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Getting to the top of your game: Will a coach help?

Career coaches—top athletes and singers have them. Should doctors have them too?

Maybe doctors resist working with coaches because they think it will involve a pugnacious guy with a whistle yelling HUSTLE! a lot and alarming the patients? Or, just as scary, someone all touchy-feely on the other end of a Skype call urging them to “visualize success”?

Whatever the reason, coaching lacks the broad appeal of mentoring and its potential benefits are not reaching many the physicians who are looking to achieve excellence.

Having a mentor, as we’ve said in other articles, “Mentors are like hidden treasure” and “Finding a mentor” is widely regarded as key to successfully launching a career in medicine. There is certainly plenty of evidence to show people with mentors do better in various ways during their education and early years as doctors. But finding a mentor and building a mentorship together is not easy. That’s where coaching can be a useful alternative.

Mentoring and coaching, although the terms are often tossed around interchangeably, are not the same. In a study published in Canadian Family Physician, Jacalynne Hernandez-Lee defines mentorship as a relationship where “an experienced, highly regarded, empathic person (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development.”

Coaching, she says, is much closer to teaching, usually focused on helping someone master a specific task or skill, and often done in the context of a direct work relationship.

Medical education is proving quite receptive to the idea of coaching, according to a 2016 article in “Medical Education Online.” It says individualized education is gaining momentum in physician training, with coaching emerging as an important method for guiding learners.

“Unlike mentors or advisors, coaches do not offer advice or therapy to learners they are coaching. Rather, after reviewing objective data on performance, coaches employ methods that help the learners gain insights into their own assumptions, clarify meaning about relevant outcomes, and help identify specific actions needed to achieve a desired result,” author Nicole Deiorio and her colleagues say.

In another 2016 article, Deiorio and Juve say coaches may be key for continuous learning: “The addition of academic coaching to medical education is emerging as an intriguing solution to achieving and maintaining competency.  A coach can help learners self-identify the best path to success, and hold learners accountable for continually identifying and closing gaps in their knowledge, attitudes, and skills.”

Outside of med school, coaching seems to be most often focused on improving physicians’ communication skills, and that’s where family physician Stephen Beeson began working as a coach. A member of a large medical group in San Diego, he was asked to start coaching his colleagues “…during a time when our physicians were nestled in the bottom decile of the patient experience when compared with other large groups in a national database.” Over the next six years, as Beeson developed his coaching program, the group’s rating passed the 90th percentile.

In an article for NEJM Catalyst (the New England Journal of Medicine’s website for sharing “innovative ideas and practical applications,”) Beeson lists four predictors of coaching success:

  • The physician asks for help;
  • The coach believes improvement is possible (too often, managers give up on challenging colleagues);
  • The coached physicians take ownership of their behaviour (they feel they’re doing something wrong);
  • The coached physicians are willing to try a new skill.

He also recommends some techniques he favours, such as focusing on team members learning together, framing coaching around outcomes physicians will value and demonstrating the new techniques, not just talking about them.

Atul Gawande, who combines careers as a surgeon at Brigham and Women’s Hospital in Boston with (among other things) working as a staff writer for The New Yorker magazine, wrote about his decision to hire a surgery coach in a 2011 piece called “Personal Best.” His unorthodox move was triggered by two things—a tennis lesson, and watching Rafael Nadal playing in a tennis tournament on TV. “The camera flashed to his coach, and the obvious struck me as interesting: even Rafael Nadal has a coach. Nearly every élite tennis player in the world does. Professional athletes use coaches to make sure they are as good as they can be.

“But doctors don’t. I’d paid to have a kid just out of college look at my serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?”

Gawande, eight years into his surgery career, was worried his ability had plateaued. He persuaded a surgeon he had studied under to watch him work. After the first session, the retired surgeon talked about “small things”— such as the way Gawande had positioned and draped the patient, which got in the way of the surgical assistant, or the way he held his arm —“You cannot achieve precision with your elbow in the air.” Those small things, Gawande says, “gave me more to consider and work on than I’d had in the past five years.”

For all the benefits, Gawande admits, it isn’t easy to submit to coaching, “especially for those who are well along in their career. I’m ostensibly an expert.” Furthermore, there’s a definite implication that a doctor with a coach is a doctor who needs help, which isn’t something most patients welcome, or colleagues respect.

But Gawande brings it back to elite performers—in sports, in opera. All understand the importance of outside eyes and ears, he says, because “…few can achieve and maintain their best performance on their own.” Most of us, given the option to work with a trusted, experienced coach to reach our best performance, should probably take the risk and say yes. But maybe ask for the whistle to be left at home.