An Intensive Physician Coaching-as-Communication Curriculum to Promote a Culture of Coaching: A Pilot Program to Assess Feasibility and Acceptability in Faculty and Residents

Abstract

Coaching is a creative process of inquiry and feedback that helps individuals increase self-awareness and build on strengths. Although individualized executive-style coaching has become popular among physicians, empowering physicians to adopt coach-like communications skills in medical education and clinical encounters could extend the benefits of coaching across medicine. However, professional coaches undergo lengthy training, and most physicians do not have the time, inclination, or need to become certified coaches. Therefore, we created an intensive, streamlined “physician coaching-as-communication” (PCC) curriculum to train physicians in a select subset of essential coach-like communication skills to use during spontaneous encounters with colleagues, medical trainees, and patients. Our goal was not to prepare physicians to provide formal coaching; rather, our aim was to help them cultivate a coaching mindset, identify everyday situations that could benefit from coach-like conversations, and apply some key coach-like communication skills during appropriate interactions. Here we describe the 2-phase development of the PCC curriculum, highlight the coach-like skills that support effective communication, and outline the key curriculum features that situate training into a clinically relevant and feasible framework for practicing physicians. We also present findings from a quality improvement evaluation that assessed acceptability and feasibility of the coaching curriculum for medical faculty and resident trainees. Lastly, we outline the key elements needed for a successful intensive program to help clinicians become skilled with using coach-like communication behaviors in appropriate clinical situations.

Keywords

coaching medical communication faculty development professional development communication in medicine

Introduction

Coaching is an interactive, creative process of inquiry, inspiration, feedback, and accountability, where coaches help “coachees” increase self-awareness, build on strengths, and develop a growth mindset.^1–4 Within medicine, numerous studies have shown that formal executive-style coaching relationships can help reduce physician burnout and enhance resilience, coping, wellbeing, and a range of technical and nontechnical skills.^5–13 Also, fostering a culture of coaching in medicine has been proposed as a way to improve interprofessional relationships and mitigate some of the more harmful aspects of medical culture, such as excessive competitiveness.¹⁴ Considering the many benefits of the coaching approach, preparing physicians to use select coach-like communication techniques could support a more collaborative clinical culture and foster reflective, experiential learning in medical education. However, the communication strategies that coaches use are less familiar than the more common top-down methods of didactic instruction, advising, and mentorship that are typically used in medical education and clinical practice, and the differences between these approaches are sometimes unclear.^15,16 Also, most physicians do not have the time or inclination to undergo professional coach training, which is expensive and requires a substantial time commitment, supervised practice, and mandatory certification examinations.

Effective and feasible training programs to empower physicians with the most helpful coach-like behaviors might bridge this gap and enhance communication within medical education.^14,17 Therefore, at our large sponsoring institution, instructional designers in Graduate Medical Education (GME) created a short-format, intensive Physician Coaching-as-Communication (PCC) training program with the goal of establishing a culture of coaching within the institution that encourages curiosity, active listening, and collaboration. Our overarching goal was to equip physicians with coach-like communication skills to use within appropriate clinical and medical education contexts to strengthen learner engagement, spark creative problem-solving, and promote a growth mindset. Specifically, we sought to train physicians in how to identify the clinical contexts in which coach-like conversations would be beneficial and to empower physicians with the skills to “take a coach approach” with peers, trainees, and patients. In this Methodology report, we outline the creation of the PCC curriculum, which distills key coach-like behaviors and communication skills within a practicable interactive seminar format. We assessed feasibility and acceptability of the program through a quality improvement survey that queried participants’ perspectives on the utility and desirability of coach-like communication as a relevant clinical tool. Our abbreviated curriculum for teaching coach-like communication to clinicians may be a helpful template for other institutions that aim to promote a culture of coaching, collaboration, and experiential learning.

Setting the Foundation: Coaching Versus Coach-Like Behaviors

The instructional designers who conceived and developed the PCC curriculum were International Coaching Federation (ICF) certified coaches (GME coach-team). Therefore, the pedagogical framework for the PCC program was based on the ICF training model for professional coaches, which relies on an iterative series of didactic instruction alongside observed interactive practice with immediate critical feedback. Importantly, we emphasize that our program is unique in that the goal of the curriculum was not to develop professional coaches who are able to establish formal coaching relationships; rather, our aims were 2-fold. First, we aimed to help physicians develop a coach mindset by learning how to identify situations that would benefit from the “coach approach.” And second, we sought to train physicians in how to use some of the best communication methods that professional coaches use, but within brief, spontaneous, everyday situations and conversations, which may last only 5 to 15 min, rather than in formal coaching sessions, which are structured preplanned events that typically last a full hour. To differentiate our training approach from certification training, we consider our physician participants to be “coach-approach partners” and will refer to them as “coach-partners” here. But for lack of a better term, we will refer to the individual engaged in dialogue with the coach-partner as the “coachee.”

