Coaching Medical Students to Become Physician Leaders: Insights from a Coach’s Journey

This summary was automatically produced by experimental artificial intelligence (AI)-powered technology. It may contain inaccuracies or omissions; see the full presentation before relying on this information for medical decision-making. If you see a problem, please report it to us here.

Introduction

This document summarizes a presentation by Dr. Samir Nangia, a highly acclaimed physician coach, on his extensive experience in coaching medical students and physician leaders. Dr. Nangia serves as an Assistant Professor at TCU School of Medicine and the University of California, San Diego, where he leads a leadership program for nephrology fellows, including those from Baylor. He is also a nephrologist with Dallas Reno Group and runs a radio program focused on renal health. Recognized as one of TCU's best-ranked and most appreciated coaches by medical students, Dr. Nangia brings a wealth of experience from his diverse roles, including six years with the American Board of Internal Medicine focusing on medical education, leadership in hospital medicine, and a passion for mental health.

The presentation aimed to:

• Describe the training and work stage-specific factors influencing coaching across medical training and physician experience.
• Discuss valuable coaching tools used with medical students.
• Describe the benefits and applications of coaching in educational and clinical environments.
• Define the benefits of coach training for the development of physician educators and leaders.

Coaching at TCU School of Medicine

Dr. Nangia highlighted his five years of experience at TCU School of Medicine, where he has completed over 1,000 hours of individual and group coaching with medical students.

• Purpose: TCU sought physician coaches to foster academic growth, resilience, professionalism, and self-awareness in medical students, addressing academic progress, professional identity formation, and personal wellness.
• Approach: The coaching model at TCU is underpinned by the tagline: "come with a goal, leave with a plan, and enforce with accountability". Initially, the approach was "pure coaching," avoiding advising or mentoring. However, it evolved into a hybrid model where coaches first attempt pure coaching, then, if necessary, offer advice or mentoring to refine the student's plan. This adaptation recognized that medical students often require guidance from experienced physicians.
• Coach Training: TCU's 12 physician coaches underwent formal training through the International Coaching Federation (ICF), completing 60 hours of training by ICF master coaches. Certification levels include Associate Certified Coach (ACC), Professional Certified Coach (PCC), and Master Certified Coach (MCC), requiring varying hours of education and coaching experience. Coaches must also complete 100 hours of paid coaching and pass a comprehensive exam.
• Modality and Confidentiality: Coaching sessions are typically mandatory quarterly meetings, initially an hour but reduced to 30 minutes for student convenience, often extending longer. As-needed sessions are also available. A formal coaching agreement ensures confidentiality, with exceptions for Title IX concerns.
• Role and Tracking: Coaches have access to student grades, step scores, and evaluations to track progress and identify areas for support. Crucially, coaches do not assess or evaluate students to maintain a trusting relationship.
• Common Coaching Topics for Medical Students:
  • Time management and study methods.
  • Leadership activities and choosing research mentors.
  • Specialty choice, rank list navigation, and residency interviews.
  • Step exam preparation.
  • Addressing burnout, imposter syndrome, and team conflicts.
  • CV and personal statement development and developing noteworthy characteristics for MSPE.
• Key Coaching Tools:
  • Growth mindset.
  • SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound).
  • Active listening: Going beyond just hearing to clarify, summarize, and probe, including non-verbal cues.
  • Powerful questions: Techniques to encourage deep thinking, self-reflection, and problem-solving, rather than directly advising.
  • Creating awareness and designing actions.
• Recent Developments: TCU has recently expanded coaching to faculty, with academic coaches focusing on students and executive coaches working with faculty on professional and career development, fostering a comprehensive coaching culture within the medical school.

Coaching Docs: External Coaching for Physicians

In 2021, Dr. Nangia co-founded Coaching Docs, a company providing coaching services outside the medical school to broader healthcare systems.

