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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3144 — Professional Coaching for Physicians: Feasibility and Implementation in the Primary Care Setting

Sternke EAMiech EMApel SECarlson KAllen A, and Frankel RM, Richard L. Roudebush VAMC, Indianapolis/Stroke-QUERI;

Objectives:
To examine the feasibility of conducting and implementing a communication enhancement coaching intervention for VA primary care physicians.

Methods:
Physicians in the Roudebush outpatient clinics and up to three of their patients were recruited and randomized to either an intervention or control group. Both a baseline and a follow-up visit were recorded via unmanned video cameras. These videos were employed to examine the communication patterns of physicians in order to tailor the coaching sessions. A one-time professional coaching intervention occurred prior to the follow-up visit. The “Four Habits” model was used as a framework for structuring the coaching sessions. This is a validated evidence-based model for improving clinic visits with a special emphasis on agenda-setting.

Results:
Five VA primary care physicians were recruited into the intervention arm and all five completed the coaching intervention, where the videorecordings were reviewed, and three initiated requests for additional coaching sessions. In all cases, agenda-setting at the beginning of the visit was an opportunity for improvement for these VA physicians and a topic for discussion during the one-on-one professional coaching sessions. Upon reviewing the difference between baseline and follow-up visit video recordings there were examples of observable improvements in agenda-setting by participating physicians.

Implications:
Professional coaching with primary care physicians at the VA is feasible. One-on-one coaching for VA primary care physicians can be highly engaging for physicians and can lead to discernible changes in physician behavior in agenda-setting. These findings come at a time when there appears to be renewed interest in coaching for experts and professionals, including physicians (see Atul Gawande’s article “Personal Best’ in THE NEW YORKER, October 3, 2011) and as the VA begins employing the PACT model of patient care.

Impacts:
Improved physician patient communication has been linked with positive functional and clinical outcomes. A one-hour professional coaching intervention based on the “Four Habits” Model produced measurable change in a critical component of the medical visit, setting the agenda with patients at the beginning of the visit. Future research will need to be conducted on the efficacy and effectiveness of professional coaching for other aspects of the medical interview.


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