Transcript 8/12: Goal-Setting and ILPs

COACHING:
GOAL-SETTING
Coaching Meeting
Carrie Rassbach, MD
August 12, 2013
Objectives
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Why do we need goals?
When do we create goals?
How do we evaluate the quality of goals?
Application to coaching
Why do we need goals?
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The relationship between clinical experience and better
patient care is not always linear
Generally we think that clinical expertise improves with
experience
Physicians in practice for more than 20 years have declining
knowledge of current medical evidence and practice
guidelines and provide lower quality of care to their patients
compared with physicians in practice fewer than 10 years
Chaudhry et al. “Systematic review: the relationship between clinical experience
and quality of health care.” Ann Intern Med. 2005;142:260-273.
Adult Learning Theory
Adults learn best when they are actively engaged in the
learning process and self-direct their own learning goals
and activities
 Experience is the richest source of learning, and we
must reflect on our experiences
 In adult learning, the role of the teacher is to engage the
learner’s needs
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Why do we need goals (cont’d)?
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There is some evidence that writing down goals is
important to goal attainment
“Reflective practice” promotes continual learning from
clinical experience through understanding current
limitations
Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292.
Creating goals or assigning goals?
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“I’m always ready to learn, although I do not always like
to be taught.”
-Winston Churchill
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“That is too important to be taught; it must be learned.”
-Carl Rogers
When do we create goals?
Residents: Individualized Learning Plans (ILPs)
◦ Tool to help develop self-directed, lifelong learning skills
◦ Required by RC/ACGME for all pediatric residents and
fellows
 Practicing physicians: Maintenance of Certification (MOC),
part 2
◦ Pediatricians required to assess and enhance knowledge
in areas important to their practice
◦ Required by ABP for practicing physicians
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Components of an ILP
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Reflection on long-term career goals and selfassessment of areas of strength/weakness
Goal generation
Development of plans/strategies to achieve the goal
Assessment of progress on goals
Based on assessment, revision of goals/goal plans
Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped.
2010;10:289-292.
Attitudes toward ILPs
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Residents & faculty agree that self-assessment and selfdirected learning improves patient care
Both groups were comfortable assessing their
strengths/weaknesses & setting goals for improvement
Residents less likely than faculty to continuously assess their
performance
Residents were more likely to believe that assigned clinical
and curricular experiences were sufficient to make them
competent physicians
Li ST et al. “Pediatric resident and faculty attitudes toward self-assessment and self-directed
learning: a cross-sectional study.” BMC Medical Education. 2009;9(16).
Obstacles with ILPs: Resident comments
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“I often don’t know what to work on”
“Recommendations for specific goals would be helpful”
“Sometimes I’m too tired or busy to really focus on my
goals.”
Stuart E, Sectish T, Huffman L. “Are Residents Ready for Self-Directed Learning? A Pilot Program
of Individualized Learning Plans in Continuity Clinic.” Amb Ped. 2005;5(5)298-301.
Li ST et al. “Successful Self-Directed Lifelong Learning in Medicine: A Conceptual Model Derived
From Qualitative Analysis of a National Survey of Pediatric Residents.” Acad Med. 2010;85(7)12291236.
Types of goals residents set
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Long-term goals
◦ More global
◦ Often based on attributes
◦ Career-focused
Short-term goals
◦ Often based on cognitive needs
Types of goals residents set (cont’d)
Medical knowledge 57%
 Patient care 25.9%
 Interpersonal and communication skills 3.8%
 Practice-based learning and improvement 10.7%
 Professionalism 1.5%
 Systems-based practice 1%
 Future practice 3.4%
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Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning
Goal Set?” Acad Med. 2011;86(10)1293-1299.
Factors affecting progress in achieving goals
Residents’ use of a system to track progress on achieving
learning goals
 Propensity for lifelong learning (as assessed by validated
Jefferson Scale of Physician Lifelong Learning).
 Greater confidence in self-directed learning abilities
 Greater time since last ILP
 (Being undecided on specialty associated with less
progress in achieving goals)
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Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning
Goal Set?” Acad Med. 2011;86(10)1293-1299.
How do we assess the quality of goals?
I-SMART goals
Important
 Specific
 Measurable
 Accountable
 Realistic
 Timeline
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I-SMART goals
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Important: relevant to the learner and prioritized by the learner as
important to achieve
Specific: with broad goals broken into incremental steps and specific
plan for each step
Measurable
Accountable: with reminder and tracking systems and building in
internal and external accountability
Realistic: achievable goals which utilize existing opportunities and
constant self-adjustment
Timeline: for completing the goal (and incorporating the goal into their
daily routine)
Examples of goals:
I will improve my use of evidence-based medicine by
forming a clinical question based on a patient encounter
every week and read about it in the medical literature
 I will improve my EKG interpretation by taking a course
on EKG interpretation and reading 1 EKG per week and
comparing my EKG read to that of the cardiologist
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Application to coaching:
Practicing goal-setting
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Create 2 goals related to your role as a coach
Create 2 goals related to your clinical or administrative
duties
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Important
Specific
Measurable
Accountable
Realistic
Timeline
Pearls for Facilitation of ILPs
Actively listen
 Use self-assessment to highlight abilities
 Encourage I-SMART goals
 Encourage near-term and long-term goals
 Do not be too judgmental
 Consider maintaining your own ILP
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Adapted from: Burke A. “Individualized Learning Plans: A Construct to Promote More Effective
Learning.” MedEdPORTAL. May 2009.
Questions for Coaches
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What modifications, if any, should we make to the ILP
form?
Should we break goals down into near-term and longterm goals?
Should we break goals down into career-related goals
and skills-related goals?
Who should review the ILP: the coach or the advisor,
or both?
References:
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Burke A. “Individualized Learning Plans: A Construct to Promote More Effective Learning.”
MedEdPORTAL. May 2009.
Chaudhry et al. “Systematic review: the relationship between clinical experience and quality of health
care.” Ann Intern Med. 2005;142:260-273.
Li ST, Burke AE. “Individualized Learning Plans: Basics and Beyond.” Acad Ped. 2010;10:289-292.
Li ST et al. “Pediatric resident and faculty attitudes toward self-assessment and self-directed learning:
a cross-sectional study.” BMC Medical Education. 2009;9(16).
Li ST et al. “Is Residents’ Progress on Individualized Learning Plans Related to the Type of Learning
Goal Set?” Acad Med. 2011;86(10)1293-1299.
Li ST et al. “Factors Associated with Successful Self-Directed Learning Using Individualized Learning
Plans During Pediatric Residency.” Acad Ped. 2010;10(2)124-130.
Li ST et al. “Successful Self-Directed Lifelong Learning in Medicine: A Conceptual Model Derived From
Qualitative Analysis of a National Survey of Pediatric Residents.” Acad Med. 2010;85(7)1229-1236.
Stuart E, Sectish T, Huffman L. “Are Residents Ready for Self-Directed Learning? A Pilot Program of
Individualized Learning Plans in Continuity Clinic.” Amb Ped. 2005;5(5)298-301.