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Nurse Education in Practice 9 (2009) 377–382
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Nurse Education in Practice
journal homepage: www.elsevier .com/nepr
Evaluation study to ascertain the impact of the clinical academic coaching rolefor enhancing student learning experience within a clinical masterseducation programme
Steve R. Tee a,*, Rosalynd M. Jowett b,1, Caroline Bechelet-Carter c
a School of Nursing and Midwifery, University of Southampton, Building 67, University Road, Highfield, Southampton, Hampsphire SO17 1BJ, UKb Faculty of Medicine, Health and Life Sciences and University Director of Education, University of Southampton, Highfield, Southampton, Hampsphire SO17 1BJ, UKc School of Nursing and Midwifery, University of Southampton, UK
a r t i c l e i n f o
Article history:Accepted 30 November 2008
Keywords:CoachingAdvanced practiceClinicalPostgraduate
1471-5953/$ - see front matter � 2008 Elsevier Ltd. Adoi:10.1016/j.nepr.2008.11.006
* Corresponding author. Tel.: +44 02380597980.E-mail addresses: [email protected] (S.R. Tee), R
Jowett), [email protected] (C. Bechelet-1 Tel.: +44 02380597980.
s u m m a r y
Aim: To explore the appropriateness of clinical academic coaching role as a tool for enhancing studentlearning and the development of advanced academic and clinical practice skills for nurses.Background: Coaching involves a relationship between individuals characterised by analyzing and com-municating mutually understood objectives and motivating others. Coaching is beneficial for developingthose entering new positions with higher level responsibilities.Method: A two stage evaluation involved analysis of structured questionnaires distributed to studentsregistered for a postgraduate advanced clinical practice programme and ten interviews with studentsand coaches. Data was analysed to develop understanding of how coaches were experienced by studentsas an aid to learning.Findings: Data indicates the role supported students through transition and provided learning support atcrucial times in the academic journey. Specific skills and behaviours enhanced the coach-student rela-tionship. The coach’s understanding of the clinical context was pivotal, as was effective preparation toundertake the coaching role.Conclusion: Supporting students to make the transition into advanced practice roles is a prominent issuewithin current healthcare literature. Clinical coaching enhances learning through a strong and coherentpartnership between the student, their practice context and the academic journey.
� 2008 Elsevier Ltd. All rights reserved.
Introduction
This paper presents finding from an evaluation of a new clinicalacademic coaching role introduced within a UK Higher EducationInstitution’s School of Nursing and Midwifery, to support studentsregistered on a modular advanced clinical masters’ programme.The drivers arose from UK higher education and healthcare policyhighlighting the need for flexible education to meet the diverseneeds of students (Department for Education and Skills, 2003).Higher level skills attainment in the work environment requiresnew ways of learning and innovative education methods to un-freeze individuals’ talent and potential. Individuals choosing tostudy health programmes are often first generation higher educa-tion students, whose preparation can be ‘non-traditional’ requiringmore student-centred approaches to enabling realisation of their
ll rights reserved.
[email protected] (R.M.Carter).
potential (Department for Innovation, Universities and Skills,2008).
The study involved an evaluation of the impact of the clinicalacademic coach, whose purpose was to support post-qualifiednursing and midwifery students undertaking a clinical masters’award. The award consists of a range of clinical specialist pathwaysleading to a MSc. Advanced Clinical Practice. Students choose froma range of modules, which have combined clinical and academicassessment strategies, and must demonstrate a high degree ofautonomy in clinical decision-making and the ability to use andapply evidence at the forefront of practice. The coach is an individ-ual with both clinical and academic credibility, often working atconsultant practitioner level, who focuses on goals which optimizethe student’s clinical role and professional and personal develop-ment. The coach supports the student throughout their learningjourney, evaluating progress against agreed goals. Through regularmeetings, of up to 10 h per academic year, the coach aims to facil-itate synthesis and application of theoretical knowledge into theclinical setting and to offer a safe platform on which to criticallyexplore and debate their experience.