A coach approach is distinct from didactic instruction in that it does not involve the transfer of knowledge from an expert, but rather, involves guiding and empowering the coachee to work through situations on their own. Therefore, not all situations are “coachable moments.” For example, a high-risk situation in the operating room in which a patient is in danger demands top-down instruction and would not be appropriate for a coach-like conversation. Rather, coach-like behaviors are best suited for lower risk situations that require awareness, thoughtful problem-solving, adaptability, and self-reflection.

One of the most elemental communication skills within the coach approach is asking open questions aimed at drawing insight out of the coachee. The key coach-like behaviors emphasized in the PCC curriculum are all related to the formal ICF coaching competencies (Table 1) and included the following:

Identify situations that would benefit from a “coach approach”: Situations in which the coachee is able to problem-solve and manage the issue—but requires guidance to gain awareness and work through solutions;

Conduct interactive conversations guided by the situation at hand—not preconceived ideas;

Ask questions and do not “give advice”;

Remain curious and reflect back by asking questions in response to the coachee's dialogue and behavior;

Listen deeply and refrain from judgment;

“Listen” to body language and watch for emotions; and

Empower coachee to problem-solve and develop solutions rather than telling them what to do.

Table 1.

Overview of Activities in the Foundational Session of the Intensive Physician Coaching-as-Communication Training Program.

Intensive training session (5 h)
Topic	Activities	Coaching competency ICF^a	Coaching competency Wolff et al ^b
What is coaching? (10 min)	Presentation: Establishing the communication framework Discussion: Why take a coach approach?	Embodies a coaching mindset	Structure & process
Archetypes (30 min)^c	Activity: Participants identify their own archetype using archetype cards	Cultivates trust & safety	Theories & models
Definitions (10 min)	Presentation: 4 frames of interaction; differences between leading, managing, advising, mentoring, and coaching Breakout Group Discussion	Embodies a coaching mindset	Theories & models
Physician context: coaching culture (20 min) ^d	Presentation by faculty physician on the goal of generating a medical culture of coaching	Embodies a coaching mindset	Theories & models
Conversation model (5 min)	Presentation: Gaining agreement for entering a coach-like conversation	Establishes & maintains agreements	Structure & process
Emotions & feelings (15 min)	Activity: Explore complexity of emotions Discussion: Emotions, feelings, and triggers that cause certain behaviors	Cultivates trust & safety	Coach development
Active listening (40 min)	Presentation: Active listening Discussion: Introduce listening map Group activity: Listening beyond words—storytellers, active-listeners, observers Debrief: Entire group debriefs about listening exercise	Listens actively	Relational skills
Goal setting (40 min)^d	Presentation: Central importance of goal-setting Group activity: Role play with an authentic topic; Practice active listening & staying present in the conversation Debrief: Entire group debriefs about Goal Setting Exercise	Establishes & maintains agreements	Relational skills
Reflective inquiry & evoking awareness (40 min)	Discussion: Uncovering current realities (values, needs, wants, beliefs) Discussion: Gaining deeper understanding and clarity leading to new perspectives Group activity: Role play with an authentic topic; practice reflective inquiry & evoking awareness in the conversation Debrief: Entire group debriefs about reflective inquiry & evoking awareness	Evokes awareness	Relational skills Coaching skills
Goal setting (20 min) ^d	Presentation: How to break down large goals Group activity: Live Group Coach-like conversation. Entire group acts as coach-partner and provides real-time feedback for a volunteer coachee	Facilitates clients growth	Theories & models
Coaching to the plan (60 min)^d	Presentation: Designing action steps, creating accountability measures, and identifying barriers Group activity: Live Group Coach-like Conversation. Entire group acts as coach-partner and provides real-time feedback to volunteer coachee Breakout activity: 3-person role play as coach-partner, coachee, and observer Debrief: Discuss coach-like encounters & experiences and pro tips	Facilitates clients growth	Coaching skills and structure & process
Wrap-up (10 min)	Discussion: Pro tips and encouragement to practice with family, friends, and colleagues	Embodies a coaching mindset	Structure and process
Example practice scenarios	Scenarios used for all coach-like conversation role play activities were determined by the participants. Some examples of common topics that people brought were the following: How to discuss training goals with the department chair Determining what to say to a patient when a trainee enters a patient room during rounding Working on how to handle conflicts in the clinic with nurses and other staff (or between-staff conflicts) Helping trainees modify nonegregious unprofessional behaviors (eg, persistent tardiness, inattentiveness during rounding, using overly casual language) Helping trainees work through challenging bedside procedures in a low-risk situation Helping trainess make time to spend with their children Helping patients gain insight into a specific health behavior and guiding them to identify barriers and possible solutions Choosing next career steps (eg, fellowship vs private practice) Choosing where to apply for hospitalist jobs Getting started with choosing fellowship programs and writing a fellowship application

The 8 competency domains for coaches per the International Coaching Federation (ICF) (https://coachingfederation.org/core-competencies, accessed December 9, 2021).

