By MARGARET CARY, JACK PENNER, and JP MIKHAIE
Burnout is one of the biggest problems physicians face today. We believe that addressing it early — in medical school — through coaching gives physicians the tools they need to maintain balance and meaning in their personal and professional lives.
We say that after reading comments from participants in our coaching program, “A Whole New Doctor,” developed at Georgetown University School of Medicine. This program, born almost by chance, provides executive coaching and leadership training to medical students, who are exactly the right audience for it.
Medical students tend to begin their education as optimistic 20-somethings, eager to learn and eager to see patients. After spending one or two years on the academic study of medicine, they move to the wards where they observe the hidden curriculum — a set of norms, values, and behaviors conveyed in implicit and explicit ways in the clinical learning environment.
In the hospital, convenience and expediency, deference to specialists, and factual knowledge tend to replace the holistic and patient-centered care that is lauded during the preclinical years. This new culture nudges some students to the brink of burnout and depression. Some consider suicide.
Jacob and Catherine (not their real names to avoid adding more pain to those who lost them) were colleagues of one of us (M.C.) in medical school. Each committed suicide as they moved from medical school to residency. Their deaths were never discussed by the faculty or the classmates they left behind.
As an antidote to these pernicious influences and secrecy, coaching helps foster students’ ability to “take the best and leave the rest” — to model behaviors that fit with their ideals and eschew those that don’t. The coaching relationship, an integral component of “A Whole New Doctor,” emphasizes the soft skills involved in medicine — empathy, effective communication, time management, and a positive outlook. In the same way clinicians learn the language of medicine and extend their knowledge base, they must also reflect, remain conscious, and work on these soft skills. Coaching can lead to increased self-awareness and self-control.
Our coaching program began when two of us (M.C. and J.P.) met and bonded over a shared love for essay writing. At the time, one of us (M.C.) was and still is a faculty member at the Georgetown University School of Medicine. The other (J.P.) was a second-year medical student.
The program works like this:
“A Whole New Doctor” is promoted to students in all four years. Those who are interested complete a six-question online application. Fellows (students who have completed the program) read the applications and invite students to join a weekend workshop. After the workshop, fellows interview the students who want a coach to set their expectations about coaching and to share their experiences with it. Students who want coaches then sign up and choose one from our Coach Bio Book, which is sent out to participants following the weekend workshop.
We structured “A Whole New Doctor” as a volunteer program because we have seen traditional professional development programs that require participation fail. In such programs, faculty members teach students with a homogeneous syllabus for all, despite each student having differing perspectives and experiences. We flip the learning environment, letting students guide themselves on how they will learn and grow, using their coaches as architects to help them build their futures.
The coaches, all professionally trained, are volunteers; none are formally associated with Georgetown University School of Medicine. (Even with the most trusted attending physicians, the power dynamics in medical education make it hard for students to open up.) The coaches create a nonjudgmental and emotionally safe atmosphere. The student participants express comfort knowing they can be vulnerable without worrying about their professional superior’s judgment.
Our first workshop in October 2016 had 13 participants. Since then, all 25 spots have been filled, with 100 percent participation in coaching in the last workshop.
In the first two years of the program, we’ve learned a lot. Here are some of the key takeaways:
Eliminate the hierarchy. Workshops and coaching sessions are title-free zones. Anyone who uses Dr., Ms., Mrs., Mr., or the like must pony up a $5 donation to the Hoya Clinic, a student-run clinic for the homeless. Titles reinforce the hierarchy and power dynamics in medicine.
Make participation voluntary. Students from all four years of the medical school are invited to join the weekend workshops but aren’t required to attend. We consistently hear about the value of getting students from different years together, of being transparent with and learning from each other.
Use adult learning techniques. Adults need to know why they should learn something other than “it will be on the test.” Medical students tend to be eager to learn what’s needed to become better physicians. They are also more responsive to internal motivators than external motivators.
Have students choose their coach. Giving students control over selecting their coach increases their investment in the coach-client relationship.
Recruit student champions. Fellows of the program understand the rigor of medical school and the experience of having a coach. These students serve as a bridge between their medical student colleagues and the coaches. In this position, the fellows work on their own kindness and listening skills, as well as learning by doing: delivering constructive criticism, working in teams, and delegating — all the skills (and more) that they might have learned about in theory in a required professionalism class.
Have fun. Making the program fun for students adds to their enthusiasm for staying the course in becoming physicians. It lets them explore and grow in a safe environment, and enjoy themselves in a communal setting, knowing they are working to improve the care they give their future patients.
We created “A Whole New Doctor” based on the hypothesis that coaching medical students would make a difference by helping them learn resilience, team leadership, and emotional durability. By connecting students with coaches who ask powerful questions, we aim to create a space for students to reflect on the tensions that naturally arise in medical education.
Our anecdotal evidence, based on interviews during and after the program, tells us we’re succeeding. Here are a few comments from the program’s fellows:
“AWND has taught me that first learning to navigate and connect with my own self is a necessary prerequisite for the connections I hope to build with my future patients.”
“Because of my coach, I feel more rooted to myself, patients and the practice of medicine and I will be a better physician because of it.”
“Coaching has helped me grow up and has led to my exploration of underlying motivations, the consequences of actions, and how to grapple with changing responsibility.”
You can see more of the feedback here.
Our approach isn’t the only one out there. The American Medical Association’s Coaching in Medical Education handbook for faculty members lists the handful of medical student coaching programs, each of which has been through curriculum committees, is run by faculty, and is mandatory.
“A Whole New Doctor” works like a startup within the medical school’s regulations. It uses business techniques like agility, continuous quality improvement, and customer feedback. It is run by volunteers for volunteers, because imposing coaching on anyone is ineffective and will leave both coaches and students feeling frustrated.
We’re now working on ways to bring the program to a larger audience, expanding to other medical schools by sharing the model or by working with faculty and medical students at their schools, handing over management within one to two years. It’s possible we will come up with a different model. If we can prevent one student/resident/physician suicide, we’ll have made a difference.
We believe that “A Whole New Doctor” provides medical students with the support and tools they need to become resilient, balanced, and fulfilled physicians. By fostering relationships between students and coaches, we are changing the conversation so students feel uplifted and empowered rather than emotionally exhausted and detached. And by changing the conversation we hope to change the culture of medicine.
Margaret Cary, M.D., is co-founder of “A Whole New Doctor,” clinical associate professor at Georgetown University School of Medicine, where she teaches the “Hacking Happiness” course, and CEO of The Cary Group Global.
Jack Penner, M.D., is co-founder of “A Whole New Doctor” and a first-year resident physician in internal medicine at the University of California, San Francisco.
JP Mikhaiel is vice president of publications for “A Whole New Doctor” and a third-year medical student at Georgetown University School of Medicine.
This post originally appeared on STAT News here.