Interview with Dr. Micaela Godzich, Assistant Clinical Professor in the Department of Family and Community Medicine at UC Davis School of Medicine [Show Summary]
UC Davis has developed its Academic Coaching Program to provide support to medical students so they feel more connected to their medical school faculty and community. Today’s episode features the Program Director and UC Davis School of Medicine faculty member, Dr. Micaela Godzich, who shares the rationale behind the program and how it is being received by students.
Dr. Godzich discusses an exciting new mentoring program for med students [Show Notes]
I’m so pleased to have on the show Dr. Micaela Godzich, Assistant Clinical Professor in the Department of Family and Community Medicine at UC Davis School of Medicine. Dr. Godzich earned her MD at UCSF in 2007 and then did her residency and started her practice in central California. In 2012 she moved to rural Shasta County in Northern California and later rural Washington State and enjoyed a “full-spectrum family medicine practice” in both places. In 2017 she joined UC Davis School of Medicine. Her clinical interests include effective longitudinal relationships with patients in a variety of clinical contexts, and physician well-being and professional fulfillment. No wonder that she is director of UC Davis’ Academic Coaching program, which will be the focus of today’s interview.
What is the Academic Coaching Program at UC Davis School of Medicine? [2:35]
The program has been around for the last two years. It is quite robust now, with 15 coaches who spend individualized time with students during the course of med school. They mentor, provide insight into how students are progressing through med school, and how to achieve goals. There are lots of different ways to interact – there is dedicated course time called “doctoring,” where students learn how to take histories, do physical exams, and shape the practice of doctoring. Coaches also go over evaluations with students so they can understand what attendings are really saying with their feedback and how to make improvements.
What prompted UC Davis to start it and why did it appeal to you? [3:58]
UC Davis is very good about gathering data from students, and at the end of 2017-18 there was a survey of graduates to figure out where there could be improvement. From the survey it was discovered that students felt a bit disconnected from faculty. They didn’t get a sense that there was someone who knew them as an individual and how they could develop as they became doctors. They had solid info on logistics, good feedback on how they were doing in courses, but an absence of an individualized touch. We are often dealing with students who don’t have a lot of acculturation to medicine, and they need someone who can help them navigate the practice of academic medicine. The new assistant dean of students had come from a school with a coaching model, so in 2018-19 we had a pilot with five coaches that was overwhelmingly positive. The school expanded that to a total of 15 coaches this year.
What are the goals of the program? [6:16]
It is about helping students develop a sense of themselves within the practice of medicine, feel they are part of medicine as opposed to feeling like outsiders, and understand areas for growth and how to achieve their goals. It is also about developing lifelong habits of self-selected learning in a field that is constantly changing. Now is the time to figure out how to continuously learn, understand the newest developments, and integrate that into practice.
Why is it Academic Coaching and not professional or personal coaching? [7:25]
Academia is a very specific world and apart from anything else. It can be confusing and disorienting, so having a coach to help you understand why you didn’t do so well in a particular subject is really important. Your coach can help you figure out how to do it differently next time. In order to do that, though, a coach needs to get to know you pretty well to understand how a particular individual learns best and to remind them to tap into particular skills.
What kind of time commitment does it involve from the med student? [9:02]
We are trying not to burden students with too much extra work. In 2018-19, which was the first year, there was a set number of meetings quarterly that were scheduled on a student’s own time. It was okay but somewhat burdensome for some students. This year we have built in the constant contact, where coaches are with the students on a weekly basis during the doctoring classes – they are part of the instructing team in small group sessions. This provides a great way for coaches to get to know students within a small group of approximately eight students. It’s important to note that coaches are never in a position of evaluation and the relationship is free of that burden. In addition to the weekly contact through doctoring classes, we also have coaches meet individually with students every few months.
When clinical rotations start there are coaching sessions every few months, after they finish each rotation. When students get their rotation results back, in terms of how they did on exams, in the clinical setting, it is hard for a student to grasp what it means and how it translates to their overall path. It is helpful for the coaches to say, “When they said this, it was code for….” Essentially they act as interpreters of the clinical experience for students who are new to it.
