Addition to Coaching in Medical Education
Written by Victoria Stagg Elliott, MA; Maya M. Hammoud, MD, MBA; Nicole M. Deiorio, MD; Margaret Moore, MBA, MA; and Margaret Wolff, MD, MHPE
One of the most common questions we get asked as authors and editors of Coaching in Medical Education, the third book in the AMA MedEd Innovation series, is how coaching differs from mentoring or advising. These terms are often used interchangeably, even though they are different interventions. While there are commonalities among these activities, they have distinct modalities, experiences, and goals.
How is an adviser different from a coach?
An adviser has gathered professional and life expertise which they adapt and share by providing expert advice. For example, a medical student may approach a medical school adviser to find out how they are progressing toward graduation requirements, identify any gaps to fill, learn how to fill those gaps, get information about options for between-semester endeavors, and consider strategies for the residency application process.
On the other hand, a coach engages in an open, evocative, inquiry to explore the perspectives, knowledge, and resources of the coachee. The coach does not have to be an expert on the intricacies of undergraduate or graduate medical education or on a learner’s specific goals.[i]
How is a mentor different from a coach?
A mentor often has in-depth personal knowledge about the lived experience of mentees and their paths and a vested interest in their success. Mentors provide expertise derived from their own direct experience on a similar path. They have usually already achieved what a mentee aspires to do, and the mentor provides guidance, contacts, and opportunities to help them get there.
A coach facilitates an expanded mindset and skills and does not need to have direct experiences related to a coachee’s goals.1
The Master Adaptive Learner Model
Coaching has become particularly important with the growth of competency-based medical education and the increasing implementation of the Master Adaptive Learner Model.1 The model involves a metacognitive approach to self-directed learning and the development of adaptive expertise. Coaching guides a learner through the Master Adaptive Learner process which includes planning, learning, assessing, and adjusting phases. These phases mirror the Plan-Do-Study-Act cycle of continuous quality improvement.
So, What Does a Coach Do?
Coaches support learners in prioritizing their own aspirations, values, and needs. A coach holds a learner accountable and improves self-monitoring. While coaches may mentor or advise, these are not their core functions.1 Coaching techniques apply elements of self-determination theory,1 unconditional regard,[ii] curiosity, motivational interviewing,[iii] intentional change theory,[iv] positive psychology,[v] appreciative inquiry,[vi] growth mindset,[vii] and mindfulness[viii] to help a coachee define and work their way toward their aspirations. Coaches will review and help a learner understand their assessments, imagine an ideal future self, identify needs and goals, and co-create a plan to move toward them.
In an advising or mentoring relationship, the agenda is heavily influenced by the institution along with the adviser and the mentor. In a coaching relationship, coachees create their own agenda for change and growth.
What Coaching Looks Like in Practice
Let’s say a medical student wants to pursue academic pediatrics. They will get information about standards for and pathways to pediatrics from their adviser. A mentor will give them additional insight into the pathway to becoming an academic pediatrician derived from their own experiences and may provide introductions and opportunities to aid that process.
A coach will help this student identify and set their long- and short-term goals using the SMART model — specific, measurable, achievable, relevant, and time-based— or the WOOP model—wish, outcome, obstacle, plan. Although the longer-term goal is becoming a pediatrician, there are many shorter-term milestones — basic science courses, clerkships, and licensing exams — that must be achieved for this to happen. A coach can use data to help a learner identify areas where they may be over-confident, so that they can give these areas more attention and gain more objectivity of their current strengths and skills. The coach will also help a learner identify areas where they may be under-confident and could have more confidence and devote less time to.
If the student identifies that they are struggling with retaining the information they need to pass an exam, a coach will help them identify more workable learning strategies and support them as they test them out. A coach will use various tools, such as the Values in Action character strength assessment, to get to know them better. The coach will also ask questions that turn the focus away from where the learner is struggling or failing to a learner’s strengths and inner motivation. The coach will help a learner develop an action plan based on character strengths and their own goals.
If a learner is struggling with isolation, a coach can help them identify strategies that work for them individually to connect with others within the educational setting who may be able to help them work toward their goal of becoming a pediatrician as well as friends and family who can support their journey. Coaches can play an important role in remediation situations as well as preventing the need for remediation.
Core Coaching Values
Coaching has long had an important role in helping athletes, leaders, businesspeople, and many others achieve their goals.[i] Coaching at its core is about drawing out intrinsic human resourcefulness, bringing it to the fore. A coaching relationship is one of discovery for both the coach and the coachee. Neither one has to be an expert adviser or a mentor who has walked the road before. Both participants need to be willing to take risks, identify new possibilities, and reach greater potential.
Coaching has only just started to make inroads in the medical education setting, and it is a valuable addition accompanying advising and mentoring that will help more learners achieve success.
 Deiorio NM, Foster KA,W Santen SA. Coaching a learner in medical education. Acad Med. December 2021 – Volume 96 – Issue 12 – p 1758.
 Cutrer W, Pusic M, Gruppen LD, Hammoud MM, Santen SA, eds. The Master Adaptive Learner. Philadelphia: Elsevier; 2020.
 Ryan RM, Deci EL. In Elliot AJ, ed. Brick by brick: The origins, development, and future of self-determination theory. 6 (pp. 111-156). Elsevier Inc.
 Ryan R, Deci E. Chapter 20: Supporting Autonomy, Competence, and Relatedness: The Coaching Process from a Self-Determination Theory Perspective. In: English S, Sabatine JM, Brownell P, eds. Professional Coaching: Principles and Practice. 1st ed. Springer Publishing Company; 2018.
 Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. Guilford press. 2012.
 Boyatzis R, Smith ML, Van Oosten E. Helping People Change: Coaching with Compassion for Lifelong Learning and Growth. Harvard Business Press. 2019.
 Positive Psychology Center. University of Pennsylvania. https://ppc.sas.upenn.edu. Accessed May 13, 2022.
 Whitney DD, Trosten-Bloom A. The Power of Appreciative Inquiry: A Practical Guide to Positive Change. Berrett-Koehler Publishers. 2010.
 Growth Mindset Institute. www.growthmindsetinstitute.org. Accessed May 13, 2022.
 Jon Kabat-Zinn: Defining Mindfulness. Mindful.org. January 11, 2017. https://www.mindful.org/jon-kabat-zinn-defining-mindfulness/. Accessed May 13, 2022.
 Wolff M, Hammoud M, Santen S, Deiorio NM, Fix M. Med Educ Online. Coaching in Undergraduate Medical Education: A National Survey. 2019 (25).