Host: [00:05] By the end of this module, you will be able to: List two questions or techniques that can be used to engage a reluctant learner and describe how flexibility can appear in coaching. This module demonstrates the following competencies: use flexibility and adaptability, and manage process and accountability. In this module, the coach needs to use different techniques to engage the M4 learner in coaching. By all accounts, the learner has done fine, and is on track to match into their desired specialty, but an opportunity to reap the benefits of coaching has been missed. This is a learner for whom self-reflection is not natural. When coaching is required, situations can arise where the learner has trouble seeing the value in the process. The learner may view meetings as an unnecessary or extra box-check or feel defensive around needing support if they're performing just fine on their own. It can be hard to allow the learner to drive the meetings, but the coach does need to put in work to lead the learner to discover the potential benefits of coaching for them. As you watch the inexperienced scenario, observe the coach's competence and flexibility. How are they discerning the changing needs of the learner and choosing the appropriate inquiry model or tool to support the learner in achieving desired goals? Also, watch how they are doing around the competency of managing process and accountability. How does accountability on the part of the coach and the learner appear in the scenario? How does the coach assess the coaching process and work to improve it?
Coach: [01:46] It's so good to see you today. I can't believe it's your last year of medical school.
Learner: [01:51] I know, it's crazy. All I can think about is everything I need to do before internship. I have one more rotation left since so much of fourth year is elective time, but it still seems really busy with finishing up my research project, getting married after graduation, and of course the match. I have to enter my rank list soon.
Coach: [02:09] Yeah, there's definitely a lot on your plate as a fourth-year medical student, but we are here today to kind of do your coaching meeting and make sure we get that requirement finished. So what topic did you bring in order to... for us to discuss today?
Learner: [02:22] Um, I don't know. I mean, everything is going fine. I don't really have any questions or pressing concerns.
Coach: [02:29] Well, that's good. I'm glad to hear that you're navigating things pretty well. But we do need to work on a goal that we can document in your ePortfolio.
Learner: [02:38] Well, I guess we could talk about my rank list.
Coach: [02:40] Okay. Rank list would be good to talk about. What is it that you're specifically trying to achieve?
Learner: [02:46] Well, I'm having the most trouble deciding between ranking Carolina University higher than Virginia University or vice versa. Carolina University is ranked higher in U.S. News & World Report, but Virginia University seems more prestigious based on the number of people they send to fellowship. I also like Maryland University too.
Coach: [03:06] What is it that you're hoping to get out of your residency experience?
Learner: [03:12] I don't know if that's the way to look at it. I just want to match them to the best program. I think what I need right now is more information about these different programs. What do you know about Maryland University? You went there, right?
Coach: [03:24] I did. But it's been quite some time and I trained in a different specialty, so I'm not sure if I have anything that I could offer you to help. Why don't we think about this from a different perspective? Like what is your dream state? Like if you could create your ideal residency program, what would it look like?
Learner: [03:45] I'm not really that kind of touchy feely person. Like I said, I just want to match into fellowships. So sure, I guess my big picture goal is to match into fellowship in three years.
Coach: [03:58] Okay, well, we can work with that. Why don't we use the WOOP framework that we've talked about in the past and look at your outcomes? What are some outcomes that you're hoping to achieve?
Learner: [04:11] Okay, fine. Before I forget, do we have to meet again after the match? I'm basically done with school after that.
Host: [04:20] Let's reflect. If a learner is assigned a coach whose style may be different from theirs, the coach will need to pay extra attention to adapting their coaching style to one the learner can engage in. We just saw an example of a coach using a one-size-fits-all approach, which further exacerbated the frustration the learner feels with this required coaching. The coach started out with an admirable plan to get the learner to a goal and accountability.
But while the coach did recognize that the meeting wasn't headed in the most productive direction, they doubled down on their initial approach, trying harder instead of trying something new.
Let's now see how that interaction could go better if the coach pays attention to openings where probing questions could lead to an opportunity for a deeper conversation, using a model that the learner shows interest in pursuing. Watch for ways in which they demonstrate better flexibility and process management than in the first example.
Although the coach has a different personality and approach to life than the student, if the coach recognizes this and tailors their approach to an appropriate inquiry, model, or tool that resonates with the learner, tangible goals and an accountability plan can successfully emerge.
Coach: [05:38] So good to see you today, it's hard to believe this is your last year of medical school.
Learner: [05:42] I know, it's crazy. All I can think about is everything I have to do before internship. I only have one more rotation left since so much a fourth years elective time. But it still seems really busy with finishing up my research project, getting married after graduation, and of course, the match, I still have to enter my rank list.
Coach: [06:02] There's a lot going on in the fourth year, but it's been so good seeing you develop from a first year medical student to almost a resident, it's just been great to see you progress along the way. Who knows, maybe you'll even have a coach in your residency program.
Learner: [06:16] Thank you.
Coach: [06:18] So what did you want to talk about today in our coaching session?
Learner: [06:22] I guess we can talk about my rank list?
Coach: [06:24] Okay, we can do that. What are your thoughts on your rank list?
Learner: [06:27] I'm trying to figure out which programs are the best ones so I can put them in that order. I'm willing to move anywhere for the best training.
Coach: [06:35] So what does "best" mean to you? Like how do you know when you'll be ready to hit "Certify" on your rank list and NRMP?
Learner: [06:45] Basically, when I'm certain I have all the information needed to make the best decision about which residency program will give me the best chance of matching into fellowship.
Coach: [06:56] What do you think that will feel like? Maybe we look at this from a different perspective and kind of work backwards, what would be your ideal dream state?
Learner: [07:05] I don't know. That's not really how I go about making decisions.
Coach: [07:09] Okay, so why don't we take a different approach? Sounds like you're uncomfortable with making decisions when you don't have all the information available? Is that accurate?
Learner: [07:20] I mean, yes, but that's just life. I really feel like I need to be using this time before the lists are due to gather as much information as possible. I'm not much of a dreamer, as you know.
Coach: [07:32] I understand. So, you know, actually, I have a colleague who graduated from the program at Maryland, and they do a lot of advising in your field. Perhaps I could connect you with him to give you some specific advice.
Learner: [07:47] That would be great. Thank you.
Coach: [07:50] Good. So why don't we talk about some other goals that you're hoping to achieve in today's meeting? Why don't we reflect back on your journey during medical school—I know self-reflection is really not your thing and you do tend to appreciate granular data more than anything. So, we can look at your ePortfolio and maybe by reviewing that, it will help you determine some things that we could talk about as our next topic. You do know you're going to have an ePortfolio and semiannual meetings during residency, too.
Learner: [08:24] Yeah, I like that idea. But most of our ePortfolio is about EPAs and competencies. Residencies don't have those right?
Coach: [08:33] Actually, yes, they do. Let me suggest that we pull out the ACGME milestones for your specialty and we can actually look at some of the domains and set some specific goals as you transition into internship. I like to do this exercise with fourth-year medical students because it really shows that medicine is along a continuum and it really emphasizes lifelong learning. And we can take a look at some specific goals as you transition to independent practice.
Learner: [09:02] Interesting. I didn't even know these existed. I like the idea of having a roadmap I can look at to set a goal around. Sure. Let's give that a try.
Host: [09:15] In the experienced scenario, the coach demonstrates competency by skillfully trying more than one approach until she found one that resonated with the learner, and at that point, they were able to move forward in the process. The coach also recognized that the learner was not a naturally reflective person, but she adapted her technique and led the learner to introspection, goal formation, and growth.
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