• Founders & Expertise: Founded by three certified physician executives (a nephrologist, an emergency medicine doctor, and a hospitalist leader) with diverse backgrounds and extensive coaching experience.
• Market Gap: The founders identified a significant gap in the market for physician-specific coaching services and actively educated healthcare systems on its value.
• Clientele & Service Areas:
  • Current clients include hospitalist and EM staffing companies, hospitals, healthcare systems, and individual physicians.
  • Key areas of coaching include:
    • Executive leadership coaching: Addressing the lack of formal leadership training for physicians.
    • Career coaching: Guiding physicians through career transitions.
    • Communication coaching: Addressing complaints related to physician communication.
    • Behavior coaching: Managing issues like anger management and professionalism concerns.
    • Wellness coaching: Addressing physician burnout, particularly post-COVID.
• Coaching Process for Physicians:
  • Involves a pre-coaching survey to understand goals and match with an appropriate coach.
  • A confidential contract is established.
  • Sessions are typically virtual and flexible to accommodate physicians' schedules, including weekends.
  • A post-coaching survey provides feedback.
  • For leadership, behavior, or wellness coaching, a structured "alignment meeting" involves the coach, the client, and a third party (e.g., hospital leadership, program director) to establish goals. This is followed by 3-4 individual coaching sessions spaced 2-3 weeks apart, culminating in a wrap-up meeting to discuss the action plan and accountability.

Insights from Behavior Coaching

Coaching Docs successfully addressed professionalism concerns and behavioral issues in physicians referred by healthcare systems.

• Critique of Traditional Solutions: Dr. Nangia pointed out the limitations of traditional approaches like sending physicians to generic courses (e.g., anger management). These courses are often expensive, time-consuming, disrupt practice, don't provide personalized solutions, and fail to address the "thing beneath the thing" – the underlying personal issues driving the behavior.
• Successes of Coaching:
  • 100% completion rate of referred clients.
  • A physician initially referred for multiple complaints was later nominated for a Daisy award by the same staff who had complained, demonstrating a significant positive behavioral shift.
  • Few client relapses, and when they occur, physicians proactively reach out to their coach before the hospital system.
  • Extremely positive feedback from physician clients, many of whom continue coaching voluntarily after mandatory sessions.
  • Physicians appreciated having a third-party physician coach who understood their perspective and was independent of their workplace.
  • Healthcare systems have facilitated funding, with some allowing the use of professional development funds or splitting costs with physicians.

Insights from Wellness Coaching

The rise of burnout, exacerbated by the COVID-19 pandemic, increased the demand for wellness coaching.

• Beyond "Band-Aid" Solutions: Dr. Nangia criticized superficial wellness initiatives (e.g., giving food, socials) as mere "band-aids" that fail to address the root causes of physician burnout.
• Research Support: A study involving 88 physicians showed that six coaching sessions led to a decrease in emotional exhaustion and overall burnout, and improvements in quality of life and resilience scores after five to six months. This data provides empirical support for the efficacy of coaching in wellness.
• Group Coaching for Culture Change: Coaching Docs implements both individual and group coaching for wellness to foster team-level improvements and address common themes collaboratively, aiming to improve the overall culture.
• Consequences of Burnout: Dr. Nangia emphasized the severe consequences of physician burnout to advocate for coaching to administrators:
  • Higher rates of medical errors.
  • Lower patient satisfaction scores.
  • Loss of empathy towards patients, colleagues, and staff.
  • High rates of job turnover.
  • Personal, family, and marital problems.
  • Higher rates of substance abuse and poor mental health.
• Common Individual Wellness Coaching Topics:
  • Barriers with workflow and efficiency.
  • Changes in organizational culture and values.
  • Loss of autonomy and flexibility.
  • Loss of meaning in work, and increased demands/workload.
  • Not feeling heard or supported.

Personal Impact of Coaching

Dr. Nangia shared how coaching has profoundly impacted his personal and professional life, making him a better communicator, husband, father, physician, and leader. He now applies coaching techniques, such as asking powerful questions, in his interactions with patients and children, leading to more engaged and accountable responses.

In conclusion, coaching provides a valuable and effective platform for fostering growth, addressing behavioral issues, and promoting wellness among medical students and practicing physicians. Its structured yet adaptive approach, focus on empowering individuals, and proven benefits make it a crucial component in modern medical education and healthcare leadership.

Artificial intelligence (AI) was used to transcribe the presentation’s contents and create a summary of the information contained in the presentation. This is an experimental process, and while we strive for accuracy, AI-generated content may not always be perfect and could contain errors. This summary has not been reviewed by the presenter to guarantee completeness or correctness of the content, so it should not be used for medical decision-making without reviewing the original presentation. If you have feedback, questions, or concerns, please contact us here.