What is central to the success of football teams such as Manchester United, tennis player Andy Murray or track and field athlete Mo Farah? Simple - they are all governed by a good coach - someone dedicated to their cause and willing to go the extra mile, pardon the pun, to enable them to achieve ultimate success. So what exactly is meant by the term coach?
University College London details the following attributes:
- Coaches need not have first-hand experience of the coachee's line of work. The coach can be an independent external professional with expertise in coaching.
- Coaches will ask 'powerful' questions and not offer or give advice.
- Effective coaching is intended to help you to learn rather than by "teaching" you. By engaging with an experienced coach, the coachee will develop insights leading to enhanced effectiveness.
This is all well and good in the domain of sport but in medicine, the concept of mentoring is more apt:
- Mentoring is customarily a planned pairing of a more skilled or experienced person (usually in the same field of work) with a less experienced person.
- Mentors will often provide direction and advice and should 'open organisational doors' for mentees.
- Mentors can provide a neutral 'sounding board', assure total confidentiality, and have no agenda other than assisting their mentees in their development and to reach their goals.
- Mentoring involves helping mentees to develop their career, skills and expertise often drawing upon the experiences of the mentor in the process.
When we look at training in the UK, where I undertook my internal medicine training, we can agree that thousands of junior doctors are housed in an appropriate system centred on curriculum enforcement and assessment. As they progress from foundation doctors to specialist trainees, in either primary or secondary care, such a cohort is even encouraged to maintain work based portfolios which are designed to keep track of their progress. The entire process from start to finish is estimated at 5-8 years depending upon which 'care pathway' they choose.
The problem lies however in the lack of appropriate mentors. Medicine seems to be devoid of instructors dedicated solely to effective mentoring. The concept of educational supervisors does no doubt exist. However, many of whom are trampled by increasing clinical commitments leaving little time to focus purely on their juniors. And there are numerous examples I have observed where training time is at a minimum. Take a post admission ward round for example. Due to patient numbers there is often pressure to review as many as possible in the quickest possible time. As a result if a junior doctor is for example presenting a case on heart failure or abdominal pain it would be rare for a consultant to assess the junior's ability to perform a full and thorough systems examination. But more common to find the consultant demanding whether an ECHO had been urgently requested or when the abdominal CT scan was likely to happen, respectively. Not to mention whether the junior in question had been apt enough to make an urgent referral to the necessary specialist teams. And as for a discussion on the latest evidence base of heart failure management or the choice of imaging in abdominal pain... again... unlikely. As for the 'gold standard' portfolio, well the reality of a true analysis around a clinical case or observation of a procedural skill is typically non-existent. As the junior's attachment to the firm comes to a close it is often too common for their supervisor to 'tick the box' globally as opposed to hone in on a specific case in question.
Of course don't just take my word for it. The GMC's National Training Survey 2013 noted that only 66.9 % of doctors in training rated the quality of teaching locally or in their department as excellent or good and that 30.8 % reported that they rarely or never had informal feedback from a senior clinician on their performance. Hardly comforting findings.
The UK certainly prides itself on delivering first class healthcare. The NHS as its backbone is prime example of its aim to showcase to the world how much resolve the country has to enable individuals to receive optimisation of their health with no financial strain. So what is the solution? Well, in order to maintain such standing globally, it is important therefore that our future clinicians are taken care of and mentored appropriately with adequate time being made available for enforcing clinical knowledge, application and feedback in the first instance. Better yet with the rising popularity of medical education as an entity in itself, a desire to develop individuals primed specifically to mentor who themselves have been trained and assessed in the art of mentorship. Of course there is no easy answer but the culture of 'Do It Yourself Medicine' must change and change urgently.