Coaching competencies for physicians
Nancy M. Merrow, MD
In this article, I am proposing that physicians and medical leaders draw on the growing knowledge base within the profession of coaching and use related competencies to broaden their skills in encounters when change is being contemplated. The ability to advance those conversations to goal-setting and being held accountable and empower the individual to draw on their own resources in problem-solving is a widely applicable skill set in medical practice, teaching, and leadership.
KEY WORDS: coaching competencies, goal-setting, artful questions, accountability, behaviour modification
The International Coach Federation defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”1 In medical practice and leadership, there are many opportunities to explore a coaching style of interaction. Whether you are interacting with patients, trainees, peers, or whole programs and departments, having a method of communication that inspires and enables behaviour change is a useful skill. Whenever you are faced with a person or group that wants things to change, there is an opportunity for coaching. Top
Coaching is not the same as mentoring or sponsoring. A mentor is someone who has traveled the path that the mentee is on or wants to be on. The mentor shares experiences and offers wisdom, advice, and connections that accelerate the mentee’s achievements. A sponsor is someone who has recognized someone’s talents and potential, and supports their progress and advancement when opportunities arise. Some of us never know who our sponsors have been.
Coaching is focused on building capacity in the person being coached (the coachee), such that the achievement of their goals is fully credited to their own commitment to action. A coach uses artful questions to clarify the coachee’s goals, help to align their aspirations with personal values, increase their commitment to action, and hold them accountable to their intentions. In a formal longitudinal coaching engagement, there is a specific rhythm to the encounters that the coach uses to continuously build on the stated goals, steps taken, and results achieved by the person. We are not suggesting that the physician is in coach mode over extended periods; however, we see the coaching style of conversation as one tool that can be very useful once the physician has explored the utility and circumstances that make it powerful. Top
A model for “coaching as medicine” was co-created with my colleagues, Dr. Cecile Andreas, a family physician and Certified Executive Coach in Cranbrook, British Columbia, and Dr. Jamie Read, a family physician and Certified Executive Coach in Toronto, Ontario. At the Canadian Conference on Physician Leadership in 2016, we described various communication techniques that focus on changing behaviour, including brief action therapy, cognitive behaviour therapy, and motivational interviewing. Most clinicians have some knowledge of one or more of these techniques, and each has a place in the compendium of methods used in practice. We introduced coaching as a related competency that is applicable with patients, with trainees, with colleagues, and with others when you have a leadership role.
Coaching is not therapy. In the world of medical practice and leadership, your “client” may be a patient, a trainee, a colleague, or someone who reports to you as their boss or leader. In this article, I am proposing that physicians and medical leaders can draw on the growing knowledge base within the profession of coaching and use related competencies to broaden their skills in encounters when change is being contemplated. The ability to advance those conversations to goal-setting and being held accountable and empower an individual to draw on their own resources in problem-solving is a widely applicable skill set in medical practice, teaching, and leadership. Top
A fundamental premise of coaching is that the coach holds the stance that the coachee is fully capable of managing their own life and circumstances. If this is not the case, coaching is not the correct technique. Coaching is initiated by a person who has an issue that they are trying to address. They may feel stuck. They are asking the coach to help them, and the coach takes a positive, appreciative, and curious approach to how the person is pursuing their goals. The role of the coach is to create a relationship within which questions can be asked that provoke the person into new insights about the issue, the options, and the person’s willingness to act. The coach holds the person accountable for their stated intentions.
In the illustration below (Figure 1), we compare the traditional medical encounter with a coaching session. In any kind of “helping” encounter, the consent of the person being helped is essential and should be explicit. The coach asks the person whether they want to be coached. As in a clinical encounter, confidentiality is of the utmost importance. Many issues that lend themselves to the coach approach are intensely personal and challenging for the individual and must be held in a safe space that develops between the coach and coachee.
