Career Focus

Cultivating a coaching culture

BMJ 1999; 318 doi: http://dx.doi.org/10.1136/bmj.318.7188.2 (Published 03 April 1999) Cite this as: BMJ 1999;318:S2-7188
  1. Sonia Hutton-Taylor
  1. independent career coach and founder of Medical Forum [email protected]

    Sonia Hutton-Taylor from Medical Forum explains why mentoring schemes may fall short of the mark


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    There are many formal, well structured mentor schemes in operation - overlapping the roles of educational supervisors, general practitioner trainers, clinical and general practitioner tutors - and many schemes have started and then fallen by the wayside because of lack of funding or time. And there are many informal yet successful mentoring relationships. 

    But if this quote is anything to go by there may still be people taking on the role of a mentor without any assessment for suitability or training to perform the duty. Do people being allocated a mentor have any right to expect that they will be talking to someone who has received some instruction in the purpose and methodology of the role? One would certainly like to think that mentors are selected for having demonstrated a basic set of skills or personality attributes. Would Victor Meldrew make a good mentor? 

    The word mentoring is bandied about in medical education documents, research into educational support schemes, and workforce reports. It could be argued that many mentoring schemes are merely papering over the cracks. By giving various people the title of mentor and placing others under their guidance, we are solving the need for better support systems - aren't we? However, papering over cracks might give a good cosmetic result, but the underlying structure is still crumbling. The very concept of mentoring assumes a prevailing ethos that promotes and encourages a Merlin-Arthur type relationship, whereas the reality may be far from this. What is needed is not just a handful of allocated or even fully trained mentors but an overall paradigm shift to a culture of coaching, with role models, positive constructive feedback, and good staff management principles. 

    'Mentoring' survivor speaks out

    “Can someone reassure me that mentor appointments (of hospital consultants) are based on some sort of criteria, or does a consultant learn to ‘mentor' on the job? Over the last 5 months, I have been thoroughly disillusioned with my ‘mentor' at work place and starting to wonder if he misunderstood the post to be that of a tor-mentor! If there are any good books written on the subject of ‘mentoring,' I would like to present it to this man as a parting gift, as a service to his future ‘mentees.'”

    Junior doctor on a career email discussion list

    While most would agree that they are desirable, these educational and training principles still go largely unchampioned (like the advisability of registering with a local general practitioner on the first day of your house job rather than self medicating), with only small isolated outbreaks of more structured projects led by the enlightened. Merely being allocated a mentor is not enough. 

    What matters far more than the title of the role is the fact that a person who has more knowledge and experience (and, hopefully, maturity and insight) passes this on to others in a way that empowers them and facilitates personal growth on both sides. For this process to be effective, it requires a contract between the two parties (even if unwritten and informal) and an understanding of what the relationship is supposed to achieve as well as an option for either party to bow out. 

    Coach or mentor?

    It is important to clarify roles at the start of any mentoring or coaching relationship so that the people involved do not get confused - there are many other roles or terminologies around that can conflict with or overlap with the role of mentor. It is not clear to the average junior doctor, for example, what the difference should be between a mentor and an educational supervisor or even a clinical tutor. Definitions of all these roles and their limits of confidentiality should be made clear to all parties. 

    The terms mentoring and coaching are often used interchangeably in the business world, but there is a subtle difference. A “career coach” is someone skilled at developing others in all aspects of their career, including exploring and generating career options, making career choices compatible with values, ensuring work and personal goals are in balance, and encouraging progress in self awareness. A coach tends to take an objective view of the process of making career choices and to be focused on a person's career pathway. 

    Mentoring, however, is the process of a skilled, experienced individual passing on some insight and guidance of his or her work to another person of less experience working in the same or a similar subject. It is a means of sharing information and of developing others in a variety of working skills. However, as mentors may have limited knowledge of career areas or information outside their own specialty, their opinions may be a touch biased (nothing wrong with this, as long as the mentee and mentor are aware of this fact). 

