The Opportunity for Coaching within Healthcare Residencies

Intention vs Impact – The Grand Canyon of Misalignment

Burnout is a word that has become omnipresent in the post-Covid world. While it certainly existed long before the pandemic, since then, hundreds of articles and books have been written on the topic. Soft skills are no longer considered soft, but rather foundational and of equal importance to other skills in the workplace. Nowhere has that been felt more than in healthcare.

According to Kidd (2021), in BMC Medical Education, nearly 85% of physician assistant respondents in a nationwide survey listed “Professional/Emotional Intelligence” – the second highest skill development activity – as part of training for physician assistants (PA) in their fellowships or residency programs. 

Kidd (2021), also shares in the National Institute of Health’s National Library of Medicine, that when it comes to the selection criteria for admission to a postgraduate PA program, “characteristics of personability, interpersonal skills, communication skills, emotional intelligence, and adaptability are as important to demonstrate as clinical acumen via board certification.” These statistics sound reassuring when it comes to the value of emotional intelligence in training the newest classes of physician assistants branching out into the various healthcare fields. 

However, there is a gross misalignment between intention and impact. According to the National Commission on Certification of Physician Assistants (2022), in their annual report for the same year as the previous data, 30.6% of PA respondents in a nationwide survey reported one or more symptoms of burnout. Likewise, 40.2% of respondents listed “feelings of professional burnout” as a factor influencing certified PAs planning to leave principal clinical positions. 

So, what is happening? The evidence suggests that the misalignment of intention and impact is the result of healthcare organizations wanting PA residents to develop their emotional intelligence but not knowing exactly how to do that in an effective and sustainable way. It reminds me of the inefficiency of doing a team-building exercise on a high ropes course in which people rely on each other for safety and build temporary trust as a result. In the moment it’s great. However, most people don’t work in the canopies of trees, so when they return to work, they revert to old beliefs and habits. One can be taught mindfulness and be encouraged to take time for oneself, but if it isn’t built into the culture of the organization, it remains merely an intellectual exercise that doesn’t translate to internalized perspective shifts.

A Path Forward for Coaching in Residencies

I am an organizational performance coach working with an orthopedic healthcare company based in Texas, one of the top states ranked by number of certified PAs, according to the NCCPA. This company is vertically integrated for total musculoskeletal care with everyone from physician assistants and radiology technicians to orthopedic surgeons, physical therapists, and pain specialists. This company includes one of the largest PA residency programs in the country. 

The coordinator for the residency program and I recognized the need for developing not only the technical skills of the PAs, but also – on a more holistic level – their emotional intelligence to better prepare them for the high-stress and complex world they’d be entering and living in. And so, I developed a six-month personal development program to coincide with each semester of the residency. 

Roughly every month we have a new theme such as imposter syndrome, motivational interviewing, trust, unconscious narratives, and psychological safety. The first week I introduce the concept and we engage in discussion with questions, insights, and real-world examples. The residents are left with one or two thought-provoking questions around that theme in which to consider for our next meeting, two weeks later, to kick off discussion. When we meet next, the residents bring their insights, questions, and real-world examples from the previous two weeks so we can engage and learn from one another. The chief resident, as well as the residency coordinator, join in every discussion; past residents who are still with the company, completing the remainder of their residency, join in each month’s second discussion to lend their perspectives and experiences. In the off weeks, during rounds, the residency coordinator asks questions to the residents and engages them in real-time on the theme for that month.

Individually, I also meet with each resident to discover their why: the unconscious lens through which they see the world and, thus, behave accordingly. This insight and discussion, as well as its routine application in the workplace, improves their ability to gauge their perspectives and beliefs on a deeper level and increases the effectiveness of their communication with colleagues and even guests. I also meet individually with the residents to explore their unconscious saboteurs, which is based on the Positive Intelligence work of author, coach, and Stanford and Yale lecturer Shirzad Chamine. One’s unconscious saboteurs are the ways in which our limbic brains instinctively react to stressors, and by better understanding those reactions, we can become more proactive in shifting to more beneficial perspectives using mindfulness. And confidential individual performance coaching is always available to the residents, in which we explore topics such as promise management, healthy boundaries, confidence, time management, and more.

Revelations from the Alignment of Intention and Impact

This personal development program within the company’s PA residency has revealed two important insights. The first is that what’s discussed and practiced in the personal development program must be integral to the company’s core values and culture. It must be felt everywhere. It must be inescapable. Colleagues consider their and others’ WHYs when engaging in conversation or email; they think about alternative viewpoints before making decisions; they display fallibility openly as learning opportunities; and emotional intelligence isn’t viewed as the latest buzzword or trend, but rather as an essential factor in a team member’s holistic health, their effectiveness, their productivity, and their sustainability within the organization and field.
The second insight from this program is that the delivery of this education must be intentionally developed and deeply engaging. These aren’t quick chats or reading groups. There is thoughtful inquiry, open discussions, displays of vulnerability, and genuine buy-in from all stakeholders. 

