Physician Coaching, An Evidence-based Tool for Resident Wellness

• Tonya L. Caylor, MD, FAAFP
• tlcaylor@mac.com
• Clinical Associate Faculty, On-call Faculty for Alaska Family Medicine Residency
• Joy in Family Medicine Coaching Services®

Physician coaching, a key tool for preventing and addressing burnout, is being incorporated into residency and fellowship training programs. Professional coaching has been around for decades for leaders in fortune 500 companies. It turns out, that it translates well to medicine and impacts burnout. In August of 2019, JAMA published an article telling of the benefits of physician coaching: it decreases emotional exhaustion and burnout out while increasing resilience and quality of life.¹  Other studies show similar results. ^2,4

For those unfamiliar with professional coaching, it’s good to start with a definition of what it is and isn’t. First, coaches are not mentors; mentors are those looked up to and emulated. Coaches are not advisors; advisors guide, direct and give advice.  Coaches are not therapists. Therapists diagnose and treat those with DSMV mental health conditions. Coaching officially defined as partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential. Foundational to coaching is that the client is seen as whole, capable, and resourceful. Most academic medicine coaches use a causal-coaching approach rooted in positive cognitive psychology.

After my own personal burnout period, I discovered coaching. I grew tremendously. I was so convinced that these principles and approaches were critical for everyone, including those I’m most dedicated to – resident physicians. I began my coaching journey in the Fall 2019, took courses, became certified, and started my business in 2020. I have had the privilege of coaching high-functioning residents that want to grow into their goals as well as some who are struggling in one area or another. The outcomes are the similar. They uncover limiting beliefs, learn tools to navigate life and career, decrease unnecessary suffering, improve their outlook, and move toward the future they envision. Physicians who are trained coaches have the unique advantage of understanding issues that augment relating to the client. It is worth pointing out, that residents need a safe space, so using non-evaluative physician coaches is crucial.  

I performed pre- and post-course surveys with the Maslach Burnout Index and a linear quality of life scale for quality improvement to residents and recent graduates who went through my 6 session 1:1 coaching plus program. Eighty percent of those participating met burnout criteria at the beginning of the course, compared to only 40% who completed the program after the conclusion. Even the remaining 40% had significant improvement in emotional exhaustion, depersonalization, and personal accomplishment scores. 80% reported improved quality of life (none showed a decrease). All reported subjective positive feedback. Each 1:1 participant completed the course if they paid (with or without program support for time) and even if they didn’t pay (scholarship or program paid) but the program carved out time for them – one hour a week for 6 weeks. 

Coaching resident physicians is not only helpful for the individual, but the program as well. They have a different approach to their colleagues, staff, and attendings. An example – during a coaching session, a resident felt a particular attending was “against him.” We parsed out fact from thoughts. He was then open to giving the attending the benefit of the doubt. He had less rumination, less unnecessary suffering, and engaged with the attending in a healthier manner. Another program I had the honor of coaching, enrolled faculty and residents in a series of separate group sessions. They now share a common language and toolbox that improve the program’s culture. The program ran pre- and post- course surveys and are in the process of analyzing the data. 

Various methods to access coaching for residency and fellowship programs are being trialed, including one-on-one coaching, group coaching, and hybrid models, both with and without mini curricular topics, and some offer CME. Some institutions, such as Harvard⁴, explored basic coach training with their faculty to coach trainees outside their primary discipline. Others, such as Stanford, contract with an outside physician coach annually for their anesthesia fellows.  

Funding sources vary. In the Mass General study³, there were grants, and volunteer hours. In the Penn State study⁵ there was a designated FTE budget utilized. Various wellness funds, CME/book funds, HSA dollars, scholarships, and individual self-funding have all been used. New physician coaches often donate hours to get experience. (A list of coaches known to me with experience in academic coaching at various levels are listed in the table.)

I encourage all residency and fellowship programs to consider incorporating coaching into their wellness and remediation structure as the next step in supporting trainees and faculty, improving the culture of medicine, and preserving a healthy workforce that enjoy their chosen career.  

Table 1

Coaches/Programs	Lead Coach	WebsiteEmailClient focus
Empowering Women Physicians	Sunny Smith, MD FAAFP	empoweringwomenphysicians.comsunny@empoweringwomenphysicians.comClients: women physicians including all levels of academics
Joy in Family Medicine Coaching Services®*	Tonya Caylor, MD FAAFP	http://www.joyinfamilymedicine.comjoyinfamilymedicine@gmail.comClients: Family Medicine residents, faculty, and recent graduates
LadyDOx	Corinna Muller, MD FACOOG	http://www.ladydox.comdr_m@ladydox.comClients: women physicians including all levels of academics, not limited to DO’s
Pause and Presence Coaching	Jessie Mahoney, MD	www.jessiemahoneymd.comjessie@jessiemahoneymd.comClients: All including residents and fellows
The Institute for Physician Wellness	Kathy Stepien, MD	http://www.instituteforphysicianwellness.comkathy@instituteforphysicianwellness.comClients: all physicians, including all level of academics
This Osteopathic Life	Amelia Bueche, DO	http://www.thisosteopathiclife.comthisosteopathiclife@gmail.comClients: all physicians, including all levels of academics, not limited to DO’s
*disclosure – the author has a financial relationship with the program that has an asterisk

References

1. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial [published online ahead of print, 2019 Aug 5]. JAMA Intern Med. 2019;179(10):1406-1414. doi:10.1001/jamainternmed.2019.2425
2. McGonagle AK, Schwab L, Yahanda N, et al. Coaching for primary care physician well-being: A randomized trial and follow-up analysis [published online ahead of print, 2020 Apr 16]. J Occup Health Psychol. 2020;10.1037/ocp0000180. doi:10.1037/ocp0000180
3. Palamara, Kerri et al. “Promoting Success: A Professional Development Coaching Program for Interns in Medicine.” Journal of graduate medical education vol. 7,4 (2015): 630-7. doi:10.4300/JGME-D-14-00791.1
4. Palamara K, Kauffman, C, et al. Professional Development Coaching for Residents: Results of a 3-Year Positive Psychology Coaching Intervention [published online ahead of print, 2018 Jul 23]. J Gen Intern Med. 2018;33(11):1842-1844. 
5. Jed D. Gonzalo, Daniel R. Wolpaw, Karen L. Krok, Michael P. Pfeiffer & Jennifer S. McCall-Hosenfeld (2019) A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program, Medical Education Online, 24:1, DOI: 10.1080/10872981.2019.1591256