Coaching models for GP Trainers - HEE NE

Coaching models for GP Trainers

Iain Lawther

Associate Director

What is coaching?

What is coaching?

• Coaching is a form of development

• The experienced ‘coach’ supports a

learner (often called the ‘coachee’) in

achieving specific personal or professional

goals

• This is facilitated by providing guidance

and training using specific models or

experience

Why use coaching models in training?

Why use coaching models in training?• GP Training is becoming increasingly

complex and challenging

– Curriculum changes and extensions

– Different ways of working

– New consultation modes and models

– New assessment tools

• RCA, CATs, Prescribing Assessments

– Erosion of teaching time

• Increased emphasis on assessments

• Surges in patient demand

• Clinical and staffing pressures

Why use coaching models in training?• Supervision of multiple learners

– More GPRs and fewer Trainers

– Multi-disciplinary training and supervision

• Nurse Practitioners, Advanced Practitioners

• Higher numbers of IMGs

– Additional teaching requirements

– NHS and cultural orientation

– More intense and individual support

– Communication skills training

– Managing more examination failures

Why use coaching models in training?• Coaching can be an effective approach to

supplementing traditional GPR teaching

– Success rates are high

• Formal coaching training isn’t needed to

use the simple models effectively

– Many descriptions are available online with

structured support information

• We’ll look at eight common options that

are really useful across a range of

scenarios

Section 1

• Setting goals and actions

• Structuring progress

The Whitmore GROW model

• What is it?

– A really simple model for action-orientated

coaching

• When might it be used?

– When the GPR is ready to explore options

and take action

• Why is it useful?

– Encourages self-directed solutions,

responsibility and taking ownership


Goal Reality Options Will


• Using the model

– Goal

• Ask about what will be achieved and how it might

help the current situation

• Try and agree an expected timescale

– Reality

• Explore what is happening now, who is involved

and what has been tried before

• Emphasise what is achievable

• Discuss how near the goal actually feels


– Options

• Look at the choices available

• Discuss the pros and cons of each

• Ask what other people might do

– Will (or Way forward)

• Agree the preferred option(s)

• Define what success might look like

• Explore the elimination of perceived barriers

• Garner support if required

• Set a first step and a start date


• Group discussion

Logical Levels of Change

• What is it?

– A tool to help identify where progress blocks

exist


– When the GPR is struggling to identify what

needs to change


– The process is straightforward, encourages

insight and gets to root causes


Environment

Behaviours

Knowledge and skills

Beliefs, values and motivations

IDENTITY


• Using the model

– Start with identity

• Ask the GPR to describe their sense of self and

personality

• Explore self-perceptions, such as optimism,

extroversion or feelings

– Explore beliefs

• Explore the internal voice controlling actions

• Consider motivations

• Recognise prejudices and preconceptions


– Knowledge and skills

• Discuss strengths and attributes

• Link existing skills to different situations

– Behaviours

• Explore what the GPR thinks, says and does

• Describe activities, roles and relationships with

others

– Environment

• Consider the workplace, rotas, structures,

demands and resources

Section 2

• Overcoming negative thinking

• Encouraging commitment

ANTs and PETs• What is it?

– A tool that looks at automatic negative

thoughts (ANTs) and performance enhancing

thoughts (PETs)


– When the GPR is doubting their ability to

reach a goal or to explore blocks to progress

– Scaling questions can add reinforcement


– It is an easy acronym to remember and the

process is simple and safe

ANTs and PETs

Event

ANTs

FeelingsEvaluation

PETs

ANTs and PETs

• Using the tool

– Ask the GPR to consider a stressful event or

situation

• Explore any negative language

– Examples include “I can’t do X”, or “Y is not an option”

– Discuss any identified ANTs

• Reflect on these objectively

– Are the ANTs wanted, helpful or logical?

– Move on to PETs

• Consider motivational statements

– Encourage reinforcement and transfer to other situations

ANTs and PETs


Precision questions

• What is it?

– A tool to challenge negative responses to

questions


– When the GPR has failed to engage or

commit to progress


– If a brick wall is reached, it gives a fresh

approach to challenging the GPR

Precision questions

• Using the tool

– Identify generalisations

• Listen for words such as ‘never’, ‘everyone’ and

‘always’

– Probe perceived process limitations

• These thoughts blame processes, using words

such as ‘can’t’, ‘ought’, ‘should’ and ‘must’

– Consider emotions

• Frustration, anger and irritation are common

feelings and require exploration

Precision questionsWhen you hear this… Examples Respond with this…

“Never…”

“Everyone…”

“Always…”

“He’ll never agree to that”

“Everyone thinks that the system

is poor”

“They always get this wrong”

“What, never?”

“Literally everyone?”

“What, always?”

“Can’t…”

“Ought…”

“Should…”

“Must…”

“You can’t change that”

“I ought to check”

“They should do it”

“I must get approval”

“What if you could?”

