Coaching in Emergency Medicine, Taking Your Clinical Supervision to the Next Level

Speakers: Dr. Jeffrey Landreville and Dr. Denyse Richardson

Bottom Lines:

• Coaching is increasingly being acknowledged as a practical and effective way to offer personalized, learner-centered developmental guidance within competency based medical education curricula

• The Royal College of Physicians and Surgeons of Canada’s coaching model was specifically designed, fit for purpose to the postgraduate medical education (PGME) context

• The associated RX-OCR faculty development tool can be used by clinical supervisors and learners in the Emergency Department to engage in coaching on their next shift

Introduction:

Consider former world champion tennis player Roger Federer. He represented one of the most successful professional athletes of our time. To what does he owe his success? While he undoubtedly possessed a remarkable amount of motivation, dedication, and athleticism, there is another factor to consider. He had a coach. In fact, he had a team of coaches who work with him on every aspect of his game with the common goal of his growth and development. In a previous tribute to his coaching team on social media, Federer wrote “Could never have been the oldest #1 without my team. Thank you to everyone who has helped me along the way”.

Despite its wide application in other high-performance professions such as athletics, music, and business, coaching has only recently gained attention within medicine and medical education. Specifically, coaching is increasingly being acknowledged as a practical and effective way to offer personalized, learner-centered developmental guidance within competency based medical education (CBME) curricula. Aligned with CBME’s core components, coaching can assist in leveraging the full potential of this educational approach.

What is coaching in competency based medical education?

Coaching focuses on progressive improvement and utilizes individualized guidance to promote growth and development. Coaches are improvement-oriented (for future practice) rather than problem-oriented and ask powerful questions to catalyze learner self-reflection, leading the learner in self-discovery.

Coaching is more than feedback. Feedback provides information about what has just happened but, all too often is received by learners well after the fact, asynchronously and in written form, without the important learning conversation that brings practical meaning to the words. Coaching assures that in addition to feedback, the learner and coach co-create a realistic actionable plan for future improvement.

Try using the RX-OCR process to coach trainees on your next shift

The RX-OCR process is intended to support practical implementation and enable the

application of embedded key coaching principles. Use of the RX-OCR process promotes coaching irrespective of the duration of the clinical experience and provides all coaches and learners with a guiding framework for preparing for and engaging in coaching. On your next shift, try using the RX-OCR process to provide coaching to trainees in the Emergency Department.

Relationship/Rapport	Establish an educational Relationship/Rapport between the learner and the coach (“educational alliance”) to establish a safe learning environment
Expectations	Set eXpectations before an encounter (discuss learning goals)
Observe	Observe the learner and the learner’s work (directly or indirectly)
Coach	Have a Coaching conversation with the learner for the purpose of improving that work and developing the next steps as part of a learning plan
Record/Reflect	Record a summary of the coaching encounter to encourage the learner to Reflect on the conversation and learning

Coaching Pearls:

• When being observed, learners may take on a performance orientation. By establishing a strong coaching relationship that promotes psychological safety and identifying learning goals at the outset, coaches can re-orient trainees towards a mindset of development and growth.

• We all know Emergency Department shifts are busy and unpredictable. Try dedicating some time to observation of your learners early, even for a short period (<5 mins) in the shift while your cognitive load may be less.

• Provide coaching to your learners immediately following the observation or at the end of your shift. Try to avoid deferring to a later time as it becomes less impactful.

References

Richardson D, Landreville JM, Trier J, Cheung WJ, Bhanji F, Hall AK, Frank JR, Oswald A. Coaching in Competence by Design: A New Model of Coaching in the Moment and Coaching Over Time to Support Large Scale Implementation. Perspectives on Medical Education. 2024; 13(1): 33–43. DOI: https://doi.org/10.5334/pme.959

Landreville J, Cheung W, Frank J, Richardson D. A definition for coaching in medical education. Can Med Educ J. 2019;10(4):e109-e110. DOI: https://doi.org/10.36834/cmej.68713

Gatto L. Tennis World USA Roger Federer pays tribute to all his coaches on Instagram. [Internet]. 2018. February 20 Available at http://www.tennisworldusa.org/tennis/news/Roger_Federer/52133/roger-federer-pays-tribute-to-all-his-coaches-on-instagram/ [Accessed May 2, 2025].

Van Melle E, Frank JR, Holmboe ES, Dagnone D, Stockley D, Sherbino J. International Competency-based Medical Education Collaborators. A core components framework for evaluating implementation of competency-based medical education programs. Acad Med. 2019; 94(7): 1002–9. DOI: https://doi.org/10.1097/ACM.0000000000002743

Ahn E, LaDonna KA, Landreville JM, Mcheimech R, Cheung WJ. Only as Strong as the Weakest Link: Resident Perspectives on Entrustable Professional Activities and Their Impact on Learning. J Grad Med Educ. 2023; 15(6):676-684. DOI: https://doi.org/10.4300/JGME-D-23-00204.1

Trier J, Turnnidge J, McGuire CS, Côté J, Dagnone JD. It’s a ‘two-way street’: resident perspectives of effective coaching relationships in the clinical learning environment. Can Med Educ J. 2022; 13(3): 5–12. DOI: https://doi.org/10.36834/cmej.72940