As hospitalists, our most powerful role is to empower the next generation of physicians.
This requires shifting our mindset from evaluating past performance to actively coaching future potential.
By adopting a 6-step framework (Chapter 6: Coaching in the Inpatient Setting: Getting Learners to Maximize Their Potential in “Teaching and Coaching in the Hospital”), I’ll explain my approach to transforming the busy wards into a continuous engine for maximizing learner engagement and growth, fostering Master Adaptive Learners (MALs).
Day 1: Laying the Foundation for Partnership (Steps 1 & 2)
The first day is dedicated to building trust and defining success, shifting my role from Evaluator to Partner/Coach.
Step 1: Create a Psychologically Safe Learning Environment
On day 1, I set clear expectations for the roles and scope of work for everyone—from the third-year student to the senior resident.
By explicitly defining the expected level of function from me up front, I can focus on coaching their own goals and step away from the purely evaluative role.
I normalize the process of learning. I share a moment of vulnerability by stating one of my own current learning goals (e.g., “I'm working on finding an effective way to share articles so you can all easily access and use them.”).
This simple act reinforces that growth is the standard for everyone, including the attending, making it safer for learners to disclose their own struggles.
Step 2: Establish Value-Based, Self-Directed Goals
After setting my clear expectations, I dedicate time in the afternoon to meeting one-on-one with each learner. This private setting allows me to focus my coaching and provide the necessary space for them to truly reflect.
Who They Are & Their Vision: I start by asking about their passion and long-term career plan. I then ask the defining question:
"What does a truly successful rotation look like for you, and why is that important for your future career?"
Coaching for Clarity: Most learners start with broad goals like "be more efficient" or "be more confident."
I use empowering questions to help them visualize success and transform the goal into an actionable commitment.
For a new intern, this might become: "By the end of this rotation, I will be able to admit two new patients with common conditions without much support from the senior resident on a call day, and I will still finish all documentation on time."
The Power of Ownership/Agency: Since the goal is self-identified, the subsequent microfeedback is automatically interpreted as help toward their defined success, not criticism from an evaluator.
Group vs. private goal settings
Goal setting is a skill to learn. Learners can learn from others’ goal setting in group goal setting.
I prefer goal setting in a private meeting. I respect their time and want to be fully present when I am having a coaching conversation.
I personally feel safer to speak more in a private setting, so I choose one-on-one meetings.
Both approaches have pros and cons. It is ultimately your choice.
One thing that I want to try is to use an online worksheet to document and update these goals frequently, keeping them central to our daily work.
Day-to-Day: The Systematic Coaching Cycle (Steps 3, 4, & 5)
My teaching rounding structure is designed to separate clinical reasoning (decision-making) from bedside communication, providing maximum opportunity for direct observation and safe practice.
Phase 1: Table Rounds in the Workroom (Coaching Reasoning)
We begin the day in the workroom to run the list, clarify plans, and address questions.
This can take 30 to 45 min depending on the patient volume and acuity.
Here, learners are instructed to share any major changes, what plans they are going to tell their patient, and any clinical questions.
This is where intellectual vulnerability is encouraged (in a quiet and safe place rather than at bedside).
Step 3: Practice Direct Observation: Even if a learner does not ask about a newly found problem, I intentionally assess clinical reasoning by initiating open questions:
"What do you think is causing this new problem (e.g., AKI)?" or "What do you know about HRS pathophysiology?"
Learning Culture, Not Judgment: When a learner struggles, my "constructive feedback" comes out as encouragement for learning, not correction.
I might say, "I can tell you're reading about your patients' problems, and that will help you show up as a confident physician at the bedside." Or, "I'll share some resources about HRS, but would you mind teaching us about it this afternoon?"
Phase 2: Patient- and Learner-Centered Bedside Rounds (Coaching Communication)
With the team aligned on the plan, we proceed to the bedside—the practice field for communication and… everything combined.
Step 3 & 4: Direct Observation & Find Strengths: The presenter leads the encounter. Introducing the team and roles, transitioning smoothly to presentation, and asking/addressing their questions at the end.
I remain physically out of the patient's immediate focus so the patient can see and focus on their primary physician and the senior resident.
Modeling Excellence: I ensure the senior resident acts as a leader, and I later mention their great approaches as concrete role models (e.g., "Note how Dr. X clearly summarized the discharge plan; that's a great approach to incorporate.")
These small and frequent encouragements capitalized on strengths and successes become a part of microfeedback to both the presenter and the senior resident.
Step 5: Give Frequent Microfeedback
Immediately after leaving the room, the coaching check-in begins. This is high-impact, developmental, and focused on the learner's goal.
1. Start with Reflection (Step 4): "How did it go? What went well?" (Always leveraging their strengths).
2. Reinforce: I offer concrete, strength-based observations (e.g., "You clearly conveyed empathy when discussing the prognosis—that worked well.")
This reinforces trust and ensures the action plan is internally driven, leading to maximum buy-in.
3. Accountability Question: "What is your next step to get closer to your ideal physician self?"
This is the critical developmental question that pushes them to generate their own action plan and build the MAL cycle.
Continuous Improvement: The Coaching Mindset (Step 6)
The final, continuous step is maintaining a culture of growth by framing every challenge positively.
Step 6: Positively Reframe Everything
When a learner misses a key step or struggles, I consistently use reframing strategies built off their identified strengths.
Reframing: Instead of criticism, I offer perspective: "I still find it difficult to manage that tough questions (normalizing), and it is a great learning opportunity for all of us (reframing). How would you approach a similar situation differently next time?"
Conclusion: A Win-Win Approach to Teaching
By consistently applying this 6-step framework, we ensure that every moment on the wards is dedicated to learning and growth.
We stop being evaluators collecting data and start being coaches building capacity, leading to deeper engagement, higher performance, and more resilient future physicians.
Adopting a coaching mindset and these approaches on the wards has truly helped me build a stronger team in a short period of time, significantly enhancing my experience and perceived effectiveness on the teaching service.
It is, quite simply, a win-win approach.
Reference:
Hirotaka Kato, MD, MEd
Clinician-Educator, Physician Peer Coach, Hospitalist
LinkedIn: www.linkedin.com/in/hkato01