The 5 competency domains for coaches proposed by Wolff et al.¹⁷

Topics/activities that have been subsequently removed from program.

Topics/activities of critical importance for understanding and developing coach-like behaviors.

Two-Phase Development of the PCC Curriculum

We developed the PCC training program in 2 phases: Phase-1, the investigational stage done in conjunction with a professional coach consultant from a globally recognized corporate coaching company; and Phase-2, the refinement phase done by the GME coach-team (Figure 1). Phase-1 was a 16h training offered to physician faculty, comprising 8 online 2h asynchronous sessions held in the winter of 2021. Physicians in Internal Medicine, Emergency Medicine, and Dermatology were invited by email to participate, and enrollment was capped at 20 individuals on a first-response basis. These programs were chosen because they are large programs with faculty who had previously communicated interest in formal coaching.

Figure 1.

Curriculum Development Framework for Training Physicians in Coach-Like Communication Skills. Flow Diagram Outlines Key Elements of the Physician-Coaching-as-Communication Professional Development Program.

The coaching consultant allowed the GME coach-team to use the Phase-1 model program as a template for developing the customized, intensive, streamlined institutional program. During Phase-1, an ICF Master Certified Coach from the consulting company led the sessions, which included interactive lectures on fundamental coaching concepts, breakout practice sessions, reflective homework, and 7 coaching practice opportunities scheduled between meetings. Participants in Phase-1 were required to practice coach-like conversations with another physician in their training cohort. The GME coach-team observed and assisted with the Phase-1 program to gather information needed for developing the streamlined PCC program.

For Phase-2, the GME coach-team shortened the 16h program to an intensive 9h PCC program, tailoring the curriculum to the institution's needs and crafting the curriculum to be more medically relevant. The PCC program included a single 5h intensive training session and two 2h guided practice sessions that took place over the course of 6 weeks. This course was offered to upper level (PGY3 and above) residents in Internal Medicine who were required to attend as part of their training in the summer of 2021. Participants were given protected time to attend. The intensive 5h introductory PCC session covered foundational coaching competencies^17,18 with interactive presentations, discussions, individual and group exercises, and debriefing sessions (Table 1). The two 2h practice sessions were designed to meet the coaching competencies of “skills development” and “embodying a coaching mindset” and included discussions, a video observation of a coaching encounter, and a role-play coaching exercise with feedback and debriefing (Table 2).^17,18 Participants were encouraged to practice their skills in between sessions in their personal and professional lives, but this was not required or tracked. Participants were required to practice coach-like skills with a more junior PGY1 coachee after the program was completed.

Table 2.

Overview of Activities in Practice Sessions for the Intensive Physician Coaching-as-Communication Training Program.

Practice sessions (2 different sessions; 2 h each)
Topic	Activities	Coaching competency ICF^a	Coaching competency Wolff et al^b
Check-in (10 min)	Discussion: Group discussion about coach-like encounters since last meeting	Embodies a coaching mindset	Development
Purpose (5 min)	Presentation to establish purpose of practice session	Embodies a coaching mindset	Development
Coaching observations	Video: Group watches a prerecorded coaching encounter	Embodies a coaching mindset	Development
Video & activity (10 min)	Presentation: Purpose of practice session
Debrief (10 min)	Debrief: Video observations
	NOTE: This was the same video both times, which included a scene of a coach-partner working with a faculty member (the coachee) on the topic of delivering difficult feedback to a trainee
Practice	Activity: 3-person role-play as coach-partner, coachee, and observer	Embodies a coaching mindset Establishes & maintains agreements Cultivates trust & safety Maintains presence Listens actively Evokes awareness Facilitates clients growth	Development Relational skills Coaching skills Theories & models
Activity (15 min)	Active feedback: Trainers give real-time feedback using a Feedback Model
Feedback (5 min)	Debrief: Group debrief about practice session
Debrief (10 min)	In groups of 3, 1 person acts as the coach-partner, 1 as the coachee, and 1 as an observer. Those playing the coachee discuss real-life situations they want to gain insight on—personal or professional (see eg, Table 1)
Group practice	Group activity: Live Group Coach-like Conversation	Embodies a coaching mindset Establishes & maintains agreements Cultivates trust & safety Maintains presence Listens actively Evokes awareness Facilitates clients growth	Development Relational skills Coaching skills Theories & models
Activity (15 min)	Active feedback: Trainers give real-time feedback
Debrief (10 min)	One person volunteers to be a coachee in front of the entire room. The coachee discusses a real-life situation that they wanted to gain insight into—personal or professional. Everyone else in the room acts as the coach-partner.
Practice	Activity: 3-person role play switching roles	Embodies a coaching mindset Establishes & maintains agreements Cultivates trust & safety Maintains presence Listens actively Evokes awareness Facilitates clients growth	Development Relational skills Coaching skills Theories & models
Activity (15 min)	Debrief: Group debrief about practice session
Feedback (5 min)	In groups of 3, 1 person acts as the coach-partner, 1 as the coachee, and 1 as an observer. Those playing coachee discuss real-life situations they want to gain insight on—personal or professional
Debrief (10 min)
Example practice scenarios	Scenarios used for all coach-like conversation role-play activities were determined by the participants (see Table 1)

The 8 competency domains for coaches per the International Coaching Federation (ICF) (https://coachingfederation.org/core-competencies, accessed June 3, 2025).

