ADVICE: Coaching competencies for physicians: goals, values, and beliefs
Nancy M. Merrow, MD
In this series of articles on coaching competencies, we have been exploring how the coach approach fits into medical practice and leadership. In coaching, artful questions and deep listening skills are used to identify the person’s goals, intentions, and inner resources that will be drawn on to move forward. In this article we explore how a professional coach would use additional tools and techniques to augment the structured conversation.
CITATION: Merrow NM. Coaching competencies for physicians: goals, values, and beliefs. Can J Physician Leadersh 2020;7(1):14-17.
So far in our series we have explored the basic concepts of coaching1 including listening at the next level2 and how to create artful questions.3 We compared coaching, mentoring, and sponsorship and explored how coaching fits into the toolbox of the physician in patient care, teaching, and leadership. Other structured conversational techniques and therapies, such as motivational interviewing, solution focused therapy, and cognitive behaviour therapy are familiar to most physicians and each has its place. In this article we explore how a professional coach would use additional tools and techniques to augment the structured conversation. Physicians may wish to consider how these options might fit into their encounters with patients or trainees.
Coaching is not therapy. It is used when a fully competent person asks for help and is willing to be coached, as opposed to seeking advice or a solution. The coach approach draws out the person’s own capacity to resolve their issues. The coach suspends their own opinions and judgement about what might work and uses their ability to listen and ask the right questions to help the person reach an insight that they are prepared to act on. Usually, the coach assists by offering to help hold the person accountable to their intentions in some agreed upon fashion. Top
The coach leverages the relationship with the person being coached by co-creating a safe, trusting environment for conversations that may be intensely personal and challenging. By listening with intent and purpose, the coach will identify beliefs, thought patterns, and assumptions that are held by the person and that may be holding them back from committing to what they say they want. By surfacing the core values and principles that the person lives by, the coach can help design tasks and actions that are more likely to be followed through by the person.
Many physicians have experience in setting realistic goals and helping others to do the same. Various frameworks exist, such as SMART goals (specific, measurable, achievable, relevant, and time bound).4 Every coaching conversation is designed to result in the person deciding to act in a specific way toward their stated goal. There is a “nest” of goals in a coaching encounter. Each coaching conversation should result in a next step toward the overall goal and each step requires some action that is SMART. Let us use the example of achieving a desired residency placement and review the roles of the mentor, the sponsor, and the coach for the trainee.
Ahmed (not a real client) is planning his last two years of medical school by choosing electives and exploring various specialties. He has excelled in all aspects of his learning and training and will be a sought-after resident for multiple programs. His uncle has acted as a mentor for Ahmed for many years. He has introduced him to his physician network, invited him into his practice as an observer, and shared with him the challenges he faced as a trainee and young physician. He has supported him by talking about choices that he made and what he has learned from experience. He imparts knowledge about the path he has traveled so that the same or a similar path will be illuminated for Ahmed if he chooses it. Their relationship is warm and casual, and interactions are candid. Top
Several of Ahmed’s preceptors have identified him as a high potential learner who is self-directed and reflective. One or two of them have acted as sponsors for him without his awareness. Their formal evaluations of him have been thorough and thoughtful, and they have taken steps to ensure that other preceptors know his attributes and that their confidence in him is well placed. Ahmed feels confident that they would provide helpful references for his residency applications. They introduce him as a candidate for leadership or research opportunities and encourage him to stretch himself.
When faced with multiple considerations about the crucial final years of medical school and a choice about what residency to pursue, Ahmed has factors to weigh in addition to a career path. Not all his goals, values, and beliefs have been fully explored, and it just does not seem comfortable to confide everything to his uncle or his preceptors as they have significant roles to play in his eventual success. At a deeply personal level, Ahmed has some doubts about the way his uncle’s life has unfolded, as he is divorced and raising a second family and has had some financial setbacks. Similarly, Ahmed feels that his preceptors should not know all his doubts and fears about the choices before him. He needs a neutral, non-judgemental confidante. He connects with a professional coach recommended by a fellow student. Top
Ahmed’s coach listens to his thoughts and ideas about his residency selection, then asks him the best coaching question of them all: “What do you want?” After some halting dialogue and uncomfortable silences, the coach suggests that they work through a values and beliefs exercise. From a sample list of values (Table 1), she assigns him homework to identify those that are most important to him, grouping some together if there is a theme. His task is to rate how well he is living his values currently, as well as to imagine one action that would improve each rating.
When Ahmed returns for his next coaching session he has identified and organized his values and rated his current ability to live them (Table 2). He has also set a goal for himself for each set of values and stated one action that would move the rating.
The coach introduces him to the concept of “limiting beliefs.” Ahmed takes home another exercise to reflect and record what he believes about his ability to move forward with planning a residency placement and a career that aligns with his goals and values. His notes include:
I believe that my chances of securing a desired residency are at risk if I do not follow my uncle’s advice.
I believe that my third year of medical school is a make or break time for my ultimate success.
I believe that putting my efforts into following a narrow-focused path is the safest way to get ahead.
In a series of three sessions, the coach asks Ahmed numerous clarifying questions about his limiting beliefs and gives him tasks to do, such as fact finding and talking with some of the clerks, residents, and preceptors whom he respects. Ahmed also decides to have a more candid conversation with his uncle about what happened in his professional life that may have impacted his marriage. Top
On resuming some of the faith practices that he learned as a boy and having an outlet for his creativity and sense of humour with the team organizing the talent show, Ahmed begins to interact with some fellow students who have many different views about the path to success. His limiting beliefs are diminished.
Finally, Ahmed sits down with his parents to talk about the possibility of using some of his elective time to join a mission to an emerging country to build health infrastructure.
While away overseas, Ahmed meets an ophthalmologist who travels three times a year to remote locations to do cataract and corneal surgery that is life altering for her patients. On returning home, Ahmed seeks out electives that lead him into the surgical field and ophthalmology as a specialty. His eventual answer to the question “What do you want?” was illuminated by his own reflection on what really matters to him and what was holding him back. By taking some actions to align his current student experience more closely with his core values, he connected differently with his peers, his mentor, and his family, and that shaped his approach to applications for electives and residency placements.
The nest of goals that led to this outcome of Ahmed’s coaching experience is illustrated in Figure 1. Top
Core competencies for using the coach approach
Coaching fits with the management of situations that are dependent 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.
In a series of future articles in CJPL, I will continue to adapt the core competencies for the coach approach for physicians and medical leaders (Figure 2) and discuss the specific skills that comprise each. My next article will be about relationships.
1. Merrow N. Coaching competencies for physicians. Can J Physician Leadersh 2019;6(1):19-23.
2. Merrow N. Coaching competencies for physicians: listening at the next level. Can J Physician Leadersh 2019;6(2):61-4.
3. Merrow N. Coaching competencies for physicians: the artful question. Can J Physician Leadersh 2020;6(3):90-4.
4. Locke E. Toward a theory of task motivation and incentives. Organ Behav Hum Perf 1968;3(2):157-89.
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.