A Guide to Peer Coaching for Health Professions Educators

Despite a significant expansion in faculty development programmes for health professional educators [1], not all teachers have received education about teaching. Many teachers have, instead, learnt solely through teaching, with their educational practice being shaped by their prior experiences as both learners and as teachers. Evaluating one's performance as an educator, with a view to improving one's teaching, is also challenging. Firstly, the shortcomings of self-assessment are widely recognised and may be compounded by receiving incomplete feedback on one's actions [2]. Although seeking feedback from students is commonplace, there are limitations with this approach too. ‘Survey fatigue’ amongst students is recognised, and the consequences of this may be poor response rate [3], inaccurate evaluations [4] and responder bias, resulting in polarised opinions [5]. Issues may also arise with how practicable such feedback is. There is often a significant lag between the actual teaching moment and receiving feedback, meaning that the recollection of events may be limited. Furthermore, student feedback is invariably more student-centric and not educator-focussed. Peer coaching has been defined as ‘a collegial process whereby two faculty members voluntarily work together to improve or expand their approaches to teaching’ [6]. The term ‘peer’ captures a broad remit, with Gosling [7] defining peers as ‘colleagues from the same department, either of a similar status or (with) differentials of status, or … from another department’. A coach may be defined as ‘an experienced person who supports a learner or client in achieving a specific personal or professional goal by providing training and guidance, with a focus on relatively short term performance’ [8]. Peer coaching requires a collaborative, stepwise approach, as outlined in Figure 1. Firstly, time is set aside before any observation for a dialogue between peer coaches and their colleagues. Colleagues' needs are explored and the focus of the upcoming observation, in terms of developmental goals, is agreed upon. The peer coach then unobtrusively observes their colleague undertaking the teaching session. Afterwards, colleagues meet again for further dialogue, where both share their observations and reflections, whilst working towards ways in which educational practice might be modified. In essence, peer coaching represents a tool for guided self-reflection that is centred on individual performance, embedded in the workplace and underpinned by respectful relationships between colleagues. “Peer coaching represents a tool for guided self-reflection that is centred on individual performance, embedded in the workplace and underpinned by respectful relationships between colleagues.” There is much diversity in how peer coaching initiatives can be structured. They may be formal or informal, voluntary or mandated. They may occur as a one-off or instead run serially over a prolonged period. Participants may be organised into dyads or may instead form part of a larger group. The observation component may occur in real time or, instead, might employ video recordings to allow observation at a time of one's choosing. When describing peer coaching, it is also necessary to acknowledge that other terminology is often employed. The term ‘peer observation’ is sometimes used, though this term's sole focus on observation risks neglecting the critical before and after elements that are required to translate observation into meaningful change to one's educational practice. The term ‘mentoring’ is also sometimes employed to describe such initiatives. Although peer coaching and mentoring share similarities, there are differences between the two approaches. Mentoring has been defined as ‘a bidirectional relationship … which focusses on mentees professional growth’ [9]. Such relationships may be deeper, often focusing on personal life, work–life balance and career progression [10]. To conclude our definition of terms, Table 1 outlines what peer coaching is not and what it ought not to be. Seen through the lens of Kolb's experiential learning cycle [11], peer coaching may be seen as a means of supporting active experimentation before, and reflective observation after, a teaching episode, thereby creating new (in this case, pedagogical) knowledge through the ‘transformation of experience’ (Figure 2). By contrast, unobserved teaching is liable to err on the side of familiarity, to repeat errors, to miss opportunities and to stifle educator development. A well-structured peer coaching cycle, like a good lesson plan, will encourage teachers to pause and reflect on the outcome they wish to achieve (e.g., active participation of the whole group of learners) and consider strategies to achieve it. This gives the coach a focus for their observations during the teaching episode, which will help their colleagues to reflect afterwards. If this gives rise to a sense of dissatisfaction or curiosity about alternative strategies, abstract conceptualisation may follow, for example, if the colleague decides to explore the literature on