Coaching program builds resilient residents

Trainees are matched with volunteer coaches outside of their discipline to help them navigate the highs and lows of residency.


Background

As chief resident of Mass General's internal medicine residency program, Kerri Palamara, MD, FACP, saw a need for residents to receive emotional support from more experienced clinicians who have little impact on their careers. So in 2012, she started the Professional Development Coaching Program, which matches trainees with volunteer coaches outside of their discipline to help them navigate the highs and lows of residency. A trainee interested in pursuing cardiology, for example, might be matched with a gastroenterologist. “That creates this opportunity for a safe space for the resident to have a conversation . . . about a number of insecurities that everybody has as they're going through training,” said residency program director Jatin M. Vyas, MD, PhD, FACP.

How it works

While this may sound like a simple buddy system, “what [Dr. Palamara] added to that was to provide the faculty members training on being a coach,” he said. The volunteer coaches, many of whom are teaching faculty, receive training in positive psychology and coaching principles.

The program is strongly encouraged, but it isn't mandatory (with 199 trainees, there are always a few who aren't interested), said Dr. Vyas, also an associate professor of medicine at Harvard Medical School. When residents join the program, each one is assigned a coach and expected to check in a minimum of three times a year, he said. At each meeting, the coaches help trainees reflect on their experiences, set goals, and engage in dialogue that encourages positive emotions and strengths.

Results

After the first year of the program was linked to a reduction in interns' emotional exhaustion, Dr. Palamara and colleagues decided to study its impact more formally over three years. Each year, the pairs were encouraged to focus their initial meeting on specific ways to encourage professional and personal success. In the first year, they worked on exploring strengths, building resilience, and finding meaning in work. The second year fostered leadership development and emotional intelligence, and the third year focused on leading authentically, finding passion and purpose, and cultivating life's lessons.

Of 179 residents who were assigned a coach in the 2014-2015 academic year, 56% fully participated in the program, and 73.1% of them reported good or excellent experiences with their coaches. Participation in the program was significantly associated with opportunities for reflection, a positive residency experience, and increased coping and relationship skills, according to results published online in July by the Journal of General Internal Medicine. Dr. Vyas views the program as complementary to traditional mentorship, which “focuses more on the career; the coaching program focuses more on the person.”

Challenges

The biggest challenge was normalizing discussions about personal challenges, as many trainees hide their insecurities to guard against perceptions of weakness, Dr. Vyas said. “Part of the difficulty is really to try to get residents, and interns especially, to recognize that this is part of growing as a physician,” he said. Other challenges included the administrative burden of tracking participation in a large residency program and the amount of time spent training the coaches.

A final barrier is that the faculty members are already very busy and aren't specifically compensated for participation, Dr. Vyas noted. “But we see this as necessary to creating the right learning environment and promoting this kind of positive psychology for the next generation of physicians,” he said. Retention of coaches has been high, and the program currently has more coaches than coaching positions, Dr. Vyas reported.

Next steps

In the future, Dr. Palamara hopes to analyze the program's impact on residents who have graduated, according to Dr. Vyas. She has also helped other residency programs start their own professional development initiatives, he said. “It's actually moved beyond internal medicine to many other disciplines of medicine,” such as Mass General's anesthesiology residency program.

Words of wisdom

The newest generation of physicians faces an intense work environment, Dr. Vyas noted. “There are certain elements of patient care in the 21st century that require a resilient physician, and we need to ensure that training programs are in a position to permit that type of growth,” he said. “In my mind, this is a program that is a great tool in our arsenal to combat burnout.”