Psychiatric Annals

CME Article 

Enhancing Physician Wellness Through Coaching: An Occupational Psychiatry Tool

Elaine E. Schulte, MD, MPH; Andrea L. Sikon, MD, FACP, ACC; Linda Love, EdD; Kari Simonsen, MD; Andrea Berry, MPA; Gaurava Agarwal, MD

Abstract

Mental health clinicians learn many of the fundamentals of coaching through their training. Occupational psychiatrists may consider using coaching skills to help directly improve the well-being of physicians and indirectly improve the functioning of health care organizations. In this article, we define what coaching is and how coaching differs from therapy, mentorship, and advising. We introduce core coaching concepts and expectations of a coaching engagement. We discuss the benefits of different types of coaching. We specifically describe how performance and developmental types of coaching can be used to help physicians in the various clinical, administrative, leadership, and research roles that they may have. We describe fundamental coaching skills and how they can be useful in the quest to help physicians achieve well-being. Finally, we briefly describe coach training and certification for those that are interested in pursuing more formal training or for those who may be looking to retain a coach. [Psychiatr Ann. 2019;49(11):492–496.]

Abstract

Mental health clinicians learn many of the fundamentals of coaching through their training. Occupational psychiatrists may consider using coaching skills to help directly improve the well-being of physicians and indirectly improve the functioning of health care organizations. In this article, we define what coaching is and how coaching differs from therapy, mentorship, and advising. We introduce core coaching concepts and expectations of a coaching engagement. We discuss the benefits of different types of coaching. We specifically describe how performance and developmental types of coaching can be used to help physicians in the various clinical, administrative, leadership, and research roles that they may have. We describe fundamental coaching skills and how they can be useful in the quest to help physicians achieve well-being. Finally, we briefly describe coach training and certification for those that are interested in pursuing more formal training or for those who may be looking to retain a coach. [Psychiatr Ann. 2019;49(11):492–496.]

Although health care organizations are increasingly recognizing the impact of physician burnout, the symptoms of distress continue to be markedly greater than for the general population.1 Coaching is one individual-focused strategy that has been successfully used to increase physician well-being,2 which is defined as an optimal physical, mental, and social state.3 Research from the field of wellness and burnout coaching suggests that coaching can increase individual self-efficacy and affect behavioral and attitudinal change.4 A few health care organizations offer novel internal physician-coaches for faculty and trainees, and/or have developed internal peer coaching programs to support professionals.5–7

Although coaches can come from various disciplines and backgrounds, occupational and organizational psychiatrists may view coaching as a possible intervention in their toolkits. Every person has unique needs and wants for his or her personal and professional lives, and it has been shown that physicians who can find meaning in at least 20% of their work day have a rate of burnout roughly half that of those who spend less than 20% of their efforts in meaningful activities.8 Occupational psychiatrists can use a wellness coaching approach to help physicians craft a sustainable and meaningful life.

Several types of coaching can be used to support the individual physician (and indirectly a physician's team), including performance, remediation, wellness, and developmental coaching. In this article, we introduce coaching concepts and discuss the benefits of the different types of coaching and what fundamental coaching skills can be useful in the quest to help physicians achieve well-being. We also briefly describe coach training and certification.

Illustrative Case 1

This doctor is a mid-career physician who is struggling to keep up at work. He has trouble closing his notes in a timely fashion and is frequently on the “late chart” list. His colleagues notice that he doesn't seem as passionate about his work as he did in the past, and his support staff report that he has become unusually distant and short-tempered with them. He is suffering from burnout. He has heard of colleagues who are suffering from burnout benefitting from “wellness coaching” and is interested in learning more about what coaching entails.

What Is Coaching?

The term “coaching” has taken on many definitions and is highly dependent on the context. Current coaching models for physicians may address wellness,9 career development, burnout,10 leadership skills, or executive presence. Other more directive or prescriptive models include coaching focused on rehabilitation for the impaired physician or communication skills for the physician with professionalism issues.11 Academic coaching for medical students and professional development coaching for residents are examples of used in medical education.7,12 It is worth noting that many of these terms overlap; thus, there is inherent ambiguity in understanding exactly what “coaching” is. One of the most prominent organizations dedicated to advancing the coaching profession, the International Coach Federation (ICF), defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.”13 Clients often seek coaching when they feel “stuck;” sometimes because they feel the need to work through a current situation, or sometimes because they want to move forward but don't know how. In either case, a coach serves as a thought partner to help the client understand his/her goals and motivations, expand options, and create accountability, all in the service of enhancing personal fulfillment.

What Coaching Is Not

Therapy

Coaching and therapy both have the common goal of improving the well-being of the person being served, but they are distinct in important ways. One broad approach to distinguishing them is that therapy tends to be grounded by behavioral health theory and methods using a diagnosis and treatment approach, incorporates elements from the client's past and present to work toward a future state of improved wellness, and is traditionally performed by a licensed mental health professional in a patient-provider relationship. The patient may have a mental illness that poses a barrier to health. The therapist is considered an expert in the concerns expressed by the client and offers potential solutions and proven professional interventions. This does not mean that clients with mental illness cannot benefit from concomitant coaching as another resource toward wellness.

