COACHING:GOAL-SETTING

Coaching MeetingCarrie Rassbach, MD

August 12, 2013

Objectives

Why do we need goals?When do we create goals?How do we evaluate the quality of goals?Application to coaching

Why do we need goals?The relationship between clinical experience and better

patient care is not always linearGenerally we think that clinical expertise improves with

experiencePhysicians in practice for more than 20 years have declining

knowledge of current medical evidence and practice guidelines and provide lower quality of care to their patients compared with physicians in practice fewer than 10 years

Chaudhry et al. “Systematic review: the relationship between clinical experience and quality of health care.” Ann Intern Med. 2005;142:260-273.

Adult Learning Theory

Adults learn best when they are actively engaged in the learning process and self-direct their own learning goals and activities

Experience is the richest source of learning, and we must reflect on our experiences

In adult learning, the role of the teacher is to engage the learner’s needs

Why do we need goals (cont’d)?

There is some evidence that writing down goals is important to goal attainment

“Reflective practice” promotes continual learning from clinical experience through understanding current limitations

Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292.

Creating goals or assigning goals?

“I’m always ready to learn, although I do not always like to be taught.”

-Winston Churchill

“That is too important to be taught; it must be learned.”-Carl Rogers

When do we create goals?Residents: Individualized Learning Plans (ILPs) ◦Tool to help develop self-directed, lifelong learning skills◦Required by RC/ACGME for all pediatric residents and fellows

Practicing physicians: Maintenance of Certification (MOC), part 2◦Pediatricians required to assess and enhance knowledge in

areas important to their practice◦Required by ABP for practicing physicians

Components of an ILP

1. Reflection on long-term career goals and self-assessment of areas of strength/weakness

2. Goal generation3. Development of plans/strategies to achieve the goal4. Assessment of progress on goals5. Based on assessment, revision of goals/goal plans

Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292.

Attitudes toward ILPsResidents & faculty agree that self-assessment and self-directed

learning improves patient careBoth groups were comfortable assessing their

strengths/weaknesses & setting goals for improvementResidents less likely than faculty to continuously assess their

performanceResidents were more likely to believe that assigned clinical and

curricular experiences were sufficient to make them competent physicians

Li ST et al. “Pediatric resident and faculty attitudes toward self-assessment and self-directed learning: a cross-sectional study.” BMC Medical Education. 2009;9(16).

Obstacles with ILPs: Resident comments

“I often don’t know what to work on”“Recommendations for specific goals would be helpful”“Sometimes I’m too tired or busy to really focus on my

goals.”

Stuart E, Sectish T, Huffman L. “Are Residents Ready for Self-Directed Learning? A Pilot Program of Individualized Learning Plans in Continuity Clinic.” Amb Ped. 2005;5(5)298-301.

Li ST et al. “Successful Self-Directed Lifelong Learning in Medicine: A Conceptual Model Derived From Qualitative Analysis of a National Survey of Pediatric Residents.” Acad Med. 2010;85(7)1229-1236.

Types of goals residents set

Long-term goals◦More global◦Often based on attributes◦Career-focused

Short-term goals◦Often based on cognitive needs

Types of goals residents set (cont’d)

Medical knowledge 57%Patient care 25.9%Interpersonal and communication skills 3.8%Practice-based learning and improvement 10.7%Professionalism 1.5%Systems-based practice 1%Future practice 3.4%

Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning Goal Set?” Acad Med. 2011;86(10)1293-1299.

Factors affecting progress in achieving goalsResidents’ use of a system to track progress on achieving

learning goalsPropensity for lifelong learning (as assessed by validated

Jefferson Scale of Physician Lifelong Learning).Greater confidence in self-directed learning abilitiesGreater time since last ILP(Being undecided on specialty associated with less

progress in achieving goals)Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning Goal Set?” Acad Med. 2011;86(10)1293-1299.

How do we assess the quality of goals?I-SMART goals

ImportantSpecificMeasurableAccountableRealisticTimeline

I-SMART goals Important: relevant to the learner and prioritized by the learner as important to

achieve Specific: with broad goals broken into incremental steps and specific plan for

each step Measurable Accountable: with reminder and tracking systems and building in internal and

external accountability Realistic: achievable goals which utilize existing opportunities and constant self-

adjustment Timeline: for completing the goal (and incorporating the goal into their daily

routine)

Examples of goals:

I will improve my use of evidence-based medicine by forming a clinical question based on a patient encounter every week and read about it in the medical literature

I will improve my EKG interpretation by taking a course on EKG interpretation and reading 1 EKG per week and comparing my EKG read to that of the cardiologist

Application to coaching:Practicing goal-setting

Create 2 goals related to your role as a coachCreate 2 goals related to your clinical or administrative

duties Important Specific Measurable Accountable Realistic Timeline

Pearls for Facilitation of ILPs

Actively listenUse self-assessment to highlight abilitiesEncourage I-SMART goalsEncourage near-term and long-term goalsDo not be too judgmentalConsider maintaining your own ILP

Adapted from: Burke A. “Individualized Learning Plans: A Construct to Promote More Effective Learning.” MedEdPORTAL. May 2009.

Questions for Coaches

1. What modifications, if any, should we make to the ILP form?

2. Should we break goals down into near-term and long-term goals?

3. Should we break goals down into career-related goals and skills-related goals?

4. Who should review the ILP: the coach or the advisor, or both?

References: Burke A. “Individualized Learning Plans: A Construct to Promote More Effective Learning.” MedEdPORTAL. May

2009. Chaudhry et al. “Systematic review: the relationship between clinical experience and quality of health care.”

Ann Intern Med. 2005;142:260-273. Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292. Li ST et al. “Pediatric resident and faculty attitudes toward self-assessment and self-directed learning: a cross-

sectional study.” BMC Medical Education. 2009;9(16). Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning Goal Set?”

Acad Med. 2011;86(10)1293-1299. Li ST et al. “Factors Associated with Successful Self-Directed Learning Using Individualized Learning Plans During

Pediatric Residency.” Acad Ped. 2010;10(2)124-130. Li ST et al. “Successful Self-Directed Lifelong Learning in Medicine: A Conceptual Model Derived From

Qualitative Analysis of a National Survey of Pediatric Residents.” Acad Med. 2010;85(7)1229-1236. Stuart E, Sectish T, Huffman L. “Are Residents Ready for Self-Directed Learning? A Pilot Program of Individualized

Learning Plans in Continuity Clinic.” Amb Ped. 2005;5(5)298-301.