Download - Coaching: Goal-Setting
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.