조언과 멘토링을 넘어: 의학교육에서 코칭을 위한 역량(Med Teach, 2021)

조언과 멘토링을 넘어: 의학교육에서 코칭을 위한 역량(Med Teach, 2021)
Beyond advising and mentoring: Competencies for coaching in medical education
Meg Wolffa , Nicole M. Deioriob , Amy Miller Juvec , Judee Richardsond, Gail Gazellee, Margaret Mooref, Sally A. Santenb and Maya M. Hammoudg 

 

 

 

서론
Introduction

의학 분야는 끊임없이 발전하고 있다. 의료 서비스 제공자(HCP)의 신속한 개인 및 전문적 개발, 적응형 전문 지식 및 자기 주도 학습에 대한 요구는 HCP의 변화를 가속화하는 데 필수적이다(Friedman 2016). 각각의 새로운 치료, 새로운 감염 및 변형 건강 정책은 HCP가 고품질의 치료를 위해 신속하게 적응할 것을 요구한다. 의료 교육에서 학술 코칭을 HCP 훈련에서 자기 주도적이고 빠르게 변화하는 적응형 전문지식의 개발을 촉진하는 프로세스로 설명한다(Deiorio et al. 2016; Cuter et al. 2018).
The field of medicine is constantly evolving. The demand from health-care providers (HCP) for rapid personal and professional development, adaptive expertise and self-directed learning is essential to accelerate HCP’s change (Friedman 2016). Each new treatment, emerging infection and transformative health policy requires HCPs to rapidly adapt for high-quality care. Academic coaching in medical education is described as a process to facilitate development of self-directed, fast-changing, adaptive expertise in HCP training (Deiorio et al. 2016; Cutrer et al. 2018).

코칭은 성과 중심 직업(예: 음악, 스포츠 및 비즈니스)에서 어디에나 있습니다. 최근 부상하고 있는 의사 코칭은 리더십 개발과 웰빙을 지원합니다(Dyrby et al. 2019). 의학 교육에서 학습자가 잠재력을 최대한 발휘할 수 있도록 돕는 방법으로 설명되었으며(Deiorio et al. 2016), 학습자를 위한 코칭 프로그램이 크게 증가했다(Wolff et al. 2020). 학습자 웰빙 향상 외에도 코칭은 기술 스킬을 개선하고 비기술적 스킬을 향상시킨다(Lovell 2018; Wolff et al. 2020). 멘토링과 조언과 유사하게, 코칭은 개인의 발전에 초점을 맞춘 과정이다. 

• [멘토링과 조언]은 일반적으로 지시적이며, 정보를 더 상급 개인에서 더 하위 개인으로 의도적으로 전달하도록 설계되었다(Deiorio et al. 2016). 이와는 대조적으로, 
• [코칭]은 '학습자가 자신의 가정에 대한 통찰력을 얻고, 관련 결과에 대한 의미를 명확히 하며, 원하는 결과를 달성하기 위해 필요한 [특정 조치]를 식별하는 데 도움이 된다'는 것을 돕는 학습자 중심입니다(Deiorio et al. 2016).

Coaching is ubiquitous in performance-focused professions (e.g. music, sports and business). Emerging recently, coaching for physicians supports leadership development and wellbeing (Dyrbye et al. 2019). It has been described in medical education as a way to help learners achieve their full potential (Deiorio et al. 2016) and coaching programs for learners have increased significantly (Wolff et al. 2020). In addition to improving learner well-being, coaching improves technical skills and enhances non-technical skills (Lovell 2018; Wolff et al. 2020). Similar to mentoring and advising, coaching is a process focused on an individual’s development.

• Mentoring and advising, however, are generally directive and designed to intentionally transfer information from a more senior individual to a more junior one (Deiorio et al. 2016). In contrast,
• coaching is learner-driven with the coach helping ‘learners gain insights into their own assumptions, clarify meaning about relevant outcomes, and help identify specific actions needed to achieve a desired result’ (Deiorio et al. 2016).