378 S.R. Tee et al. / Nurse Education in Practice 9 (2009) 377–382
Evidence for the benefits of coaching in postgraduate healthcareprogrammes is limited and we believe the findings from this eval-uation will be useful to higher education institution’s seeking inno-vative strategies for integrating theory and practice and supportingstudents working at advanced practice levels.
Literature review
According to the International Coach Federation (2008) coach-ing involves a partnership within which a process involving crea-tive thought and debate enables development of the individual.Similarly clinical academic coaching, as conceived for this study,involves a relationship between individuals where mutuallyunderstood goals and objectives, focused on personal and profes-sional development, are determined which motivate the studenttoward higher level practice. The literature highlighting the bene-fits of coaching has grown considerably in recent years. But whilstcoaching is not new within management and professional develop-ment it has not, until more recently, become so widely used acrossthe health professions (Broscious and Saunders, 2001; Blow, 2005;Driscoll and Cooper, 2005; McElrath et al., 2005; Browne, 2006).
The literature indicates that process of coaching is beneficial indeveloping those entering new roles with higher level responsibil-ities. Recent regulatory pronouncements in the UK (Nursing andMidwifery Council, 2006) have emphasised the importance of astrong and coherent relationship between the student, their prac-tice learning environment and the university in supporting learn-ing in practice. A study by Makenzie (2007) highlights theusefulness of the coach in enabling the coachee to transfer learningback into practice a core requirement for those taking on advancedpractice roles.
The use of coaching to support learning in advanced practiceprovides an opportunity to influence workforce development.Coaching places the student at the centre of learning by focusingon the student’s specific developmental needs and encouragingthem to take responsibility for their own learning. Jarvis et al.(2006) suggest that coaching is beneficial because it provides sup-port that can be aligned to the organizations goals and strategies.By being student-centred the student can be assisted to exploreopportunities for development of intellectual and practice skillsas well as subject specific skills through research-led learning.Coaching is becoming more embedded across the health profes-sions (Broscious and Saunders, 2001; Blow, 2005; Driscoll and Coo-per, 2005; McElrath et al., 2005; Browne, 2006). The importance ofadvanced nurse practitioners possessing coaching skills is beingadvocated by Erwin (2005) and Graham (2003) who believe theseare essential skills required to support and empower others toachieve excellence in practice.
Determining the coaching role in this study involved usingacademic time more creatively and linking with similar develop-ments using Roberts funding (Roberts, 2003) to support transfer-able skills. Coaching is increasingly seen as an ideal method forthe exploration and transmission of expertise. Studies demon-strate that coaching can help ‘experts’ in their field share theirexpertise (Claridge and Lewis, 2005; Mulec and Roth, 2005). Priorto undertaking their role, the coaches attended preparatory work-shops consisting of pre-reading, presentations, role play and dis-cussion of the literature. It was important for the rigour of thestudy that a baseline of coaching skills and behaviours was agreedand understood. This is supported by Jarvis et al. (2006) whoemphasise the importance of training and support for coachesand believe for coaching to be effective there must be agreedobjectives.
As is common across the higher education sector, postgraduatehealthcare awards are designed to enable development of practi-
tioners into distinctive clinical leaders who can translate research‘from bench-to-bedside’ ( UKCRC, 2006). This project postulatesthat this process of transition could be greatly enhanced throughaccess to coaching at key points in the academic journey. The pro-ject was established from the outset with the purpose of undertak-ing an early evaluation.
Method
A case study research design was chosen for this study, as itaims to explain phenomena through the process of reviewing cur-rent literature and collecting and analysing data in order to an-swer specific research questions ( Pegram, 2000 Bryar, 2000;Vallis and Tierney, 2000; Yin, 2003a). Consideration was given toa number of research designs but the desire to know ‘how’ the roleof coach had impacted on the student and ‘why’ the coach hadbeen of value, or not, led us toward a case study design. As Yin(2003a) points out, case studies can contribute to our knowledgeof phenomena which occur as a consequence of organisationalchanges. Introducing the new coaching role thus led us to asktwo research questions:
1. ‘‘How has the role of clinical academic coach impacted on thestudent’s learning?”
