AVMA Convention Proceedings 2022: Coaching, Show Me The Evidence
Amanda Oden, DVM and Life Mastery Consultant/Coach
Imagine a football team with a burning desire and intention to win the highest title. They all get together for a bunch of lectures and exams, and then play real games especially towards the end of the series of lectures. Then one day, they start their regular season with a team captain and a quarterback. Their performance is pretty good, but everyone feels and knows it’s not what it could be, and they pick apart what’s going wrong day after day in an effort to improve. Soon the team is losing morale and results are following. The team owners decide to bring in a sports psychologist and a social worker and they help immensely. But something still seems to be missing. The team doesn’t have a coach.
Consider some questions. If we can’t imagine a winning sports team without a coach, why would we expect our veterinary teams to be exceptional without coaching? Would an individual athlete go for the gold without a coach? Why then do we expect to have gold medal results on our teams and in our careers without a coach?
In 2011 a human surgeon of 8 years published an article in the New Yorker Magazine about his experience hiring a coach for his surgery. He writes in the article, “There was a moment in sports when employing a coach was unimaginable—and then came a time when not doing so was unimaginable. We care about results in sports, and if we care half as much about results in schools and in hospitals we may reach the same conclusion. “ 1.
BRIEF HISTORY OF COACHING
Thirty or 40 years ago, if you told someone you’re a coach, they would ask, what sport? The perception and definition of coaching has gradually evolved over the years, however. Emphasized in most coaching definitions now is coaching’s facilitative approach, helping the one being coached to reach new insights, and to define, clarify, and progress towards self actualization and goals.
References to coaching for a debate team are found in magazines as early as 1911. Coaching as a facilitative modality for factory workers is found in1930, about the same time that coaching for sports entered the game. Sir John Whitmore’s 1992 seminal book on coaching, Coaching for Performance, drew on Timothy Galwey’s inner game model, and provided this definition of coaching: “Coaching is unlocking a person’s potential to maximize their own performance. It is helping them to learn rather than teaching them – a facilitation approach.” 3. In contrast to the knowledge transfer of teaching or training, Whitmore believed that coaching works with individuals to develop responsibility and self-awareness.
Thomas Leonard launched life coaching in 1980 to give his financial advisees a more effective structure of support to reach their financial goals. In 2010 Moore and co-authors linked coaching to positive psychology. The International Coach Federation now defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” 2. 3.
COACHING OR THERAPY
Coaching and psychotherapy have many commonalities. Some of the similarities are believing the client is able to change, interviewing, active listening, Socratic questioning, being involved with developmental issues, and building client awareness. Passmore and Lai discuss three differences between coaching and therapy. First, coaching clients are seeking improvement and development rather than eliminating psychological problems and dysfunctions.
Second, expected outcomes and evaluation methods are usually defined at the beginning of a coaching program. Third, coaching has a defined time horizon, process, and number of sessions, contrasting with therapy which can continue indefinitely, for as long as it takes. 2.
Dr. Gail Gazelle, who has coached over 500 physicians and physician leaders and whose 2015 article Physician Burnout: Coaching a Way Out 4. was one of the first articles on coaching in a medical journal, emphasizes that coaching for physicians has the following distinctions: Focus on strengths and accomplishments (rather than a deficit model), creation of structure and accountability, focus on results, and creating a partnership where the physician retains the role of an expert. 4.
THE EVIDENCE BASE
The evidence base to support coaching for physicians is growing. In the area of physician burnout and well being, the studies with the strongest methodology were two recent randomized, controlled trials. Both studies demonstrated effectiveness of professional coaching for improved measures of well being.
In the first study published in 2019, Mayo Clinic physicians in Minnesota, Florida, Arizona, and Wisconsin with five to 30 years in practice volunteered to take part in a randomized clinical study of a coaching intervention.5 There were 48 female and 40 male physician volunteers split into two groups, an intervention group and a control group. The coaching, which was conducted on the phone, involved a one-hour initial session, followed by five 30-minute sessions every two or three weeks within five months. The control group received no coaching intervention until after the study completion. Coaches were from an established firm with experience coaching physicians and other leaders. The coaching cost was approximately $1400 per physician. The study used pre and post surveys of the physicians to track measures of distress, well-being, career satisfaction and meaning in work. 2
Coaching resulted in significant reduction in burnout at the end of five months of coaching. These results are higher than reported for other interventions. High emotional exhaustion decreased by 19.5 percent in the intervention group and increased by 9.8 in the control group. Symptoms of burnout decreased by 17.1 percent in the intervention group compared to an increase of 4.9 percent in the control group. The resilience scores of the intervention group improved significantly compared with the control group. (p = .04)
No improvements in job satisfaction, engagement and meaning at work were reported. Coaching also provided the ability to confidentially explore personal needs, values, and goals outside the regular hierarchy. Physicians also focused on activities outside of work such as work/life balance, hobbies, recreation, self-care, and personal relationships. The limitations which the authors discuss are small sample size, single organization, even though at multiple sites, a single source of coaches and no assessment of longer term results 5. 6.