an alternative teaching strategy. This in turn may give rise to further active experimentation (with or without the coach observing) the next time the session is run. “A well-structured peer coaching cycle, like a good lesson plan, will encourage teachers to pause and reflect on the outcome they wish to achieve.” As we make clear throughout this paper, a challenge in implementing peer coaching is achieving buy-in from colleagues, and it is helpful here to consider psychological theories of motivation. We find that self-determination theory [12] helps us to explain peer coaching to colleagues and to gauge whether it has been effective (Figure 3). Done well, peer coaching engages the colleague's intrinsic motivation to do a good job (competence), to do it their way (autonomy) and to feel part of a teaching and learning community (relatedness). By contrast, if the process is perceived to be a pointless hoop-jumping exercise or a covert surveillance operation conducted by the leadership team, colleagues may lose all desire to participate in the initiative (amotivation) or be driven to participate solely by an external locus of control (extrinsic motivation). Both amotivation and extrinsic motivation are associated with poorer performance and well-being. If the goal is personal growth, one can readily appreciate that colleagues must therefore find intrinsic motivation to engage, and this principle can guide us on how to cultivate an environment that supports this. Peer coaching builds on the development agendas of colleagues and establishes person-centred growth as a foundational principle. This makes it a flexible tool that can be effective across experience and expertise levels [13]; indeed, peer coaching can benefit from diverse participants in a learning community, as the outcomes are co-constructed. It is recognised that peer feedback can increase self-worth for teachers [14], which, in turn, can promote workforce satisfaction and sustainability [15]. A bidirectional coaching relationship creates a supportive and collegiate approach, demanding equal participation between partners and mitigating power dynamics between colleagues [16, 17]. When both colleagues share a teaching context, they can develop a more nuanced understanding of the realities of the education setting, including its dynamism and its challenges. Such collaboration fosters development via multiple pathways. A participant can develop new skills by receiving feedback on their own skills and through reflective, developmental dialogue with their peer coach. Peer coaching also brings reciprocal benefits to the peer coach, who, by observing and discussing their colleague's teaching, can develop their own teaching skills. As a collaborative process, peer coaching has the potential to strengthen existing relationships between colleagues or build new ones within the participants' community of practice [18]. Where institutional values align with peer coaching principles, reflective and developmental practice can become embedded. This may encourage teachers to adopt a more reflective, collaborative approach in their general educational practice [13] and may also facilitate cross-pollination of good practice between teams and departments. “Peer coaching also brings reciprocal benefits to the peer coach, who, by observing and discussing their colleague's teaching, can develop their own teaching skills.” We acknowledge that despite these myriad benefits, there may be barriers to implementation of peer coaching initiatives. In Table 2, we share, from the perspective of the colleague being observed, these potential barriers alongside strategies we offer to mitigate against these. For educators who are seeking to introduce, or refine, a peer coaching programme in their institution, the influence of ‘departmental culture’ is likely to be at the forefront of their thinking. Faculty development, and health professions education more generally, is provided within a diverse range of cultural contexts. Yet, it is recognised that culture is somewhat of an amorphous notion that is variably and infrequently defined, thus making it challenging to determine which elements of culture are relevant to faculty development initiatives such as peer coaching [19]. We choose to define culture using the ‘three lens’ approach described by Watling et al. [20], whose novel theorisation offers a helpful framework for reflecting on how peer coaching initiatives might be embedded. The first lens Watling describes is the ‘organisational perspective’, where organisational culture is the product of the shared assumptions, beliefs and values that characterise a setting. This is typically considered in retrospect and is often construed as being a barrier to change, rather than as a resource that can itself be a catalyst for change. For example, in the cultural context of hierarchical societies, great trust and respect is placed in authority figures, which can manifest in deference to, and more guarded dialogue with, colleagues with perceived seniority [21]. Hofstede's cultural dimension theory also recognises this phenomenon. Hofstede's six categories that define culture