Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Judges versus coaches in medical education

Muthu Alagappan, MD
Education
October 4, 2018
458 Shares
Share
Tweet
Share

I flash a smile as I look up from my notes. “Do it again,” I say, encouraged by his progress, “but this time start with the physical exam.” I am the internal medicine resident leading our “twilight” admitting team, and Vikram, a student on the first day of his medicine clerkship, sits across from me. It is his third time practicing the presentation of Ms. R, a 56-year-old woman with pancreatitis who was recently admitted to our hospital.

When I first met Vikram earlier that day, I explained that I viewed my role as both his evaluator and coach as a conflict of interest and admitted that I could only choose one — I had chosen to be his coach.

Atul Gawande discussed the concept of a medical coach in his New Yorker article “Personal Best,” where he describes the experience of enlisting a former surgical mentor to observe him in the operating room. In the article, he raises the question of why elite performers often have coaches but physicians rarely do and makes the compelling case that dedicated coaching can lead to significant improvement in clinical skills. But what about young physicians, like Vikram or myself, who are still in training? Some would argue that we are surrounded by coaches — our program directors, clinic preceptors and hospital attendings amongst others. However, I would contest that these individuals play the dual role of coach and judge — a task that on the surface seems plausible but contains within it a set of opposing responsibilities.

Although coaches and judges are similar in some ways — they assess performance, provide feedback and possess domain expertise — their differences are more notable. Coaches carry us forward while judges assess us how far we’ve come. Coaches feel like they’re on our team, while judges feel impartial. Coaches see mistakes as opportunities for improvement, while judges see them as opportunities for evaluation. In clinical training, is it fair to ask one person to play both roles? And what is it about coaches that make them more effective in helping us improve?

My hypothesis to Vikram is that coaching allows clinical skills to flourish because trainees feel safe in discussing their weaknesses, and the trainer feels longitudinally invested in the trainee’s success. I suggest that medical education needs fewer judges and more coaches — and most importantly, that the two roles be separate.

Especially early in my training, I often concealed my clinical weaknesses to attendings because I feared their evaluations of me could have an adverse effect on my career aspirations. During my fourth-year subinternship, I rounded one morning with one of our school’s prominent teaching faculty. He leaned in to listen to the heart of a young man with meningitis and upon removing his stethoscope whispered to me, “A classic systolic flow murmur, you should have a listen.” I hurried to take his spot and leaned in myself. But I heard nothing besides the normal sounds of the heart. I stepped back, unsure of what to say, but eventually nodded in agreement, “I hear it as well.” At the time, it was an innocent lie about an innocent murmur, but the repercussions now seem much larger. Maybe I was listening with the wrong side of the stethoscope or in the wrong part of his chest? Maybe I needed to push harder with the stethoscope or palpate the pulse at the same time? What was a flow murmur and why couldn’t I hear it? I tabled these questions at the time, electing to search for the answers myself rather than learning from the expert before me, for what if my questions caused him to doubt my abilities — “A fourth-year medical student who cannot appreciate a simple murmur…” I imagined him telling our clerkship coordinator. On many occasions such as this, my desire to impress a judge overwhelmed my desire to improve.

Coaching is built upon a mutually beneficial relationship in which an individual’s success motivates both the trainer and the trainee. The opposite is true for judges; by common ethical standards, they must not be invested in the success of those they judge for doing so would be a conflict of interest. By asking our medical teachers to serve as both coach and judge, we place upon them an unsolvable contradiction — want what is best for the trainee but be prepared to evaluate them in a way that may hinder their success, whether by rating them poorly at the end of a rotation or recommending them less strongly to a future employer. In contrast to judges, effective coaches are allowed to be deeply invested in the learner’s success.

There are many barriers to implementing a coaching model in medical training. Coaching thrives when a coach can focus on a small cohort of learners, which is challenging in the resource-constrained environment of medical education. Coaching also requires longitudinal investment, but in medical training, we are frequently introduced to teachers who work with us for only a few days or weeks. These individuals parachute into our training without an understanding of where we started or how far we have come, and their impending departure makes them poorly suited to invest in our long-term success. These barriers may be difficult to overcome, but an acknowledgment of their existence is the first step toward change.

By the end of our week together, I am impressed by Vikram’s growth. His first few presentations were riddled with filler words and lack of structure, but within a few days, his presentations are almost indistinguishable from those of an intern.

A few days after our experiment, I receive an email request to evaluate Vikram’s performance. As promised, I kindly refuse to complete the evaluation; I will reserve this role for someone else. Meanwhile, I return to my place on his sideline, eager to offer my support when he needs me next.

Muthu Alagappan is an internal medicine resident who blogs at his self-titled site, Muthu Alagappan.

Image credit: Shutterstock.com

Prev

Where this physician finds joy in medicine

October 4, 2018 Kevin 0
…
Next

With rising obesity, microbiomes tip the scale

October 5, 2018 Kevin 9
…

Tagged as: Medical school, Surgery

Post navigation

< Previous Post
Where this physician finds joy in medicine
Next Post >
With rising obesity, microbiomes tip the scale

More by Muthu Alagappan, MD

  • After COVID-19, there’s no turning back from a digital clinical workforce

    Muthu Alagappan, MD
  • Dear intern: Some advice about your first year

    Muthu Alagappan, MD

Related Posts

  • The medical education system hates families

    Anonymous
  • America’s inadequate LGBTQ medical education

    Haidn Foster
  • Why positive role models are essential in medical education

    Robert Centor, MD
  • How medical education fails minority students

    Shenyece Ferguson
  • Reimagining medical education from within a pandemic

    Kasey Johnson, DO
  • What is anti-racist medical education?

    Sylk Sotto, EdD, MPS, MBA

More in Education

  • The secret to success in medical school: self-awareness and courage

    Kaelor Gordon
  • Is mandating pre-medical training widening disparities in the U.S. physician workforce?

    Deepak Gupta, MD and Sarwan Kumar, MD
  • Equalizing the future of medical residencies: standardizing work hours and wages

    Deepak Gupta, MD and Sarwan Kumar, MD
  • From studying to baby kicks: Navigating motherhood in medical school

    Natalie Eichner-Seitz
  • The power of advocacy: a medical student’s journey to helping an uninsured immigrant

    Fabiola Plaza
  • From AI to love: the key to a better future in medical education

    Stevan Walkowski, DO
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...