It Takes a Village: Optimal Graduate Medical Education Requires a Deliberately Developmental Organization

Centering on self-improvement makes growth and future performance more highly valued than current performance and combats tendency to hide weaknesses and errors

Regularly identify and share growth goals

Coaches recast failures as opportunities, helping learners to surface and exploit suboptimal performance rather than hide weaknesses

Promote regular sharing of growth goals by faculty and trainees (start of procedure/shift, during conference, etc.)

Combat tendency to hide weakness by supporting both self-assessment and disclosure

Prioritize individual growth as central to organizational success through valuing a developmental orientation in recruiting and evaluating learners & establishing structural frameworks and incentives for goal-setting and sharing

Create and protect forums for interprofessional colleagues to share growth goals across professional boundaries

Strengthen program requirements around setting and supporting implementation of learning goals

Leverage entrustable professional activities and milestones to support programs in building curricular structures that regularly share identified weaknesses with individuals

Create requirements around setting improvement goals for maintenance of certification

Embrace responsibility for pursuing one’s own growth and for helping others do the same

Approach coaching interactions open to feedback and trusting the other’s commitment to one’s development

Faculty and interprofessional colleagues exemplify openness to coaching by showing humility, engaging in intellectual candor, and asking for feedback on self-identified weaknesses and unknown gaps

Coaching not limited to individual relationships: train all faculty and trainees on coaching and being coached

Spaces are created for coaching exchanges during clinical care and/or educational routines

Leaders are “chief coaches” while demonstrably inviting coaching and visibly working on growing themselves

Optimize support for continuously being coached and asked to grow; this includes role modeling from leadership, protecting and incentivizing coaching, and ensuring a supportive clinical learning environment

Facilitate inter-professional coaching: create spaces for exchange of feedback, empower other professions to coach

Competence in coaching treated as essential to the profession and embedded in program requirements/assessments

Commitment to coaching reinforced by incorporation in professional organizations’ requirements for certification

Make internal operations public and invite feedback to identify personal tendencies, gaps, and blind spots

Assume responsibility for self-reflection and improvement, including searching for and pursuing constructive destabilization (activities resulting in feelings of inadequacy or incompetence, representing opportunities for growth)

Respond to moments of learner vulnerability (sharing internal operations, identifying personal weaknesses) with respect and support, avoiding judgement

Faculty encourage trainees to experience constructive destabilization and reframe resulting feelings of incompetence as learning opportunities; faculty pursue their own opportunities for constructive destabilization

Transform clinical and didactic offerings into safe spaces with explicitly stated expectations of non-judgment and a focus on improvement (as is the case in Morbidity & Mortality and quality improvement sessions)

Develop conversational routines and activities to 1) engage individuals in reflecting on and sharing personal tendencies and internal thought processes and 2) promote feedback from others in response

Use assessment data and competency mapping to design training to promote graduated challenges

Establish expectations that all trainees and professionals adhere to a culture of “well-held vulnerability”

Structure training and professional development programs to expose individuals to areas in which less proficient

Allow assessments of competency to inform individualization of training to promote graduated challenges

Support programs in using assessments of competency to match gaps to required graduate and continuing medical education and other professional development activities

Incorporate self-reflection and sharing feedback into certification and maintenance of certification by professional bodies