코칭은 마스터 적응 학습자(MAL) 개발에 필수적이다(Cuter et al. 2018). MALs는 실천에 적응하고 진화하기 위해 지식 격차를 식별하고 완화하기 위해 지속적으로 자체 규제 학습자이다(Cuter et al. 2017). MAL 프로세스의 계획, 학습, 평가 및 조정 단계를 통해 학습자를 체계적으로 코칭하면 교육자는 필요에 따라 일상적인 전문 지식과 혁신적인 전문 지식을 신속하게 전환할 수 있다(Cuter et al. 2020).
Coaching is essential to the development of the master adaptive learner (MAL) (Cutrer et al. 2018). MALs are self-regulated learners in constant pursuit of identifying and mitigating their knowledge gaps to adapt and evolve their practice (Cutrer et al. 2017). Systematically coaching the learner through the Planning, Learning, Assessing and Adjusting phases of the MAL process prepares trainees to rapidly flex between routine and innovative expertise as needed (Cutrer et al. 2020).

상당한 성장에도 불구하고, 의학 교육에 대한 코치 준비에 대한 명확한 기준은 존재하지 않는다. 교육은 기존 멘토링 및 조언 프로그램을 채택하거나 경영진 코칭 문헌(Deorio and Hammoud 2017, Athanasopoulou and Dopson 2018, ICF 2019)을 토대로 작성되었습니다. 국제코칭연맹(ICF)은 공인된 전문 코치(ICF 2019)의 핵심 역량을 설명한다. 그러나 의료 교육의 고유한 맥락, MAL 기술 개발을 촉진하려는 욕구 및 의료 교육에서 코치가 종종 동시에 여러 역할을 수행한다는 고려(Brooks et al. 2020)를 고려할 때, 우리는 의학교육 코칭을 위한 특정 역량을 개발할 필요성을 확인했다. 명확한 역량이 없다면, 코치를 훈련시키고, 성과를 평가하거나, 코칭 프로그램을 평가하는 것은 어렵다. 이는 의료 교육 내에서 코칭 프로그램이 효과적이고 확장할 가치가 있는지 여부를 결정하기 위한 결과 측정의 개발을 방해한다(Carney et al. 2019). 이를 해결하기 위해 의료 교육을 위한 일련의 핵심 코칭 역량을 개발했습니다.
Despite significant growth, no clear standards exist for preparing coaches in medical education. Training has been adapted from existing mentoring and advising programs or extrapolated from the executive coaching literature (Deorio and Hammoud 2017; Athanasopoulou and Dopson 2018; ICF 2019). The International Coaching Federation (ICF) describes core competencies for certified, professional coaches (ICF 2019). However, given the unique context of medical education, the desire to facilitate MAL skills development and the consideration that coaches in medical education often engage in multiple roles simultaneously (Brooks et al. 2020), we identified a need to develop specific competencies for coaching in medical education. Without clear competencies, it is difficult to train coaches, assess performance or evaluate a coaching program. This hinders development of outcome measures to determine whether coaching programs are effective and worthy of expansion within medical education (Carney et al. 2019). To address this, we developed a set of core coaching competencies for medical education.

방법들
Methods

Delphi 프로세스는 전문가 합의를 형성하기 위해 잘 확립되어 있다. 또한 실무(Togneto et al. 2019)와 훈련(Santen et al. 2014)에서 HCP에 대한 역량 프레임워크를 개발하는 데 사용되었다. 이 프로세스는 데이터 수집, 데이터 수집, 검토 및 개선을 위해 그룹에 데이터를 다시 제시하는 반복적인 라운드로 구성된다.

The Delphi process is well-established for building expert consensus (Hasson et al. 2000) and has been used to develop competency frameworks for HCPs in practice (Tognetto et al. 2019) and in training (Santen et al. 2014). The process consists of iterative rounds of data collection, collation of data and then presentation of the data back to the group for review and refinement.

