|Year : 2017 | Volume
| Issue : 1 | Page : 89-92
Going the extra mile: Lessons learned from running coaches applied to medicine
Ryan Graddy1, Scott Wright2
1 Division of Chemical Dependence; Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
2 Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
|Date of Web Publication||13-Jul-2017|
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Source of Support: None, Conflict of Interest: None
Master clinicians and successful long-distance runners have a lot in common. Both are dedicated to continuous improvement and are flexible in their approach, allowing for adaptation to meet unplanned challenges. Given these similarities and the important role of coaches in athletics, there is an opportunity for medical educators to learn from excellent running coaching. The authors spent time with three respected running coaches at different levels (high school, college, and postcollegiate online) and identified six principles employed by these coaches that seem to be particularly relevant for promoting skill development in medicine. Three of these may be considered foundational tenets for a successful coach: know your coachee; model the qualities you seek to instill; and communicate clearly and consistently. An additional three principles represent higher order coaching skills that enable superior coaches to develop others into truly outstanding performers: be a keen observer; purposefully build strong and interconnected teams; and inspire greatness. Longitudinal, individualized coaching predicated on these six tenets may be an effective means for optimizing professional development in medicine.
Keywords: Coaching, direct observation, medical education, role modeling
|How to cite this article:|
Graddy R, Wright S. Going the extra mile: Lessons learned from running coaches applied to medicine. Educ Health 2017;30:89-92
| Background|| |
To the medical student, the master clinician seems to effortlessly synthesize a complex array of data to arrive at the correct diagnosis. A deep well of medical knowledge honed through years of deliberate practice informs the expert physician's careful approach to each patient. Similarly, excellent athletes can make challenging sports look easy. In particular, outstanding performers in endurance events attribute much of their success to an abiding investment in preparation, painstaking attention to detail, and a continuous commitment to development.
Distance running specifically is an endeavor that shares many similarities with the practice of medicine. Famous runner-physicians who have co-opted skills from running and medicine into each endeavor include George Sheehan, acknowledged by many as the driving force behind the recreational running movement that began in the 1970s, and Sir Roger Bannister, the first person to break the 4-min mile barrier. Beyond the required planning and organization, the act of running a race is in many ways similar to the provision of high-quality care to patients; both require the flexibility to adjust to unexpected surprises along the way, focus in working toward distant objectives, and wisdom that is gained over time. Successful runners are disciplined throughout the race, mindful of the fact that the strength of their overall performance rests as much on their physical fitness as on a series of tactical decisions made on the fly. Correspondingly, master clinicians listen intently, ask clarifying questions, and carefully examine patients because they understand that these preliminary processes are indispensable steps toward making the correct diagnosis. Outstanding runners will often credit great coaches as being highly influential in their achievements. Roger Bannister, who became a celebrated neurologist following his successful running career, has noted, “if a man coaches himself, then he has only himself to blame when he is beaten.” In coming to appreciate fundamental commonalities between distance running and medicine, we considered whether coaches could produce similar yields in enhancing the development of the clinical apprentice.
The potential role for coaching-based strategies in medical education has gained increasing traction in the past several years, perhaps most widely popularized by Atul Gawande. He articulated concern that his surgical expertise may have stagnated after residency and suggested that coaching by a senior colleague helped him to become a better surgeon. Indeed, other authors have explored the expert-performance model in medicine, emphasizing that continued honing of skills is essential and optimized through direct observation and timely feedback. Coaching can be simplified as corrective and reinforcing guidance., Through ongoing feedback and a focus on distinct elements of the larger multidimensional task, coaching provides a means of achieving continuous improvement through deliberate practice.
As avid fans and participants in recreational and competitive sports, and with one of us having extensive personal experience in distance running (RG), we were inspired to examine the ways in which some core principles of coaching distance runners may be applicable to medical education. To gather insight into these possible linkages, we spent time with three successful USA coaches who work with runners at different stages. These coaches were identified as a convenience sample based on the authors' personal experiences; two were known to one of us (SW) having coached his children, and one was a former college cross country teammate of another of us (RG). All of the coaches work with both male and female runners, and all have worked with runners from diverse backgrounds, cultures, and countries of origin. Mr. Z is a veteran high school cross country and track coach. Dr. H has coached a collegiate marathon team for the past 12 years. Mr. G is an online running coach with 10 years of coaching experience. One of us (RG) spent approximately 4 h watching each coach working with individual runners and their teams. We then interviewed each coach, asking about their approaches and coaching philosophies. RG took meticulous notes; the authors reviewed and discussed these with the goal of synthesizing them into overarching themes. Interviews and observations intentionally focused on the following three areas: feedback (with specific attention to technique for giving feedback), motivational strategy, and relationship with athletes.
