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Appreciative Inquiry Model

Learning Objectives
1. Describe appreciative inquiry as a problem-solving framework
2. List the five D’s of the 5D approach
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: [00:05] By the end of this module, you will be able to describe Appreciative Inquiry as a problem solving framework and list the five ds of the five D approach.

The competency covered in these videos are identify and use coaching theories and tools that best fit the coachee's needs. There are many different coaching theories and tools that exist. Your job as a coach is to identify and use the coaching tool that best fits your coachee's needs in that moment.

In this video, a faculty coach is working with an intern who just started their first inpatient general rotation. The intern has found this rotation very challenging and is really feeling discouraged with how rounds are going. The coach approaches the situation with a traditional problem-based approach. Notice what the coach does well during this video, and notice what maybe could have gone better.

Coach: [01:01] Hi, Alex, is good to see you. How have you been since the last time we met?

Alex: [01:04] I'm doing okay. I just started inpatient service last week, and it's harder than I expected it to be.

Coach: [01:10] Okay, can you tell me more about that? What do we need to fix?

Alex: [01:13] I feel like I'm not doing a good job. My presentations feel so scattered and then the senior resident has to chime in for the plan, and then it takes forever for me to finish my to-do list. I miss teaching at noon conference because I'm still putting in orders.

Coach: [01:33] So what do you think are the barriers for you getting your orders in?

Alex: [01:37] Everything, there's just so many orders to put in, and half the time I don't even know what the management plan was at the end, and then I have to go talk to my senior resident and figure out what orders I need to put in.

Coach: [01:48] Sounds like you're really frustrated.

Alex: [01:50] Boy am I ever.

Coach: [01:52] So let's see if we can go through the challenges and find a way to make this easier for you.

Alex: [01:57] Please.

Coach: [01:58] Sounds like you're most frustrated with not being able to get your orders in and missing the noontime sessions. Is that right?

Alex: [02:06] Yes, and I feel so disorganized.

Coach: [02:09] So what do you think your barriers are?

Alex: [02:12] Well, updating the patients. I could ask the students to update the patients while I put orders in after rounds.

Coach: [02:20] Will that help?

Alex: [02:22] Yes, and then I could actually go to noon conference and learn.

Coach: [02:26] Sounds like you're excited about this plan.

Alex: [02:28] I am! Thank you. I think I'll go try that tomorrow in the afternoon on rounds.

Host: [02:35] Let's reflect. The coach demonstrated many aspects of effective communication during this meeting. The video demonstrated a traditional problem-based approach.

The conversation could have been improved if the coach utilized a different tool to help the learner view the situation from another angle. There are many different coaching theories and tools that exist. Your job is to identify and use the coaching tool that best fits your coachee's needs in that moment.

The Appreciative Inquiry Approach is one example that a coach can utilize. In most of our roles, we approach situations through a problem-based lens. In contrast to this, Appreciative Inquiry is a problem solving framework that can be used by coaches to prepare coachees for change.

They do this through encouragement and support. This is a strength-based approach that focuses on having the coachee take action based on their strengths.

In the second video, the coach demonstrates a different approach to the situation by using Appreciative Inquiry. By using Appreciative Inquiry, the coach guides the intern to identify their strengths and utilize them to problem solve and reset when maintaining a positive mindset.

The coach will demonstrate the 5D Model of Appreciative Inquiry. This stands for five steps that the coach will guide the coachee through. The steps are Define, Discover, Dream, Design, and Deliver. Some people say "Destiny" instead of "Deliver." The first step, Define, simply means to find the overall focus of the inquiry. The next step is Discover. This is a dialog to explore what is working and what the individual's strengths are.

This is followed by the Dream step, where the coach guides the coachee to imagine what could be. This uses past achievements and successes that were identified in the Discover phase.

The next stage is the Design stage, which brings it all together to determine what should be. The final stage is the Deliver—or Destiny—stage which identifies how the design will be delivered.

In this video, observe how the coaches utilizes the five Ds. How does this conversation differ from the last one?

Coach: [04:55] Hi, Alex, it's nice to see you again. How have you been doing on your inpatient rotation.

Alex: [05:00] Doing okay, it's a lot harder than I thought it would be.

Coach: [05:03] Let's dig into that a little more. What do you want to focus on?

Alex: [05:07] Probably the mornings, I feel so disorganized. I feel like my presentations feel so scattered and my senior resident often has to chime in to get the plan. Then it takes me forever to finish the to-do list, so I ended up missing noon conference, because I'm still entering orders in.

Coach: [05:29] So I can see you feel a little discouraged by that. What seems to be going well?

Alex: [05:34] Gosh, I don't know. It all seems so bad.

Coach: [05:38] So let's take some time and think about the last few days. Were there moments when you felt proud of what you were doing or things you were enjoying?

Alex: [05:48] Well, now that you mentioned it, yes, I feel like I've been doing a really good job talking to patients. I've been able to answer all their questions and really engage with them. I've also been able to teach some of the students after rounds, and I think they really appreciate that.

Coach: [06:05] I could tell that's really important to you, you really lit up when you talked about it.

Alex: [06:09] Yes, it is. The connections with patients is my favorite part of medicine.

Coach: [06:13] That's great. Now, let's think about the rest of your morning. What if the rest of your morning went like those interactions? What would that look like to you? How do you envision your ideal state of rounds?

Alex: [06:28]

Well, in addition to all of that, I'd want to be able to give a concise presentations to the team and have a formulated plan for the day. I'd also want to be able to enter all my orders during rounds. That way I'm done with it and I can go to noon conference.

Coach: [06:44] Okay. Let's focus on what you said about making concise presentations with formulated care plans. What do you need to do to achieve this?

Alex: [06:56] Well, I probably need to wake up earlier and get there 20 minutes early. I could probably talk to my senior in advance... I could probably talk to her this afternoon before we sign out to the night team.

Coach: [07:09] Okay, that's an excellent idea. Can we go back and talk about something you mentioned earlier? Putting in your orders during rounds?

Alex: [07:17] Yes, I'd love that.

Coach: [07:18] So what do you see yourself doing that you're not doing now?

Alex: [07:27] I don't know. Well, I probably need to stop teaching the students during rounds, and maybe cut back on the conversations with patients a bit.

Coach: [07:38] Are you willing to make those changes?

Alex: [07:40] Those are the parts I really love.

Coach: [07:42] Yeah, I remember, you did mention that that was what you liked to do.

Alex: [07:47] I don't want to make those changes.

Coach: [07:49] And that's okay. I'm glad though that you were able to identify some areas where you were doing well and that you enjoy, and that you want to continue to nurture those.

Alex: [08:00] I can ask my senior when I talk to her about my presentations and plans.

Coach: [08:04] Wonderful. So to recap, you're going to talk to your senior later today, you're going to arrive early tomorrow and formulate your plans, and then talk to your senior.

Alex: [08:17] Yes.

Coach: [08:19] Excellent. I can't wait to hear how this goes. The next time we meet you'll have to tell me all about it.

Host: [08:25] In this experience scenario, the coach demonstrates the competency identifying and using coaching theories and tools that best fit the coachee's needs. The coach demonstrated the ability to utilize an appropriate coaching tool or approach by utilizing the 5-Ds of AI.

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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