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Welcome to ASA’s Central Line, the official podcast of the American Society of Anesthesiologists, edited by Dr. Adam Striker.
DR. CRYSTAL WRIGHT (HOST):
Welcome to Central Line, I’m Dr. Crystal Wright your guest host for this month’s leadership episodes. This is the first in a series of five episodes tied to the Monitor’s special issue out now, Mentoring, Coaching, and Negotiation: Connecting with Purpose.
Today I’m here with Dr. Scott Markowitz to discuss the Monitor article he co-authored with Drs. Nina Deutsch, Olubukola Nefiu, and Jennifer Lee. The article is titled Through Their Own Lens: Supporting Women and Minorities in Anesthesiology Through Coaching.
I've been so excited to talk about coaches and mentors, that's something that's a passion of mine. I'd like to start about asking you to sort of disentangle the terms coaching and mentorship for our listeners. Oftentimes, there's some confusion and they’re are sometimes used synonymously, but in reality, they're quite different. Tell us how.
DR. SCOTT MARKOWITZ:
Thank you, Dr. Wright. I think that when we think about traditional mentorship, we think about someone who has walked the path before us. This is a person who has had an experience of following a pathway that we would like to follow and having the experience of being in our shoes in the past. And they can give us advice and perhaps even help with some sponsorship along the way to remove some obstacles.
A coach doesn't necessarily have the lived experience or the content expertise that a mentor in our field would have. What a coach brings to the conversation is a process to help us to develop our best selves, despite the fact that they do not have an opinion, nor have they followed a pathway that will necessarily be ours.
DR. WRIGHT:
I think that is such an interesting concept, because oftentimes, particularly in medicine, we often feel as though we need someone that has been through what we have been through in order to help guide us along and make the decisions that we are seeking answers for. But what you're saying is through coaching, that is not necessarily the case. So when would a mentor use coaching?
DR. MARKOWITZ:
Yes, you know, I would say that the ideal scenario is to have a mentor who also has coaching skills. It would be wonderful if everyone could have a mentor to help them follow the pathway, to help them find the same level of achievement, success, knowledge and expertise. But in many cases, those mentors are not available or we’re following a pathway that no one has tried before.
Now a mentor can use coaching skills, and so your mentor can also be a coach. And in that setting, a mentor would use coaching skills when they have one of several objectives. One would be to make sure that you feel a complete sense of ownership over your decision and your pathway. Without giving you advice, the only person who can bring the path, who can bring the insights, will be the mentee, will be the protégé. And therefore there is no circumstance when coaching is employed in which the protégé says, well, so-and-so told me to do this, but I'm not sure it's really authentically what I want to do.
Another reason why you might use coaching instead of mentoring, or at times instead of mentoring, is when you don't have advice or when you don't have lived experience that would help your mentee. And in those settings, you can still be of use to them by asking them questions that help them to clarify what their goal is, helping them to understand where they stand now in relation to their goal and helping them to define and decide for themselves what pathway they will follow toward goal achievement, even if it's something that you do not have expertise or experience in.
DR. WRIGHT:
So when a mentor uses some of the coaching style in helping a mentee they’re almost allowing, or empowering, the mentee the opportunity to make their own decisions.
DR. MARKOWITZ:
I think that's true. I think that we all like to think that just because we give advice, people don't necessarily take it. But, you know, in a quality mentoring relationship, that is to say that people feel empowered to decide whether they will or they will not follow the advice of a mentor. But the, the challenge there is that in a, in a high quality mentoring relationship, especially a long-standing one, there is a sense of responsibility and duty to one another. And the idea of adding extra weight to the advice and using it as your pathway, even if you might have come up with a slightly different pathway, given complete freedom, I think those are valid questions. And so in that setting, the opportunity to have someone feel a real sense of ownership can be brought about by coaching. And with mentoring, you're never quite sure if someone is prepared to spread their own wings and leave the pathway for their own sake or for their own values.
DR. WRIGHT:
Right. Right. So let's talk a bit about who needs a coach and why.
DR. MARKOWITZ:
Sure. You know, anyone who is interested in professional or personal growth can benefit from a coach. Whether you need one or not is a different story. Very often coaching is applied in settings in which behavior change is requested from an outside source. And this can be behaviors that are less effective. It can be disruptive behaviors, but it can also be a, a mode of leadership or lack of engagement that might be hurting someone's leadership presence. But coaching is most effective when we seek it out voluntarily for the purposes of identifying our own goals, for the purposes of understanding where we are right now, to have a partner in developing a learning plan and a process for change, and to have someone to give us honest feedback or help curate honest feedback for us about where things stand and how we're doing on our pathway toward our goal. And so in that sense, everyone can benefit from a coach, especially when it is by our own choice and for the purpose of our own personal, heartfelt change.
