CBD and coaching
Understanding the CBD Coaching Model
The Royal College has developed a coaching model to support resident learning.
The CBD Coaching Model is part of an important philosophical shift in thinking about assessment and its purpose. In shifting emphasis from Assessment OF Learning (summative assessment) to Assessment FOR Learning (formative assessment), the Coaching Model uses assessment as a learning tool, not just an evaluation method.
CBD Coaching Resources
The Coaching Model Diagram
The CBD Coaching Model includes 2 coaching components:
- Coaching in the Moment
- Coaching over Time
In CBD, clinicians are encouraged to think of themselves as coaches. “Coaching feedback” is a conversation between resident and clinician, and is meant to guide learners through a growth process that leads to performance enhancement. Coaching feedback tells residents what was witnessed during a direct or indirect observation, and, most importantly, focuses on specific actionable suggestions for improvement. In other words, coaching feedback helps a resident understand what adjustments and modifications will allow them to progress to the next level of capability/proficiency.
Coaching in Practice
Coaching in the Moment
Coaching in the Moment requires clinicians to establish rapport and set expectations with their residents, observe the residents doing their daily work, provide coaching feedback, and record the encounter. Frequent observation is a key ingredient in resident learning and assessment.
Coaching in the Moment follows the RX-OCR step-by-step process:
- Establishing educational Rapport between the resident and the clinician (an educational alliance or partnership)
- Set eXpectations for an encounter (discuss learning goals).
- Observe the resident (directly or indirectly).
- Engage in a Coaching conversation for the purpose of improvement of that work (“coaching”).
- Record a summary of the encounter.
Over time, many “Coaching in the Moment” conversations and documented summaries help build a complete picture of a resident’s progress, which is stored in a resident’s ePortfolio (eP) and informs the work of a program’s competence committee.
Coaching Over Time
Coaching over Time requires a longitudinal relationship between a clinical faculty member and a resident. This educational partnership lasts longer than any one clinical experience. It requires regularly scheduled face-to-face discussions about the resident’s progression toward competence. Learning opportunities are planned to address any recognized performance patterns. For an educational partnership to work well, residents must feel confident that the clinician has the resident’s best learning interests in mind.
This component of the model, in particular, focuses on helping the resident become an independent, competent clinician that is prepared for a career as a self-regulated learner.
Coaching and Learner Progression
A modification of the Coaching Model highlights an important relationship between coaching and a resident’s progression through the CBD stages of training.
This “coaching and progression” diagram shows the addition of a competence committee. This addition is meant to illustrate that a competence committee regularly reviews data from multiple EPA and milestone observations to make evidence-informed decisions about when a resident is ready to progress to the next stage of their program.
A resident and their “Coach over Time” will often use competence committee reviews and recommendations to inform the resident’s learning and performance goals.
The Royal College would like to thank the following individuals for their assistance in developing the coaching model:
- Denyse Richardson, MD, MEd, FRCPC
- Carol Aschenbrener, MD; Former Chief Medical Education Officer, AAMC (retired); currently Executive Coach
- Farhan Bhanji, MD, MHPE, FRCPC
- Marissa Bonyun, MD, MEd
- Rose Hatala, MD, MSc, FRCPC
- Shelley Ross, PhD
- Joan Sargeant, MEd, PhD
- Shirley Schipper, MD, CCFP, FCFP
- Chris Watling MD, MMEd, PhD, FRCP(C)
Tools and resources
- CBD Coaching Model PowerPoint Slides
- The Competence by Design (CBD) Coaching Model handout (2 pager)
- Video Snippet* (01:00) The Coaching Model for CBD
- Workplace-based Assessment Implementation Guide: formative tips for medical teaching practice
- Understanding Workplace-based Assessment and CBD handout
- Competence Committees — Guidelines for the Terms of Reference
- Competence Committees — Process and Procedures in Decision Making: A framework
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