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Abstract
Introduction Medical students experience higher rates of distress and burnout compared with their age-similar peers overall. Coaching has been proposed as one means of combating distress and burnout within the medical profession. The purpose of this systematic review is to synthesise the current evidence on the effects of coaching interventions on medical student well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms.
Methods and analysis We will conduct a systematic review of interventional and observational comparative studies that assess the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms among undergraduate medical students internationally. We will search PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, ERIC, Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID) from their respective inception dates using the following search terms: (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). Studies in any language will be eligible. Studies that report one or more outcomes of distress or well-being among medical students who receive a coaching intervention will be included. Data on participant and intervention characteristics, outcomes and instruments used will be collected as well as quality/risk of bias assessments. Two reviewers will screen studies against the inclusion criteria and perform data extraction. We will conduct a narrative synthesis, with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias.
Ethics and dissemination Ethical approval is not required for this review. Results will be disseminated by publication in a scientific journal.
PROSPERO registration number CRD42022322503.
- MEDICAL EDUCATION & TRAINING
- Quality of Life
- EDUCATION & TRAINING (see Medical Education & Training)
- Health Education
- MENTAL HEALTH
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- MEDICAL EDUCATION & TRAINING
- Quality of Life
- EDUCATION & TRAINING (see Medical Education & Training)
- Health Education
- MENTAL HEALTH
STRENGTHS AND LIMITATIONS OF THIS STUDY
This study will synthesise international evidence on the effects of coaching interventions on medical student well-being.
This study will not assess other potential benefits of coaching among medical students, such as skill acquisition or academic performance.
This study will not assess the effects of coaching on distress and well-being among non-medical student health professionals.
Anticipated heterogeneity among interventions may limit quantitative analysis.
Introduction
Compared with their age-similar peers in the general population, medical students are at increased risk of distress, including burnout,1–3 depression1 4–6 and anxiety,4–6 and are more likely to report suicidal ideation.1 3 In addition to the high personal burden of these phenomena on those who experience them, high levels of burnout in medical students have been associated with impaired academic performance,7 unprofessional behaviour7 8 and decreased empathy.8 9 Distress among medical students therefore threatens patient care quality as well as students’ personal well-being and professional development.
The factors contributing to the development of multiple manifestations of distress among medical students are varied and include both environmental and individual components.7 10 Interventions aimed at reducing medical student distress are similarly diverse and include both programmatic and individual-level approaches such as wellness curricula, grading schema and curricular changes, peer and faculty mentorship programmes, mindfulness training and programmes to support social engagement and physical activity, among others.11–16 Institutional approaches to generating participation in these programmes range from compulsory elements with protected curricular space to voluntary offerings that students engage with on their own time.12 Some institutions have attempted to take a comprehensive approach that incorporates many of the above-mentioned interventions and mandate different levels of participation across the included elements.11
Coaching has gained a foothold in business to improve multiple aspects of performance and well-being17 and has been proposed as one method of addressing distress, including burnout, among medical professionals.18 Coaching is a recipient-driven process that emphasises inquiry to facilitate reflection on the recipient’s goals, values and abilities. Coaches aid recipients in identifying actions required to achieve their objectives, provide accountability and facilitate problem-solving.19 Coaching offers an individualised approach to reduce medical student distress by allowing the learner to identify their own wellness priorities, set goals and select specific strategies for meeting them.
Coaching is distinct from mentoring and advising in that it assumes the recipient is the expert and already possesses everything that is required to achieve their potential.20 21 For this reason, a coach does not necessarily require expertise in the field of the coaching recipient. Mentors and advisors, conversely, possess experience and expertise in the recipient’s area of interest and the goals of their interactions are the transfer of knowledge and provision of guidance.20 21 Coaching is a practice of inquiry and listening, whereas mentoring and advising are disciplines of directing and answering.