The 5 competency domains for coaches proposed by Wolff et al.¹⁷

Key Elements of the Intensive 5h PCC Foundational Session

The coach-like behaviors, didactic topics, and interactive activities in the 5h intensive PCC training session were chosen to align with the coaching competencies defined by the ICF and described in a previous study (Table 1).¹⁷ The program started with a presentation defining the coach approach. Although no single definition of coaching has been agreed upon, one grounded theory study identified several core elements of the coaching process, including a focus on growth and development, a need for ongoing reflection by both coach and coachee, and the recognition of failure as a key element in the learning process.¹⁹ The ICF definition of coaching highlights that coaching is a creative partnership that can inspire individuals to “maximize their personal and professional potential.” Thus, as in a formal coaching session, a coach-like conversation is an interactive process of creative inquiry, inspiration, feedback, and accountability, where coach-partners help coachees increase self-awareness, build on strengths, and develop a growth mindset.^1,2,4 Next, a brief activity in discovering one's personal “archetype” was done to help participants gain an understanding that different people enter conversations with different viewpoints. However, this element has been removed because it was time-intensive, and it has now been replaced with a simple discussion about various personalities and viewpoints.

A critical element of the intensive session involved a presentation to establish the “Physician Context,” which was conducted by an institutional physician who had substantial coaching experience. Here, the physician presented the benefits of a medical culture of coaching and shared personal experiences about how they had used coach-like skills in the clinic and how it helped them as a leader. The involvement of a physician with clinical coaching experience was a critical element for establishing credibility, and we emphasize that having medical professionals as facilitators and champions is essential. One key message emphasized by the physician was that in a culture of coaching, coach-partners use questioning techniques to shift the coachee's expectations away from being given an answer and toward an active exploration of developing their own answers. Other cultural features emphasized were the willingness to cultivate a solution-oriented mindset and an appreciation for the power of curiosity and asking versus knowing and telling.

Another critical aspect of the session was a section on identifying various modes of communication, including a particular emphasis on the differences between mentoring, advising, and coaching. This element was covered throughout the training activities, in which trainers consistently pointed out and asked participants to ponder which scenarios would be most appropriate for a coach-like conversation versus the other more common forms of communication. Importantly, the topics used for practicing coach-like conversations during the training and practice sessions were all suggested by the participants and involved real-world experiences and needs. Examples of topics that participants regularly brought up included scenarios such as how to get started with choosing a fellowship program and writing a fellowship application; determining what to say to patients when a trainee enters a room during rounding; handling common interpersonal conflicts in the clinic; helping trainees modify nondisciplinary unprofessional behaviors, and others.

Crucially, these were all common clinical scenarios that could benefit from a coach approach in that they were focused, actionable situations in which the coach-partner could help the coachee raise awareness, explore solutions, and commit to action. For example, persistent tardiness is a common behavior that a coach-partner might address by first helping the coachee gain insight and awareness into the consequences of tardiness and the underlying causes of their lateness; then asking questions such that the trainee explores solutions to the problem; and lastly guiding the trainee to determine actions to mitigate the problem rather than providing suggestions or advice. Within a patient context, promising coach-like conversations might involve helping a patient gain insight into a specific health behavior (eg, consistently missing a medication dose), explore barriers (eg, the patient realizes they have too many medications and the dosing strategies are complex), derive possible solutions, set realistic goals (eg, use a pill organizer or smart phone notifications), and begin to formulate an action plan (eg, have a family member or friend help them out). Again, these are situations in which the top-down approach of simply telling an individual what to do may not be fruitful.

The session then covered the key steps of a coach-like encounter, starting with gaining an agreement for entering into a coach-like conversation between coach-partner and coachee. Activities to explore the importance of accurately identifying emotions, feelings, and triggers that cause certain behaviors, as well as the key elements of active listening were also discussed before introducing the critical element of goal setting. Establishing well-defined goals is an important element of coach-like conversations. Thus, coach-partners were taught how to help coachees establish well-defined goals; recognize that initial goals may not end up being the ultimate goals; clarify goals through effective questioning; reframe goals into a positive framework; and “chunk down” goals into smallest steps. A group role play activity with an authentic clinical topic was used so that participants could apply active listening and practice staying present in a conversation. A live group coach-like conversation with a volunteer coachee allowed participants to get real-time feedback on their skills from the coach trainers.

