Rebalancing the power dynamic in education and health
Rebalancing the power dynamic in education and health through coaching conversations Dr Arti Maini Deputy Director of Undergraduate Primary Care Education (SPH), and Coaching Lead for the School of Medicine
Direction of Imperial Learning and Teaching Strategy “An interactive teaching and learning environment has at its heart active students who are partners in shaping and enhancing their own education”. • • Student-centred approach Active learning Students and Teachers as co-partners Students take responsibility for their learning
Translating the vision to reality through a coaching approach… • Mindset: People are resourceful. The educators’s role broadens from expert to genuine facilitator of learning-in partnership with students. • Skillset: How to hold non-judgemental, respectful, inclusive, challenging, effective conversations leading to meaningful change
Coaching training for… • Medical students • Medical educators • Local NHS healthcare professionals and organisations
Training medical students in health coaching skills Key principles • Facilitating patient’s active participation in managing their own health • Rethinking power dynamics: practitioner moves from expert to enabler Courses • SSC in Y 3 community placement • Integrated Clinical Apprenticeship (ICA) in Y 5 • Y 5+6 SCPs in health promotion, health inequalities, med ed • Experiential learning, authentic practice
Methodology Aim of study To explore the impact of training medical students in health-coaching skills. 10 week ‘medicine in the community’ attachment for year 3 medical students n=225 (self selected) Health coaching course n=48 (self selected) Patient-Practitioner Orientation Scale (Krupat, 2000) Measures attitudes towards patient-centredness-sharing, caring n=38 (79% response rate) Focus groups Impact of training using thematic analysis n=39 (81% response rate)
Comparison of pre and post course PPOS scores 108 88 P<0. 00 P=0. 0 overall PPOS score precaring' post score sharing score 68 48 28 8
Some Quotes from Students PATIENTCENTREDNESS: Its made me feel that I have to on some level think who the patients are. VALUE TO TEAM: It’s worthwhile doing. You’re a positive addition to the team COMMUNICATION I've noticed significant transformation in the way I interact with people. I'm much more receptive and I listen more…it just makes the conversation a lot better. EMPOWERING PATIENTS: you’re actually making patients realise that they have the power to change their own situation RESILIENCE: you now have the exact structure of how to solve your own problems essentially”.
Impact of training students in health coaching skills Patient empowerment, including for those with long term conditions, mental health issues and multimorbidity Mind set & skills to hold person-centred, empowering conversations with diverse patients Students’ professional development communication, selfawareness, reflection, motivation, study skills, resilience, leadership skills Value to clinical team through meaningfully contributing to patient care
Coaching Training for Medical Educators Interactive, skills-based course • 165 medical educators trained to date • Now hosted through EDU, RCP-accredited Impact of coaching skills training on medical educators • Mindset: students are resourceful • Skillset: active listening, better communication, encourage reflection, application of a coaching model, assessing learning needs and giving feedback • Outcomes: better student engagement, more effective pastoral discussions
Some quotes from medical educators This has radically changed my view of the power of language and I don’t think I appreciated it until doing this course The most surprising thing about the course was how transformative it was. I can see multiple scenarios for the coachee-centred approach to coaching/teaching/ training For me it worked perfectly and exceeded my expectations. The course has reinforced my understanding of how beneficial a tool this can be and developed my skills significantly
Training NHS Grenfell Outreach Team in health coaching skills • Course co-developed with students and clinical lead for GOT • Evaluation: all 10 participants felt more confident in holding more empowering, enabling conversations with clients • Imperial role as a socially accountable anchor institution
Rebalancing the power dynamiccreating the foundations for collaborative conversations • Faculty and students • Colleagues within and across teams • Students, faculty, clinicians, patients, community
Next steps in building a coaching strategy Coaching training for students • Health coaching skills training for all phase 1 medical students Coaching training for educators • • Continue EDU coaching courses-for medical educators including personal and academic tutors Online coaching training for educators (MOOC) Developing coaching ethos within Fo. M and College • • Contribute to new Fo. M Equality, Diversity and Inclusion committee Continue to work with Imperial Coaching Academy Imperial as an anchor institution for our local community • Socially accountable university-community-student projects-including White City, in collaboration with College community outreach team Spreading the word nationally and internationally • conferences, publications, workshops, research collaborations, training for other medical schools e. g. Harvard, UCL
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