Five focus groups had a total of 25 participants, with five faculty members participating in more than one group; no single participant attended all three time points. The 20 unique participants included eleven women, nine men, sixteen Academic Coaches, and four learning community directors (Table 1). Respondent quotes are identified by the time of year when the focus group was conducted (early, mid, end) and focus group number (1–5).
Faculty participants reported four main benefits of coaching: (1) providing guidance; (2) identifying problematic student issues early; (3) developing student work-life balance, and (4) fostering clinician connectivity.
Coaches described their role as “providing guidance” for students:
I see myself as helping them to navigate through the process [...] They need to get perspective and I’m there to help them get perspective” [Early in year, FG1].
Another coach framed guidance as helping students “navigate the system” [Mid-year, FG3].
Identifying issues early
Coaches described a unique component of their role as early identification of students at risk and to “catch students with problems earlier” [Mid-year, FG3]. One director described this capability:
We have been able to identify students who are struggling very early, as early as the first missed lecture or the first missed PBL. We immediately know what’s going on. We can immediately have someone either call the student or meet with the student and ask what’s going on. And you also have a mechanism for regular follow-up and feedback. [late in year, FG5]
Faculty shared their experiences with this function of coaching:
So if I noticed something wasn’t quite right or there were some failures, or there were some things going on in their personal lives, [it’s] a first line of defense to kind of be able to guide them in the right direction [Late in year, FG4]
We had a student [...] who was very, very disengaged and almost disinterested, and with time and multiple discussions with her coach, and with other folks, I think she actually became one...of the most engaged students. [Late in year, FG5]
Developing student work-life balance
Coaches perceived their role as providing a unique opportunity to guide students in professional development beyond academic success. They described a central function of coaching in helping students learn to develop their own healthy life habits that could sustain them throughout their medical training and careers:
I think helping to ground them, like to help them think of a good balance between … work-life balance, school work and life reminding them that hey, ‘let’s look at your goals other than study habits’. [Late in year, FG4]
I also would ask them not just about their classes, but are you eating healthy, are you exercising, are you keeping a balance? So, it was really to just to keep them moving forward; so I felt like it was to make sure that they were progressing well scholastically, but also to touch on the other things. [Late in year, FG4]
Coaches described general conversations about work-life balance as well as helping students through specific challenges, including personal illness and death of a family member. One coach reported her conversation with a student who was a new parent:
We had to have a conversation about making sure his wife, who has a new baby and stays at home all day in an apartment, gets some time to go to Target or something by herself. It's a culture shock for her to have this change where now her husband is gone and she has a baby. He does great on exams and he's got everything else together but that has been the one thing we've consistently worked on. [Early in year, FG2]
For some coaches, understanding the broader aspect of coaching increased as the year progressed:
It is about academics, but it’s also about developing them as whole people. I kind of thought the coaching was going to be about “go, study hard”, and then realizing that there are so many more nuances, and it really is much more individualized to their goals and who they want to be as physicians and then trying to develop that, [it] is way more interesting than just telling them to study. [Late in year, FG4]
Coaches believed this exposure to clinical faculty member coaches, “right off the bat” [Early in year, FG1] was helpful in professional socialization and that meeting with the same clinician-coach over time would benefit students.
I thought it was a really nice way for each student to have sort of a personal touchstone; that they had somebody who they were accountable to, but who was also accountable to them [Late in year, FG4]
Some faculty members contrasted the current coaching experience with their own experiences as medical students when they were more isolated from clinical faculty, especially in the first 2 years.
Well I think, you know, they want to aspire to be like us, right? And if they don't have a role model, if they don't get to see other physicians who have already gone through what they're going through, that kind of gets lost in the shuffle of what they're aiming for. And so just to put a face to this is what I want to do. I want to be a practicing physician. I think it's important for them early on. As a medical student, I didn't get to know clinical faculty really much at all. [Early in year, FG1]
Coaches also reported that one of the benefits of this connectivity between clinicians and students was that they were able to normalize the often anxiety-producing experience of medical school:
I think with my group it’s more reassurance than anything. “This is normal. This is going to be OK. This is normal.” (Early in Year, FG2)
I think it also offers them some perspective. We've all been through med school and we can offer support. It's very trying and there are times when you're not going to do as well as you think you're going to do or you've done in the past because not everyone is the top 10%. Having to deal with failures as well as successes, we've all been through that so I think that offers some perspective for them. [Early in year, FG1]
Finally, coaches reported personal benefits from connectivity as they built relationships with students.
I think what’s happening as a result of us doing all of this is that we’re getting more—I feel like I’ve got more connection to this class than I have ever had to any medical school class in the past. (Mid-Year, FG3)
Especially, I mean, as an introvert I want to be able to make connections one-on-one, not in a group of 50 or 100, so it made me feel much more connected to the students and to the new curriculum. [Late in year, FG4]
Faculty described two main challenges: uncertainty about the structure of coaching sessions, and difficulty balancing some of the roles expected of the coach.
Uncertainty about structure of coaching sessions
Respondents reported feeling uncertain about flexibility of structure in coaching sessions. For example, coaches were instructed to have students create personal goals, but were met with variable amounts of success. The extent of flexibility in conducting coaching sessions also emerged in discussions of how to adapt coaching to individual students. Participants noted that they felt the need to tailor coaching sessions to individual students and to adapt approaches as the year progressed.
At the beginning, when we had a little more structure on the coaching [...], it’s a level playing field to start with. So, it was a quite a lot of anxiety and we filled up the time, I think, almost every time for those first few sessions. Then as they start, like in a race, spreading out, and some of them are doing more poorly and some better, that amount of time changed. [ … ] It really varies according to the person. [Mid-year, FG3]
The focus group of directors at the end of the year discussed the tension between structure across coaching while maintaining responsiveness to individual student needs:
I do think it would be beneficial for us to build some more topics, goal topics to hit [...] for this block we talk about this, this block we talk about this. I do think that would be helpful for people. Again, I do hesitate to push things on the [coaches]. To allow for that autonomy, to allow for the things that they feel are necessary to take place, [ … ] they don’t have to talk about things that they don’t find helpful. [Late in year, FG5]
The respondents in this group went on to say that they did not want the suggestions to be “so structured” or feel like a “script” but that “giving general topics might be helpful.”
Difficulty balancing roles
Coaches described tension in balancing the supervisory and mentoring roles:
Finding that balance between being friend and being coach and mentor and supervisor is a little challenging. We are there to coach them up, to pick them up when things are going bad or good for that matter, but also to serve as supervisory role if they’re not
attending classes or if there are things that they're required they're not doing. [ … ]that can be a little tricky navigating, to be someone that they can confide in but also someone that does have authority. [Early in year, FG1]
I think for a coach to be effective, I think the coach needs to be friendly and accessible to the student on the one hand, but also needs to be somewhat detached and objective. If you are not friendly and accessible, you will not have a good interaction and I don’t think the student will have a positive interaction, and may not necessarily open up, especially when there are sensitive things going on—and they wouldn’t trust you. But also, if you’re not somewhat detached and objective, then you end up with that slippery slope where it becomes a personal relationship, and I don’t think the role is designed to be a personal relationship... [Late in year, FG5]
While most coaches agreed that this balance was needed, it was not always easy to navigate.