A brief part of the session addressed the need for reflective inquiry and the importance of evoking awareness in the coachee. Here, group discussions were held on the differences between values, needs, wants, and beliefs and how to gain clarity that leads to a new perspective. Another role playing activity with an authentic clinical topic allowed participants to practice reflective inquiry and evoking awareness in the coachee. Participants engaged in mirroring back what they had heard or seen and summarizing what was being said while naming observed emotions.

Lastly, the essential coach-like behavior of how to “coach to the plan” was covered. The critical elements of this feature involve the coach-partner guiding the coachee in recognizing how goals will be accomplished in a step-by-step process, identifying potential barriers that could impede reaching goals, developing alternative routes to achieving goals, and gauging the true level of commitment to reaching goals; however, in a short coach-like conversation, this element would not be as fully developed as in a formal coaching relationship. Lastly, a 3-person role play activity allowed participants to take turns being coach-partner, coachee, and observer to practice behaviors needed for coaching to the plan. Overall, this comprehensive session covered numerous foundational coach-like skills and concepts that have been the focus of other targeted coaching models (Table 1).²⁰

Guided 2h Practice Sessions

After learning the essential fundamentals of key coaching behaviors, guided practice sessions were conducted to allow participants to gain fluency and comfort in using coach-like behaviors within appropriate situations (Table 2). Crucially, these sessions were guided by trainers who were experienced coaches. Practice sessions included group discussions about the coach-like encounters that participants may have had since the last meeting, a coaching video observation activity, and 3 role-play/practice activities where participants received essential real-time feedback from trainers. After participants completed all program requirements, they had the option to request an observation in the clinic with feedback from an instructor. Notably, clinical observations were not required due to staffing limitations and the administrative challenges to conducting activities in the clinic, as well as the difficulty of planning for inherently spontaneous, coach-like interactions in a real-world situation. However, participants were also offered a voluntary 2h refresher course. The incorporation of guided practice sessions with feedback from a qualified coach cannot be overstated (Table 2).

Feasibility and Acceptability

Participants were asked to complete an 8-question postprogram survey for Phase-1 and a 7-question survey for Phase-2. Surveys queried perceptions on the utility of program and the applicability of coaching to clinical communications. One free response question asked for feedback on the program (Supplemental Figures 1 and 2; Table 3). Basic themes evoked in the free responses were identified by the GME coach-team based on their professional expertise, with no formal thematic analysis.

Table 3.

Select Quotes From Physician Faculty and Resident Trainees After Phase-1 and Phase-2 Pilot Coaching Training Programs.

Phase-1 (16h training conducted by corporate group) (n = 7 responses from N = 14 faculty respondents)
Comments (C)	Theme
C1. I really enjoyed this training and learned a lot. I think it teaches us the importance of asking good questions, looking for the emotion behind the statements, seeing all perspectives. Mostly I think this is very useful for using our words to empower others to make their own decisions that are best for them	Enjoyment Core coaching competency Communication Value of coaching
C2. This was an incredible program and I am so happy I was able to participate. The skills taught are absolutely crucial for any medical educator, especially those in medical education leadership…I believe through the first few courses, I was pushing myself to stay engaged because it hadn’t clicked for me yet…However, right around the third session, I started to realize how effective this coaching approach could be and started noticing myself using it without even realizing it. I think it's important to acknowledge this with the group in the beginning and emphasize that this is a stepwise process	Program quality Skills Personal experience
C3. For trainees, it requires buy-in, so I would consider offering it to residents in leadership positions—ie, chief residents and roll out from there	Trainees
C4. Top tier program; very honored to be a part of it	Program quality
C5. I really enjoyed the program and feel the skills are extremely valuable	Enjoyment Skills
C6. I do think that the trainees would also strongly benefit from going through this training as part of their learning process	Trainees
C7. Great instruction. Loved the experiential learning. Glad you assigned outside coaching exercises with partners	Program quality Experiential learning
Phase-2 (9h streamlined, intensive training) (n = 14 responses from N = 36 respondents)
C8. I like the practice sessions of coaching because I tend to want to give advice as opposed to coach	Experiential learning
C9. More examples of live coaching	Instruction
C10. I very much appreciated the general process for life and certainly there were points that I took away. However, for interacting with my mentee specifically…I do not feel it is applicable. As a mentee, I don’t want to be coached, I would want to be mentored. And as a mentor, I really don’t ever see myself using coaching	Trainees Personal experience
C11. I realized how important [it] is to learn how to coach the interns or other trainees. It is amazing	Value of coaching

Pilot PCC Sessions and Survey Results

A total of 20 faculty physicians participated in a single Phase-1 program, and 41 physicians (36 residents, 4 Internal Medicine staff physicians, and 1 Associate Program Director) participated in the intensive Phase-2 program in 3 separate course offerings. Participation in the postcourse survey was high (77% Phase-1; 88% Phase-2).