Coaching assumes the client is whole and healthy and has the strengths and answers within to focus on present concerns and future goals. Coaching is often grounded in positive psychology and is performed by a coach who may have a variety of educational or training backgrounds relevant to the client. In the purest state, coaches do not offer solutions to their clients but facilitate their personal growth by allowing an opportunity to explore and find their own solutions. Coaches do not treat any mental illness or diagnosis.

Mentoring and Advising

Coaching can also be confused with more traditional roles in the academic medical center such as mentor or advisor. Mentors are subject matter experts who use their experience to guide and shape the development of their mentees. Mentors are typically prescriptive. They tell the mentee what to do based on their own judgment and interpretation of what they believe is best for the mentee. Advisors may serve a more defined and specified institutional role, such as a research or career advisor, and have specific metrics, timelines, and goals that help assure accountability from the advisee. This may be within the context of a mentoring relationship but is frequently outside the role of the primary mentor and more aligned with institutional governance.

Coaches, instead, are not necessarily subject matter experts but may have some other leadership or life experience that provides value to their clients. They provide an opportunity for clients to strategize and explore ideas, primarily through asking questions that probe deeper and support self-discovery. Coaches refrain from providing detailed advice to clients related to subject matter expertise but can add value as accountability partners in helping clients uncover means of unlocking productivity, harnessing their strengths, and working more effectively with others to achieve their goals.

Types of Coaching

Although coaching is an important construct in academic medicine, it is important to discern the types of coaching that appropriately fit the desired outcome for continuous professional and personal development. Coaching has many potential applications for medical professionals, all of which could fall under the umbrella of “enhancing wellness,” yet various coaching methodologies and goals have discrete purposes and outcomes. Two distinct coaching constructs include performance coaching and developmental coaching.

Performance Coaching

Undoubtedly, professionals, when performing at their best, have a net cascading positive effect on health care organizations. Investing in achieving a personal best gives physicians control over how they are viewed and valued by organizations, and how they feel about their work. Even star performers, if they apply a growth mindset, can be energized by learning that refines their skills. Finally, mastery, achievement, and achieving flow in one's work are core drivers of well-being and engagement for professionals.

Unfortunately, as careers progress, our continual development is often achieved on a “do-it-yourself” model, fitting in learning as time and resources permit. Performance coaching can be a form of individualized, precision professional development, one that is a hallmark of learning organizations. It can be applied in situations where remediation, or improvement, is needed and/or desired. Performance coaching entails direct observation of performed skills with the incorporation of feedback to generate reflective questions and co-constructed “experiments” to practice modified behaviors toward the goal of more effective performance in a specific domain (eg, patient communication).

Although physicians and leaders are often vocal about championing new equipment or competitive services, rarely is the same energy dedicated to championing investments in the most important core component in the health care enterprise—its people. Performance coaching is one intentional activity that helps physicians fine tune their performance and maximize their unique human capacity. Applications are largely skills- or behavioral-based and include optimizing procedural skills, or effective clinical or systems functions. As Dr. Atul Gawande mentioned in his own quest for coaching, some seek out coaches because they are concerned that their performance has “just stopped getting better.”14 He wondered if there might be a better way to do things to improve his efficiency, processes, and patient outcomes.

Performance coaching, like sports coaching, expands mindful awareness and is aimed at long-term self-efficacy. Coaches and those who are being coached engage, observe, and test personal mastery goals and plans, with practice and experimentation to reach idealized outcomes. Attention to skills can help the professional become better.

Developmental Coaching

The path toward a successful medical career can be ambiguous, contributing to unnecessary stress in the workplace and a mismatch between a clinician's skillset and the skills required for other aspects of one's identity, such as administrator or medical director. Whereas performance coaching focuses on critical skills, developmental coaching focuses on the person. Developmental coaching focuses on constructing specific self-defined goals and bridges the gap between practicing professionals' current perspectives of their skills, achievements, and roles and those desired to enhance their career trajectory. Developmental coaching can be wide-ranging and is ideally suited for navigating career transitions such as promotions. It can include executive coaching for physician leaders, which not only benefits the person but indirectly influences direct reports. Positive leadership qualities have a direct effect on the personal well-being of the physicians they lead.15 Developmental coaching, unlike performance coaching, is less prescriptive and relies on a “coachee's” reflection, introspection, self-awareness, and inquisitive pursuit of professional and personal aspirations. The developmental coaching relationship is not directive but exploratory in nature. Attention to the humanistic or whole person can help professionals become their best self.

Facilitating Physician Wellness Using a “Coach Approach”

Although mental health clinicians are not expected to be experienced coaches, they can use the performance and developmental coaching models, and take a “coach approach” to help their colleagues move toward an enhanced state of well-being and sustained positive change. Using a coach approach to facilitate wellness, regardless of coaching model, involves practicing active and deep listening, empathy, and positive psychology. A healthy coaching relationship is founded on trust and mutual respect, in which both people agree to bring their best selves to the coaching work.

