March 28, 2018 | Akl C. Fahed, MD, MPH
Career Development

Shortly after matching in cardiology, FITs feel pressed to make several career choices. From subspecialty decision to practice type, there is a struggle to find a research or clinical niche. In medical school and residency, we followed defined patterns of success. In fellowship, the focus suddenly becomes on creating our own new path rather than joining a defined group. All of these choices are paralleled by adult life decisions out of the hospital such as getting married, raising children, buying a home or caring for ageing parents. Like a rocket propelled in outer space, it is easy to feel lost. It is estimated that half of all physicians in the U.S. report symptoms of burnout. Rates are often higher among trainees and consequences include poor performance, depression and suboptimal patient care. Cardiology FITs are particularly vulnerable as their training is among the longest of all specialties. Cardiac disease is also associated with acuity and urgency, which could further elevate burnout and stress.

Finding the right balance between well-being or happiness and career success is often challenging. Many cardiology training programs focus on career mentorship and while mentorship is essential for career development, even the best mentors are incapable of addressing the problem of burnout. The problem is also not unique to the U.S. In 2011, I worked with a group of young doctors from around the globe called the Junior Doctors Network to put forth a white paper on well-being. The experience taught me that the problem of burnout spans different cultures and training systems. Our work eventually led to a statement by the World Medical Association in its 66th General Assembly in Moscow in 2015.

Positive psychology coaching presents one solution that I found extremely effective. It is based on making the person cognizant of her or his strengths and utilizing them to curb self-deteriorating thoughts and increase self-control. Coaching is an iterative process that allows you to constantly question shackling thoughts and circumstances and then shift your perspective to gain more self-control. Coaching using positive psychology theory is widely used in the business world and has helped many executives reach their highest potential, and studies showed up to five-fold increase in return on investment. Using coaching in medicine is an incredible opportunity to fight burnout, especially at critical transition periods such as fellowship training. Emerging data on the use of coaching in the health care setting is encouraging. One successful model is at the Massachusetts General Hospital, where Kerri Palamara, MD, started a professional development coaching program for internal medicine residents several years ago. I was lucky to be among the first residents in the program. Through experiencing the power of coaching firsthand, I became a certified coach after graduation. The program is detached from all career mentoring and performance evaluation and is designed to focus on strengths. Due to its success, the program is growing into other specialties and subspecialties.

As a coach, I find myself asking questions, listening and re-directing. I rarely answer or give advice. I would ask Eric, a resident in internal medicine, "What have you felt best about since we met last?" His answer was often a story of success that opens the session positively and highlights a unique strength. He would then hesitate and say, "But, I'm worried how I will be good enough to lead a team in six months. There's so much that I still need to learn!" We determined that he currently ranks himself at six on a 1 – 10 fictional milestone scale, with 10 being his ideal vision of leading a team in six months. I asked Eric to spend the following 10 minutes completing his Values in Action Inventory of Strengths, a psychological assessment tool that identifies an individual's unique profile of character strengths. Then, I asked him to brainstorm ways that he can use those strengths to get from six to 10. The GROW model is one of many tools used in coaching. We ask the trainee to identify a goal (G) or topic to focus on with a vision of what they like to achieve in that area. Next, we ask them what the current reality (R) is. This question is followed by brainstorming options (O) to achieve that goal. Finally, we pave the way (W) forward by selecting one achievable item to focus on for the next session.

The opportunity for using positive psychology coaching to improve happiness, well-being and success of cardiology FITs is huge. Coaching programs for cardiology fellows is most effective when it is individualized and provided in longitudinal manner.

As cardiology training becomes longer and more competitive, the need to balance well-being and success is more important than ever. Professional development coaching based on positive psychology theory and tailored for cardiology fellows could reap more well-being, happiness and success.

This article was authored by Akl C. Fahed, MD, MPH, Fellow in Training (FIT) at Massachusetts General Hospital in Boston, MA.