# Coaching with Good Judgment #moc/publish | #on/coaching | #on/goodjudgment | #centerformedicalsimulation # Case studies and examples _Faculty need fluency in coaching with good judgment. Coaching with good judgment has been introduced, but examples of teaching and coaching are fully explored in the literature. This post outlines the values and a framework that can be applied to coaching moments using the with good judgment value system._ ## **Introduction:** ![[Sim training - 2.jpeg]] Coaching as a key skill required for learning leaders in health professions Several coaching frameworks have been used in pause and discuss moments such as R2C2, none use the concepts from [[good judg ment]] Those using with good judgment during their debriefing will want to have a unified framework and value system to reduce the challenge of learning and to have a consistent process to make the experience of being a learner in their programs easier Frameworks are helpful for providing schema for those seeking to acquire a skill We outline a framework based on the four phases of debriefing with good judgment ## **Overview:** [[Good Judgment]]: 1.     Hi standards for the work and Hi regard for the people 2.     Transparency in thinking 3.     Using conversational methods most appropriate for the moment ## **Coaching:** ## **Four-Phases of a coaching conversation:** 1. Introduction: sign posting 2. Reactions: quick check in on feelings and facts 3. Coaching with Good Judgment: raise learning moment/offer options or ideas 4. Future action plan 5. Clear return to the case, they need an opportunity to do it again ### **Examples:** #### **1)**    **Pause and Discuss during a simulation:** **Here’s the model:** ![[Sim training - 1.jpeg]] 1. _I’m going to pause right here: The patient is suspended in time, they won’t get better or worse while we talk. Let’s take two minutes for a quick coaching conversation, first we will do a quick check in, then I’ll share some approaches I hope you find helpful to reducing the time off chest during a rhythm check and explicitly declaring a leader, then we will rehearse putting them into action, then I’ll step out and we will restart from where we are._ 2. _First quick reactions to where we were at, how are you doing right now? We just spent the first 90 seconds in a cardiac arrest scenario for a patient who’s not in a medical bed location, is that how you’re seeing it? Anything we need to clear up before coaching?_ 3. Now into the coaching: - _Let’s talk about minimizing time off chest during a rhythm check_ _That last rhythm check actually took 21 seconds, our goal is less than 10 seconds_ _What works for me is when I am the person running on the left-hand side of the facing OK rhythm then if anybody stops compressions make sure they stay on compressions until we’re charged. That way the moment compression stop. I’m ready to deliver the shock and I’m already looking at the team so I can clear them and defibrillate. It usually only takes about 3 to 5 seconds._ _Let's try that right now_ - _I would like to talk about the importance of explicitly declaring a team leader ._ _I noticed that there was lots of leaderly activities, but I'm not seeing anybody with their hand up clearly designated the team leader._ _How do we get to that point? I'm going to offer some ideas, but I really want you to consider like what would work for you._ _A proposal is you have to take the initiative to explicitly declare yourself a leader, or we have to ask who’s leading this team? What would that look like to you guys?_ _Let's practice right here._ 1. _Now, I'll step out and you can put reducing time off chest and assigning a leader explicitly into action. The case will restart with 15 seconds before the rhythm check, right when I close the door._ #### **2)**    **Faculty development peer coaching:** **Here’s the model:** _a. I’m going to pause right here: The conversation is suspended in time_ _Let’s take two minutes for a quick coaching conversation, first we will do a quick check in, then I’ll share some approaches I hope you find helpful to ensuring a specific observation, then we will rehearse putting them into action, then I’ll step back and we will restart from where we are._ _First quick reactions to where we were at, how are you doing right now? You just gave the introduction and reactions section, and now you’re forming a Preview, Advocacy-Inquiry statement, is that how you’re seeing it? Anything we need to clear up before coaching?_  _I’d like to talk about the importance of having a specific observation._ _I saw a clear preview to inform the conversation, I did not see a specific observation, instead I saw an inference, which was “You weren’t acting like a leader”_ _I’m thinking a clear observation in that moment would sound something like “I didn’t see anyone declared the explicit leader.”_ _Let’s brainstorm right now how you want to say that so that it was not an inference but instead is a clear observation._ _Now, I'll step back and you can put a specific observation into action in your Preview-Advocacy-Inquiry moment._ #### **3)**    **During a clinical moment, building a resuscitation team leader:** ### What about questions that come up? Here you have a choice, best to ask them to experiment with the answer and see what happens. Alternatively, you could defer it and plan to discuss at debrief. #### Example from case study 1 RCDP cardiac arrest: - I'm left-handed, should I still stand on the right? - _Go ahead and experiment, do it one round on the left and one round on the right and see how it feels._ - Why should I name myself as team leader, I'm the emergency physician, they always see me as team leader? - _Great question, why don't we try naming yourself right now, then in the debrief we will talk more about why this is important, and see how the team felt._ ## **Conclusion:** By providing some examples of coaching during action, using with good judgment, we hope we have provided a framework for you to implement these ideas.