Consider the doctor in Illustrative Case 1, who is suffering from burnout. Although he might need psychological support and therapy, he may also benefit from using a coach approach to address his well-being. An occupational psychiatrist may employ parts of performance coaching to help this doctor address his communication skills and possible disruptive behavior. The provider would help him establish goals for improving his relationships with others, explore current challenges including overall stress reduction, and create a measurable action plan. When he is emotionally ready, he may be receptive to a more developmental coach approach, in which a provider can help him remember his underlying motivations for selecting medicine as a field and help him imagine and create career roles that he finds more meaningful and sustaining.

Illustrative Case 2

Consider another physician who is feeling stuck and just cannot seem to get his grant submitted for renewal. Even though the doctor in this second illustrative case is not suffering from burnout, he could benefit from working with a provider who serves as his professional thought partner. Using a coach approach here might help the doctor discover a renewed sense of self-efficacy. A performance coach approach could enhance his time management skills by helping him identify a goal, expand options for attaining that goal, and then help hold him accountable for the chosen option. Adding a developmental coach approach could broaden his untapped internal and external resources, which could facilitate grant completion.

Illustrative Case 3

Finally, we consider a doctor who is an emerging leader. This doctor has been asked to take on a new administrative role and is also thinking of moving to another organization. She is proactively working toward maintaining her wellness. A provider would use a developmental coach approach to help explore her professional goals, listen for strengths and values, and instill confidence–all with the intent of increasing self-awareness about what would be most meaningful to her. Through the lens of curiosity and visualization, they would help her to discover a range of career trajectory possibilities and thoughtfully narrow down the list to one option on which to concentrate and then develop an implementation plan.

Coach Training and Certification

Unlike becoming a physician or obtaining a graduate degree, there are numerous pathways one can take to become a coach, and the field of coaching is not regulated by any country or state. This can create confusion as to when a “true” coaching approach is being offered or requested and also lead to some quality issues in terms of people claiming to be coaches that are not trained in the paradigm. There are, however, a variety of types of coach training programs, and coaching credentials and certifications that can help someone requesting coaching feel more confident in the training of the coach. Coaching credentials are awarded to coaches who have met stringent education and experience requirements through coach training programs, and who have demonstrated a thorough understanding and practice of the coaching competencies. The ICF is one of the most popular and well-established coaching credentialing organizations.13 As an accrediting body, the ICF reviews coaching training programs to ensure they follow the highest ethical standards and provide the appropriate content for coach training. The ICF itself does not provide coach training. Another type of coaching certification, the board-certified coach, is provided through the Center for Credentialing and Education (CCE). Like the ICF, the CCE accredits coach training programs. There are hundreds of ICF programs, and nearly 100 CCE-accredited coach training programs in the United States and around the world. Coach training programs vary by delivery method (eg, in person and/or online), cost, coaching specialty (eg, executive or career coaching), educational program type (eg, universities or independent entities), and the type of credential, which typically represents the amount of educational training and coaching experience (eg, Associate or Master Coach).

Conclusion

We invite occupational and organizational psychiatrists and other mental health clinicians to consider using a coach approach as an additional technique to help physicians enhance their well-being. As professionals with inherent experience with some of the coaching fundamentals (eg, building rapport, active listening, empathy) by virtue of their professional training, occupational psychiatrists may be uniquely positioned to best impact physician colleagues.

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Authors

Elaine E. Schulte, MD, MPH, is the Vice Chair, Academic Affairs and Faculty Development, Children's Hospital at Montefiore; and a Professor of Pediatrics, Einstein College of Medicine. Andrea L. Sikon, MD, FACP, ACC, is the Chair, Department of Internal Medicine & Geriatrics, Center for Specialized Women's Health–Women's Health Institute; the Director, Center for Excellence in Coaching and Mentoring, Cleveland Clinic; and an Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Linda Love, EdD, is the Co-Director, University of Nebraska Medical Center (UNMC) iLEAD Program; the Director, UNMC Faculty Development; and an Assistant Professor, Department of Psychiatry, UNMC. Kari Simonsen, MD, is the Assistant Vice Chancellor for Faculty Affairs; a Professor and the Vice Chair of Pediatrics; and the Chief, Division of Pediatric Infectious Diseases, UNMC. Andrea Berry, MPA, is the Director, Faculty Life; the Co-Director, Geriatric and Principles of Palliative Care Longitudinal Curricular Theme; and an Instructor, Department of Medical Education, College of Medicine, University of Central Florida. Gaurava Agarwal, MD, is the Director of Physician Well-Being, Northwestern Medical Group; and an Assistant Professor, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine.

Address correspondence to Elaine E. Schulte, MD, MPH, Academic Affairs and Faculty Development, Children's Hospital at Montefiore, 3411 Wayne Avenue, Bronx, NY 10467; email: elschult@montefiore.org.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20191010-02

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