include ‘power distance’ [22]. In countries where this is large, the culture is one where there is great respect for, and deference to, rank, authority and experience—in essence, ‘subordinates expect to be told what to do’ [22]. For peer coaching to be effective, open discourse, where vulnerabilities can be shared, is crucial. One might conclude that a culture with large power distance would therefore be incompatible with peer coaching. Yet, as Watling suggests, this cultural factor may provide potential for change, as the power of positive role-modelling is amplified in such a cultural setting [23], making senior colleagues, who are invested in peer coaching, particularly powerful agents for change. Yet, the potency of this cultural phenomenon, and the extent to which it is in entrenched, must not be underestimated when planning peer coaching initiatives. Second, Watling refers to the ‘identity perspective’, where identity and culture become intertwined. Through this lens, culture is about how people make sense of themselves within a given community or setting. Teacher identity is recognised as an important determinant of excellence in education and something that departments ought to strive to nurture through faculty development initiatives [24]. A teacher's identity is not a passive possession; instead, it is dynamic, actively colouring what a teacher values, how they practice and how they develop. Considering peer coaching, an educator whose teacher identity is secure and comfortable may be inclined to perceive peer observation as an opportunity to develop. But an educator whose teacher identity feels more insecure may perceive the same opportunity as a chance to ‘fail’. Legitimising discussion about teacher identity within peer coaching initiatives is therefore important and should form part of any accompanying training or briefing. Finally, Watling's ‘practice perspective’, which, perhaps counterintuitively, eschews culture and instead focuses on practice, that is, what happens, and how is it enacted by people and things? Through this lens, culture does not exist in terms of ‘some unseen force directing people and their practice’ [20]; there are instead only actions that happen in time and space. For example, consider the educator seeking to implement peer coaching who is encountering resistance to doing so within their department. Rather than drawing on assumptions and interpretations of culture, the practice perspective would encourage this educator to examine the multitude of elements that influence peer coaching practice (e.g., identifying a peer colleague, timetabling and the physical spaces where observation/discussion occurs). A deliberate, analytical examination of all the elements that inform practice may reveal flaws that can be remedied, rather than erroneous assumptions about the individuals or the culture perpetuating sub-optimal practice. We close this discussion around culture with an acknowledgement that though the three lenses were considered separately, they are in practice, often co-existent, either colliding or complementing depending on the educational milieu. Furthermore, aiming for a ‘one size fits all’ standard for peer coaching is not our aspiration. We have instead sought to moderate our guidance through cultural humility. This approach acknowledges that there are likely to be a variety of effective, contextually appropriate approaches to peer coaching globally [25] and that there is much to be learnt through international collaboration and bidirectional learning [19]. “There are likely to be a variety of effective, contextually appropriate approaches to peer coaching globally and that there is much to be learnt through international collaboration and bidirectional learning.” In this toolbox article, we offer a definition and a structure for embedding peer coaching within a health professions education context. The potential benefits of implementing peer coaching are outlined whilst acknowledging the barriers that exist to doing so and offering mitigation strategies against these. Accessible summaries of relevant educational theory are presented, seeking to illuminate the pedagogy that underpins the three-step approach to peer coaching that is suggested. Theory is also used to offer explanations for variable engagement with peer coaching programmes. The impact of the local educational milieu on peer coaching schemes is further considered through discussion about culture. James Fisher: conceptualization, writing – original draft, writing – review and editing, project administration, visualization. Anna Ainsworth: conceptualization, writing – original draft, writing – review and editing, visualization. Richard Thomson: conceptualization, writing – original draft, writing – review and editing, visualization. Joanna Matthan: conceptualization, writing – review and editing, visualization. Vishna Devi Nadarajah V: conceptualization, writing – review and editing, visualization. Yvonne Steinert: conceptualization, writing – review and editing, visualization. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.

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