“What if you didn’t?”

“Why can’t you?”

“Must you, really?”

Emotional expressions of

frustration, anger, irritation or

other negative perceptions

“This is such a frustrating

process”

“She really irritated me”

“In what way?”

“Why did you feel irritated?”

Precision questions


Section 3

• Changing behaviours

• Increasing behavioural awareness

The Karpman Drama Triangle

• What is it?

– A depiction of the three classic roles of victim,

persecutor and rescuer


– When the GPR is stuck in a situation and is

unaware their behaviour is perpetuating the

problem


– Recognition that the three roles are

interdependent and sustain each other


Victim

Rescuer

Adult to adult conversation

Persecutor


• Using the model

– Ask the GPR to consider their current position

• The victim acts like a child, blames others and

rejects ownership

• The persecutor acts like a critical or dismissive

parent

• The rescuer acts like a nurturing parent and needs

positive affirmation

– Recognise there is no ownership, repeated transfer of

blame and feelings of helpfulness

– The situation is now self-perpetuating


– Breaking the cycle

• An adult to adult conversation is needed

– Ask open and specific questions

– Show understanding of other people’s feelings

– Listen attentively

– Admit openly to mistakes

– Check the facts

• The adult is:

– Controlled, dispassionate and evaluative of the facts

– Their actions are expedient, appropriate, unbiased, calm,

rational and consistent

Behaviour styles

• What is it?

– A model by Blake and Mouton exploring two

personality axes from Myers Briggs (E and I,

and T and F)


– When the GPR needs to focus on

relationships, particularly dysfunctional ones


– The styles are easy to understand and

recognise in others

Behaviour styles

Amiable Expressive

Analytical Driven

Relationship focus

Responsiveness

Task focus

AssertivenessHigh

High

Low

Low

Behaviour styles

• Using the model

– The model considers the characteristics of an

individual with regards to task and relationship

– The four style domains consider

responsiveness and assertiveness and place

the GPR in one area

– No one area is better than another, but

diagonally opposite styles are the most

contrasting

– The GPR should gain greater insight into

different styles and how to work effectively

Behaviour styles

• Ideas to communicate with other styles:

Break the ice

Listen and respond

Be lively

Canvass ideas and opinions

Be prepared

Cover all bases

Be brief

Get to the point

Behaviour styles


Section 4

• Managing conflict

• Understanding relationship dynamics

The Thomas Kilmann conflict model• What is it?

– A model to explore ways of handling conflict

– Uses two axes of graduated assertiveness

and cooperativeness


– When the GPR needs to understand the

approaches available and their default style


– Easy to understand and helps facilitate

collaboration and conflict resolution

The Thomas Kilmann conflict model


• Using the model

– Ask the GPR to reflect on current and earlier

conflict situations (personal or situational)

– Consider where in the model they are now

– Explore where they would like to be

• In some cases, compromise might be a better

outcome than collaboration

– Use the GPR’s current skills, perceived

strengths and previous experiences to agree

a way forward

Thomas Kilmann behavioural interactions

DEMAND

win-lose

NEGOTIATE

win-win

WITHDRAW

lose-lose

CONCEDE

lose-win

I’m aggressive,

you’re passive

We’re both

assertive

We’re both

passive or

aggressive

I’m passive,

you’re

aggressive

I win

I lose

You winYou lose

Section 5

• Giving positive feedback

• Encouraging forward thinking

The BOFF model

• What is it?

– A really simple tool for providing constructive

feedback


– When the GPR needs greater awareness of

the impact of their actions


– The acronym is easy to remember and

presents feedback constructively

The BOFF model

Behaviour OutcomeFact or Feeling

Future

The BOFF model

• Using the model

– Behaviour

• Ask about what the GPR did or said

– “You explained things very clearly to the patient”, versus

“You used a number of medical terms in your

explanation”

– Outcome

• Explore what the outcome was, why it mattered

and what happened next

– “This helped the patient understand their condition”,

versus “They didn’t understand and you had to go over

the key points again”

The BOFF model

– Fact or Feeling

• Share how this made you, as the Trainer, feel

– “I was really pleased for you. I know this is an area

you’ve worked hard on”, versus “I was a little confused.

We’ve discussed using clear language a few times and I

know you’ve found some good phrases to use”

– Future

• Explain what you’d like to happen in the future

– “Tell me how you might go about explaining a different

condition”, versus “What do you think happens with

patients that doesn’t happen when you’re here with me?”

The BOFF model


Overall summary

• Many simple coaching models exist

• Coaching models are:

– Straightforward to use without formal training

– Easy to remember

– Wide-ranging

– Evidence-based and effective

• Coaching really can enhance GPR training

– Give some options a try!

Thank you for your participation

Any questions?

Coaching models for GP Trainers - HEE NE

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