Physician Coaching: Establishing Standards and Core Competencies

Competencies for Those Who Coach Physicians: A Modified Delphi StudyMayo Clinic ProceedingsVol. 99Issue 5PreviewThe rapidly evolving coaching profession has permeated the health care industry and is gaining ground as a viable solution for addressing physician burnout, turnover, and leadership crises that plague the industry. Although various coach credentialing bodies are established, the profession has no standardized competencies for physician coaching as a specialty practice area, creating a market of aspiring coaches with varying degrees of expertise. To address this gap, we employed a modified Delphi approach to arrive at expert consensus on competencies necessary for coaching physicians and physician leaders. Full-Text PDF Open Access These are dynamic and challenging times for physicians. Changes to practice structures within health care have decreased autonomy and flexibility, leaving many physicians feeling as if they are cogs in the wheel of an impersonal system. Other structural changes to health care delivery have also contributed to frustration, eroded meaning in work, and occupational distress for many physicians. Addressing these challenges requires interventions at both the system and individual levels.1Shanafelt T.D. Physician Well-being 2.0: where are we and where are we going?.Mayo Clin Proc. 2021; 96: 2682-2693Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar,2Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-BeingNational Academy of Medicine, National Academies of Sciences, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press, 201925521Google Scholar Although the focus of organizations and leaders should be on improving the practice environment, there are effective steps individual physicians can pursue to shape their work, design their path, enhance work-life integration, find their voice, and optimize meaning in work. Multiple randomized trials have found that professional coaching can be a helpful tool in this process.3Dyrbye L.N. Shanafelt T.D. Gill P.R. Satele D.V. West C.P. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial.JAMA Intern Med. 2019; 179: 1406Crossref PubMed Scopus (155) Google Scholar,4Mann A. Shah A.N. Thibodeau P.S. et al.Online well-being group coaching program for women physician trainees: a randomized clinical trial.JAMA Netw Open. 2023; 6e2335541Crossref Scopus (5) Google Scholar5Kiser S.B. Sterns J.D. Lai P.Y. Horick N.K. Palamara K. Physician Coaching by Professionally Trained Peers for Burnout and Well-Being: A Randomized Clinical Trial.JAMA Netw Open. 2024; 7e245645https://doi.org/10.1001/jamanetworkopen.2024.5645Crossref PubMed Scopus (0) Google Scholar Given the strong evidence for this approach, professional coaching is being more broadly incorporated as a resource to support physicians by many health care organizations. Whereas general coaching competencies exist, there has not yet been an expert consensus on the specific competencies necessary to coach physicians and physician leaders. Familiarity with common challenges physicians face and the professional norms of the culture of medicine will enable coaches to help physicians navigate these challenges more effectively. Accordingly, there is critical need to develop standards and to define competencies for individuals who coach physicians. In this issue of Mayo Clinic Proceedings, Passarelli et al6Passarelli A.M. Gazelle G. Schwab L.E. et al.Competencies for those who coach physicians: a modified Delphi study.Mayo Clin Proc. 2024; 99: 782-794Abstract Full Text Full Text PDF Google Scholar report the results of a rigorous study to define competencies for physician coaches. Through a modified Delphi process, the authors defined 6 core competencies for those who coach physicians:1.Physician-specific coaching2.Understanding the physician and health care context, culture, and career span3.Coaching theory and science4.Diversity, equity, inclusion, and other social dynamics5.Well-being and burnout in physicians6.Physician leadership Importantly, these standards are intended not to replace existing competencies for all coaches but rather to equip physician coaches to build on that foundation and enable them to tailor their approach to support physicians more effectively. We briefly consider these 6 competencies and highlight specific thematic domains important for coaching physicians. In contrast to traditional coaching relationships, which are less reliant on the coach's having considerable understanding of the work life of their "coachee," Passarelli and colleagues articulate the importance of such awareness in physician coaching (ie, physician-specific coaching). Although intuitive, this requirement introduces a challenge for those who train and certify physician coaches who are not physicians themselves—how does one truly understand the experience of physicians throughout their training and career life cycle and the nuances of practicing medicine in today's health care environment from a classroom, book, or online module? How does one demonstrate knowledge of these concepts and translate that knowledge into the skills, mindset, and approach necessary to coach physicians effectively? Although these questions remain unanswered by Passarelli et al, their work establishes a framework from which they can be approached and evaluated. The second competency is "understanding physicians and health care context, culture, and career span." In this domain, the concepts of post traumatic growth and trauma-informed coaching are helpful and should be applied beyond the physician leader competency where they receive the most attention. Whereas the American Psychiatric Association defines trauma as "when an individual person is exposed to actual or threatened death, serious injury, or sexual violence," a broader definition, such as that used by the Substance Abuse and Mental Health Services Administration (SAMHSA), has greater utility in physician coaching. In this regard, SAMHSA defines trauma as "an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual's functioning and physical, social, emotional, or spiritual well-being."7SAMHSA's Working Definition of Trauma and Guidance for a Trauma-Informed ApproachHHS Publication No. (SMA) 14-4884. Substance Abuse and Mental Health Services Administration.2014Google Scholar This broader definition invites physicians to identify the potential impact of their past experiences and growth available to them through coaching, which can build self-efficacy through reflection on prior post traumatic responses and growth with respect to past experiences. Coaching competency related to diversity, equity, and inclusion is important and overlaps all the important areas, including physician leadership. Many