The evolution of academic advisor and resident dyadic coaching relationships: a two-year longitudinal qualitative study.

Abstract

Implementing competency based medical education (CBME) has generated enormous amounts of assessment data. To help residents synthesize and use these data, some programs have appointed academic advisors (AA) to 'coach over time'. This study explored how resident and faculty AA dyads perceived their relationship developing and evolving, and the extent to which it aligned with 'coaching over time'. Over a two-year period at four separate time-points, we conducted longitudinal qualitative interviews with nine dyads of Internal Medicine residents (32 interviews) and their paired AA (27). We used constructivist grounded theory to develop a conceptual understanding of how AA-resident relationships evolved. Three major themes were identified. 'Building the Relationship' included elements perceived to facilitate or impede growth of the relationship. Most relationships flourished, facilitated by passage of time, 'fit' between the two, and often by working together clinically. Still, many residents perceived the need to 'save face' with their AAs. 'Enacting the AA Role' had features that appeared to align more with mentorship than coaching. 'Finding Meaning in the Relationship' underscored the perceived value fostered by the longitudinal pairing. The relationships often, but not always, achieved far-reaching benefits, though not necessarily limited to those intended by the program. Our study helps us understand what 'coaching over time' might look like for large residency programs wherein residents rotate through many sites and services. The dyads created an opportunity for a coaching relationship to form and develop in beneficial ways, though it was different to and went beyond the narrower focus on meeting CBME requirements.