1. C OACHING : G OAL -S ETTING Coaching Meeting Carrie Rassbach, MD August 12, 2013

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

3. Why do we need goals? The relationship between clinical experience and better patient care is not always linear Generally we think that clinical expertise improves with experience Physicians 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.

4. 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

5. 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.

6. 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

7. 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

8. Components of an ILP 1. Reflection on long-term career goals and self- assessment of areas of strength/weakness 2. Goal generation 3. Development of plans/strategies to achieve the goal 4. Assessment of progress on goals 5. Based on assessment, revision of goals/goal plans Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292.

9. Attitudes toward ILPs Residents & faculty agree that self-assessment and self- directed learning improves patient care Both groups were comfortable assessing their strengths/weaknesses & setting goals for improvement Residents less likely than faculty to continuously assess their performance Residents 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).

10. 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.

11. 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.

15. Types of goals residents set Long-term goals ◦ More global ◦ Often based on attributes ◦ Career-focused Short-term goals ◦ Often based on cognitive needs

16. 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.

17. Factors affecting progress in achieving goals Residents’ use of a system to track progress on achieving learning goals Propensity for lifelong learning (as assessed by validated Jefferson Scale of Physician Lifelong Learning). Greater confidence in self-directed learning abilities Greater 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.

18. How do we assess the quality of goals? I-SMART goals Important Specific Measurable Accountable Realistic Timeline

19. 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)

23. 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

24. Application to coaching: Practicing goal-setting Create 2 goals related to your role as a coach Create 2 goals related to your clinical or administrative duties  Important  Specific  Measurable  Accountable  Realistic  Timeline

25. Pearls for Facilitation of ILPs Actively listen Use self-assessment to highlight abilities Encourage I-SMART goals Encourage near-term and long-term goals Do not be too judgmental Consider maintaining your own ILP Adapted from: Burke A. “Individualized Learning Plans: A Construct to Promote More Effective Learning.” MedEdPORTAL. May 2009.

26. 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?

27. 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.