    In a sports analogy, a mentor may be a more senior player on the team who can share knowledge of the competitions, politics, rules, and players, whereas the coach knows the game but focuses more on leading individuals forwards in terms of self development. Good coaches often make good mentors, and vice versa, as the skills required are similar. What is different is the emphasis of the role and the knowledge base, although some people might have the knowledge and skill to perform both roles. 

    The earlier the better

    Promoting a coaching or mentoring culture requires a much broader formalisation of it and resourcing of it than that which takes place at present. The benefits of mentoring should not be available only to the few who happen to stumble on it by accident, are fortunate enough to be allocated a competent mentor, or who have an inherent aptitude for developing mentorships because of good interpersonal skills. Working towards a coaching culture could make the benefits of better human communications available to all. 

    If mentoring was integrated into the culture of medicine at an early stage in medical training the excuses of time and money not being available to sustain it would become less convincing, as it would become part of the furniture so to speak. Encouraging everyone to find a role model, coach, or mentor at the start of their training might help to ensure that those without natural aptitude for networking also benefit from the process. 

    Coaching, mentoring, and the skill of networking are concepts that need to be portrayed as highly desirable and enjoyable from the first year of medical school. Perhaps every student should be allocated someone in the year below them, so that coaching and mentoring are seen as activities that everyone has a responsibility to participate in. 

    The sequelae of the lack of a coaching culture are legion. Too often the skills of coaching, leadership, and staff management are not developed in the people destined for coaching, leadership, and management. This can result in senior doctors being ill equipped for these roles. Doctors frequently struggle on in their careers feeling entirely alone - often floundering or missing opportunities for advancement or greater job satisfaction. It is not unusual to find highly capable doctors who get their certificate of completion of specialist training (CCST) without having undertaken any substantial research whatsoever - something that an effective mentoring relationship would, in theory at least, have picked up and rectified years earlier. 

    How does a coaching culture start?

    The responsibility for developing a coaching culture lies not only on the side of the provider of support. Each individual must recognise the advantages and importance of building up a support network and must acknowledge the duty to offer this support to more junior colleagues. In addition, those responsible for medical education and those with managerial responsibility need to acknowledge that some training resources should be allocated for this activity. The benefits to hospital trusts and to the NHS as a whole in terms of recruitment and retention of doctors are likely to far outweigh any investment. 

    Can we afford not to develop a coaching culture when so many junior doctors are voting with their feet? If the coaching culture is “sold” to everyone as a desirable, worthwhile, and fundamental necessity for the health service and its staff, developing mentoring, role model, or coaching relationships may one day be regarded as mandatory as registering with the GMC and as routine as buying your first skull or stethoscope. 

    We are all mentor and mentee at different times in our careers, and we are all responsible. If you are involved in medical education at any level, introduce the concept of a coaching culture at your next departmental meeting. Ask the training officer in your hospital trust whether any training materials, such as videos or CD roms on coaching or mentoring techniques, are available. Whatever your grade or specialty, make a move towards mentoring someone you know today and contact the people whose opinion you always valued and tell them that it has helped. All external change begins by looking first at yourself. The change to a coaching culture is no exception. 

    Further reading

    • Guidelines on how to develop your own mentor, coach, or role model network can be obtained from Medical Forum, mentor{at}ultimate.org

    • Lloyd BW. How to be an effective educational supervisor. Br J Hosp Med1996;56:585-7.

    • Honey P.Improve your people skills (2nd ed.) London: Institute of Personnel and Development, 1997. 

    • Lingham L, Gupta R. Mentoring for overseas doctors.BMJ 1998:(classified section 11 Jul)2-3http://www.bmj.com/cgi/content/full/317/7151/S2-7151>

    • Alliott R. Facilitatory mentoring in general practice. BMJ 1996:(classified section 28 Sept ): 2-3http://www.bmj.com/cgi/content/full/313/7060/S2-7060>

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