Love et al22 described four coaching archetypes within medical education: coaching for academic success, skill development, career and professional development and for ‘at-risk’ individuals displaying self-limiting behaviours. They suggest that trainees may stand to benefit from any of these coaching archetypes. Studies on coaching in the medical field have investigated its use in surgical skill development,23 professional identity formation,24 increasing resilience and well-being,25 and reducing burnout.26 27
The American Medical Association has advocated for increased use of coaching in medical education by promoting the adoption of coaching programmes as a key initiative for its Accelerating Change in Medical Education grant programme.28 A survey of participating medical schools showed that nearly all had coaching programmes or were in the process of developing one.29 Despite this, a previous literature review on coaching in medical education found limited evidence for coaching to support well-being and skill development.30 Given the growing interest in coaching within medical education, the current body of evidence warrants an updated, rigorous review and analysis. The purpose of this proposed systematic review is to determine the effect of coaching interventions on the well-being of medical students by answering the following research question: in medical students internationally, what are the effects of coaching interventions compared with no intervention on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work and distress, including burnout, anxiety and depressive symptoms?
Methods and analysis
This review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) 2020 guidelines for systematic reviews.31 This review is registered with PROSPERO.
Eligibility criteria
Studies will be eligible for inclusion in this systematic review based on the characteristics described below.
Study design
Peer-reviewed interventional and observational comparative studies will be eligible for inclusion in this review.
Setting and characteristics
We will include studies conducted among medical students at undergraduate medical institutions internationally. We will exclude studies conducted as part of graduate medical training, postgraduate professional training or development, training in non-physician career pathways and studies conducted outside of medical training. We will also exclude studies in which the recipient of the coaching intervention is not a medical student (eg, a health coaching intervention where a medical student serves as the coach for a non-medical student recipient).
We will include studies that compare coaching as the primary intervention to a control group that does not receive a coaching intervention, including single-arm pre-post studies. We will not include studies reporting on mentorship or advising interventions unless coaching is explicitly described as part of the intervention. We will also not include studies on interventions to promote well-being and reduce distress that do not use coaching as part of the intervention. For the purpose of this review, coaching will be defined as a recipient-driven exchange between a coach and coaching recipient that emphasises inquiry and reflection to define recipient goals and identify strategies and actions to meet them. Studies which use the terms ‘coach’ or ‘coaching’ but which do not describe an intervention that meets this definition will be excluded.
Outcomes
Our main outcomes of interest will be burnout and symptoms of depression and anxiety. We will also include studies that report on additional outcomes of well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work. Outcomes measured by either self-assessment or formal instruments supported by specific validity evidence will be included. We will not include studies that report only on skill acquisition or advancement. We will not include studies that describe a coaching intervention but do not report empirical data on outcomes of interest.
Information sources and search strategy
We have developed a comprehensive search strategy in partnership with an experienced medical librarian (CC), with testing for sensitivity to detect known examples from the literature with refinement of the strategy as necessary. Databases to be searched are PubMed (MEDLINE), Embase (OVID), PsycINFO (OVID), Scopus, Education Resources Information Center (ERIC), Cochrane Database of Systematic Reviews (OVID) and Cochrane Central Register of Controlled Trials (OVID). Titles, abstracts and keywords will be searched using the terms (medical students OR medical student OR undergraduate medical education) AND (coach OR coaching OR coaches). No temporal or language restrictions will be applied. The detailed final search strategy, with records identified as of 26 May 2023, is shown in online supplemental file 1. Studies in languages other than English will be translated into English prior to their review. Reference lists of included studies will be reviewed to identify additional relevant studies. Reference lists of prior reviews on this and related topics will also be searched for eligible studies.
Supplemental material
Data management and selection process
Search results will be uploaded to a shared-access online database, from which each step of review and data extraction will be performed and logged. First, duplicate studies will be removed from the search results. Inclusion and exclusion processes will then be piloted and refined on an initial sample of at least 10 abstracts. Two reviewers (LB and CW) will then independently screen the titles and abstracts of the remaining studies for relevance to the research question. If either reviewer determines that the study is relevant, it will advance to full-text review against the previously outlined inclusion and exclusion criteria by the same two reviewers. Any disagreements between reviewers regarding inclusion of a study will be resolved by discussion and consensus between the two reviewers. A third reviewer (LD) will be consulted if consensus cannot be reached.
Data extraction
Two reviewers (LB and CW) will independently extract data from all studies included in the final review. Data collected will include information about participant characteristics (eg, age, gender, year in training), characteristics of the coaching intervention (eg, number and structure of coaching sessions, length of intervention, characteristics of coaches, mandatory vs voluntary participation), outcomes (including effect sizes) and instruments used to measure outcomes. Study characteristics including year of study conduct, funding source, study site(s) and country/countries of origin will also be collected. The primary outcomes of interest are effects on well-being and distress as previously described. Information regarding study design and quality will also be collected (eg, study design, study size, randomisation). Any discrepancies in data collection between the two reviewers (LB and CW) will be discussed and resolved by consensus, and a third reviewer (LD) will be consulted if consensus cannot be reached.
