Using a Learning Coach to Develop Family Medicine Residents' Goal-Setting and Reflection Skills

摘要

What was known Many residents do not formally engage in self-directed learning skills, such as self-reflection and goal setting, which can facilitate learning throughout a physician's career.;What is new A junior faculty member served as a learning coach and met monthly with second-year family medicine residents during protected time to set learning goals and promote reflection.;Limitations Single-specialty, single-site study, and low sample size limit generalizability.;Bottom line Engaging with a learning coach and having protected time allowed residents to develop self-directed learning skills at their own pace.;Introduction With medical knowledge increasing exponentially and health care changing rapidly, physicians must adapt and learn throughout their careers. The goals of medical education must shift from imparting knowledge, which rapidly becomes obsolete, to teaching metacognitive skills, which allow active regulation and monitoring of one's thinking and learning processes.1 Self-directed learning (SDL) is a set of metacognitive skills, or ways of “thinking about thinking,” that can support physician lifelong learning.2 A systematic review of SDL in the health professions' literature provides the following framework for SDL: the educator as a facilitator of a process that involves diagnosing learning needs, formulating learning goals, identifying appropriate resources, implementing learning strategies, and evaluating learning outcomes.2 A subsequent review comparing SDL approaches to traditional teaching methods noted that SDL resulted in improved medical knowledge and appeared beneficial to residents and attending physicians.3 Additionally, the Accreditation Council for Graduate Medical Education's (ACGME's) practice-based learning and improvement competency requires resident self-evaluation and lifelong learning.4 In a previous study, we found that our graduating residents lacked confidence in their ability to manage their learning, especially in clinical settings.5 Residents rarely engaged in goal setting or reflection on learning, and expressed a need for more guidance in managing their own learning. We identified a need to coach residents to develop SDL skills. In academic medicine, faculty often serve as mentors for residents. Mentoring involves a relationship whereby a more senior physician facilitates the development of a junior colleague with emphasis on professional development. Mentors typically supply information, advice, and practical and emotional support, especially in difficult circumstances, with an emphasis on professional development.6,7 The difference between coaching and mentoring is that the “coaching [relationship]…addresses performance in some aspect of an individual's work or life…”8 We describe the implementation and mixed-method evaluation of an intervention using a learning coach to enhance residents' SDL skills.;Methods Setting We conducted this study from 2008–2010 at the Brown Family Medicine Residency in Pawtucket, Rhode Island. The residency is located in a community hospital. The intervention group consisted of 2 consecutive classes of second-year residents (n??=??25). The hospital's Institutional Review Board approved the study and participants gave informed consent. Residents could opt out of the program evaluation.;Results Twenty-five residents participated in the intervention and attended an average of 5.5 meetings with the coach (range, 3 to 8 sessions). We reviewed portfolio entries for these same 26 residents. We completed both intervention and postintervention interviews for 11 residents in the first intervention year. We did not conduct structured interviews in the second intervention year. Goal Setting Resident portfolios documented goals in several domains, often focusing on medical knowledge, for example “genetic testing in children,” “geriatric assessments,” or “indications for colposcopy.” Other domains included procedural proficiency, teaching skills, communication skills