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Coaching the Struggling Learner

Learning Objectives
1. Describe how a coach can employ the process of co-creative brainstorming to elicit new perspectives and possibilities in order to facilitate problem solving
2. Identify at least one question you can ask to cultivate a coachee’s emotional intelligence
3. Articulate one strategy a coach might use to help a coachee who is struggling with well-being
0.25 Credit

The AMA Accelerating Change in Medical Education Academic Coaching team has provided several workshops to develop faculty coaching skills and recently published new coaching competencies. As the team works to disseminate coaching and facilitate training of medical students and residents, there is a need for training about the coaching competencies. The AMA Accelerating Change in Medical Education coaching video series is a resource to help faculty coaches improve their coaching by incorporating the competencies into their coaching practice. The nine video modules demonstrate coaching competencies and include examples of inexperienced and experienced coaches. These modules may be used as a component of a comprehensive coaching curriculum to prompt reflection and discussion.

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The AMA ChangeMedEd initiative works with partners across the medical education continuum to help produce a physician workforce that meets the needs of patients today and in the future. Learn more

Video Transcript

Host: [00:04] After viewing this module, you'll be able to describe how a coach can employ the process of co-creative brainstorming to elicit new perspectives and possibilities in order to facilitate problem solving, identify at least one question you can ask to cultivate a coachee's emotional intelligence, and articulate one strategy a coach might use to help a coachee who is struggling with wellbeing.

The coaching competencies demonstrated are: helping a coachee overcome challenges with co-creative collaboration, and cultivating a coachee's emotional intelligence.

In this video, a coach will meet with a resident who was not progressing towards independent practice. The program director reached out to the coach to advise them about a lower-than-average in-training exam score, as well as some evaluations that indicate there may be concerns about professionalism, specifically arriving late, coming to clinic unprepared to see patients, and not responding to pages in a timely manner. Receiving such feedback can be an emotional process for a coachee. Watch to see how the coach handles the coachee's emotions. As previously explored in the Coaching Skills Module, coaches can help a coachee cultivate their emotional intelligence through thoughtfully guiding a learner in exploring and leveraging emotions for growth.

Though the resident in this video faces a number of challenges, the coach has the opportunity to demonstrate the competency of helping their coachee overcome challenges by using co-creative collaboration. When helping a coachee overcome challenges, a coach should employ strategies that support brainstorming on new perspectives and possibilities. To do this, a coach can ask questions that prompt the coachee to seek encounters or feedback from a different perspective, or entice the learner to explore their curiosity or intrinsic motivation around learning.

As you watch the encounter between this coach and their coachee, tried to identify ways in which the coach can augment the interaction to cultivate their coachee's emotional intelligence. Also, try to identify strategies the coach could implement to facilitate co-creative collaboration to help the coachee brainstorm new perspectives or possibilities.

Coach: [02:13] Hey, Colleen, thanks for coming in last minute and meeting with me.

Colleen: [02:16] Yeah, it's okay.

Coach: [02:18] I did get a call from your program director today about some behavioral issues, some things that we really need to try and nip in the bud early.

Colleen: [02:27] Oh, you know, it's just been a really long week. I don't think there's been anything major. Do you think it'll take very long?

Coach: [02:36] No, I mean, it's going to depend on if you have any questions. The behaviors we were specifically referencing where I'd heard you'd had problems getting to clinic on time, you are not answering your pager in a timely fashion, and you're not prepared to see your patients.

Colleen: [02:55] Honestly, there hasn't been really that much. I'm just so tired, to be honest. I try to get there on time, but it just doesn't seem to happen. I just don't feel like I could do anything right.

Coach: [03:08] I get that this is hard and intern year is hard, but these are not professional behaviors of a physician, we really need to figure out how to make them better.

Colleen: [03:17] Well, like you said, internship—it's been way harder than I expected. And I'm worried that medicine isn't right for me anymore. I'm just tired all the time and on top of that, I don't have any support here. I just feel all alone.

Coach: [03:35] Hold on, hold on, hold on. It sounds like you just need some rest. Go home this weekend, get some sleep, why don't you call some of the other interns talk with them about it, get some of their strategies.

Colleen: [03:46] I don't really want to call the other interns. I don't want them to know that I've been struggling to seems like that would be really embarrassing.

Coach: [03:53] Well, you need to do something to address these issues.

Colleen: [03:55] I mean, they're not really that big of a deal, though. It was just a few comments, right? And I'm just so tired.

Coach: [04:01] Professionalism issues are serious issues. If you're not prepared to see your patients, they're not going to trust you. If you don't return your pages to other physicians, they're not going to be able to rely on you. Nurses aren't going to be able to trust that you're ready to care for your patients. You get that this is serious.

Colleen: [04:17] I mean, I guess so. Expectations on interns are so high and I'm just literally so exhausted all the time. I just don't feel like I'm going to make it.

