3 Educators Offer Lessons Learned on Rheumatology Training

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Leslie Kahl, MD, on Coaching

I have been an academic clinician-educator for my entire career and, like most of my colleagues, have been called upon to advise, mentor and coach countless trainees and junior faculty members. Unlike most clinician-educators, though, I also served as associate dean for student affairs at Washington University School of Medicine, St. Louis, for 18 years, supporting more than 2,000 students through graduation. So I thought I knew what I was doing. But last year I learned the difference between advising, mentoring and coaching, and it has changed my career path and taught me three big lessons.

1. Be a coach: First, simply put, an advisor is typically an expert in the field, senior to the advisee, who provides answers to questions and solutions to problems. Similarly, a mentor is generally a senior colleague in the field who serves as a role model and provides opportunities for the mentee to proceed along a predetermined path.

A coach, in contrast, stands next to the coachee as a peer and partners with them to listen and ask questions that help the coachee realize where they are now, where they might aspire to be and how to get there. The coach does not give advice or offer opportunities, but instead empowers the coachee to synergize their values with their vision and actions, and helps them hold themself accountable for the outcomes. The coach listens, asks powerful questions and supports the coachee in developing a personalized plan for self-development.

A few simplified sample conversations should clarify these differences.

Advisor: “Let’s talk about your research project. I think you should use a multivariate analysis on this dataset. Don’t forget the Bonferroni correction. And I’d like to see a draft of the methods section by next Friday.”

Mentor: “Let’s talk about your research project. The data analysis here could be tricky. You might want to touch base with Dr. Number Cruncher; I will email an introduction for you. And when it’s time to submit the manuscript, please consider the Journal of Really Important Findings; they have been receptive to similar publications from my lab in the past.”

Coach: “So you wanted to talk about your research project. Which sections are giving you trouble? What does a great outcome to those hurdles look like? What steps can you think of to get that great outcome? Which of those are you willing to commit to doing next, and when do you plan to have it finished?”

2. Ask questions. The second lesson I learned is about questions. As an educator I ask a lot of questions, nudging the learner to come to a conclusion, take a stand and commit. This is not pimping in the pejorative or Socratic sense, but gently supporting the trainee to consider alternatives and take ownership of a plan. I believe that asking for this commitment leads to learning and growth in a way that simply telling the learner what to do cannot.¹

In a coaching relationship, asking the coachee to prioritize and come up with a plan, rather than telling them what to do, leads to commitment and follow-through. Coachees are often surprised with the responses they come up with. The answers were in there all the time, but needed a little prodding to come out.

To ask powerful questions, though, the coach needs to be a great listener, paying as much attention to what is not said as to what is said, picking up on subtle changes in the coachee’s energy while speaking and, sometimes, using intuition to fill in the blanks. Here, the great coach shares territory with the great rheumatologist: The nuances of the patient’s history and exam inform the skilled clinician’s approach to the diagnosis and treatment plan.

3. Embrace developmental coaching: The third lesson I learned is the power of developmental coaching. During our coach training, our cohort members were assigned to coach each other on multiple occasions. Although many of us were novices at this, we still had some profound aha moments, breakthroughs and leaps across that gap between what is and what could be.

In a powerful essay in The New Yorker, Atul Gawande described how even an experienced surgeon can benefit from the fresh perspective of a coach.² Further, a study at the Mayo Clinic showed that 88 practicing physicians who each received six coaching sessions facilitated by a professional coach demonstrated significant decreases in overall burnout and emotional exhaustion, along with significant improvements in quality of life and resilience.³

The benefits may go beyond the individual who is receiving the coaching. A study from the Mayo Clinic demonstrated that for every one point increase in the composite leadership score of their supervisors, physicians had a 3.3% decrease in likelihood of burnout and 9% increase in the likelihood of satisfaction.⁴ Components of the 12-item leadership score included easily coached skills, such as, “Holds career development conversations with me,” “Is interested in my opinion,” and “Recognizes me for a job well done.”

Finally, the principles of developmental coaching—listening, asking questions and supporting—could also readily be applied by clinicians to their patients’ care.

Having completed training through the Physician Coaching Institute, I am now a Certified Physician Development Coach. While continuing my work in rheumatology and education, I look forward to coaching mid-career faculty who have recently assumed leadership roles at my institution. I also anticipate continuing to receive coaching, and would ask you to consider if it might be just the thing to help you reach the next level in your own work and personal life.