Coaching and Mentoring – Underutilized Resources for an ICU Fellow

Coaching and mentoring are valuable tools in a physician's professional development. They serve similar goals but have unique roles and boundaries. A mentor tells you how, but a coach asks you why. 

Mentoring is a seasoned colleague directing a junior colleague on how to succeed from a vantage point of the mentor's experience. By sharing knowledge, advice, and insights from their career, they help the mentee avoid pitfalls and can open doors for them. It often is a longer-term relationship aimed at development and career advancement¹. Coaching focuses on specific goals or outcomes ². It is led by a trained coach who asks probing questions, offers feedback, and provides support to help clients unlock their potential and achieve the desired results ³. Coaching tends to be more short-term and task-oriented. Both are beneficial for professional development.

Professional coaching for client physicians offers numerous benefits, contributing to individual and organizational success². A coach will provoke answers from the client to help them achieve their goals. Every physician has a unique career path and confronts challenges, but they also possess specific strengths and talents a coach can help them realize about themselves. Professional coaches tailor their approach to the client to foster a supportive environment where physicians can explore their objectives, concerns, and aspirations in a confidential setting³. Coaches assist in identifying career aspirations, creating actionable plans, and navigating career transitions. Whether a physician aims for a leadership position in research or education, coaching unlocks the answers from the coach with the guidance and support needed to achieve these goals.

One obvious advantage is the development of leadership skills. Physicians often find themselves in leadership roles, whether leading medical teams or managing administrative projects, sometimes out of the physician＊s comfort zone. Coaches work with physicians to find their personal way to strengthen their teamwork, conflict resolution, and interpersonal skills, creating a more productive and efficient working environment. Coaches facilitate transformative dialogues that can find hidden strengths to be used as tools and strategies to lead⁴.

Professional coaching also promotes physician well-being and prevents burnout. As healthcare organizations increasingly recognize the importance of supporting their staff's mental and emotional health, coaching offers a proactive and individualized solution. Professional coaching provokes self-reflection, leading to new personal insights. Through guided introspection, physicians can discover their values, priorities, and motivations, aligning their work with their inherent purpose⁵. This way, physicians can find their passion and focus on what matters most. 

The benefits of professional coaching for physicians are multifaceted. From leadership development and stress management to career advancement and improved communication, coaching contributes significantly to individual and organizational success in healthcare. Sometimes, as a younger physician, you may need to figure out what questions to ask, what direction to take, or where to focus your energy. Mentoring can more directly help with that. As the medical profession becomes more challenging, embracing coaching as a valuable tool can lead to more fulfilled, resilient, and effective physicians.

The theory of mentorship is simple - guidance, direction, and influence provided by someone more senior and experienced ⁶. The practice of mentorship is more nuanced. The mentor's goal is to develop a trainee professionally; however, effective mentorship encompasses more of a spectrum besides career growth. Mentors offer insights from their experiences, helping mentees develop critical skills, expand their networks, and confidently navigate career challenges. Through mentorship, mentees gain access to valuable advice, constructive feedback, and tailored guidance, accelerating their learning curve and avoiding common pitfalls. A mentor-mentee relationship encourages and fosters emotional and psychological support, and the mentor must be prepared for support in areas outside of work^6,7. Because of this, the most influential mentors are often those with similar interests, personalities, and values that foster a relationship of trust and integrity. A good mentorship will often naturally develop into a relationship that is, in essence, a friendship. Deciding to be a mentor has the natural tendency and responsibility to be long-lasting, as any strong friendship⁶. Furthermore, mentorship will evolve as the mentee progresses through their career^6,8.

Physicians should strive to obtain a spectrum of mentors as they progress through various stages of life and career^8,9. There may be a point where a mentee has met their goals with a mentor and seeks new mentorship as mastery within an area is achieved. In addition, sometimes goals change, or the mentee needs mentorship in a different aspect of life outside clinical practice, including research⁸. Having various mentors increases the breadth of experience and knowledge that can be gained, broadens the mentee＊s skills, and adds quality relationships to enhance the person＊s life. A good mentor should always be present along the mentee's journey, no matter where life takes them⁶. It is notable to mention that as a mentee progresses through life, they may, in turn, become a mentor⁹. It brings up the point that mentorship is a continuous cycle as experiences and guidance are shared amongst individuals; as the mentee enters their mentorship cycle, they will pass on all the guidance they have acquired⁸ and pay it forward. It is also important to remember that as individuals progress to the mentor stage, they remain close to their mentors to continue their growth and maintain those meaningful relationships^6,9. 

There are traits that great mentors and coaches both share. Both coaching and mentoring strive to get the most out of their collaborative partner, and both push their collaborative partners beyond their comfort level so that they can grow. Mentorship is a more experienced colleague providing the mentee structure, framework, and instruction^6,9. Coaching involves outlining goals and providing a safe space for the coached through guided self-discovery to find answers to achieve those goals. While mentorship should also have defined goals, mentorship is different because the solutions come from the mentor^6,9. Mentorship is a symbiotic relationship. In the mentor role, the mentor must be encouraging, open about their experiences, and lead by example. Sometimes, that involves sharing mistakes and how they grew from them. This should come naturally as the mentor and mentee share similar attributes⁹. Coaching is more directly focused on the person being coached, where the coach is merely the guide.

