Implementing Coaching into Medical Education

A Research Paper By Ute Hauck, Career Coach, AUSTRALIA

Coaching in medicine has emerged over recent years and ranges from coaching medical students to doctors and patients.

Coaching is a powerful tool that supports student well-being during their studies and improves academic performance. Physicians also benefit from coaching to cope with personal and professional challenges and reduce burnout.¹ Patients have opportunities to receive health coaching to support them in accomplishing their health-related goals.²

This research article focuses on the relevance of coaching undergraduate and postgraduate medical students, described as “Academic Coaching”.³ Embedding coaching into medical education is “unlocking a person’s potential to maximise their own performance”.⁴

As a medical doctor and lecturer at various medical schools, I have observed that many students encounter similar challenges during their educational journey. Prior to entering a medical course, competitive selection processes already add to uncertainty or fear of failure. Once admitted, many students face complex lifestyle changes while transitioning from school, undergraduate studies or an established career into medicine. Often students identify previous learning styles as insufficient to cover the course content. Several students, especially in postgraduate medical courses, feel like an imposter and are afraid to share this concern with their peers.^5,6

Identifying their learning style and choosing between a broad range of student-created resources and those recommended by the university fills students with uncertainty and anxiety. Making an informed decision to adhere to a learning style that might suit best often causes frustration and loss of motivation. Dealing with stressors in their personal environment such as financial problems, childcare logistics, and accommodation adds another level of complexity. Initial excitement about being admitted to medicine is fading fast for some during the first weeks of entering the degree.

Many medical schools have introduced mindfulness practices to support students during these perceived challenging times and offer individual mentoring sessions. These interventions help students by laying out strategies. Universities embed mindfulness techniques in the course delivery, e.g. students practise mindfulness exercises at the start of a tutorial. Mentors are frequently assigned to students for a limited time and provide advice based on the expertise of a mentor.

Both processes support student learning but have limited capacity in empowering the student to identify strategies or possible solutions themselves. Predominantly ‘passive’ advice limits students’ self-reflection and internal monitoring to accomplish their goals. The American Medical Association recognises this gap as an unmet need in medical schools and suggests implementing coaching as an opportunity for students for their professional development.⁷ Coaching engages the learner in a reflective process that empowers them to identify underlying beliefs and limitations and leads to an improved and sustainable long term outcome. Coaching in its purest form does not require the coach to be an expert in the field to arrive at this goal.⁷  However, attentive listening skills combined with curiosity and empathy as the key elements to good coaching are essential.

The definition of ‘academic coaching’ has not yet been standardised and includes hybrid models of coaching combined with advising and mentoring.⁸ Blending these approaches can potentially create a conflict of interests should the coach be involved in assessing the coachee.

Before discussing how to implement coaching into the medical course, it is necessary to define its goals. Improving learning outcomes and resilience through increased self-awareness and goal setting is one aspect; another critical driver for coaching in medical education is ensuring student well-being to arrive at a healthy study-life balance.

Drawing from almost ten years of experience in medical education, it is evident that many students become overwhelmed with the medical course requirements. Often medical schools reinforce this phenomenon by emphasising future challenges over opportunities, e.g. mental and physical demands as a future doctor showcased to increase student anxiety by creating a gloomy outlook on their future career resulting in increased uptake of counselling services and psychological support offered by the institution. However, it is vital that students are introduced to realistic perspectives on their future work, but rather than limiting their support to mindfulness techniques and counselling, it would be beneficial to provide students with the opportunity to create resilience via coaching. Under the skilled guidance of an experienced and credentialled coach, students will share what they are most concerned about or want to improve on. Powerful questions posed by their coach will then support them to identify new perspectives. This shift in their mindset contributes to personal and professional growth and sustainable long-term outcomes. The crucial difference to the established interventions such as advising, mindfulness and mentoring is that students are empowered to find their solutions and therefore take ownership and accountability of their action’s steps.

To meaningfully implement coaching into medical education, students should have the option to choose between several coaches and then continue the relationship with their coach for the entire duration of the medical program.⁷ A longitudinal relationship with a trusted coach forms a “trusted alliance” conducive to improved outcomes.⁹

Before establishing the coaching relationship, the Australian Medical Association suggests drawing up a contract between the coach and the coachee to ensure that both parties have a clear and binding agreement, although course fees cover coaching.⁷

In addition, selecting a coach should be based on the credentials the coach can provide or a robust training process at the medical school that ensure that coaches have a clear concept of what coaching entails.¹⁰ Ideally, coaches also have been provided with a good foundation of the various theories underpinning coaching and ensure that they have attended the adequate training required by the International Coaching Federation. Anonymous pre- and post-coaching surveys completed by participating students will further ensure the program’s robustness and highlight whether some coaches need further training. In addition, coaches and the institution will benefit from coaching supervision and professional development opportunities for coaches.

In conclusion, thoughtful implementation of coaching into a medical course will support students during their medical journey and help them become the resilient, reflective and self-empowered future doctors the health care system desperately needs.