In Samuel Shem’s acclaimed book, The House of God, which has been described by Cosmopolitan as “Catch-22 with stethoscopes,” and has been widely regarded as disturbingly authentic by physicians since it was published in 1978, the protagonist mentions heading to “M and M Rounds.” This stands for “Morbidity and Mortality” and is a common fixture of residencies even today. Shem writes, “At this conference, mistakes were aired, with the idea of not repeating them. In practice, it was a chance for the higher-ups to s[**]t on the lower-downs” (Shem, 1978, p. 290). Sadly, this is as true today, according to many physicians, as it was in the 1970s. And it speaks to the misalignment of intention and impact that results in such prevalence of emotional intelligence development programs in PA residencies as well as such high rates of burnout in PAs. 

The Path Forward is Far from Straight

Before joining the company I currently work with, I had coached several nursing administrators, including the Chief Nursing Executive, at a hospital. This hospital was in the process of developing a new residency program. A similar idea to the one described above was floated around and there was some initial buy-in about including an emotional intelligence component to the program. However, the idea never came to fruition. There were multiple reasons for this. One was a lack of effective advocacy from people of high influence within the hospital. Another factor was the defensiveness of the status quo. This was a new idea, and there were people in positions of authority who didn’t fully understand emotional intelligence and its potential role within the residency. In healthcare, change moves slowly – partly due to the impact of decisions on people’s health, but also because of the glacial grind of bureaucracy. But ultimately, emotional intelligence wasn’t a part of this hospital’s culture. Despite what they may have said, it wasn’t genuinely aligned with their core values. And so, it was never going to take root in soil that lacked the necessary nutrients. 

In the company I work with, many of the PAs choose to stay with the organization post-residency. Those who decide to leave and pursue other institutions, from private practice to hospitals, are highly sought after and regard their time in the residency with high esteem. Our PAs value the culture, the effective communication with colleagues, the emphasis on work/life balance, and attention given to them to build on their emotional intelligence. The value, development, and practice of emotional intelligence within the organization is pervasive. And thus, this program is a sustainable model that has a direct return on investment. Whether PAs stay or leave, they have the insights, tools, and skills to navigate the complexity and challenges of their healthcare careers.

See the Path; Walk the Path

Healthcare is an industry that is vital to our society. We experienced this during the pandemic, and it’s taught many of us how non-negotiable the development and wellbeing of our healthcare workers are. These include physician assistants, nurses, surgeons, pain specialists, physical therapists, radiology technicians, billing specialists, guest care, practice managers, and people at every level and in every function of a healthcare organization. The sooner we align intention and impact regarding emotional intelligence development within our healthcare residencies, the better. We cannot say that we value these people and then treat them like disposable necessities. We cannot say that we value work/life balance if we overschedule them, which equates to time away from their families. We cannot say that our organization’s culture has specific values that are only expressed in motivational posters and marketing material. 

The opportunities are everywhere for the education of our healthcare professionals to include emotional intelligence development, not as an insincere acknowledgment of the need but as an integral function of residents’ holistic education and sustainable success. We, as coaches, should advocate for such programs. It isn’t easy, and the changing of minds happens slowly. But we have the chance to show healthcare organizations how and why emotional intelligence programs within their residencies are an essential foundation to the future of healthcare. This is our lane, our specialty, our profession. And I encourage those of us passionate about coaching in this industry to begin these conversations, forge these relationships, and lead the way in bringing effective coaching into healthcare education.

References

Kidd, V.D., Vanderlinden, S. & Hooker, R.S. A National Survey of postgraduate physician assistant fellowship and residency programs. BMC Med Educ 21, 212 (2021). https://doi.org/10.1186/s12909-021-02613-y
Kidd, V. D., Vanderlinden, S., & Spisak, J. M. (2021). An analysis of the selection criteria for postgraduate physician assistant residency and fellowship programs in the United States. BMC Medical Education, 21(1). https://doi.org/10.1186/s12909-021-03059-y
Kidd, V. D., Vanderlinden, S., & Spisak, J. M. (2022). Correction to: An analysis of the selection criteria for postgraduate physician assistant residency and fellowship programs in the United States. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03184-2 
National Commission on Certification of Physician Assistants. (2022). Statistical Profile of Certified PAs Annual Report 2021. https://www.nccpa.net/wp-content/uploads/2022/08/2021StatProfileofCertifiedPAs-A-3.2.pdf
Shem, S. (1978). The House of God. Berkley.