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Coaching for health professionals: The evidence

Coaching can help health professionals to build a healthy career*

The aim of coaching is to support your professional and personal development so you can reach the next level of functioning in your work and your life.

Coaching can help health professionals thrive by supporting and empowering them to:

  • Plan a meaningful, purposeful and sustainable work life in a traditional, non-traditional or blended pathway
  • Develop leadership, supervision, mentorship or teaching skills
  • Build capacity to manage complex worklife situations
  • Meet the challenges of study and training programs.
  • Increase resourcefulness and skills in managing burnout and stress and promoting wellbeing.
  • Manage tensions between personal and professional life.

What is coaching?

Coaching is a personal learning program that helps you see the world (and yourself) in a new way so you can take action and make the changes you need to grow, develop and meet your goals.

Drawing from elements of consulting, mentoring, and therapy coaching has emerged a unique discipline that is designed to help people create positive and purposeful change, achieve personal and professional goals, maximise potential as well as enhance subjective and psychological wellbeing (1). Fair enough.

But coaching is not therapy (or consulting or mentoring for that matter). While coaching draws heavily from psychology and impacts on wellbeing, it is not designed to directly address psychological problems or mental health issues. That does not mean that people with mental health issues such as depression or anxiety cannot engage in or benefit from coaching – but it does mean that coaching is not the right modality to directly address those issues.

Evidence-based

The term ‘evidence-based coaching’ was first used in 2003 and derived from the concept of evidence-based medicine. The idea was to establish coaching, in particular coaching psychology, as a discipline grounded on a knowledge base derived from methodologically rigorous and relevant research. Coaching psychology was keen to be differentiated from non-scientific popular approaches like pop psychology (a la Tony Robbins), new age and self-help genres (1).

Evidence-based coaches are trained in coaching psychology and base their practice on empirically tested frameworks, theories and techniques . This builds confidence in the efficacy of their methods in helping clients achieve the outcomes they want (2). One example of a theoretically based coaching approach is cognitive behaviour coaching (CBC). CBC is currently the most frequently assessed theoretically based coaching methodology. Ten of 18 studies included in a recent meta-analysis assessed the efficacy of coaching involving CBC (combined with or without a solution-focussed approach) (3). Derived from cognitive behaviour therapy (CBT), the coaching version aims to effect behaviour change through identification and correction of maladaptive thoughts, emotions and behaviours to develop more evidence-based and adaptive thinking. But remember, coaching is not therapy. So where CBT focuses on addressing clinical problems and developing coping mechanisms, CBC focuses on the promotion of wellbeing and purposeful change. CBC does this through facilitation of greater self-insight into thoughts, feelings and behaviours and removing psychological blocks to goal attainment and change (4). A seemingly subtle but important difference.

Evidence collection and interpretation assumes agreed standards of practice and outcomes. However, coaching is unregulated so agreed standards are few. This means it is not clear how generalisable evidence is across contexts. Further, coaching operates in an environment of complexity, uncertainty and instability with no guaranteed linear relationship between cause and effect making evidence-based coaching difficult to apply (5). Currently, the volume of high quality coaching specific research is limited, of variable quality, evolving, and reveals only a small slice of the whole ‘truth’ about coaching (6). Evidence cannot speak to all elements of importance and not everything can be measured (7). Even the most rigorously conducted and replicated studies designed to remove bias and random error cannot fully describe the true effect of an intervention (8). This is as true for medical science as it is for coaching.

The National Health and Medical Research Council (NH&MRC) has long recognised this challenge. Not every research question is a randomised controlled nail so we need to learn which hammer (or indeed other tool in the box) to best ‘hit’ the research question with. Matching the methodology to the research question is the key. Research on coaching highlights this need, and effective, replicable methods based on an evolving theoretical framework are still being developed.

The theory

Theories and techniques used in evidence-based coaching are grounded in psychological theories of human behaviour and motivation. These theories include:

  • Control theory – how people self-regulate
  • Goal theory – how people set and attain goals (and why effective goal setting is more than setting SMART goals)
  • Self-determination theory – how meeting basic psychological needs (autonomy, competency and connectedness) enhances motivation and goal attainment
  • Change theories – how to help people design and implement change (and understand what gets in the way)
  • Adult development theory – how people develop perspective taking and meaning making
  • Systems and complexity theories – how groups, teams, and organisations operate

Many techniques have been adapted from clinical psychology and used proactively to promote purposeful and positive change. These include:

  • Acceptance and commitment coaching
  • Cognitive behaviour coaching
  • Developmental coaching based on constructive-develepmental theories of adult development
  • Person-centred (humanistic) coaching
  • Positive psychology and strengths based approaches
  • Psychoanalytically informed coaching
  • Solution-focussed coaching

Doctors and coaching

Coaching can be provided in a range of domains including business, career, executive, health and wellness, leadership, life, relationship, and workplace. Coaching is rapidly gaining ground in the health sector – particularly with the rise of health coaching (see box). Doctors aren’t over represented in the early adopters in using coaching to address their own personal and professional developmental needs but there is considerable benefit to be derived from using coaching approaches, and not just for our patients.

