Bexhaustion is one of the biggest problems facing doctors today. We believe that addressing this problem early – in medical school – through coaching gives physicians the tools they need to maintain balance and meaning in their personal and professional lives.
We say this after reading comments from participants in our coaching program, “A Whole New Doctor,” developed at Georgetown University School of Medicine. This program, born almost by accident, provides executive coaching and leadership training to medical students, who are exactly the right audience for it.
Medical students tend to start their studies optimistic in their twenties, eager to learn, and eager to see patients. After spending a year or two in university medical studies, they move to wards where they observe the hidden curriculum – a set of norms, values and behaviors implicitly and explicitly conveyed in the environment of clinical learning.
In the hospital, convenience and expediency, deference to specialists, and evidence-based knowledge tend to replace the holistic, patient-centered care that is lauded during the preclinical years. This new culture is pushing some students to the brink of burnout and depression. Some people think of suicide.
Jacob and Catherine (not their real names to avoid adding more pain to those who lost them) were colleagues of one of us (MCs) in medical school. Each committed suicide while moving from medical school to residence. Their deaths were never discussed by the faculty or the classmates they left behind.
As an antidote to these pernicious influences and secrecy, coaching helps foster students’ ability to ‘take the best and leave the rest’ – to model behaviors that match their ideals and avoid those that don’t. are not. The coaching relationship, which is an integral part of “A Whole New Doctor”, emphasizes the soft skills involved in medicine – empathy, effective communication, time management and a positive attitude. In the same way that clinicians learn the language of medicine and expand their knowledge base, so too must they reflect, stay aware, and work on these soft skills. Coaching can lead to increased self-awareness and self-control.
Our coaching program began when two of us (MC and JP) met and bonded around a common love for essay writing. At the time, one of us (MC) was and still is a faculty member at Georgetown University School of Medicine. The other (JP) was a second year medical student.
The program works like this:
“A Whole New Doctor” is promoted to students within four years. Interested parties complete an online application with six questions. Fellows (students who have completed the program) read the applications and invite the students to participate in a weekend workshop. After the workshop, the scholarship holders question the students who want a coach to define their expectations in terms of coaching and share their experiences with it. Students who want coaches sign up and choose one from our Coach Bio Book, which is sent to participants after the weekend workshop.
We have structured “A Whole New Doctor” as a volunteer program because we have seen traditional professional development programs that require participation fail. In such programs, faculty members teach students with a seamless curriculum for all, although each student has different perspectives and experiences. We turn around the learning environment, letting students guide themselves on how they will learn and grow, using their coaches as architects to help them build their futures.
The coaches, all professionally trained, are volunteers; none is formally associated with Georgetown University School of Medicine. (Even with the most trusted attending physicians, the power dynamics in medical education make it difficult for students to open up.) Coaches create a non-judgmental and emotionally safe atmosphere. Participating students are reassured that they can be vulnerable regardless of the judgment of their professional supervisor.
Our first workshop in October 2016 had 13 participants. Since then, the 25 places have been filled, with 100 percent participation in coaching during the last workshop.
In the first two years of the program, we learned a lot. Here are some of the main takeaways:
Eliminate the hierarchy. Workshops and coaching sessions are untitled areas. Anyone who uses Dr, Mrs, Mrs, Mr, or similar should donate $ 5 to the Hoya Clinic, a student-run clinic for the homeless. Titles reinforce the hierarchy and power dynamics in medicine.
Make participation voluntary. Four-year medical school students are welcome to participate in weekend workshops, but are not required to attend. We constantly hear about the value of bringing together students from different years, being transparent and learning from each other.
Use adult learning techniques. Adults need to know why they should be learning anything other than “it will be on the test”. Medical students tend to be eager to learn what it takes to become better doctors. They are also more sensitive to internal motivations than to external ones.
Ask the students to choose their coach. Giving students control over the selection of their coach increases their investment in the coach-client relationship.
Recruit student champions. Scholarship recipients understand the rigor of medical school and the experience of having a coach. These students act as a bridge between their fellow medical students and the coaches. In this position, fellows work on their own kindness and listening skills, as well as learning by doing: providing constructive criticism, working as a team, and delegating – whatever skills (and more) they would have. could learn in theory in a professionalism class required.
Enjoy. Making the program fun for the students adds to their enthusiasm in staying the course to become doctors. It allows them to explore and grow in a safe environment, and to have fun in a community setting, knowing that they are working to improve the care they provide to their future patients.
We created “A Whole New Doctor” on the premise that coaching medical students would make a difference in helping them learn resilience, team leadership, and emotional sustainability. By connecting students with coaches who ask powerful questions, we aim to create a space for students to reflect on the tensions that naturally arise in medical education.
Our anecdotal evidence, based on interviews during and after the program, tells us that we are successful. Here are some comments from the fellows of the program:
“AWND has taught me that first learning to navigate and connect with myself is a necessary prerequisite for the connections I hope to make with my future patients. “
“Thanks to my coach, I feel more grounded in myself, the patients and the practice of medicine and I will be a better doctor because of it.”
“Coaching helped me grow and allowed me to explore the underlying motivations, the consequences of actions and how to deal with changing responsibilities. “
You can see more comments here.
Our approach is not the only one. The American Medical Association’s Coaching in Medical Education Handbook for Faculty Members lists the few medical student coaching programs, each of which has gone through program committees, is faculty administered, and is mandatory. .
“A Whole New Doctor” operates as a startup under the regulations of the medical school. He uses business techniques such as agility, continuous quality improvement, and customer feedback. It is run by volunteers for volunteers, as forcing coaching on anyone is ineffective and will leave coaches and students frustrated.
We are now working on ways to present the program to a wider audience, extending it to other medical schools by sharing the model or working with faculty and medical students in their faculties, outsourcing the management. within one to two years. We may end up with a different model. If we can prevent the suicide of a student / resident / doctor, we will have made a difference.
We believe “A Whole New Doctor” provides medical students with the support and tools they need to become resilient, balanced and fulfilled physicians. By fostering the relationship between students and coaches, we change the conversation so that students feel elated and empowered rather than emotionally exhausted and detached. And by changing the conversation, we hope to change the culture of medicine.
Margaret Cary, MD, is co-founder of “A Whole New Doctor,” Clinical Associate Professor at Georgetown University School of Medicine, where she teaches the “Hacking Happiness” course, and CEO of The Cary Group Global. Jack Penner, MD, is a co-founder of “A Whole New Doctor” and a first-year resident physician in internal medicine at the University of California, San Francisco. JP Mikhaiel is vice president of publications for “A Whole New Doctor” and a third year medical student at Georgetown University School of Medicine.