How could this benefit our ICU fellow trainees? Only a few studies have been done to answer this question, but we may get some insight from other fields of medicine and how they have utilized coaching and mentoring. Utilizing a mentoring program within an ICU as part of the THRIVE model (threat, harm risk investigation, and engagement) translated to a benefit to the follow-up of patients and families in post-ICU care settings¹⁰. Mentoring as a part of trainee education in regard to advanced care planning (ACP) precipitated increases in ACP documentation, more prompt communication, and improvements in ICU quality measures^11. Mentorship and coaching from large mature ICUs to more rural and newer ICUs improved the clinical care¹². Surgeons who function at the highest levels receive coaching to keep their heads in the game and grow their excitement for performance improvement¹³. Professional development for ICU pharmacists to become better equipped as young professionals for research and to improve leadership skills was beneficial to the pharmacist and the institution in which they practiced¹⁴. The common thread is that coaching and mentoring benefit providers and patients. 

Mentoring and coaching are distinct approaches to professional development, each with its unique focus and methodology. With engaged coaches and mentors, trainees could benefit in their professional development. 

References:

1. Viera, Carlos Antonio. 2021. A Comparison of Mentoring and Coaching: What’s the Difference? Performance Improvement 60 (7): 13-20.
2. Carmel, Roofe G., and Miller W. Paul. 2015. Mentoring and Coaching in Academia: Reflections on a Mentoring/Coaching Relationship. Policy Futures in Education 13 (4): 479-91.
3. Al Hilali, Khalid Said, Badar Mohammed Al Mughairi, Mooi Wah Kian, and Asif Mahbub Karim. 2020. Coaching and Mentoring. Concepts and Practices in Development of Competencies: A Theoretical Perspective. International Journal of Academic Research in Accounting Finance and Management Sciences 10 (1). https://doi.org/10.6007/ijarafms/v10-i1/6991.
4. Hussey, L., and Jennifer Campbell-Meier. 2021. Are You Mentoring or Coaching? Definitions Matter. https://doi.org/10.26686/wgtn.13557494.v2.
5. Schneider, Suzanne, Karen Kingsolver, and Jullia Rosdahl. 2014. Physician Coaching to Enhance Well-Being: A Qualitative Analysis of a Pilot Intervention. Explore (New York, N.Y.) 10 (6): 372-79.
6. Dirks, Joni L. 2021. Alternative Approaches to Mentoring. Critical Care Nurse 41 (1): 9-16.
7. De Rosa, Silvia, Denise Battaglini, Victoria Bennett, Emilio Rodriguez-Ruiz, Ahmed Mohamed Sabri Zaher, Laura Galarza, Stefan J. Schaller, and NEXT Committee of the ESICM. 2023. Key Steps and Suggestions for a Promising Approach to a Critical Care Mentoring Program. Journal of Anesthesia, Analgesia and Critical Care 3 (1): 30.
8. Narang, A., “Mentorship in Fellowship.” American College of Cardiology, 2 Jun. 2015, www.acc.org/latest-in-cardiology/articles/intouch/2015/07/02/10/38/mentorship-in-fellowship. Accessed 3 Mar. 2024.
9. Sarabipour, Sarvenaz, Sarah J. Hainer, Feyza Nur Arslan, Charlotte M. de Winde, Emily Furlong, Natalia Bielczyk, Nafisa M. Jadavji, Aparna P. Shah, and Sejal Davla. 2022. Building and Sustaining Mentor Interactions as a Mentee. The FEBS Journal 289 (6): 1374-84.
10. Haines, Kimberley J., Carla M. Sevin, Elizabeth Hibbert, Leanne M. Boehm, Krishna Aparanji, Rita N. Bakhru, Anthony J. Bastin, et al. 2019. Key Mechanisms by Which Post-ICU Activities Can Improve in-ICU Care: Results of the International THRIVE Collaboratives. Intensive
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11. Amen, Sara S., Allison E. Berndtson, Julia Cain, Christopher Onderdonk, Meghan Cochran-Yu, Samantha Gambles Farr, and Sara B. Edwards. 2021. Communication and Palliation in Trauma Critical Care: Impact of Trainee Education and Mentorship. The Journal of Surgical Research 266 (October): 236-44.
12. Sultan, Menbeu, Lemlem Beza, Demelash Ataro, Ephrem Hassen, Yenegeta Walelign, Mitiku Getu, Yonas Hagos, Sue Anne Bell. 2023 Ethiopian Journal of Health Development. 37 (1).
13. Smith, Jeffrey M. 2020. Surgeon Coaching: Why and How. Journal of Pediatric Orthopedics 40 Suppl 1 (July): S33-37.
14. Gerlach, Anthony T., Jessica L. Elefritz, Joshua Arnold, Megan Phelps, Keaton S. Smetana, and Claire V. Murphy. 2022. Development of a Critical Care Pharmacist Career Coaching and Professional Development Program at an Academic Medical Center. Journal of the American College of Clinical Pharmacy: JAACP, October. https://doi.org/10.1002/jac5.1713.