2. ‘‘Why did the coaching role enhance or inhibit the student’slearning?”
By answering these specific questions the aim was to address thebroader organisational concerns as to the degree of benefit of theclinical academic coaching role and the argument for continuedinvestment. Consequently our desire was to know the backgroundof the students receiving coaching and then to explore more deeplythe impact of coaching in order identify operational links betweencoaching skills, student support and the transition to advancedpractice.
To achieve this, the evaluation was structured in two phases.Phase one involved a questionnaire which sought to obtain:
� Data related to the student’s background and chosen pro-gramme pathway.
� The reasons for accessing their coach� What aspects of the coaching they had found most or least
helpful� Whether overall coaching had been useful or not
An initial questionnaire was designed, tested and re-tested on agroup of peers to determine the validity of the tool. The secondphase involved in depth interviews drawn from a sample of thequestionnaire respondents and from a sample of coaches. Theinterview schedule was derived from the responses to thequestionnaires.
As this was a qualitative study with the aim of studying theissues in depth, sampling decisions were consistent with thisaim. The total student population (number of students whohad registered for the MSc award in 2007 = 35) and the coachpopulation (number of coaches who had undertaken coach prep-aration = 15) were both relatively small. The decision was takento issue the questionnaire to all students (n = 35) and then topurposefully sample five students from the questionnairerespondents and five coaches from those who had completedthe coach preparation programme. To ensure information richcases were chosen the student interviewees were a mixture offull and part-time students undertaking different clinical path-ways. The sample of coaches also reflected the range of clinicalpathways.
Table 3Aspects of the coaching relationship the students found most useful.
A non-judgemental style of questioning that facilitated reflectionA more generalised, rather than strictly academic, approachThe coaches awareness of the clinical specialtyLinking diverse modular learning to the broader clinical contextUnderstanding my worldContinuity of support across a modular programmeA focus on meaningful goalsUnderstanding the challenges of moving into a new role
Fig. 1. Aspects of clinical academic coach – ‘useful’.
(5 - very important, 1 - not important)
5
4
3
2
1
S.R. Tee et al. / Nurse Education in Practice 9 (2009) 377–382 379
Ethical issues
The project was subject to rigorous ethical review by the highereducation institution’s ethics committee. An issue raised by thecommittee was that student participation could have been seenas an increased burden to students, over and above that resultingfrom their studies. The decision to provide short questionnaires, of-fer a range of response routes and to interview only a small sampleof the students were aimed at managing the research burdenwhilst not reducing the overall quality of the study.
Consent was sought from all participants. The students wereself-selecting, basing their decision to participate on the informa-tion distributed at the students’ induction event or by post to thosestudents unable to attend induction. The coaches were also self-selecting basing their decision on the information distributed atthe programme of preparation.
Data analysis
Analysis of questionnaire data was managed within an SPSSdata base and analysed using descriptive statistics through a sys-tem of code numbers assigned to each answer. Themes identifiedwere used to develop the interview schedule in order to explore is-sues in more depth. Data derived from the interviews were subjectto further thematic analysis to develop understanding of the spe-cific helpful components which would inform future developmentof the role.
Results
The study generated a significant amount of data and so for pre-sentation purposes Section A is the summarised data generatedfrom the 35 questionnaire responses and Section B is data drawnfrom the ten interviews.
Section A – Questionnaire responses
Table 1 illustrates that by far the largest number of studentswere on a full-time neonatal pathway, whilst Table 2 lists the eightmost common reasons for accessing their coach:
Table 1Clinical pathways.
Student numbers
Long-term conditions 2Neonatal (full-time) 15Critical care 1Child and adolescent mental health 1Urgent care 3Midwifery 1Cancer care 2Palliative care 1Community nursing 2Standard (non specific) 7Total 35
Table 2Reasons for accessing the coach.