2010-2020년 사이에 PubMed, ERIC: Educational Resources Information Center 데이터베이스 및 PsycNet의 영어로 기사를 제한하는 범위 검토를 수행하여 다음과 같은 검색어를 활용했다. 추가 논문 발굴을 위한 스노우볼 참조 교차조회가 완료됐다. 모든 요약본이 검토되었고, 환자의 건강 코칭과 관련된 원고는 제외되었다. 2018년 10월, 의학교육 컨소시엄 학교(AMA 2020)의 변화를 가속화하는 AMA를 포함한 전국 주제 코칭 회의가 소집되었다. 문헌 검토에서 얻은 정보를 바탕으로 국제 코칭 연맹(ICF) 모델을 출발점(ICF 2019)으로 사용하여 논의를 주도하고 카테고리와 개별 역량을 생성했다.
We performed a scoping review between 2010–2020 limiting articles to the English language in PubMed, ERIC: Educational Resources Information Center database, and PsycNet, utilizing the following search terms: coach, coaching competencies, coach training and medical education. Snowball reference cross-checking was completed to find additional papers. All abstracts were reviewed; manuscripts pertaining to health coaching of patients were excluded. In October 2018, a national Thematic Coaching Meeting including AMA Accelerating Change in Medical Education Consortium schools (AMA 2020), experts in coaching, adaptive learning, neuroscience and medical education convened. Informed by our review of the literature, we led the discussion and generated categories and individual competencies, using the International Coaching Federation (ICF) model as a starting point (ICF 2019).

새로운 역량을 제안한 전문가 패널에게 결과가 제공되었습니다. 주제별 코칭 미팅에서 8명을 모집하여 의학교육 및 코칭 전문가 패널로 위촉하였으며, 7명이 참여하였다. 3명은 ICF 공인코치, 1명은 상무코치로 훈련받은 의료교육자, 나머지는 의료교육 코칭 경험이 있는 의료교육자들이었다. 세 차례의 의견 일치를 통해 최종 도메인과 역량이 도출되었다.
Results were provided to our expert panel who proposed new competencies. Eight individuals were recruited at the Thematic Coaching Meeting to serve on the expert medical education and coaching panel; seven participated. Three were ICF certified coaches, one was a medical educator trained as an executive coach and the remainder were medical educators who had experience with coaching in medical education. Three rounds of consensus resulted in the final domains and competencies.

결과.
Results

패널 7명 전원이 3차례 델파이 라운드에 참여했다. 이 과정을 통해 코칭 프로세스/구조, 관계형 스킬, 코칭 스킬, 코칭 이론 및 모델, 코치 개발 등 5개 영역에서 코치에 초점을 맞춘 15가지 역량을 얻게 되었습니다(표 1).
All seven panel members participated in three Delphi rounds. This process resulted in 15 competencies in five domains focused on coaches working with learners across the continuum:

• coaching process/structure,
• relational skills,
• coaching skills,
• coaching theories and models, and
• coach development (Table 1).

코칭 구조 및 프로세스
Coaching structure and process

이러한 역량은 [프로세스 로지스틱스]를 코칭하는 데 초점을 맞춥니다. 이러한 것들은 역할과 책임, 만남의 구조 및 예절에 대한 명확한 이해를 확립하는 데 필수적이다. 또한 코치는 코칭 관계가 어떻게 작동하고 있는지, 어떻게 개선해야 하는지 탐구해야 합니다.
These competencies focus on coaching process logistics. These are essential to establish a clear understanding of roles and responsibilities, structure and cadence of encounters. Coaches should also explore how coaching relationship is working and not working and how to improve.