What happens if a student is on a rotation and having a difficult time? [12:40]
A coach is definitely a touchstone for that person. Students often wonder if some experience is normal or appropriate. I have had trainees come up to me and say, “This is what happened….is this normal?” Without having that faculty viewpoint they might have internalized the experience and carried it around with them thinking that this is normally what happened in a particular field. It is not about the learner themselves.
How has it been received by students and coaches? [18:12]
The students have found it beneficial, and those before said it was harder earlier since they didn’t then have coaches. It has been really nice to have the opportunity for someone to really get to know them, understand them in a 360-degree way, what are you hoping to do, etc. I have heard very positive feedback – in a survey we did it has been either “extremely helpful” or “very helpful.” It is too soon to see if there is any impact on exams or the number of times students need to be referred for professionalism issues, but we expect there will be some tangible impact.
AAMC had an interesting article on “Navigating the hidden curriculum in medical school” which discussed the hidden message or the socialization of students in med school. What are some examples of that “hidden curriculum” and how is the coaching program addressing the negative part of that curriculum? [21:55]
Hidden curriculum is the notion of everything taught outside the classroom like our behaviors, how we treat patients, how we treat staff, what happens when we put on the white coat and take it off, etc. These are intangible and we model them every single day. A concrete example would be an attending provider who gives a presentation on communication and then berates a nurse in front of the entire team. That incongruous behavior in front of learners is confusing. Without a safe, trusting relationship like we hope the students and coaches will have they can’t name it. We aim for a place where students can give voice to concerns or express discomfort, and say, “I saw an instructor behave in a way that didn’t seem respectful, what do I do with this?” The relationship will allow the conversation to take place. We also can bring these concerns back to the school of medicine and look whether or not there are patterns so we can communicate it is not the learning environment we want. Coaches are acting as intermediaries, and students can share information without consequences.
In a positive way, hidden curriculum also allows the students to experience the challenges of medicine and for the coach to be a confidante. Things like, when things go wrong how do you go on, how do you show up even when sitting in a place of sadness or disappointment, or guilt for negative patient outcomes. The dean in charge has chosen coaches relatively close in developmental stage of the students – within 10 years of graduating. With recent training coaches remember the moments of the first time X happened – patient died, patient yelled at them, etc, and being fresh in the mind can be really constructive to students.
How has your personal experience as a med student or physician influenced your decision to get involved with the Academic Coaching program and your interest in physician well-being and professional fulfillment? [30:07]
We all have that feeling, what if we did something over. For me this is an opportunity to fill in some blanks in my med school training. I am fortunate to have had gratuitous formative relationships when I was in school, and these relationships remain. Not everyone has that. What I wanted to do is provide for everyone to have the opportunity to feel connected to a near peer who could help with the confusing and sometimes dark corners of medicine. Being part of the program is part of my work that feels effortless. It is fun, stimulating, and talking intimately with students is a privilege. Coaching is almost like primary care – you are meeting regularly with the patient, providing preventive care, taking vitals, and see if anything else is going on. If you have a good primary care doctor you feel safe and they know you.
What do premeds just not get about medical school and the practice of medicine until they’re in the thick of it? What would you really like them to know? [34:06]
Until you are in the thick of things it is hard to explain to a premed what it will be like to be at the bedside of someone who has just learned they have an inoperable disease – there is a shift, and that is hard to explain. Being the one who is there to catch a baby and also to tell someone that the drinking they are doing is making them very ill – having all those experiences in a day changes you as a person and how you look at the world. Some people chafe at it, leading to burnout. And some people embrace it and realize it is a privilege. Knowing you won’t be the same person on the other side is important. Your approach to life will be profoundly altered as a result of being in the program – it is a truly transformative experience.
What would you have liked me to ask? [39:30]
Do you really think this makes a difference? I can only tell you by intuition and of course I am biased, but I think solid relationships always make a difference. It is about learning how to process your experience in medicine, learn what type of doctor you want to be, how to think through how you want to approach things and do things differently next time. You can write an elaborate protocol for a patient that works on paper, but if the patient isn’t willing to do it or doesn’t have the means to do it…if you haven’t had successful communications with that patient, all the protocols will never work. We are anchoring students with clear communications, insight, working through how people interact with one another, and providing tools to be successful navigating difficult situations before they are facing them as a doctor.
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