Coaching toward your goalsSetting objectivesSupport with advanced skill developmentChoosing modules of learningSupport with academic workPromoting independent learningTime spent talking about personal circumstancesDeveloping personal development plan
Fig. 2. Aspects of clinical academic coach – ‘understanding of clinical environment’.
Table 3 lists the responses to a question asking what aspects ofthe coaching role was most helpful and not typically found withinother academic role relationships. Fig. 1 reveals over 60% of stu-dents found the role to be useful or very useful.
An important dimension as to the ‘usefulness’ of the role wasthe need for the coach to appreciate the student’s clinical contextto support their transition into advanced practice roles. Fig. 2 illus-trates that almost all thought it was an important aspect of therelationship.
Section B – Student and coach interview data
As indicated the questionnaire responses were used to con-struct the semi-structured interview schedule to enable deeperanalysis of the data. The key emerging issues for follow-up werethe role of the coach in supporting transition into advanced prac-tice roles, the characteristics of ‘support’ and how this differedfrom normal academic support, how expectations of the role wereunderstood by both parties and how preparation for the role couldbe improved (see Table 4).
Table 4Issues forming the basis of the interview schedule.
1 Transition into advanced practice2 Support in achieving learning needs of students3 Expectations of role/understanding of role of coach4 Preparation for the role and support
Table 5Skills used by coaches.
Customised approach: eg. picking up on individual needsStudent-centred: eg. determining whether students were visual or kinaestheticNon-judgmental: eg. using an open communication styleSelf-aware: eg. being aware of own communication behavioursActive listening: eg. being there for mePartnership: challenging in a supportive way (use of socratic questioning to elicit
solutions)Future focused: eg. using GAP analysis to define the current situation, the target
‘state’ and the gap between them
380 S.R. Tee et al. / Nurse Education in Practice 9 (2009) 377–382
NB: Responses within each category are indicated by an S forstudents and C for Coaches.
1. Transition into advanced practiceWhen asked whether coaching had helped the student make
the transition into advanced practice roles there was an unequivo-cal ‘‘yes”. Students commented that the coach helped them look atclinical issues from new perspectives:
‘‘..I think it has definitely helped me to sort of look at a whole widerpicture.” (S)
This ‘wider’ comment implies expansive thinking a point rein-forced by another who reported a change in their beliefs as a directresult of the coach’s use of a socratic style of questioning:
‘‘..yes by helping me to think differently and throw new ideastogether....” (S)
The suggestion of a journey was evident from comments aboutrole development and transition:
‘‘.. help me to sort of focus on where I could take these roles in prac-tice and how to expand on them...” (S)
Knowing that attrition rates on these clinical masters pro-grammes can be high, support at such a stressful time can becrucial:
‘‘ I knew I was undertaking an MSc in Advanced practice but didn’texpect it to be so difficult....she (the coach) supported my develop-ment and transition..” (S)
The value of the coach role appears therefore to be a combina-tion of professional support, acceptance and facilitating a sharedjourney with the student:
‘‘The coach supports students to professionally accept their rolesduring the transition....it is extremely valuable..” (S)
Leading on from transition was the coach’s role in supportinglearning.
2. Support in achieving learning needs of studentsIt was evident that students valued an individualised
approach:
‘‘my coach was able to assist me through discussion around thevarious aspects of my personal needs . . ...” (S)
They found it useful to have someone who appeared to be inde-pendent, able to take an overall view of their learning needs andhelp them set goals in relation to this.
‘‘I think it (the coach) is a very good role because sometimes whenyou are doing different modules. . .it is useful to have someone whowill see you through the programme and is independent of thepathway. . .” (S)
Most students found their coach was approachable and it wasvery important for them to have an appreciation of their contextor what Schon (1987) would have referred to as the ‘swampy low-lands’ of clinical practice:
‘‘because my coach works in a similar environment that wasreally useful because she has that inner knowledge of the spe-cialty..” (S)
When asked to summarise the most helpful aspects derivedfrom contact with the coach the items listed in Table 5 were typicalresponses.