Utility of Training

All respondents in both phases indicated that they would be somewhat likely or highly likely to use at least one strategy from their training and agreed or strongly agreed that they had learned something new (Supplemental Figure 1A-B). When asked whether participants thought that trainees would benefit from training in coaching, 14% of faculty and 6% of trainee respondents were neutral, suggesting that coaching may be viewed by some as an advanced skill more relevant to experienced practitioners (Supplemental Figure 1C). Because Phase-1 participants were all medical faculty, only they were asked whether they would recommend the program to their trainees if the program was expanded: 71% strongly agreed, 14% agreed, and 14% were neutral (Supplemental Figure 1D).

Effect of Coach-Like Training on Communication With Different Groups

When asked whether what they learned in the program would affect the way they approach communication with patients, peers, and trainees, all faculty respondents agreed that it would affect their communication with all 3 groups, whereas some residents were neutral or disagreed (Supplemental Figure 2).

Open-Ended Qualitative Evaluation

Qualitative free responses revealed a range of helpful feedback and insightful experiences. From the Phase-1 program, one faculty participant praised the way that the training emphasized the importance of asking good questions and seeing others’ perspectives (Table 3, C1), revealing an understanding of critical coaching concepts.¹⁸ Another Phase-1 faculty participant noted that they had a hard time staying engaged during the first few sessions, but that by the third session, they realized the value of the coach-approach (Table 3, C2). Overall, faculty communicated enjoyment of the program more than residents (Table 3, C1-C6), potentially revealing differences in career trajectories, readiness for reflective learning, and intrinsic motivation. And notably, one faculty participant suggested that this type of training would require buy-in by trainees, and that the training might best be restricted to residents in leadership positions (Table 3, C7).

Resident participants of the Phase-2 PCC program conveyed appreciation for the coach approach, with one respondent suggesting that more live coaching examples would be helpful (Table 3, C8). Another resident from Phase-2 conveyed how they “tend to want to give advice as opposed to coach” (Table 3, C9) revealing an understanding of diverse communication approaches. Also, one resident noted that they would prefer being mentored rather than coached, again suggesting that stage of career trajectory may influence the perceived utility of coaching (Table 3, C10). Other positive comments centered upon the value of skills learned and the benefits of experiential learning (Table 3).

Changes to the Curriculum Based on the Pilot Program Experience

The GME coach-team have modified and further streamlined the PCC program based on feedback from the pilot sessions. Notably, the intensive 5h introductory session has been condensed down further to 4 h to accommodate physicians’ demanding time pressures. Additionally, the concepts of reflective inquiry and evoking awareness, which were treated as independent topics in the pilot program, have been combined into one discussion and activity to save time. Refresher practice sessions for participants are now offered annually. And lastly, one of the coaching activities in the introductory session has been replaced with a coaching video observation in which participants identify the key elements of a coach-like interaction as they view a recording of a physician in a leadership position having a coach-like conversation with a physician trainee. This activity bolsters the medical context of the program. Box 1 summarizes the crucial learning elements of the PCC intensive introductory session.

Box 1.

Essential Elements of the Intensive Physician Coaching-as-Communication Program.

Establishing the physician context for a coaching culture

A physician coach (certified, trained coach) presents on the benefits of a medical culture of coaching with a focus on shifting coachees’ expectations away from being given an answer to exploring their own answers

Practice sessions use real-life scenarios for practicing coach-like conversations; participants provide recent experiences as the scenarios for practicing coach-like communication

Coach-partners help coachee cultivate a solution-oriented mindset

Coach-partners shift coachee's attitude from knowing to curiosity and from telling to asking

Identifying emotions & engaging in active listening

Provide opportunities to role play with authentic clinical topics to discover the importance of active listening and accurately identifying emotions during a coach-like conversation

Participants are reminded and encouraged to name emotions throughout the entire coach-like conversation

Remind coach-partners to use active listening before every coach-like conversation practice event

Guiding goal setting

Goal setting is central to a coach-like conversations

Coach-partners help coachees clarify goals and understand the importance and relevance goals

Coach-partners use questioning to lead the coachee in creating well-defined goals

Coach-partners help coachee “chunk the goal down” into the smallest steps

Coach-partners help the coachee reframe goals into a positive framework

Evoking awareness and guiding reflective inquiry

Be fully present during a coach-like conversation

Shift perspective from initial thoughts to what is discovered

Examine values, needs, wants, and beliefs to improve likelihood of reaching specific goals

Help coachees learn to differentiate between what they mean and what they have actually communicated

Coach-partners maintain awareness for situations that are beyond the scope of a coach-like conversation and may require additional team members, such as therapists or wellness specialists