For included studies with missing or unclear data, the corresponding author for the study will be contacted for clarification. In such cases, the corresponding author will be contacted at the email address provided in the published manuscript. If the corresponding author has not responded within 1 week, a second email will be sent. If the corresponding author has not responded after 1 week from the second email, we will attempt to contact additional authors and attempt contact by telephone if possible. If all contact efforts are unsuccessful, the author will be listed as unable-to-contact and no further attempts will be made. If the author responds after the final 2-week period, but prior to the final analysis of this review, the information obtained will be included in the analysis.
Risk of bias assessment
Risk of bias of included studies will be assessed at the study level using the V.2 Cochrane Collaboration risk-of bias tool for randomised trails (RoB 2)32 and risk of bias in non-randomised studies of interventions (ROBINS-I)32 tool as appropriate. Each study included in the analysis will be independently assessed for bias by two reviewers (LB and CW), and any discrepancies will be resolved by consensus. A third reviewer (LD) will be engaged if consensus cannot be reached. In the event of meta-analysis, publication bias will be assessed through funnel plot evaluation.
Analysis
A PRISMA 2020 flow diagram will be used to outline phases of study screening and selection. We plan to conduct a narrative synthesis of included studies’ designs, participant characteristics and interventions with meta-analysis if evidence permits quantitative pooling of results. Heterogeneity of results across studies according to study design, learner level and study risk of bias will be evaluated, as well as publication bias. Given anticipated heterogeneity across study contexts and outcomes, random effects models will be applied.
Confidence in cumulative evidence
A ‘Summary of findings’ table will be presented, and levels of certainty will be determined using the grading of recommendations, assessment, development, and evaluations (GRADE) approach if meta-analysis is supported. Otherwise, the overall strength of evidence will be summarised descriptively.
Patient and public involvement
The design of this systematic review protocol did not involve patient or public input. The subject of this research is undergraduate medical students. The first author (LB) was a medical student at the time of project initiation and was involved in every aspect of protocol design.
Ethics and dissemination
This study does not require ethical approval as it does not include human subjects and involves analysis of previously published data. Results of this systematic review will be disseminated by publication in a scientific journal.
Discussion
Medical students experience high rates of distress, including burnout, anxiety and depressive symptoms during their undergraduate medical education, jeopardising their personal well-being and professional development. Sources of distress are multifactorial, and efforts to combat them should look to address both personal and environmental contributors. Coaching may offer a means to promote medical student well-being by addressing their individual sources of stress during training. However, no high-quality synthesis of evidence on coaching to support well-being or reduce distress in medical students currently exists. This systematic review will fill this gap by determining the effects of coaching interventions on well-being, including engagement, resilience, quality of life, professional fulfilment and meaning in work, and distress, including burnout, anxiety and depressive symptoms in medical students internationally.
Anticipated limitations of this review are related to the expected heterogeneity in study design, characteristics of coaching interventions and measured outcomes that may limit the strength of conclusions that can be drawn. Additionally, in choosing to limit our review to interventions in undergraduate medical students, generalisability of our findings to other medical and non-medical learners who experience distress (eg, nursing students, medical residents, law students, etc) may be limited. By looking only at outcomes related to well-being and distress, we may also overlook other instances where coaching could have a positive impact on learners (eg, development of clinical skills). These choices to narrow the scope of this review are intentional and reflect the unique nature of medical school training and the challenges to well-being that have been documented during this process.
The intent of this review is to evaluate and synthesise the evidence for the use of coaching interventions to promote well-being and decrease distress among undergraduate medical students. The findings will be relevant to medical schools looking to promote the well-being and optimal development of their learners within supportive learning environments.
Ethics statements
Patient consent for publication
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors LB—Main contributor to protocol design and primary contributor to the writing of this manuscript. CC—Developed preliminary search strategy for the proposed review and was a major contributor to the writing of this manuscript. LD—Contributed significantly to the protocol design and was a major contributor to the writing of this manuscript. CW—Contributed significantly to the protocol design and plan for analysis and was a major contributor to the writing of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.