Geisel Coaching Program to Support Medical Student Enculturation and Belonging Through Coaching About Well-Being, Academics, and Professionalism

Abstract

Medical school curricula well prepare students for the cognitive and technical skills required to become competent physicians; however, programs often lack a similar intention approach to guide professional identity formation and enculturation into the rituals and ideals of the profession. Furthermore, our medical student engagement with resources, supports, and opportunities was highly variable depending on how proactive and knowledgeable a student was about the system, which created disparities. We replaced our existing advising system with a 4-year longitudinal coaching program based on the Doctor Coach model 1 to better support all students with a structured approach to enculturate into the medical field, develop professional identity, cultivate professional networks, address unique needs, and manage challenges. Coaches meet with students individually and in small groups to cover topics in the domains of well-being, academics, career exploration, and professional character development. The program launched in 2019 for incoming medical students. Online surveys based on survey about underrepresented minority (URM) student needs 2 were administered to first-year (M1) students in the coaching program (1 by program and 1 external), second-year (M2) students in the prior advising program, and coaches. Likert anchors ranged from 1 (strongly disagree) to 5 (strongly agree). Chi-square test was used to compare M1 vs M2 responses M2 in the external survey. Qualitative responses were summarized. Response rates were 77/92 (84%) for M1 internal, 63/92 (68%) for M1 external, 65/99 (66%) for M2, and 13/13 (100%) for coaches. All coaches (13/13, 100%) and 56/77 (73%) students agreed that the program added value to the curriculum. Most coaches (12/13, 92%) and students (54/77, 70%) agreed that the program would make the students better physicians. All coaches (13/13, 100%) and 60/77 (78%) students agreed that the program improved students’ sense of belonging. Nearly all students (73/77, 95%) agreed that they felt comfortable having candid conversations with their coach. Students had a more positive experience with coaching than the prior advising program, including (all P < .0001): comfort expressing vulnerability (4.0 vs 2.4), coach understands your challenges (4.2 vs 2.6), addressing your unique concerns/questions (4.0 vs 2.6), and connecting with resources (4.0 vs 2.8). Some students preferred that small group coaching time focus on current issues they are facing, while others wanted to minimize the group time spent “complaining.” Of the 36 M1–2 students who in the external survey indicated that they identify with an underrepresented minority group, only 4 (11%) “somewhat agreed” that identifying with their coach/advisor on race/ethnicity was important. In the qualitative comments, these students indicated that they wanted more support and resources. Triangulation between coach and student perspectives and internal and external sources of data strengthen the conclusions. Nearly all students felt comfortable with their coach. All coaches and most students found the program valuable and thought it increased students’ sense of belonging. Students had a more positive experience with the coaching program than the prior advising program in all domains. There was a tension between some students wanting to focus their small group time on current issues and the need to cover the full coaching curriculum to guide enculturation and help prepare students for the next steps in their training. Coaches should be aware that students who identify as URM may have unique coaching needs. Our coaching model was an effective way to support student enculturation and sense of belonging. We adjusted some of the small group sessions based on student feedback. The coaching program infrastructure enabled a rapid response and support system for students during the pandemic. We used the survey results to construct a faculty development to train coaches on resources and approaches to supporting students who identify as URM. At Learn Serve Lead 2021: The AAMC Annual Meeting, we will also report on the student outcomes following this faculty development session and during the pandemic. The authors wish to thank all the students and coaches who generously gave their time to participate in this study.