To the Editor:
An increasing volume of published work is focused on coaching as an approach for enhancing the quality of medical education, including two recent publications in this journal, by Ericsson1 and Wenrich and colleagues.2 These articles and other recent similar forays have stimulated thoughts, often challenging the status quo, about refining the role of medical educators. Having personal experiences coaching others and having benefited ourselves from training with great coaches, we too are excited about improving the quality of medical education in this vein. As coaching principles are applied to medical education, we believe that there are at least two important features of great coaches in medicine that distinguish them from those aiming merely to teach the next generation of physicians.
First, coaches work with coachees (medical learners) toward a goal of excellence rather than competence. Ericsson1 summarized the research on expert performance and the need for goal-directed training with immediate feedback in building superior performers. While competence is a prerequisite for superior performance, an enduring pursuit toward the highest attainable goal is a fundamental tenet of coaching. Because the progression toward mastery often comes slowly in medicine, longitudinal coaching relationships may be necessary if there is to be a genuine commitment to support the next generation of expert clinicians.
Second, coaches in medicine must inspire learners. Wenrich and colleagues2 describe many early teachers as “cheerleaders” who are rather passive in their approaches and who set modest goals for learners. Beyond the knowledge, skills, and behaviors they impart, great coaches ignite and foster passions in learners that motivate them toward personal visions of success. Inspiring others requires keen attentiveness and generosity of spirit to learners’ needs, empowering them with the confidence that they are a part of something special. Coaches additionally help learners to understand that there is always room to improve by constructively bringing their blind spots into focus. For a well-coached individual, there is no choice but to become a lifelong learner, consistently working to improve on her quest in pursuit of greatness.
Coaches in medicine must establish the goal of excellence and inspire coachees, both of which necessitate time invested to truly understand learners as individuals. While this is a resource-intensive proposition, working to understand which trainees may benefit most from this strategy and when in training the delivery of coaching is most valuable may allow for the realization of transformative education in medicine.
Ryan Graddy, MD
Chief resident and instructor, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center Internal Medicine Residency Program, Johns Hopkins University School of Medicine, Baltimore, Maryland; firstname.lastname@example.org.
Scott Wright, MD
Professor of medicine and director, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
1. Ericsson KA. Acquisition and maintenance of medical expertise: A perspective from the expert-performance approach with deliberate practice. Acad Med. 2015;90:14711486.
2. Wenrich MD, Jackson MB, Maestas RR, Wolfhagen IH, Scherpbier AJ. From cheerleader to coach: The developmental progression of bedside teachers in giving feedback to early learners. Acad Med. 2015;90(11 suppl):S91S97.