Doctor Coach

Don't teach more, coach better!

The Coaching Relationship

The coach, the learner, and the relationship they create through their coaching dialogue and work together form the foundation of a successful coaching relationship.

A coaching relationship is unique to each coach-learner dyad and the coaching setting.  You and your learner both bring your own past experiences, teaching and learning preferences, needs and expectations. By establishing an open dialogue early in your coaching relationship, you will create an important shared language that enables each of you to better understand and communicate with one another, and will deepen your mutual trust.

Share your commitment & expectations

Help your learner understand your role as their coach (and evaluator, if appropriate) and share your commitment to their skills development.

  • Talk about your approach to coaching, and what the learner can and should expect from you as their coach with regard to schedules, timing, flow, as well as how and when observations and feedback will occur.
  • Share your observation lenses and the milestones for the skills about which you will be observing and coaching them.
  • Discuss the importance of setting and striving for goals, and devoting time to intentional practice.
  • Review your specific professional and clinical performance expectations while the learner is working with you and your patients.

Cultivate mutual trust & respect

Effective coaching requires that your learner trust and respect you as their coach. They must be comfortable being observed by you, and be open and receptive to your feedback. Be clear with your learner that you will be directly observing them in a variety of situations, and providing ongoing formative feedback – both reinforcing and corrective. Invite your learner to share with you what methods work well for them. Ask your learner let you know how your approach can be improved so that you may work together to adjust your styles and approaches.

Effective clinical coaching also necessitates that your learner continuously demonstrate sufficient competence to be entrusted with independent performance and practice activities, and their demonstrated competence must be respected and allowed to flourish. Many competencies can initially be assumed given the learner’s training level and then confirmed during your early performance observations. Through coaching, your learner’s competence and level of independent performance and practice should continue to advance with their achievement of new milestones, such that you can entrust them with higher levels of independent care and professional activities.

Discuss safety

By definition, effective learning occurs in an environment in which errors and mistakes are tolerated (or even invited), but learning through patient care creates a unique challenge for the clinical coach: balancing the learner’s need with patient safety and satisfaction. Discuss how you will balance supervision with autonomy and independent practice. Set expectations about how the learner should alert you to practice situations in which s/he feels uncomfortable, and ensure that your learner feels comfortable speaking up. Discuss your expectations about how clinical errors by the learner will be mitigated and (if needed) addressed. The need for an intentional discussion with your learner about these issues, prior to beginning practice, cannot be overemphasized.

Incorporate learner preferences

Ask your learners about their past coaching experiences and what they have found to be most helpful as a learner.  For example, some learners prefer more modeling before they feel ready to try a skill for themselves while others learn best by jumping in and trying it out.  See Engaging in Apprenticeship for different methods to facilitate learners' practice. Some learners like to think out loud to process their learning experiences while others prefer to read and think about a topic before discussing it.

Discuss your learner's need, concerns and questions. An effective method for demonstrating an early commitment to your learner is to explore their own assessment of their current skills level, strengths, and areas for improvement. Since you will not be able to form your own coach's assessment of the learners' milestone levels until you observe them, asking for their self-assessment can help you to know where to start, and where your learner’s limits of independent practice lie. Be sure to ask learners about barriers they have encountered in the past.  While you as an external observer may best be able to describe your learners' performance, the learner may be best able to explain what they think is most holding them back from advancing to the next milestone level.  This information is invaluable to help your learners better understand their performance and to overcome or circumvent their barriers.

Be flexible

Over time you will develop a “toolkit” of observation lenses, feedback approaches and practice activities that you commonly use in your coaching. However, be flexible and willing to adapt to your approach to suit each learner’s individual needs. Despite their relative competence, some learners may prefer and benefit from shadowing you for a few hours prior to being observed. Occasionally a learner will ask to be coached on a skill with which you are less familiar. Strong experiential learners may need to “work it out themselves” first prior to being guided by you. In each case, begin by trusting that your learners know themselves, and adapt your approach to meet their needs.

By the same token, learners who are unaccustomed to being coached may initially need to “suspend their disbelief” in order to be open to your observations and feedback. Good coaching over time will win their sincere trust and acceptance. For example, some learners may resist a suggestion to practice through role-play, despite its usefulness to practice the right words to difficult news. Encourage your learner to be flexible and to try your approach a few times before dismissing its utility. In the end, if your methods are sound, most learners will overcome their doubts and embrace the opportunity to overcome a performance barrier.

Set goals together

Establishing mutual goals with your learner involves integrating the expectations for the rotation (based on what you have been told by the educational leader), your own coaching lens, as well as the learner's goals.  Discussing preliminary goals at the start of the experience is a great starting point and way to deepen your coaching relationship.  You should continue to revisit and refine these goals during the experience through your dialog with your learner. 

See the next section on 
Setting and Using Goals Effectively for tips and tools to help you set goals with your learner.