Based on our time with these coaches, we came to consensus on ten distinct themes that characterized their coaching approaches. Six of these principles were felt to be especially relevant for medical educators, and all six were employed in distinct ways by each of the three running coaches that we studied. We characterized three as foundational tenets that are essential for success, and three as higher order coaching skills that may allow superior coaches to develop others into truly outstanding performers.
| Foundational Principles|| |
Understand your coachee
Mr. Z, Dr. H, and Mr. G coach runners who are at varying levels of physical and mental development. Each coach has an approach that is thoughtfully tailored to the progressive stage of their athletes. Mr. Z, coaching high school students, focuses primarily on imparting values to sustain lifelong love of the sport among his athletes. This goal can be understood as an important objective of early undergraduate medical education, in which students embarking on the decades-long journey in medicine are inspired to discover the passions that will sustain their careers. Dr. H, as a college coach, stresses a concrete, regimented approach to training in his athletes. Every workout and training session has clear goals and serves a specific purpose in pursuit of success. These objectives and expectations are explicitly defined so that runners are fully aware of the task at hand. Making the most of the available time for training is a shared key to success in college athletics and in medical residency, where multiple competing responsibilities compress opportunities for dedicated skills improvement. Mr. G, the online coach, builds individually targeted workout plans across a wide range of experiences and abilities with realistic, practical goals for his runners. Similarly, learning plans in continuing medical education (CME) must be flexible and learner-centered. Both Mr. G and successful CME programs keep overarching goals in sight, usually linked to steady development that will translate into ongoing improvement.
While the parallels we have drawn here are deliberately linked to the American medical education system, these lessons apply across the continuum of learning in medicine more broadly. For example, the importance of knowing your coachee has been explicitly illustrated in contexts as diverse as problem-based learning coaching for medical students in China  and transitional career coaching with junior doctors in Denmark.
Model the qualities you seek to instill
Two of the coaches, Mr. Z and Dr. H, consistently run with their athletes during training and sometimes even race alongside them. Dr. H knows that his athletes appreciate his regular presence during both easy and hard workouts, putting in long miles every day. His runners clearly express their reverence for his work ethic and their acknowledgment of the success it has brought him, as we noted in speaking with several of his athletes while observing a team practice. This purposeful role modeling establishes credibility for the coach, inspires respect in learners, and inculcates self-belief that following the plan will enable their success. In medicine, role models are critical for imparting values such as humanism and professionalism and at the same time play significant roles in career choice.
Communicate clearly and consistently
The learner–coach relationship relies heavily on trust and mutual respect. Mr. G frequently corresponds unambiguously by phone and E-mail with his athletes. The challenge of coaching athletes remotely has made clear to him the necessity of forming genuine connections with learners. High-quality communication allows coaches to establish specific expectations and to provide thoughtful, timely, and actionable feedback. In medical education, faculty teachers must establish open lines of communication for building rapport and to actively facilitate learner development. Without explicit discussion and feedback, learners in medicine can misinterpret or overlook intended corrective messages from faculty members. This is not surprising since they are perpetually multitasking as they expand their knowledge, acquire new skills, and construct their professional identity.
| Higher Order Coaching Tenets|| |
Be a keen observer
Using the principles of appreciative inquiry, coaches will often highlight the ways that the coachee is thriving and performing optimally. Mr. Z asks himself consistently, “How can I enable my athletes to have a positive experience and become passionate about the sport?” This big picture emphasis informs the way he deliberately engages with individual athletes, highlighting the positive aspects of their performance, and building confidence.