A key area in this respect is burnout prevention (9). A 2013 South Australian study showed a cognitive behaviour coaching intervention reduced distress and improved retention in rural GPs (10). And a 2016 study showed group coaching supported junior doctors in their transition from medical school in a number of areas – professional identity development, career planning and managing a healthy work/life-balance (11).

Choosing a coach

Done well, by appropriately trained and experienced practitioners, coaching is an effective evidence-based behaviour change methodology. Numerous large corporates and public sector agencies were quick to recognise the benefits for their staff, and have been effectively utilising coaching for some time. Up until recently, the Australian health sector predominantly utilised coaching approaches for patients. Health professionals are now beginning to appreciate the gains for themselves. But getting the right coach with good quality skills can take a bit of searching.

Training

Coaches come from a range of professional backgrounds and training. These include professionals with, often extensive, on the job experience rather than formal qualifications, those who’ve paired their professional background with coaching courses of various lengths and rigour, and some who have sought to complement their professional background with a postgraduate-level university qualification. The University of Sydney has recognised the need for rigour in this field and offer a well-regarded and highly competitive entry Masters in Coaching Psychology through their psychology department. The requirement for psychological training is not compulsory but recent Australian and Israeli research shows coaches who have an academic background in psychology are more effective (12).

There are conflicting opinions on whether a coach needs a background in your professional discipline or industry. For doctors, there are potentially some advantages for a coach to have health care knowledge and experience. These include a deep understanding of the industry and the unique challenges doctors face. Doctors often like talking with other doctors because we feel that we each ‘get it’. However, sometimes having a person outside the health sector can provide fresh, and needed, insights.

Accreditation

There are a number of accrediting organisations through international bodies including the International Coach Federation, the Association for Coaching, and the European Mentoring and Coaching Council. Accreditation primarily assesses whether a coach is ‘good enough’ against pre-determined standards (13). Accreditation is different to certification, which is less reliable and is often self-applied (14).

Methodology

Not all coaches practice the same way. It’s important that a coach can explain the methodology they propose to use, how long coaching will take, and how coaching will be evaluated. As one writer notes: “If a coach can’t tell you what methodology he uses – what he does and what outcomes to expect – show him the door.” (14)

Experience and reputation

Doctors, including those who practice as coaches, are prohibited from using testimonials to advertise their services, so ask around. As we all know, a recommendation from a trusted colleague can be invaluable. A satisfied customer may be one of the best ways to tell how good a coach is. Ask for references and see if you can talk to some of the people they have coached before.

So much of the work doctors do is focused on our patients’ needs. And that’s how it should be. But if our needs – both as professionals and humans with lives beyond our work – are not acknowledged and met, we are little use to our patients. “Physician, heal thy self”. Coaching has a lot to offer in this regard.

References

  1. Grant AM. An integrated model of goal-focused coaching: An evidence-based framework for teaching and practice. International Coaching Psychology Review. 2012;7(2):146-65.
  2. Stober DR, Grant AM. Evidence based coaching handbook: Putting best practices to work for your clients. Chichester: Sons; 2006.
  3. Theeboom T, Beersma B, van Vianen A. Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organizational context. The Journal of Positive Psychology. 2014;9(1):1-18.
  4. Good D, Yeganeh B, Yeganeh R. Cognitive Behavioral Executive Coaching. Research in Organizational Change and Development. 2014;21:175-200.
  5. Cavanagh M, Lane D. Coaching psychology coming of age: The challenges we face in the messy world of complexity. International Coaching Psychology Review. 2012;7(1):75-90.
  6. Grant AM. What constitutes evidence-based coaching?: A two-by-two framework for distinguishing strong from weak evidence for coaching. International Journal of Evidence Based Coaching and Mentoring. 2016;14(1):74-85.
  7. Ritchie J. Not everything can be reduced to numbers. In: Berglund C, editor. Health Research. Melbourne: Oxford University Press; 2001. p. 149-73.
  8. Guyatt G. Therapy and harm: Why study results mislead – bias and random error. In: Guyatt G, Rennie D, editors. Users’ guides to the medical literature. United States of America: AMA Press; 2002. p. 315-29.
  9. Gazelle G, Liebschutz J, Riess H. Physician burnout: coaching a way out. J Gen Intern Med. 2015;30.
  10. Gardiner M, Kearns H, Tiggemann M. Effectiveness of cognitive behavioural coaching in improving the well-being and retention of rural general practitioners: Cognitive Behavioural Coaching. Australian Journal of Rural Health. 2013;21(3):183-9.
  11. de Lasson L, Just E, Stegeager N, Malling B. Professional identity formation in the transition from medical school to working life: a qualitative study of group-coaching courses for junior doctors. BMC Medical Education. 2016;16(1):1-7.
  12. Bozer G, Sarros JC, Santora JC. Academic background and credibility in executive coaching effectiveness. Personnel Review. 2014;43(6):881-97.
  13. Clutterbuck D, Megginson D. Coach maturity: An emerging concept. In: Wildflower L, Brennan D, editors. The handbook of knowledge-based coaching: From theory to practice. Hoboken: Wiley; 2011. p. 299-313.
  14. Coutu D, Kauffman C. What can coaches do for you? Boston: Harvard Business School Press; 2009. p. 91.
*Based on an article first published by The Medical Republic: Coaching: science or snake oil?

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