Coach: [04:30] I know, intern year is hard, okay? It's hard work. But you know, sometimes you just have to power through and do the hard work. You know, when I was an intern, sometimes I would do some power sleep techniques where you know, sleep for 12 hours and then I'd be ready to go. Why don't you try that?

Colleen: [04:47] I mean, I could I guess I just... kind of miss my friends and family a lot and I feel so alone and tired. I'm sorry.

Coach: [04:57] Okay, I get it, but I think we've got a plan. So you're going to try and get some power rest—12 hours—maybe reach out to those interns. And then, you know, see how you're doing, email me, we'll get something on the books for another month, and then just see how you're doing. Okay?

Colleen: [04:57] Yeah. Okay, I'll try.

Coach: [05:12] Okay.

Host: [05:15] Reflect on what you just watched. What do you think the coach could have done differently to help the learner brainstorm and problem solve in order to overcome the challenges they identified: being tired and feeling as though they couldn't do anything right?

In this scenario, the coach could have asked their coachee more about the feedback they received regarding being late or coming unprepared. Probing the coachee about their perceptions of any one of those behaviors could have helped the coach gain traction in helping the coachee process feedback, and brainstorm new perspectives and possibilities.

The coach told the coachee how their behaviors could impact their colleagues. They were directive by offering solutions to the coach's comments about being tired by advising the coachee just to get more sleep.

Did you notice how the coach missed the opportunity to help cultivate the coachee's emotional intelligence? The coachee repeatedly dismissed the feedback they received and continued to reiterate that they were tired and that too much was expected of interns, rather than taking ownership for their performance and identifying solutions to their challenges. In the next video, try to identify ways in which the coach helps the coachee cultivate emotional intelligence and overcome challenges with co-creative collaboration. How do you think developing a coachee's emotional intelligence can support their overall wellbeing?

Coach: [06:37] Coleen, thanks for meeting with me today. I know you weren't really expecting to be coming in.

Colleen: [06:41] Yeah. Do you think this will take very long I'm really hoping to get home as quickly as possible.

Coach: [06:47] Okay, I'm hearing you need to get home, maybe get some rest. I did get some feedback from your program director about some issues. Have you had time to look at your portfolio?

Colleen: [06:57] I did look at my portfolio, but I didn't see anything that was super bad. Like, I don't know... What do you think?

Coach: [07:07] Okay, well, let's take a look at it and see if we can figure out what's going on.

Colleen: [07:11] Okay. Well, when I looked at it, I saw someone had said something about not being on time and being unprepared. And there were a couple of comments about not returning pages. But again, they didn't seem like that it was that big of a deal. I'm just having such a hard time managing everything, in all honesty.

Coach: [07:30] Okay, let's talk about being late. How do you think being late impacts patient care and clinic workflow?

Colleen: [07:37] Well, I mean, I don't think there was that much of an impact. It was only 15 minutes.

Coach: [07:42] Sure. 15 minutes, it doesn't seem like a lot. But think back to a time when you had an appointment, and someone was late to see you.

Colleen: [07:54] Actually, now that you mentioned it, I remember being upset. Like I remember feeling like they didn't value my time, but my day is planned out to the minute, so I don't know what I could do.

Coach: [08:06] Well also think about, you know, if you're continually late showing up each time, do you think those patients are going to come back and see you?

Colleen: [08:14] Wow, that's a good point, actually. But I'm just so tired. Clinic starts so early, and I struggle to get out of bed, and right now it just doesn't feel like I can't do anything right. I don't know what to do. But I want to do better.

Coach: [08:32] Okay, I hear that you're really tired and really struggling to get out of bed, you do need to give yourself some grace. It's a really hard year. But the problem is we still need to meet expectation. We need to come up with some strategies or some ways where we can maybe try and get us some more rest and sleep.

Colleen: [08:49] Wow, okay. You know, I do study like four or five hours every night.

Coach: [08:58] Wow, really? That's a lot. I'm wondering if we could kind of think about some changes to that study strategy that would allow us to shift some of that time to sleep.

Colleen: [09:08] Yeah, if would you be willing to help me plan a goal around that?

Coach: [09:12] Sure. Let's think about that.

Host: [09:15] In this exchange between an experienced coach and their coachee, the coach demonstrates the competency of helping their learner overcome challenges with co-creative collaboration. The coach asked questions, as opposed to telling and directing. In doing that they elicited master adaptive learning characteristics in their coachee and supported their coachee's ability to process feedback, problem solve, and be self-motivated with solutions in order to overcome challenges.

Sometimes changing the perspective of the learner—in this case, asking the learner to put themselves in the patient's shoes—can help cultivate the coachee's emotional intelligence. Finally, a coach can serve as a support to cultivate a coachee's wellbeing and emotional intelligence by helping them explore and address their non-constructive behaviors that may be stifling growth and development.

Video Information

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

If applicable, all relevant financial relationships have been mitigated.

Participation Statement: Upon completion of this activity, learners will receive a Participation Certificate.


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