A second similar trial was conducted at a health system in Boston, results were published in 2020. 7. The researchers’ hypothesis was that, “a positive psychology coaching intervention will promote positive emotional states in PCPs, which will improve their levels of personal resources and well-being. We selected personal and work-related outcomes of coaching that align with our theoretical framework and are indicators of well-being across different PCPs, despite variation in individual PCP’s goals: psychological capital, sense of compassion, job self-efficacy, job satisfaction, work engagement, job stress, burnout, and turnover intentions.”
Five coaches with master’s or doctoral degrees and experience in coaching health care professionals were recruited for the study. The 59 PCPs who were part of the study were recruited from four medical practices. They were early and mid career physicians of whom more than 70% were women. Part of the study exclusion criterion was that those coached were free of psychological distress that would need mental health support, thus all physicians were screened. The PCPs were randomized with a coin flip to start coaching immediately (29) or waitlisted as a control group with coaching beginning 6 months later (30). The PCPs completed online surveys pre-coaching, immediately post-coaching, and at 3 months and 6 months after coaching.
The coaching intervention significantly reduced burnout, job stress, and turnover intentions. Coaching improved psychological capital, job satisfaction/engagement, and job self-efficacy. These results were stable at 3 and 6 months post-coaching, except for turnover intentions which increased between 3 and 6 months after coaching but were still below levels before coaching, and compassion levels which increased later between 3 and 6 months after the study ended. While the first study mentioned here did not find improvements in job engagement or satisfaction, this study did. This study is also one of the first coaching studies to evaluate psychological capital. Psychological capital includes the interrelated 3 dimensions of efficacy, hope, optimism, and resilience. 8. The researchers conclude that coaching is an effective intervention for reducing PCP burnout, improving work engagement, and psychological capital. 7.8.
IMPORTANT TAKEAWAYS FOR VETERINARIANS
Coaching is an intervention and interaction where the veterinarian retains their role as a professional and expert. Coaching is a very distinct entity from therapy. Coaching could be an effective intervention for veterinarians’ well being. Coaching on the phone, with a one-hour initial session, followed by five 30-minute sessions every two or three weeks within five months would be the schedule. This approach alone can significantly reduce high emotional exhaustion, symptoms of burnout, resilience scores, job stress, and turnover intentions. Coaching can also improve psychological capital, job satisfaction, job engagement, and job self-efficacy.
If you have any questions regarding this paper and presentation, please feel free to contact me at https://dreamitanyway.com/contact/ or Amanda@dreamitanyway.com
FOOTNOTES and REFERENCES
1. Gawande, Atul. “Top athletes and singers have coaches. Should you.” The New Yorker (2011): 44-53.
2. Passmore, J., & Yi-Ling Lai. (2019). Coaching psychology: Exploring definitions and research contribution to practice? International Coaching Psychology Review, 14(2), 69–83.
3. Moore, Margaret. IOC Research Dose: A Brief History Of Coaching Definitions. https://www.instituteofcoaching.org/resources/brief-history-coaching-definit ions
4. Gazelle, G., Liebschutz, J.M. & Riess, H. Physician Burnout: Coaching a Way Out. J GEN INTERN MED 30, 508–513 (2015). https://doi.org/10.1007/s11606-014-3144-y
5. Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1406–14.
6. Soltes, F, Moore M. IOC Research Dose: Heal Thyself WIth Coaching. https://instituteofcoaching.org/resources/heal-thyself-coaching
7. McGonagle AK, Schwab L, Yahanda N, Duskey H, Gertz N, Prior L, Roy M, Kriegel G. Coaching for primary care physician well-being: A randomized trial and follow-up analysis. J Occup Health Psychol. 2020 Apr 16. Epub ahead of print. PMID: 32297776
8. Moore, M, Cook, C. IOC Research Dose: Coaching Reduces Burnout https://instituteofcoaching.org/resources/coaching-reduces-burnout 4