관계 기술
Relational skills

이러한 역량은 신뢰와 명확하고 효과적인 커뮤니케이션을 구축하는 데 매우 중요합니다. 코치는 학습자를 이해하고 필요에 적응할 수 있는 정서적 지능과 적응력이 필요하다. 게다가, 코치는 코치의 정서적 지능을 길러야 한다.
These competencies are critical in establishing trust and clear, effective communication. The coach needs emotional intelligence and adaptability to understand the learner and adapt to needs. In addition, the coach must cultivate the coachee’s emotional intelligence.

코칭 스킬
Coaching skills

코칭 스킬은 4단계 모두를 통해 MAL을 개발하는 데 중요합니다. 코치는 효과적인 질문을 사용하여 학습자의 성장을 촉진하고 최대한의 발전을 도모하면서 학습자에게 이러한 단계를 안내해야 합니다. 또한 코치는 coachee가 웰빙과 전문적 성취도를 함양하면서 동기부여와 자기효율을 높일 수 있도록 지원한다.
Coaching skills are important in the development of the MAL through all four phases. The coach should guide the learner through these phases, using effective questioning to facilitate learner growth and maximum development. In addition, the coach supports the coachee in improving motivation and self-efficacy while cultivating well-being and professional fulfillment.

이론 및 모델 코칭
Coaching theories and models

코치는 개별 학습자 목표 달성을 촉진하기 위해 가장 적절한 모델과 도구를 활용할 수 있도록, 이론과 모델을 코칭하는 데 정통해야 합니다.
Coaches should be well versed in coaching theories and models, to utilize the most appropriate models and tools as they facilitate achievement of individual learner goals.

코치 개발
Coach development

이 과정에서 필수적인 요소는 지속적인 코치 개발 및 자기 관리 능력 배양입니다. 감독으로서 자신의 한계를 인식하고 언제 참고해야 하는지 아는 것도 중요하다.

An essential component of this process is ongoing coach development as well as cultivating self-management. It is also important for a coach to recognize their limitations as a coach and know when to refer.

논의
Discussion

우리는 HCP 학습자와 함께 일하는 코치를 위한 역량을 정의하기 시작했다. 결과 프레임워크는 코치를 위한 학습 목표, 교육 및 개발 커리큘럼을 개발하기 위한 출발점을 제공합니다. 역량은 효과적인 코칭을 정의하고, 효과적인 코치를 개발하며, 코치 평가를 만들고, 프로그램적 평가를 수행하는 기본이며, 이는 효과와 가치를 입증하는 데 필수적이다.
We began to define competencies for coaches working with HCP learners. The resulting framework provides a starting point to develop learning objectives, training and development curricula for coaches. Competencies are the basis of defining effective coaching, developing effective coaches and creating coach assessments and performing programmatic evaluation, which is essential for demonstrating efficacy and value.

여기서 개발된 역량은 ICF(ICF 2019)에 의해 요약된 역량과 유사성을 공유하지만 의료 교육 맥락은 그 역학을 변화시킨다. ICF의 명시된 목표는 '개인적이고 전문적인 잠재력을 극대화하도록 영감을 주는 사고 자극적이고 창의적인 과정'에서 고객을 돕고 싶어하는 자격 있는 코치들에게 있다. 이번 연구에서 확인된 의학교육 코치의 역량은, 한 단계 더 나아가 평생, 자기 주도 및 적응형 학습자의 개발을 지원하고자 한다. 이러한 MAL은 실천에 적응하고 진화하기 위해 지식 격차를 식별하고 완화하기 위해 지속적으로 자기조절하는 학습자이다(Cuter et al. 2018). 식별된 역량은 학습자가 MAL 프로세스에 참여하는 데 필요한 기술을 개발하는 데 도움이 되는 코치의 역할을 강조합니다. 코치는 코치에 특화된 전략을 파악하여 환자의 요구에 맞게 계획, 학습, 적응 및 조정할 수 있는 능력을 갖춘 기술에 대한 성찰을 장려합니다.

