Category Archives: Family Medicine Stories

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

In Pursuit of Equity

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Cleveland Piggott, MD, MPH

“He died because he’s black!” screamed his mother, inconsolable in the intensive care unit as her unresponsive teenage son underwent formal neurologic examination. We had done all that we could. Mr M had experienced a cardiac arrest for unknown reasons at home, and his mom felt the emergency medical technicians treated her son differently, possibly even withholding care, because of his race. She already knew what the result of the neurologic testing would be, as did I, a second-year family medicine resident at the time. Now I’m an assistant professor, and I still remember the despair in that mother’s voice and the weight of her statement.

His mother may be right. The report Unequal Treatment showed us that health care disparities still exist among racial and ethnic groups even when you control for income, age, insurance, and severity of medical condition.1 Regardless of the facts of Mr M’s clinical course, his mother lost a son that day. Her trust and view of the health care system will never be the same. Our health care system often fails people that look like Mr M. It fails people that look like me.

Being new faculty and the only black, male member in our department of family medicine (DFM), which comprises more than 200 faculty, comes with its share of challenges and opportunities.

I love what I do. I’m so incredibly grateful that I found a job where they pay me to do what I love:  care for patients and teach the next generation of physicians. I find that to be a great privilege and honor. However, I pay close attention to what opportunities I take on, as I try to minimize the “minority tax” I have to pay.

The minority tax refers to the extra responsibilities placed on minority faculty in the name of diversity.2 This tax is extremely complex, and it is sometimes self-imposed by faculty due to a sense of responsibility they feel. For example, as a young faculty member in medical education, I know a day will come when I have to decide if I’ll be the one implementing curriculum or the one creating it. I worry that my ability to develop curriculum and essentially create change will be limited by my own obligation to make sure students of color see faculty that look like them. Nationally, only 4% of full-time faculty in academic medicine are black/African American, Hispanic/Latino, or Native American/Alaskan Native.3

Being an example for students of color is something I don’t take lightly. However, I have mixed emotions at times. I’m happy to stand with them in solidarity on issues that disproportionately affect them and people who look like them, but it can be emotionally exhausting at times—never more so than at last year’s White Coats for Black Lives Annual Die-In on the medical school campus.

During our demonstration, I felt a variety of emotions. Pride, as I lay on the ground with more than 50 medical students, residents, and other faculty as we reflected on dire outcomes inequity has in our society and the importance of health professionals using their power and their voice to advocate for change. Sad, that not a single one of my family medicine colleagues was out there with me. Tired, as I reflected on the long road ahead to achieve equity for all people. Determined to continue to advocate for equity, diversity, and inclusion (EDI) in medicine, starting with my own DFM.

Though family medicine boasts to be a specialty that advocates EDI, I was disappointed in the work happening in my own DFM. When I brought up some of my concerns with my department chair, to my surprise, he agreed. Additionally, he provided support and a stage to make improving EDI a priority in our department. I, along with some of my colleagues, formed a working group with that mission, and we called ourselves the “Justice League”.

Through the Justice League, we’re changing the culture of the DFM and have a lot of accomplishments and ongoing endeavors in less than a year of work, including the following:

  • Changing our mission, vision, and values statement to reflect our verbal commitment to EDI,
  • Providing monthly education sessions to DFM personnel on issues of EDI in medicine and how they can make change,
  • Reinvigorating a conversation among our researchers on how we incorporate EDI in all of our research,
  • Changing our website to make EDI more visible,
  • Collaborating with our clinical affairs team in changing their hiring practices,
  • Analyzing our health outcomes based on race and ethnicity at our largest clinic,
  • Conducting a climate survey to take a hard look at ourselves and areas of improvement,
  • Partnering with an outside consultant to do a training on racism in medicine,
  • Lastly, we’re in the process of creating a senior leadership position for EDI for our department and in negotiations for funding a team.

I’m incredibly proud of the work we’ve done and know we have so much more we can do both inside and outside of our department. More importantly, I look forward to seeing the impact this work and our future work will have on my colleagues, medical students, and our community.

Though I have little faith that we’ll get to equal treatment in this country, I am proud to be someone fighting to close the gap, one step at a time.

References

  1. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666-668.
  2. Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15(1):6. https://doi.org/10.1186/s12909-015-0290-9
  3. Association of American Medical Colleges Diversity Policy and Programs. Diversity in Medical Education: Facts and Figures. Washington, DC: AAMC; 2012.

 

STFM Is My Most Precious Membership

Figueroa_9-180

Evelyn Figueroa, MD

I have learned so much from its people, meetings, collaboratives, group projects, and online resources. STFM’s mission is my professional mission – to advance the health of our patients through education. STFM was the first place where I found mentors that looked and sounded like me. It has created the space for me to find and develop my professional identity and learn so much more beyond the physical medicine promoted in medical school. My involvement in STFM has provided repeated opportunities to learn and expand my reach in health care education.

Like many members, STFM is my happy place, a place where I can recharge and stretch. After each spring meeting I normally return to Chicago with a list filled with new ideas to build into my university work. Its work on health equity and social responsibility inspired me to develop curricula and clinical programs aimed at addressing health conditions related to food insecurity, homelessness, and drug use. What is so special about STFM is that it gave me the tools to advocate and integrate concepts related to bias in healthcare such as racism, sexism, heterosexism, and privilege into my everyday teaching and patient care. Family medicine thought leaders like Camara Phyllis Jones and Warren Ferguson have given me the courage to disrupt and push for more humanistic and equitable care.

Between meetings STFM maintains its connection and I feel its support. My distance peer mentors Ed Figueroa (my “brother from another mother”), Judy Washington, and Jo Brown Speights taught me about how to provide quality mentoring to underrepresented minority physicians. On the Board of Directors, we explored what responsibility STFM as an organization has in providing social determinants of health training in substantial and sustainable ways. How validating it has been to feel the support of our entire organization in issues that matter to the community I serve so strongly!

So now here I am, a family physician activist in academic medicine pivoting my work towards health equity training in medical education. In 2017, with my incredibly supportive partner Alex Wu and our children, we started the Figueroa Wu Family Foundation. Our main project is the UI Health Pilsen Food Pantry, a program that has distributed more than 300,000 pounds of healthy food and household items to nearly 10,000 visitors since opening in January 2018. This open-access pantry operates 20 hours a week and is staffed by community, student, and resident volunteers. Our pantry teaches about bias, inequity, and food justice while providing an important service to the community. The pantry also serves as a learning laboratory to help students preserve their humanism while keeping patients at the center. With the help of medical students, we are developing a medical legal partnership to further advocate for our patients. Chicago is a place of excess where there is enough for everyone. I am trying to engage with the UIC community in order to help the overlooked and marginalized be heard and recognized.

I am not sure I would have found my professional voice without STFM. I appreciate all that STFM keeps teaching me about the power of family medicine. I want to be the physician my patients deserve and STFM is an integral part of my motivation and inspiration.