Clinical coaching: Evolving the apprenticeship model for modern housestaff

Abstract

Feedback is one of the core components of teaching in the clinical setting. Traditionally, this activity has emphasized observations made by senior physicians and delivered to medical trainees. However, the optimal approach to feedback remains uncertain, and the literature abounds with trainee-perceived inadequacies in feedback content, quality, and impact. Moreover, given the multiplicity of demands on trainees and their physician mentors, we propose that medical trainees themselves—specifically, medical residents—are poised to serve as unique adjunct effectors of feedback. We propose a model of “clinical coaching” for residents as teachers, with emphasis on the active roles of both the feedback “giver” and “recipient”. We define “clinical coaching” as “a helping longitudinal relationship between coach and apprentice that provides continuing feedback on and assistance with improving performance.” Here, “coach” is the more experienced trainee (e.g. supervising resident), and “apprentice” is the less experienced trainee (e.g. intern or medical student). By working to better recognize and prepare residents for this vital role, we propose to encourage efforts to optimize the structure, execution, and impact of feedback in the contemporary climate of medical education.

Acknowledgments

The authors extend their gratitude to Drs. Belinda Chen, Rachel B. Levine, Scott M. Wright, Roy C. Ziegelstein, and David H. Roberts for their thoughtful review of this manuscript. These individuals received no compensation for their contributions.

Disclosure statement

The authors extend their gratitude to Drs. Belinda Chen, Rachel B. Levine, David H. Roberts, Scott M. Wright, and Roy C. Ziegelstein for their thoughtful review of this manuscript.

Notes on contributors

Dr. Deepa Rangachari, MD is an Instructor of Medicine at Harvard Medical School and a member of the Division of Hematology/Oncology at the Beth Israel Deaconess Medical Center. She serves as Associate Director of the Hematology/Oncology Fellowship Program and Associate Chief of the Tullis Firm for the Internal Medicine Residency Program.

Dr. Lorrel Brown, MD is an Assistant Professor of Medicine at the University of Louisville School of Medicine and a member of the Division of Cardiology. She serves as Associate Director of the Cardiology Fellowship Program and Physician Director for Resuscitation. She is a physician champion for statewide efforts in cardiopulmonary resuscitation.

Dr. David Kern, MD, MPH is an Emeritus Professor of Medicine at the Johns Hopkins University School of Medicine and a member of the Division of General Internal Medicine (GIM) at the Bayview Medical Center. He is a nationally-recognized leader in medical education and faculty development.

Dr. Michael Melia, MD is an Associate Professor of Medicine at the Johns Hopkins University School of Medicine and a member of the Division of Infectious Diseases. He serves as Director of the Infectious Diseases Fellowship Program and is the Associate Director for Faculty Engagement within the Osler Medical Training Program.