Whilst the skills used were easily identifiable it was evidentthat there was some confusion about the role and in terms ofexpectations and the relationship to other academic roles
3. Expectations of role/understanding of role of coachIt was generally acknowledged there were some operational
challenges with the role such as time constraints. Students typi-cally felt they would have liked more contact with their coach:
‘‘..but I think they need to be more accessible....you would valueseeing them more often....” (S)
Another commented that it was not always frequency but moreabout immediacy of contact:
‘‘..because we have got targets at work and then she (the coach)is not always at the university so it was just getting the timewhen we were both available really..” (S)
Linked to this was role expectation. There was some confusionas to how it overlapped with other academic roles. This was re-flected in responses to questions determining expectations:
‘‘...because it is a new role it is very much about finding your feetand seeing how things develop.” (C)
However some students had a very clearer perspective of therole:
‘‘from what I understand from the original discussion...it is thatthe coach is supposed to help you interpret your learningthrough university into everyday practice.. ......” (s)
Others saw the function as more akin to the academic tutor roleand had expectations that the coach was there to offer supportwith academic writing:
‘‘what I was expecting the role to be was to get me through the nit-ty gritty of academic work....” (S)
In response to a similar line of enquiry it was clear that somecoaches had found the move toward student-centred approachesa challenge:
‘‘...I think I have struggled with this, but I really do see it as facili-tative..” (C)
This was also picked up by students:
‘‘. . .in fact I think she was a bit confused as to what her role was inthis new way of working.” (S)
However there had been important learning through the expe-rience of being a coach:
‘‘my first impressions ...I thought it would span clinical practice andacademic. I guess I have come to understand what the role is....Ithink I understand more than when I started....” (C)
The general confusion around expectation, accessibility and roleboundaries have implications for how individuals were prepared.
S.R. Tee et al. / Nurse Education in Practice 9 (2009) 377–382 381
4. Preparation for the role and supportThe developmental programme for coaches attempted to
achieve a baseline of skill and ensure a shared understanding ofthe role. Whilst there were many positive comments as to the va-lue of the programme, there was consensus that the role playaround coaching skills was the most useful as it revealed key ele-ments of the process:
‘‘...the role play we did in groups....I found that very useful....andgave us the idea of how coaching should be....and how we are notjudging and telling...we are facilitating and enabling....” (C)
Clarity in relation to other academic roles was also important:
‘‘the bit abut talking about the role and what it was and how itintegrated into the student support system. . .” (C)
In fact some commented they would have liked more opportu-nity to practice specific coaching skills. A day on advanced commu-nication skills using Neuro-Linguistic programming techniqueswas particularly well received although there remained some anx-iety about using the skills in their coaching behaviours.
‘‘..the NLP day was revision and perhaps just brings it forward toyour mind but I think it wasn’t enough for me to use it accuratelywithin my coaching, I don’t know enough about it..” (C)
Those with a more theoretical orientation expressed a prefer-ence for a broader appreciation of different coaching models:
‘‘...I tend to be more of a theorist, I would have liked more theoryabout the different approaches coaches can take....” (C)
Perhaps most importantly was the coaches interviewed saidthey utilized the coaching tools they had been introduced to andfound them extremely useful although they would have appreci-ated more ongoing support and the opportunity to meet with othercoaches to discuss common issues.
Discussion
The research questions that this study sought to answer were:
1. ‘‘How has the role of clinical academic coach impacted on thestudent’s learning?”
2. ‘‘Why did the coaching role enhance or inhibit the student’slearning?”
The results appear to suggest that coaching had a positive im-pact on the students learning experience and was instrumentalfor some in helping them make the transition into advanced prac-tice roles. What emerges is a developing confidence in their newpractice roles, key to which is the coach, who are themselves ex-perts, understanding the practice context of the student and assist-ing them, not only in setting goals, but in enabling them to thinkcreatively about their practice. Flaherty (1999) emphasises theimportance of the coach enabling the client to see things in a dif-ferent way whilst Egan (1990) suggests that the purpose of helpingrelationships is to enable the client to overcome blind spots thatinhibit transformation.
