would like to prioritize being able to break bad news compassionately. I want patients to see that I have empathy, but I don't want to get too emotional or too detached.
Coach: [06:48] Yeah, that's interesting. I think that that's important to look toward, and why do you think this is so important to you?
Resident: [06:56] Well, for example, with this patient, I especially have a hard time telling patients that they have cancer, my mom is struggling with breast cancer right now and I know how important this moment can be and so I put a lot of pressure on myself to get it right. But it just... makes me too emotional and I get really sad thinking about my mom.
Coach: [07:15] Wow, I'm so sorry to hear that and thank you for sharing that with me. You know, I think I can understand I have a brother with ALS, and whenever I take care of patients who have ALS, I have that same difficulty as you do. I can give you some of my strategies of how I deal with this, but I think that's really individualized and personalized so I'm going to ask you a few more questions to see what we can set that you think would be right for you.
Resident: [07:39] That sounds great.
Coach: [07:41] So I know you've been trained in the rubric that helps you break bad news to patients. When you're talking about showing compassion toward patients, especially I know when you're breaking bad news, I think you're talking about the rubric which has step five, which is about giving that empathetic response to patients and showing your compassion. So what happened when you said to the patient? "Are you finding it hard to understand, ma'am?" Why did you use that choice of words?
Resident: [08:11] Well, honestly, she just looked so shocked and I was so taken aback and to keep myself from getting too upset, I just started blurting out some phrases that we were taught when we were working with our SPs and I know that it didn't make any sense, but it's just what was coming out of my mouth at the time.
Coach: [08:27] Okay, let's talk about how you can have increased awareness before a situation that you think might upset you. I think it's also important to be able to have some strategies that can overcome obstacles in advance because I think that way you'll feel less concerned going in. Let's go back and talk a little bit. I'd like to know when you started feeling upset, and what did it feel like for you?
Host: [08:53] In this experience scenario, the coach demonstrates competency and effective communication by sharing a personal story to establish credibility and trust. The coach was careful to not advise or imply that the learner must follow the same path as the coach. Coaches must elicit the learners own emotions and motivations.
It can be helpful to allow a learner to acknowledge areas in which they would like to improve. Naming negative emotions—such as a sense of failure—can be clarifying for the learner, but a good coach will redirect the conversation toward how the learner can build off their strengths. This is how positivism and appreciative inquiry can increase the likelihood that goals will be met.
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