DR. WRIGHT:
And I think that lends itself to the beauty of the self-actualization that comes through coaching during one's career. And I think you hit the nail on the head when you said that, you know, we all can oftentimes use an appropriate peer coach to help guide us along our path, our, our journey of during our career.
DR. MARKOWITZ: I completely agree. One, one thing that I would offer is that the most successful coaching outcomes do feel, to the person being coached, completely authentically their own. And so when someone comes to me as a professional coach and says, you know, I've really grown a lot, I can't tell at all what you gave me, but I can tell that I've grown in this process. And I think that that is because coaching can be a very wonderful behind the scenes phenomenon. Following this process does not disempower someone. It enables them to make their own choices for success and also allows them to own the entire outcome.
DR. WRIGHT:
Right. For listeners who want to step into peer-to-peer coaching, what's the first step?
DR. MARKOWITZ:
Well, I think a fundamental skills approach to coaching and an understanding of the coaching process are all it takes. So what is the coaching process? The coaching process involves a trusting relationship in which the coach might ask questions to help the person being coached or the protégé to understand what their goal really is. And maybe the coach will ask challenging questions to help them clarify that it is really their own goal and not someone else's value set imposed upon who they ought to be.
And then to understand where things are right now, an unvarnished mirror about the real self. And then finally to sit in the discomfort of figuring out what the learning plan, or what the behaviors to try, or what the training will be in order to move toward the goal and then to re-circle the process or circle around the process to see if we're approaching it the way we want. And so coach approach, as well as coaching skills, which are challenging questions and really good listening.
DR. WRIGHT:
I like that you mentioned here about challenging questioning. It's almost that you have to ask questions so that the other person, the person that is being coached, can come to the conclusions that, that they need to come to for themselves. But if you have the right questions, you can somehow lead them in that direction.
DR. MARKOWITZ:
I think being, being forced to put words to your thoughts really helps each of us to clarify what we're thinking and what is important to us. And I think a coach really makes us think out loud, which helps us to become clearer about those things.
DR. WRIGHT: Right. In the article, you talk and address coaching for women and underrepresented minorities, but importantly, you sort of untangle these categories as well. Can you share any thoughts on why it's important not to view racial and ethnic diversity through the same lens as gender diversity?
DR. MARKOWITZ:
Well, I, I'm certainly not the world's expert on this. What I would say is that although there is a tremendous amount of intersectionality, when we talk about a variety of groups that have been traditionally underrepresented in medicine, women are becoming better represented, represent about half of medical school classes and half of junior faculty. In most areas, women are still underrepresented in senior faculty and dean positions.
In terms of underrepresented minorities, the additional issue or the other issues are that it's very hard to find mentors. It's very hard to find someone who has had a similar lived experience in their career. And the reason why is because the people who are from underrepresented minorities have senior leaders who are rarely from a similarly underrepresented minority. And therefore those people who have a lived experience that would help someone in navigating the similar pathway do not have a lived experience that teach them about someone who has additional struggles, someone who has additional challenges and who suffers micro aggressions and micro insults on a multiple time of day basis and sits in a different position relative to their nonminority counterparts.
In that setting, I think that having a coaching approach can be very helpful when especially mentors are just not available. What the coach needs to do in that setting is to be more aware of the challenges and circumstances of people coming from a variety of backgrounds that may not be the coach's own. And this is an important level of awareness because it's really hard to ask good and probing questions if you don't understand the context of someone else's lived experience. And although no one else can truly walk in your shoes, I think it's incumbent upon the coach to learn as much as possible, both by talking with the person being coached and also their own learning outside of the coaching relationship to be able to ask appropriate and challenging questions and to be able to understand the additional challenges that someone may need to overcome, even if they've coached others in a similar position who aren't from underrepresented backgrounds.
DR. WRIGHT:
You bring up very interesting points about the differences with mentoring underrepresented minorities and the fact that women and underrepresented minorities are in very definitive and different categories of being a minority, in that there are different mentoring and coaching styles that are necessary when guiding both in terms of their choices, career paths and their thought processes, but that it can, from the coaching perspective, it can be learned through some self reflection on the coach’s part, which is encouraging because that lends itself to the fact that there are opportunities for women and underrepresented minorities to go through the coaching process, with or without a mentor, successfully.
DR. MARKOWITZ:
Absolutely, I think that coaches that in general really strive to be able to understand the circumstances of the person they're coaching, whether that's a professional coach or a peer, someone who really cares about your professional development and your personal well-being. And I think that those people can take it upon themselves to understand your lived experience, to a degree, helpful in being able to give challenging questions and listen for the, the circumstances of your challenges, of your goals.