physicians experience stress related to microaggressions, bias, and mistreatment in the learning and practice environment, which can interfere with their ability to focus, learn, process information, and exhibit cognitive flexibility.8Ripp J.A. Thomas L.R. Caring for Caregivers to Be: A Comprehensive Approach to Developing Well-Being Programs for the Health Care Learner. Oxford University Press, 2023Crossref Google Scholar It is imperative for coaches to create the space to acknowledge these experiences and have the skills to help physician leaders explore their role in creating inclusive work environments as well as to recognize and respond to early signals in the workplace environment. With respect to competency in the domain of physician well-being and burnout, it is critical for coaches to recognize that physicians are a remarkably resilient population.9West C.P. Dyrbye L.N. Sinsky C. et al.Resilience and burnout among physicians and the general US working population.JAMA Netw Open. 2020; 3e209385Crossref Scopus (233) Google Scholar Accordingly, a focus on building resilience is often better shifted to reconnecting with resilience and the coping strategies that have supported their resilience in previous challenging times. Resilience is a dynamic quality composed of skills, actions, and mindsets that can be learned and strengthened. Coaching can help physicians consider what resilience means for them today and what matters most to them, rather than how to "increase resilience." Central to competence in this domain is the concept of not simply eliminating distress or navigating challenges through resilience but the aspirational (and achievable) goal of fostering professional fulfillment. Professional fulfillment is a construct including meaning, purpose, self-worth, self-efficacy, and satisfaction at work.10Trockel M. Bohman B. Lesure E. et al.A brief instrument to assess both burnout and professional fulfillment in physicians: reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians.Acad Psychiatry. 2018; 42: 11-24Crossref PubMed Scopus (313) Google Scholar Whereas Passarelli and colleagues describe many of these concepts separately, we encourage considering them holistically through the lens of professional fulfillment. Helping physicians identify, explore, and personalize their definition of this construct and reflect on how to foster it can be one of the most edifying outcomes of physician coaching. Several further considerations merit reflection related to the competencies of "coaching theory and science" and "physician leadership." First, although simple, the value of vision and goal setting should not be underestimated. In contrast to the business world, where goal setting is routine practice in annual reviews, physicians in practice are rarely asked to set a vision or goals and to assess attainment. The physician training culture is based on achieving major time-intensive and, at times, grueling milestones that often leave one with a surprising feeling of disappointment or discontent rather than fulfillment, consistent with the concept of "arrival fallacy" described by psychiatrist Dr Tal Ben-Shahar.11Ben-Shahar T. Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment. McGraw-Hill, 2007Google Scholar Once in practice, it can be challenging to see growth over time. Encouraging physicians to define and set a vision for success unrelated to externally defined professional milestones and to identify the goals that will help them reach that vision is a crucial competency for physician coaches. Cognitive flexibility is another central consideration for physician-specific coaching that is alluded to but not explicitly described in the key area of coaching theory and science. Cognitive flexibility is essential to help physicians optimally identify, construct, and approach solutions and make effective decisions.12Menon N.K. Trockel M.T. Hamidi M.S. Shanafelt T.D. Developing a portfolio to support physicians' efforts to promote well-being: one piece of the puzzle.Mayo Clin Proc. 2019; 94: 2171-2177Abstract Full Text Full Text PDF PubMed Google Scholar Imposter phenomenon and low self-compassion, common challenges for physicians, negatively affect cognitive flexibility, whereas growth mindset and cognitive reframing foster cognitive flexibility.13Shanafelt T.D. Dyrbye L.N. Sinsky C. et al.Imposter phenomenon in US physicians relative to the US Working population.Mayo Clin Proc. 2022; 97: 1981-1993Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar These concepts are particularly amenable to coaching, and although discussed under the physician leadership competency, we suggest they be incorporated as a component of the physician-specific coaching competency and applied to all physicians receiving coaching. Finally, the concept of value warrants special consideration. Value as a construct includes what physicians value, how that aligns with what their organization values, and what it means for them to feel valued by their organization. Effective coaching creates space to reflect on these aspects, including how physicians can advocate for what they may need to feel valued.14Palamara K. Sinsky C. Four key questions leaders can ask to support clinicians during the COVID-19 pandemic recovery phase.Mayo Clin Proc. 2022; 97: 22-25Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Helping physicians reflect on their experiences, name their emotions, and understand the needs behind those feelings are critical coaching skills to foster personal-organization values alignment and to help physicians feel valued. These themes may be incorporated in the coaching theory and science and physician leadership competency domains. Defining competencies for individuals who coach physicians is essential to inform coach education, training, and certification. The work of Passarelli and colleagues provides a critical, evidence-based foundation from which to build. Future work focused on how to develop and evaluate these skills and how to ensure that those who coach physicians have the knowledge, skills, attitudes, and experience to optimize effectiveness can be pursued. Such efforts are likely to expand the number of organizations providing coaching as a resource to extend the benefits of coaching to a larger proportion of physicians. Dr Shanafelt is co-inventor of the Well-being Index instruments and the Mayo Leadership Index. Mayo Clinic holds the copyright for these instruments and has licensed them for use outside of Mayo Clinic. Dr Shanafelt receives a portion of any royalties received. As an expert on the well-being of health care professionals, Dr Shanafelt gives grand rounds/key note lecture presentations and provides advising for health care organizations. He receives honoraria for some of these activities.