you are asked what is meant by the term “coach.” How would you describe the role of the coach?
Write your response on a piece of paper and then compare your response with the one found at the end of this chapter.
Clinical skills are developed through a process known as coaching. The coaching process includes three closely related phases:
Demonstration of the clinical skill by the trainer;
Practice of the skill by the participant under the supervision of the trainer, first on models and then with clients; and
Evaluation of the participant’s skill competency by the trainer.
Coaching refers to a general philosophy or approach to training, as well as a specific activity carried out during a training session in order to help a learner learn something new. It involves the use of active listening, questioning and positive feedback and the development of problem-solving skills to help create a positive learning climate. Helping a learner, through coaching—to analyze and apply new information, develop a new clinical skill or address a certain attitude—is one of the most important roles of a clinical trainer. In this role, the he clinical trainer is able to guide the learner through the learning stages, while enhancing and maintaining and learner confidence and self-esteem that are critical to independence.
Training Perspectives: Coaching to Competency
As a trainer, you have a range of training techniques and tools to assist you in developing the competency of your learners. But there may be no single technique or tool that is as critical to your role as the ability to coach. Coaching helps close the gap between desired performance and the practices, beliefs and attitudes that your learners bring with them—without embarrassing or belittling them. Because it is not overly authoritative in tone, it blurs the traditional line between teacher and learner—calling upon learners to take an increasingly active role in discovering, exploring and developing their own abilities.
Communicating during Coaching
How the trainer communicates during coaching is key to the technique’s effectiveness. Active listening, using questions and providing feedback are all important coaching tools for developing learner competency.
Active Listening during Coaching
Active listening is a communication technique that enables a clinical trainer to stimulate open and frank exploration of ideas and feelings and establish trust and rapport with learners. It helps the clinical trainer clarify learner comments and enables the learner to be heard and understood. In active listening, the trainer accepts what is being said without making any value judgments, clarifies the ideas or feelings being expressed and reflects these back to learners.
The following are examples of active listening techniques:
Stop talking and listen to the speaker.
Restate the speaker’s exact words.
Paraphrase in your own words what the speaker said.
“Reflect back” the underlying feelings/emotions of the speaker.
Active listening is a powerful communication tool that can be used to shape learning and reinforce correct information, good practices and positive attitudes in a supportive way. It can also “draw the learner out” to explore and expand further on their thought processes, beliefs and feelings. When actively listening, it is appropriate to:
Maintain a nonjudgmental tone, refraining from questions that have only one correct answer.
Ask open, “non-leading” questions such as, “Can you tell me more about that?” When asking “probing” questions, avoid making it sound like you are “cross-
examining” or doubting the learner. “That’s an interesting choice you made there. Can you share your reasons with us?” or “The client still seems upset. What are some other things you might try to reassure her?”
Ask for clarification, when needed; for example, “I’m not sure I fully understand what you are saying—can you explain more?” or “I’m confused as to what your exact question is—can you try putting it another way?”
Identify with the speaker’s emotions and state the implications of those feelings; for example: “It sounds like you were concerned that the woman’s family might not support her decision. That must have made it difficult to counsel her with them present.”
Everyone likes being heard and appreciated. Supportive comments from the clinical trainer strengthen and reinforce desired behavior.
Using Questions during Coaching
Questioning is used during coaching learners as they develop new knowledge, types of skills and attitudes. Questioning does not mean interrogating. The trainer should let learners know that the purpose of questioning is to help target instruction, not to berate and belittle them. Asking them what they know and what they want to learn will help assess their needs and focus training more precisely.
Questions can range from those that elicit for facts and information to those that present new or hypothetical situations for consideration. Questions can also assess learner
progress and help learners apply new competencies. Questions are very important in developing and assessing decision-making skills. Examples of such questions are:
Factual questions, beginning with what, where or when, that obtain information and begin discussion—“Many of your clients are pregnant women. When would you first talk to them about postpartum family planning?”
Broadening questions that assess additional knowledge—“If your diagnostics
revealed X, how would that change your treatment plan?”
Justifying questions that challenge ideas and assess depth of knowledge and understanding—“Why did you select that as your working diagnosis?”
Hypothetical questions that explore new situations—“If the client had this condition, what specific questions would you ask during the medical history?”
Alternative questions that assess decision-making skills—“If the treatment you identified resulted in Y outcome, how would you change your diagnosis and treatment plan?”
Probing questions to help address attitudes—“If the client responds in this way, what would your personal opinion be of that person? How can you maintain a professional attitude?”
Providing Feedback during Coaching
Providing feedback is essential throughout the coaching process, whether it is feedback on knowledge, skill or attitudinal assessments.
Guidelines for the clinical trainer to follow in giving feedback are:
Be timely. Give your feedback soon after the event.
Be specific. Describe specific behaviors and reactions, particularly those that the learner should keep and those that should be changed.
Be descriptive, not judgmental. Describe the consequences of the behavior; do not
judge the person. Examples:
Descriptive, specific feedback: “When you gave the injection of local anesthetic, you did not tell the client what to expect. I saw her wince and tense up, making it difficult for you to gain her cooperation later in the procedure.”
Judgmental, non-specific feedback: “You always seem to be in such a hurry that you completely ignore the client’s needs.”
Take responsibility for your own feedback. Speak for yourself, not for others. Guidelines for the learner to follow in receiving feedback include:
Ask for it. Find clinical trainers who will be direct. Ask them to be specific and descriptive.
Direct it. If you need information to answer a question or to pursue a learning objective, ask for it.
Accept it. Do not defend or justify your behavior. Listen to what people have to say and thank them. Use what is helpful; quietly discard the rest.
Characteristics of an Effective Coach
Situation 3-2: You are conducting a clinical skills course. During the last day of the course