Category Archives: Advocacy

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/ProgramsLead CoachWebsiteEmailClient focus
Empowering Women PhysiciansSunny Smith, MD FAAFPempoweringwomenphysicians.comsunny@empoweringwomenphysicians.comClients: women physicians including all levels of academics
Joy in Family Medicine Coaching Services®*Tonya Caylor, MD FAAFPhttp://www.joyinfamilymedicine.comjoyinfamilymedicine@gmail.comClients: Family Medicine residents, faculty, and recent graduates
LadyDOxCorinna Muller, MD FACOOGhttp://www.ladydox.comdr_m@ladydox.comClients: women physicians including all levels of academics, not limited to DO’s
Pause and Presence CoachingJessie Mahoney, MDwww.jessiemahoneymd.comjessie@jessiemahoneymd.comClients: All including residents and fellows
The Institute for Physician WellnessKathy Stepien, MDhttp://www.instituteforphysicianwellness.comkathy@instituteforphysicianwellness.comClients: all physicians, including all level of academics
This Osteopathic Life Amelia Bueche, DOhttp://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

Physician, Scientist, Educator…Advocate?

Walden_pic

Jeffrey Walden, MD

As both physician and educator working primarily with underserved patients, I have seen time and again how the idealism in caring for patients can fall short of reality when working in our current health systems.

While it may be tempting when confronted with these shortfalls to take the easy path towards cynicism, our patients deserve better. As do our learners—it is never too early to model right behaviors when educating medical learners on various ways to tackle health disparities. And one of those ways is through patient-centered advocacy.

Remember the Stories

This past weekend I was fortunate to attend the 2018 Family Medicine Advocacy Summit in Washington, DC as a recipient of the STFM New Faculty Advocacy Scholarship. The Summit proved a great opportunity to learn more about advocacy in general, as well as the importance of putting patient stories first.

The conference ran for 2 days. The first consisted of a full day of learning about current issues in healthcare, including changes in advanced payment models, updates on health coverage in the media, strategies to engage with legislators, and the requisite discussion of opioids. As an AAFP-organized conference, Summit topics skewed heavily towards changes in the health care landscape in the United States today and how these changes affect the practicing family physician.

Continue reading

#FightingforFamilyMedicine

IMG_7896

Kari-Claudia Allen, MD, MPH

The Family Medicine Advocacy Summit 2018 was super dope.

On May 21, I joined family medicine physicians and teachers from all over the nation to converge on the District of Columbia to advocate for issues that affect our patients, families, and friends. The three main topics of discussion at this year’s convention were: improving access to primary care through affordable insurance and expanding rural healthcare, finding solutions to the opioid crisis, and preventing maternal mortality.  

The event kicked off with a welcome from Michael Munger, MD, American Academy of Family Physicians (AAFP) president, and  Karen Smith, MD, chair of the AAFP Commission on Governmental Advocacy. They gave inspiring remarks and acknowledged student, resident, and new faculty scholarship awardees, such as myself, from organizations like the AAFP and the Society for Teachers of Family Medicine.  They reminded us to keep #FightingforFamilyMedicine and continue telling our stories about the very real people we serve around the nation.

Continue reading