Coaching to the plan

Establish a plan of action to accomplish specific goals

Identify barriers to reaching goals

Help coachee create proactive solutions to potential barriers

Practicing with feedback

Experiential practice sessions are essential and should occur after each step of the process has been taught

Providing authentic scenarios for coach-like conversations helps participants observe and evaluate alongside experienced coach instructors, enabling participants to identify conversations that would benefit from a coach approach

Follow-up practice sessions with experienced and trained coaches are critical for solidifying long-term skills

Follow-up check-ins/office hours provide an environment for participants to share successes and pitfalls that have occurred in their professional practice

Discussion

In this Methodology report, we described an intensive training program in coach-like communication skills for physicians and the results of a pilot program to assess feasibility and acceptability at a large teaching hospital. Overall, we found that both established faculty and resident trainees predominantly viewed taking a coach-approach as a desirable communication strategy in the clinic and felt that they would incorporate at least some coach-like behaviors in their clinical encounters. However, a key takeaway from the pilot experience was that this training may be more appropriate for established faculty—who are at a more advanced career stage than residents—and perhaps for select resident trainees who are in leadership positions.

Coaching is unique from the more familiar approach of mentorship in medical education. Whereas coaching is a nonhierarchical process of skillfully guiding a coachee to work through situations themselves, mentorship involves a hierarchical process of directing a mentee in how to do something.^2,17,21 During medical training, physicians receive instruction from educators, preceptors, advisors, supervisors, tutors, mentors, and coaches, and the differences between these individuals’ communication approaches are not always recognized or agreed upon.^16,21 In developing the PCC training, we prioritized helping participants recognize key differences between leading, managing, advising, mentoring, and coach-like partnering and helping them understand how to gauge the appropriateness of each approach for different clinical encounters. We believe that our emphasis on recognizing when to use coach-like versus other communication behaviors is a unique strength of the PCC program.

Two critical aspects of quality training in coach-like communication skills are instructor competence and the opportunity for learners to engage in supervised practice with feedback. Our PCC curriculum was created and conducted by educators with high level training in coaching and covers coach-like behaviors that align with the key competencies of coaching as established by the ICF, which also align closely to a proposed coaching competency model developed specifically for medical education (Tables 1 and 2).¹⁷ The PCC program included substantial required practice opportunities with feedback provided by coaching experts, and this requirement cannot be overemphasized; however, this essential curriculum feature requires that institutions either invest in training physician faculty in professional level coaching or engage a third-party coaching consultant to conduct customized trainings, which might be cost-prohibitive for many institutions. Overall, our program might minimize overall cost and time-commitment by distilling the bare-bones essential coach-like communication skills that have utility within a medical context while still respecting the inherent complexity of the coaching approach and maintaining the key instructional design feature of psychological safety.²²

During the development of the PCC program, we wondered whether more experienced faculty and less experienced trainees might have differing views on the utility of coach-like behaviors in medicine, and our observations highlight the importance of considering audience receptivity. Established physicians may have more history to draw on and more readily recognize the relevance of different communication approaches in medicine. Residents, on the other hand, are still within a demanding formal level of medical training, and because they have less clinical and professional experience, their ability to internalize new communication techniques and effectively implement them may be more challenging. Introducing yet another difficult skill to learn during an already demanding residency could be overwhelming for some. One study that explored faculty perceptions on the various roles of mentoring, advising, and coaching for residents found that faculty felt that mentoring was the most important strategy for residents, although they had a strong interest in specialized training in coaching and conveyed that coaching residents had provided particularly rewarding experiences.²³ And a review of coaching in residency training programs identified several barriers to implementing this type of training for residents, including difficulties in engaging in the dual roles of coach and supervisor and role ambiguity.²⁴ However, we emphasize again that our PCC program did not aim to prepare full-fledged coaches—rather, we selected key coach-like behaviors that can be used in spontaneous encounters that have the hallmark features of a “coachable moment.”

Our future PCC programs will target faculty and only residents who are in leadership positions, since resident leaders have more instructional and “coachable” interactions with other trainees and may be more intrinsically motivated based on their leadership positions. In fact, one study of a peer-to-peer coaching program for surgery residents structured their program to have trained chief resident coach-approach partners work with junior resident coachees and observed a high level of skilled coaching techniques used during surgical skills training.²⁵ Overall, we are now using a more rigorous process of participant selection, and we emphasize the importance of protected time and institutional support to encourage engagement. However, we anecdotally note that one resident participant who struggled during the PCC training approached an instructor 2 months after the end of the course and asked to be coached on a professional issue, underscoring the importance of time for internalizing the utility of coaching. Therefore, long-term follow-up to gauge how medical practitioners are implementing coach-like behaviors is advised.