DR. WRIGHT:
Right. So we discussed who needs a coach, but let's sort of flip the script a little bit. Who should be a coach? Do you have to be in a senior position? Is it important to share lived experiences with the person you're coaching, or are can you come from a different point of view?
DR. MARKOWITZ:
Well, certainly, I think we’ve discussed how a coach can and sometimes automatically does come from a different perspective or background. What I'll say is that since many of the people listening will be clinicians, one of the things about being or becoming an effective coach is to disengage from the need to diagnose and from the desire to fix. And that's one of the fundamental differences in a coaching relationship than, say, an advising or mentoring relationship, where it is not my job to determine what the ideal outcome is, or what your goal should be, or what path you should follow to get there. It is my job to help you make sure that when you pick what your goal is and when you decide upon your path that it is authentically yours and that you are taking responsibility for your own growth.
Now, that said, I will tell you that one of the hardest things about training to be a professional coach when you're already a physician is to not diagnose and to not treat and to not have the opinion about what the right answer is, and to not bring those opinions into the questions that I ask leading someone to my conclusions rather than to their own. So who shouldn't be a coach? Well, people who are not able to disengage from their own value set or from their own interpretation and judgment in order to benefit the other person. And so you really need to retain your empathy, but eliminate your judgment in that. And that can be really challenging for many clinicians who live our lives to help and serve others. Now, it does serve others to follow coaching process. And so most of us will eventually have our heads around that. But up until then, it can be pretty hard to make that transition.
Others are really about, other considerations are really about the relationship, the most effective coaching relationships involve mutual trust between the coach and the person being coached. And in that setting, building trust is a key element in the person being coached, being able to share in a sense of safety and to be open and complete in their descriptions and in their elaboration on their thoughts, feelings and motivations. And in that setting, the building of trust is a key element and therefore the most beneficial coaching relationships do not come where there's a power differential and do not come where there is a reporting line or an evaluation line between the coach and the coachee. These situations are, are fraught with metacognition about what impression am I giving and what is my goal here? And it's not always about personal development. And so in that setting, I would say that being peer coached by someone who has an interest in your well-being and outcome without any particular way to influence it might be the best choice.
DR. WRIGHT:
You spoke a lot about not being the fixer, so to speak, and I think you're so right. Often times, I know even for myself, when I'm giving advice or serving as a mentor to someone, it's very tempting to go in and fix, say, you know, like, you mentioned as clinicians, that, that's what we do. That's what we're trained to do. We think we know what the right answer is, and in the clinical setting we do. But in a mentor-mentee relationship, although we may be in a place to be able to see further down the line for the person that we are mentoring, we have to recognize that we can't fix things for them because their answers and their responses need to be their own. And we have to allow them to, to get there.
In conversations about this podcast series, the other word that has been a key word that I've noticed when talking about leadership and guidance and authentic leadership and authentic development of one during their professional career, and a lot of it has to do with trust. And I think as we start to recognize that within leadership, there is so much of trust that has to be present for the development of one throughout their professional careers.
DR. MARKOWITZ:
Absolutely, an absolutely key element is trust.
DR. WRIGHT:
So finally, I'm going to ask a question that I will be asking all of our guests during this podcast series. What's one misconception about leadership that's common among anesthesiologists, and why does it matter?
DR. MARKOWITZ:
Well, I don't know if I can speak for all anesthesiologists, but I think that it's about the same as a common misconception of leadership from many people, including many leaders. That's the leader needs to know the answer. I think that the days of a leader being able to be both skilled in leadership and emotional intelligence, as well as the content expert or the top content expert, are long since past.
We are super subspecialized in every area, and while demonstrating leadership and understanding anesthesiology are separate and one can develop expertise in both, the ultimate leader, the true leader does not feel the need to be the only person bringing information about the content. And so a leader needs to be able to know where to draw additional information, bring others into the expertise, and really share the responsibility of filling the pool of meaning in order to be able to make the best diagnosis or the best decision.
DR. WRIGHT:
I like that. I like that idea and concept of, of shared, of shared value in, in leadership.
Well, Dr. Markowitz, I truly enjoyed our conversation today. This was very enlightening for myself as a physician, as a clinician and as someone who hopes to be a meaningful mentor to many other residents or early- or mid-career physicians.
To our listeners, you won’t want to miss the March issue of the Monitor on Mentoring, Coaching, and Negotiation: Connecting with Purpose. Visit asamonitor.org to check out this article, and others, on connecting with purpose that will be featured in this month’s special episodes of Central Line. Join us again soon.
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