At the beginning of a coaching session, the coach uses questions to establish clarity on the goal for the dialogue. The goal belongs to the coachee and the coach sets aside their own agenda for what they might hope will be achieved. It is essential that both parties are committed to work toward the agreed upon goal of the session. The three Cs — consent, confidentiality, and commitment — are common to clinical work and coaching. Top
In a traditional medical encounter, using the SOAP format, the clinician gathers subjective information by asking specific questions to elicit and understand the patient’s complaint. The questions are structured to add to the history of the complaint with pertinent positive and negative details. Generally, the clinician is using information to narrow down possible causes of the complaint and form a differential diagnosis. Objective input is obtained by physical examination, observation, and various investigations as appropriate. The assessment is reached by the physician using information, diagnostic acumen, and experience. A plan is proposed to the patient, and the next step is agreed on, including who will do what, and how follow up will occur. In the sometimes-hectic pace of clinical encounters, the rhythm of the cycle is often very rapid, but identifiable.
In a coaching conversation, the cycle is also identifiable and can be closely aligned with the clinical skills physicians use every day. The coachee brings a concern. The coach focuses very carefully on what the person wants and helps them frame it as a goal. If the goal is not clear, the rest of the conversation will not likely yield a fruitful next step or plan. The clinician, in coach mode, uses questions to clarify the person’s goal and to help insights emerge from the person. Artful questions will cause the person to reflect on what they need to do and what needs to be different to make progress toward their goals. It takes practice to design your questions for the best impact. The coach maintains a firm attitude of non-judgemental belief that the person can make choices and take action on their own issues. Top
When acting as a coach, the physician checks often to ensure that the coachee is comfortable with the conversation. Challenging a person and holding them accountable in a relationship with a power or authority differential requires tact, kindness, and authentic concern for the psychological safety of the person.
The coach works hard to resist offering advice. The coach ensures that, at all times, the person maintains ownership of the issue, the potential solutions, and the next steps. The plan belongs entirely to the person, who takes away the tasks necessary to achieve the next step toward their stated goal. The coach ends the encounter with establishing how the person wants to be held accountable for their commitment to next steps and may participate in some way, such as agreeing to another session or receiving a message about tasks accomplished. Top
In a traditional medical encounter, the clinician has most of the responsibility for flushing out the likely causes of the patient’s complaint, for knowing the possibilities that need to be investigated, and for proposing plans of treatment. The clinician is the expert and is focused on finding the right answers. In coaching, the coachee is the expert and the coach’s job is to ask the right questions. You will know you are on the right track when the person pauses after one of your questions and then states an intention. When the intention arises, the coach uses more questions to define the level of commitment to act. A wrap-up question that establishes what will be done and by when leads to the coach asking the person how they would like to be held accountable. The responsibility for progress toward the person’s goals rests completely with them, and the coach helps by reliably following up on the accountability plan that they agree on.
There is no need to spend excessive amounts of time to use the coach approach. It is just a different way of managing the structure of the conversation, and we have had lots of experience with brief interactions no longer than the average office appointment that create the right atmosphere for change. Top
Try these questions to change the conversations you have with people about their goals. Notice the coach generally does not ask “why,” as this requires the person to justify their approach. The best non-judgemental, open-ended questions start with what and how.
Core competencies for coaching
Our adaptation of coaching competencies to the clinical setting and medical leadership has a place in your toolkit of behaviour modification techniques, in the management of situations that depend on the patient or person making choices, decisions, and changes. The goals and the solutions are theirs. By acting as a coach when people bring you problems that are within their control, not yours, you build their capacity for problem-solving. Further, the relationship is clarified and strengthened, whether it is doctor–patient, teacher–student, or leader–team member.
There are related competencies in the field of medical practice that do not need to be duplicated in a coaching model. In a series of articles in future issues of CJPL, I will adapt eight core competencies for the coach approach for physicians and medical leaders and discuss the specific skills that comprise each (Figure 2). At the Canadian Conference on Physician Leadership in April 2019, we explored “Listening at the next level,” which will be the focus of my next article. Top
1.Core competencies. Lexington, Ky.: International Coach Federation; n.d. https://coachfederation.org/core-competencies
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Nancy M. Merrow, MD, CCFP(PC), FCFP, G(CEC), Certified Executive Coach, is chief of staff and VP medical affairs at the Orillia Soldiers’ Memorial Hospital in Orillia, Ontario.
This article has been peer reviewed.