Whilst the skills and behaviours identified as helpful, such asactive listening, open communication and supportive challenging,may be found in many helping relationships, it was the underpin-ning use of appreciative inquiry (affirming and supportive) and thevalues of a shared and enabling contract between the two parties,which appeared to bring most benefit. This is perhaps wherecoaching can more uniquely assist the student, through techniquessuch as Socratic questioning, by requiring those in the role of coachto give up positional power and adopt a mindset of shared discov-
ery in order to avoid traditional didactic approaches. Dingman(2004) has highlighted key attributes of the coach that can enhancethe coach/coachee relationship these include interpersonal skills,communication skills and instrumental support.
The issue of role clarity, from both the student’s and coach’s per-spective, was revealed to be a concern and has significant implica-tions for how coaches are prepared. It was evident that there wasconfusion amongst some as to the nature and purpose of the role.Consequently where both parties are oriented toward traditionaldidactic learning methods, adopting coaching behaviours pre-sented a challenge to the relationship. Makenzie (2007) acknowl-edges this, stating the coachee may find the coaching relationshipdaunting at first but argues it is the coach’s role to clarify the pur-pose of the relationship. It was certainly evident that some coachesfound it a struggle to be facilitative and help the learner to acceptthemselves as instigators of action and to take responsibility fortheir own learning and development.
This issue appears to suggest that role transition was as muchan issue for the coaches as for the students. Mezirow (1990) arguedthat key to making any role transition is the notion of transforma-tive learning involving an alteration in beliefs and principles.Whilst coaches found aspects of the preparatory programme usefulsome still found the transition challenging. They articulated diffi-culty avoiding imposing their own perspectives on a situationrather than use coaching techniques.
It is perhaps clear that to be an effective coach within an envi-ronment where there are many other academic and clinical rolesfrom which the student may seek support, it is important for thecoach to clarify boundaries from the outset in terms of what it isthe learner wants from the coach. This will help to facilitate a stu-dent-centred approach but also avoid an unhealthy level of depen-dency. Whilst some students in this study commented that lack ofcontact with the coach was an issue and would have valued moretime, Jarvis et al. (2006) suggest that for coaching to be most effec-tive, it is important for sessions to be frequent enough initially tonegotiate objectives and then sufficiently spaced to maintainmomentum toward achieving negotiated goals.
Whilst this was a small study and further research is needed,the findings reinforce those of previous studies that coaching canbe a powerful alliance which aids advanced practitioners in trans-ferring theory into practice (Makenzie, 2007). It is clear that thecoach /coachee relationship is pivotal, requiring coaches to possesscertain attributes (Dingman, 2004) which in turn has implicationsfor their selection, training and support (Jarvis et al., 2006).
Conclusions
This study sought to determine the impact of clinical academiccoaching on the student learning experience within a postgraduateclinical programme. The findings suggest that the role, properlyconceived and implemented brings benefit in the development ofstudent learning and transition to advanced practice. Howeverthe underpinning philosophy of coaching presents challenges totraditional academic perspectives. Clearly development and ongo-ing support for the coach is a vital ingredient and needs to be care-fully considered in any preparatory programmes.
If higher education is to fulfil it’s role in supporting higher levelskills attainment in the work environment, new ways of learningand innovative education methods, such as the role of clinical aca-demic coaching need to be introduced and evaluated in order todetermine their effectiveness. Role transition to advance practiceis a key priority for the development of effective healthcareprogrammes around the world. Whilst limited in scale this pro-ject does at least support the proposition that coaching could forma valuable component within programmes seeking to unfreeze
382 S.R. Tee et al. / Nurse Education in Practice 9 (2009) 377–382
individuals’ talent and potential and prepare the next generation ofadvanced healthcare practitioners.
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