I flash a smile as I look up from my notes. “Do it again,” I say, encouraged by his progress, “but this time start with the physical exam.” I am the internal medicine resident leading our “twilight” admitting team, and Vikram, a student on the first day of his medicine clerkship, sits across from me. It is his third time practicing the presentation of Ms. R, a 56-year-old woman with pancreatitis who was recently admitted to our hospital.
When I first met Vikram earlier that day, I explained that I viewed my role as both his evaluator and coach as a conflict of interest and admitted that I could only choose one — I had chosen to be his coach.
Atul Gawande discussed the concept of a medical coach in his New Yorker article “Personal Best,” where he describes the experience of enlisting a former surgical mentor to observe him in the operating room. In the article, he raises the question of why elite performers often have coaches but physicians rarely do and makes the compelling case that dedicated coaching can lead to significant improvement in clinical skills. But what about young physicians, like Vikram or myself, who are still in training? Some would argue that we are surrounded by coaches — our program directors, clinic preceptors and hospital attendings amongst others. However, I would contest that these individuals play the dual role of coach and judge — a task that on the surface seems plausible but contains within it a set of opposing responsibilities.
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