The coaching program was established in 2016 using the model that was developed at MGH about 6-7 years ago by Dr. Kerri Palamara. The idea was to incorporate professional development coaching into residency for the purpose of helping residents though this extremely challenging time in the formation of their professional identity and to help in their well being. Physicians (and other clinical staff) and training physicians are experiencing all time high rates of burnout and carving out time to debrief experiences, think about the bigger picture, and set goals for their development may be an antidote to this. The framework used is based on positive psychology that emphasizes positive emotions, meaning and engagement as the means to flourish. Much of this was developed by Martin Seligman at Penn and Barbara Frederickson at UNC and there is a robust literature supporting it. The other part is the emphasis on individual strengths whereby people identify their own unique strengths (the project team uses a modified version of Seligmans tool that was developed at Harvard by Carol Kaufman) and leverage them to manage challenges and adversity.
Dr. Palamara created a curriculum that was imported to BMC and essentially involves training volunteer faculty in coaching skills utilizing these concepts and then pairing them up with new interns joining the program. The coaches and interns were asked to meet four times per year for coaching sessions that are to last from 30 – 60 minutes and they stay as a coaching pair for all three years of the residents training. So it became clear after the first year that it is really hard to get two very busy people together even four times per year. A qualitative study was done at the end of the first year doing semi-structured interviews with the interns and learned that they really appreciated the program and many got a lot out of it but they didn’t all meet the 4 times per year but perhaps more significant, by not engaging more, the interns’ comfort to share information was less. Dr. Tulsky then had the idea to utilize an app to somehow connect outside the 4 times per year (not instead of), they may feel more engaged with each other. In addition to connecting through a messaging tool (micro-coaching), it was also a way to track and monitor goals, share words of encouragement and for those inclined, to keep a journal. The app was developed by Achiiva, based in Australia.
Dr. Tulsky initially planned to run this pilot as a clinical trial which means he recruited the coaches as usual but randomized one group to coaching and using the app and the other group only coaches. The coaches didn’t choose which arm they were in but were assigned by a computer algorithm. 14 coaches and 24 interns used the app for a year and completed pre- and post- surveys asking about burnout, stress management, and sources of support. Unfortunately, due to low use of the app, he was not able to make any meaningful conclusions on outcome differences between the groups. The project was, therefore, a feasibility study that demonstrated low uptake of an electronic adjunct to coaching even among a younger tech-savvy group of learners. There may still be value in the use of a coaching app for a self-selected group of coaches and coachees who are motivated by the option of an asynchronous coaching relationship untethered by the constraints of busy schedules.