Other anecdotal clues regarding the acceptability of the program were gleaned in several follow-up conversations. Faculty were keen to know when the next program would be offered so that they could recommend it to colleagues. And the chief resident participants consistently asked about using the “coach approach” and requested feedback on their own performance. Participants have also requested that the GME coach-team develop a didactic session on high-yield coach-like questions that can be used during interactions with trainees and patients. Thus, we conclude that faculty and chief residents were considerably more connected to taking a coach approach than nonleader residents.

Lastly, we have anecdotal evidence that our pilot coaching programs are beginning to foster a culture of coaching at our institution because many physicians regularly give us unsolicited and enthusiastic feedback about their successful coach-like conversations. We hope that establishing an institution-wide culture of coaching through medically relevant intensive faculty development initiatives like PCC will create an environment of collaboration, trust, and safety and help physicians develop a growth mindset, which will hopefully lead to increased physician wellbeing and improved patient care.

Limitations

Our program was limited in that it was a small pilot initiative at a single institution. Not all participants completed surveys, so additional perspectives may have been missed. Long-term observations and in-depth interviews are needed to assess whether physicians maintained use of coach-like behaviors. Future PCC cohorts will include follow-up surveys to examine how frequently participants use coach-like communication and the contexts within which they find them most helpful. As mentioned, observations in the clinic are difficult to plan due to the spontaneous nature of situations that would benefit from a coach-like conversation. Therefore, more formal skills evaluations strategies with simulated encounters may be a better way to evaluate coach-like behaviors.

Conclusion

Skilled communication is an essential aspect of quality medical care and training. Developing coach-like communication skills for clinical encounters that would benefit from a “coach approach” is one way that physicians can expand their competence as communicators, educators, and clinicians. More broadly, a clinical culture of coaching may improve interactions among medical professionals and enhance professional wellbeing by helping physician educators develop a growth mindset, assist colleagues and trainees in gaining insight into professional behaviors and setting and attaining concrete goals, and empower trainees to be more self-reflective problem-solvers. While physicians may not have the time to undergo extensive certification training in coaching, our pilot study suggests that a streamlined, intensive seminar-style course taught by qualified coaches and including ample, supervised practice opportunities is a feasible way to help busy clinicians develop coach-like communications skills. Key elements of the program include the following:

Instruction by qualified instructors who have ample coaching experience;

Abundant supervised practice opportunities with real-time feedback from qualified instructors;

Use of clinically and educationally relevant practice scenarios determined by participants; and

Involvement of physician-leaders with experience in coaching to enhance buy-in and acceptability.

Our intensive program may be used as a foundational template by institutions looking to provide professional development opportunities for physicians who want to add coach-like communication skills to their toolkit.

Supplemental Material

sj-docx-1-mde-10.1177_23821205251384831 - Supplemental material for An Intensive Physician Coaching-as-Communication Curriculum to Promote a Culture of Coaching: A Pilot Program to Assess Feasibility and Acceptability in Faculty and Residents

Supplemental material, sj-docx-1-mde-10.1177_23821205251384831 for An Intensive Physician Coaching-as-Communication Curriculum to Promote a Culture of Coaching: A Pilot Program to Assess Feasibility and Acceptability in Faculty and Residents by Mara M. Hoffert, Jennifer Newman, Vicki Panzenhagen, Odaliz Abreu Lanfranco, Karla D. Passalacqua and Kimberly Baker-Genaw in Journal of Medical Education and Curricular Development

Footnotes

Abbreviations

Acknowledgments

The authors thank DJ Mitsch from The Pyramid Resource Group, Inc. for “coach approach” training in the Phase 1 pilot program and for providing a foundation for development of our in-house PCC training program. The authors also thank Mina Brown, founder of Coach Academy International, for her support and high-quality coach training of MMH and VP.

ORCID iDs

Mara M. Hoffert

Odaliz Abreu Lanfranco

Karla D. Passalacqua

Kimberly Baker-Genaw

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

Funding for the Phase-1 pilot program with The Pyramid Resource Group, Inc. was provided by a philanthropic grant from the Jan Rival Fund.

Ethical Consideration

The Institutional Review Board at Henry Ford Hospital deemed that this educational quality improvement project did not meet the definition of Human Subjects Research and did not require a process of informed consent. All surveys were done voluntarily and anonymously via SurveyMonkey, and all surveys contained a preamble that gave respondents key personnel contact information for questions and notified respondents that surveys were anonymous, voluntary, that data would not be able to be connected to any individual, and that no aspect of participation or nonparticipation would affect their status at the institution. All data were analyzed in aggregate and no data could be linked to any individuals. All methods were carried out in accordance with all relevant US and Henry Ford Health institutional guidelines and regulations and ethical standards. Survey evaluations were developed by GME instructional designers and were based on the standard quality improvement survey template used for educational programming at our institution. All data were analyzed in aggregate and no data were linked to any individuals.

Data Availability

All questionnaire data generated and analyzed during this study are included in the published article.

Supplemental Material

Supplemental material for this article is available online.

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