Creating a culture of coaching: examining clinical teachers' coaching behaviors through a behavior change lens

Despite the integral role that clinical teachers' coaching behaviors play in shaping residents' learning experiences, these behaviors are not always enacted. To better understand the behavioral determinants of coaching, the objectives of this study were to (a) identify barriers and facilitators of engaging in coaching behaviors using behavior change theories (Behavior Change Wheel, BCW; Theoretical Domains Framework, TDF), and (b) propose relevant interventions and policy changes to facilitate the engagement in coaching behaviors. Using a social constructionist approach, we interviewed 13 clinical teachers with relevant lived coaching experiences. We first used reflexive thematic analysis to analyze the data inductively. Second, we deductively mapped the themes onto the BCW and TDF to identify the behavioral determinants of coaching, relevant interventions, and applicable policy changes. Participants' perceptions of coaching behaviors were captured in six themes pertaining to clinical teachers' capability (a self-directed journey; a balancing act), opportunity (the show must go on; setting the stage), and motivation (call me coach; an audience for coaching). Although clinical teachers had the necessary coaching knowledge and skills, social and environmental constraints limited the practical implementation of these behaviors. This work supports applying behavior change theories in medical education research. Recommendations include shifting interventions beyond targeting individual-level knowledge to fostering coaching-supportive environments, including focusing on training, modelling, and enablement and developing policy-level supports such as guidelines, planning, services, and regulation.