The learning culture in third year clerkships: medical students' perceptions through a coaching lens (Published 2015)
Apr 06, 2016
Rosenkrans D, Klamen D and Roberts N
The aim of this study is to provide an insight into the learning culture in clerkships and whether it is similar to students’ previous coaching experiences.
Purpose: Medicine is rapidly changing. New clerkship models have been proposed, including coaching. The authors studied a group of individuals able to comment on both worlds: medical students who had been coached to high levels of performance in sports, music, and debate. The study was undertaken to understand the learning culture in the clerkships and whether it was similar to the students’ previous coaching experiences.
Method: Using a constructivist grounded theory approach, the authors conducted two focus groups with 23 students. Data were analyzed iteratively using constant comparison. Key themes were identified to obtain a conceptual understanding of coaching and clerkships.
Results: Five types of learning events regularly occurred between coaches and students, and a sixth was unique to medical students in the clerkships. These were: relationship with the teacher, expectations, observation, practice, feedback, and measures of success (in the clerkships). The five events associated with coaching were noted as strengths by students, while the same five were noted as weaknesses in the clerkships.
Conclusion: Medicine’s current learning culture makes it difficult for teachers to impact learners’ development, making thoughts about incorporating coaching into clinical settings problematic. The culture must be addressed, so that coached deliberate practice may be used.
Medical training began with an apprenticeship model for learning clinical skills. Although there were certainly disadvantages to this kind of training as reflected in the Flexner report, the apprenticeship model did have its advantages. The function of apprenticeships is to bring learners from the periphery of participation (as an observer) progressively into the center of a community of practice as their skills improve (Lave & Wenger, 2003). That is, master physicians had their apprentices simply observe in the beginning, but gradually increased their involvement in patient care until they could care for patients as competent physicians. The speed of this evolution was determined by the master, based on a longitudinal relationship with his apprentice and hours of direct observation, practice and feedback. This required skills on the part of the master very similar to that of a coach today, although it is doubtful that the masters called what they were doing by that name.
An interesting although difficult paper to read. I doubt very much whether the majority of medical educationalists would disagree about the need for a more coaching type approach to student learning and hence i am not sure that this paper adds much to the present date. It would have been I think uncommon for the clinical teachers to approach their teaching via coaching or whether they would have been trained in the approach.
Deborah Murdoch Eaton
I thought this was an excellent paper. The authors have discussed and introduced the analogy of coaching as a mechanism to facilitate and support learning. There are some similarities that they discuss with chris Watlings work around feedback perception. The conclusions are interesting and thought provoking about how we might embed the coaching strengths approach into how we organise clinical placements. The paper is well written and well worth a read.