The adjustment and honing of behaviors in the pursuit of improvement is equally important. Identifying major deficits is something good coaches do well; finding the small things that need correcting in the pursuit of excellence is a hallmark of a truly great coach. The progression from early medical educator to seasoned coach is characterized by increasingly specific constructive feedback. As an online coach who cannot see his athletes in real time, Mr. G has athletes videotape their running to make suggestions about enhancing their form. There are many fine details that most runners cannot fully appreciate themselves including stride length, posture, and foot pronation. After careful analysis, Mr. G targets strengthening and flexibility plans to improve each runner's biomechanics. A great medical educator similarly helps a learner attend to the weaknesses that she cannot see for herself – blind spots. Direct observation in medical education does not occur frequently enough, and committed clinical coaches find time and appropriate venues to watch trainees. This allows for targeted guidance based on what they see, hear, and perceive.
Purposefully build strong, interconnected teams
The practice of medicine has evolved from a largely individual endeavor into an increasingly complex pursuit requiring cooperation and collaboration among disparate individuals and groups. Neither the importance of nor the skills required to operate effectively in team-based care settings are consistently conveyed to learners as a part of their medical education. Mr. Z, the high school coach, emphasizes team unity through a number of methods including “backtracking,” a strategy in which faster runners who finish a training run before the slower athletes circle back so that the entire team completes the workout together. This practice highlights the group's encouragement and support for all team members. In considerate medical learning environments, every individual is intimately linked to the team's overall success in patient care and is boosted by their colleagues' compassionate efforts. A coach's deliberate focus on teams, while working with a single individual or a few learners, may serve to effectively prepare learners for career-long cooperation with diverse interprofessional groups.
Assisting an individual to reach her absolute potential requires tapping into her own drive to succeed. For some athletes and learners, this is close to the surface and easy to find, but for others, it can be more difficult to unearth. Mr. Z has a gift for arousing motivation within his athletes, delivering fitting messages, and pushing appropriate buttons at opportune times. This talent was acknowledged by a former athlete who invited him to her Ivy League University as an honored guest to celebrate students' most impactful high school mentors and coaches. Inspiring greatness in others may result naturally if the five former coaching precepts are followed, and coaches who demonstrate their authenticity through active investment in the success of learners can have a profoundly positive impact. Fostering confidence in learners and enthusiastically encouraging pursuit of passions are keys to transformational coaching, an effective brand of coaching that transcends the sometimes transactional nature of coaching interactions. This level of attentiveness and generosity of spirit to learners' needs has been explicitly acknowledged in a revered medical teacher, Sir William Osler. In William Osler: The Man, Harvey Cushing writes of his legendary mentor, “Little wonder that he was idolized by the students…he…gave up an evening in each week to successive groups of them in his home, learned them as individuals and never forgot them.” In connecting deeply with his students, Osler made them feel that they were the part of something special, and in doing so he inspired them to reach for great heights.
| Conclusion|| |
Preparing for a long-distance race requires the dedicated development of a diverse set of tools including running technique, physical endurance, finishing speed, strategic planning, and mindfulness. Similarly, the pursuit of clinical excellence in medicine is a career-long process of professional growth composed of a broad array of skills. In both areas, effective coaching may be instrumental in allowing individuals to realize their potential, thereby maximizing satisfaction from their efforts and supporting genuine fulfillment.
The coaching model, with its focus on building a strong set of foundational skills and fostering the subsequent pursuit of excellent performance, provides a useful lens through which to conceptualize high-quality medical education. Procedural, cognitive, and relational skills or behaviors can all be cultivated by effective coaches. Coaching is not limited to one stage of learning, setting, or education system; it is applicable across the continuum from student to seasoned clinician wherever educational resources and relationships exist. Longitudinal, individualized coaching in medicine is not the current standard, both because of the lack of strong evidence for its utility and the significant investment that would be required for widespread adoption. Hopefully, the insights delineated in this paper will provide a helpful perspective to those wishing to identify important components of effective coaching and apply such attributes to their practice and study of coaching.
The authors would like to thank Mr. Richard Zmuda, Dr. Tom Hattar, and Mr. Jeff Gaudette for their time, their wisdom, and for inviting us into the special coaching relationships that they have with their athletes.
Financial support and sponsorship
Dr. Wright is a Miller–Coulson Family Scholar and is supported through the Johns Hopkins Center for Innovative Medicine.
Conflicts of interest
There are no conflicts of interest.
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