• 계획 단계에서 코치는 효과적인 질문을 사용하여 coachee가 목표를 결정하고 학습자의 자기 성찰을 유도할 수 있도록 지원합니다.
• 학습 단계에서 코치는 최상의 학습 전략을 결정하기 위해 coachee와 적극적으로 질의합니다.
• 평가 단계에서 코치는 coachee의 책임을 묻고 피드백을 제공하여 정확한 자체 평가를 개발합니다.
• 조정 단계에서 코치는 coachee의 능력을 파악하여 추가 개발을 돕습니다.

The competencies developed here share similarities with the competencies outlined by the ICF (ICF 2019) but the medical education context changes their dynamic. The stated goal of ICF is to credential coaches who want to help clients ‘in a thought provoking and creative process that inspires them to maximize their personal and professional potential.’ The competencies for coaches in medical education identified seek to go further and support the development of life-long, self-directed and adaptive learners. These MALs are self-regulated learners in constant pursuit of identifying and mitigating their gaps in knowledge to adapt and evolve their practice (Cutrer et al. 2018). The competencies identified highlight the coach’s role in helping the learner develop skills needed to engage in the MAL process. The coach identifies and uses strategies specific to their coachee to encourage reflection about skills with the ability to plan, learn, adapt and adjust to meet their patients’ needs.

• In the planning phase, the coach uses effective questioning to help the coachee determine goals and elicit learner self-reflection.
• In the learning phase, the coach engages in active inquiry with their coachee to determine the best learning strategies.
• In the assessing phase, the coach holds the coachee accountable and provides feedback to develop accurate self-assessment.
• In the adjusting phase, the coach identifies abilities of the coachee, assisting further development.

결론 및 향후 방향
Conclusion and future directions

의료 교육에서 학문적 지도를 위한 다음 단계는 다음과 같다.

• 학습자와 코치의 성공을 측정하는 방법을 정의합니다. 
  
• 평가를 통해 코치 역량을 뒷받침하는 유효성 증거 수집 
  
• 학습자, 기관 및 코치에 대한 코칭의 영향을 문서화하고 추적할 수 있는 도구 개발 
  
• 모범 사례 개발을 위한 코칭 결과 추적 및 의료 교육에 가져다주는 가치 정의

The next steps for academic coaching in medical education include:

• defining how we measure success of both learners and coaches;
• gathering validity evidence supporting coach competencies through assessment;
• developing tools to document and track the impact of coaching on learners, institutions, and coaches; and
• tracking coaching outcomes for best practice development and for defining the value brought to medical education.

 

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Med Teach. 2021 Oct;43(10):1210-1213. doi: 10.1080/0142159X.2021.1947479. Epub 2021 Jul 27.

Beyond advising and mentoring: Competencies for coaching in medical education

Meg Wolff 1, Nicole M Deiorio 2, Amy Miller Juve 3, Judee Richardson 4, Gail Gazelle 5, Margaret Moore 6, Sally A Santen 2, Maya M Hammoud 7

Affiliations collapse

Affiliations

1Departments of Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA.

2Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA.

3Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA.

4Medical Education Strategy Unit, American Medical Association, Chicago, IL, USA.

5Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.

6Institute of Coaching, McLean Hospital, Harvard Medical School Affiliate, Belmont, TN, USA.

7Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA.

PMID: 34314291

DOI: 10.1080/0142159X.2021.1947479

Abstract

Background: Coaching supports academic goals, professional development and wellbeing in medical education. Scant literature exists on training and assessing coaches and evaluating coaching programs. To begin filling this gap, we created a set of coach competencies for medical education using a modified Delphi approach.

Methods: An expert team assembled, comprised of seven experts in the field of coaching. A modified Delphi approach was utilized to develop competencies.

Results: Fifteen competencies in five domains resulted: coaching process and structure, relational skills, coaching skills, coaching theories and models, and coach development.

Conclusion: These competencies delineate essential features of a coach in medical education. Next steps include creating faculty development and assessment tools for coaching.

Keywords: Mentoring; medical education research; medicine.