We got the chance to interview Dr. Robin Craven, a PGY2 in Family Medicine – Surrey South Fraser. Dr. Craven helped set up the Peer2Peer initiative at her program, which connects junior and senior residents together to encourage learning and connectivity. We loved chatting with Dr. Craven about this program, and we hope you enjoy reading about it just as much—especially as it will soon be offered to residents interested in setting up Peer2Peer at their own program!
You are the creator of Peer2Peer Coaching, a program in Family Medicine – Surrey South Fraser which connects junior residents with senior residents. Can you tell us a bit more about the program, such as how long has it been active, how do residents get connected, and what can a junior and a senior resident expect from the program?
We are just getting started with Peer Coaching, we implemented the first real-time part of the program at this years’ (2022) orientation on July 7, and we are continuing by giving monthly session during academic day to further help the seniors get acquainted with the juniors.
But actually behind the scenes, peer coaching began virtually when the juniors matched to the program (the day after Match day) we sent out a survey asking them their interests, and created a chat group for them to get to know the senior residents and each other. The Co-lead residents matched junior residents with a senior buddy so they could ask questions directly to their buddy. We had a chat group for “how to find a great place to live” and other groups for “what you need to get done before July 1”. It was really neat to see the enthusiasm of the incoming residents, and to watch them get to know each other and create strong bonds even BEFORE residency started. Those bonds continue to this day. Peer coaching is not just about senior-junior interactions, in my opinion, but about any resident supporting another resident.
On orientation day at the beginning of July, we introduced each new resident and their interests with a powerpoint presentation that kicked off the day, presented both to the senior residents and to the faculty. As each resident was introduced, we brought them to the front of the lecture hall and “initiated” them into the group with matching t-shirt with their names on the front and “UBC Family Medicine” on the back (pictures attached) so they felt they were part of a larger group who knew their names and cared about them. Later in the day we included pictures and interests of the senior residents too so the juniors could get to know them further. When everyone had a t-shirt, we went around the hospital together to see the various areas where they would work and learn, and posted pictures and contact info of the resident groups at each PCC station.
When we got back to the lecture hall in the last week of July, we had an activity where the senior residents helped the juniors set goals for their first in-hospital rotation which starts in August, and we made sure they knew how to log onto hospital computers and how to find pre-printed orders. We role played how to set a rotation goal even with a preceptor who was busy, to get our important learning gaps addressed.
In August, we worked through the SNAPPS preceptor method which is encouraged by UBC as an effective method for a medical student or resident to develop clinical reasoning skills without fear that the preceptor will find them lacking, but instead allows the resident to “probe the preceptor” for areas that they want to know more. The junior resident was given a clinical case and given time to present it to the senior resident. We will practice this more in coming sessions. At the same time, during a preceptor training meeting in Langley, the preceptors were encouraged to use the SNAPPS method with the residents.
This month, September, we are going to learn more about the CAMP (coaching and mentoring program in rural BC) from Bruce Hobson, and practice how to create a safe mentoring/coaching environment, for those of us who have not had much exposure to safe learning. This will allow any residents who wish to continue to be involved in the coaching/mentoring program after graduation, as they will understand that CAMP exists and how it works. Currently CAMP is only offered rurally but it is in the process of expanding to urban locations.
Later in September we are going to have a few skilled preceptors come in to watch us as we practice the SNAPPS preceptor method between residents in focused clinical settings such as OB/Surgery/Pediatrics.
In January we are having a whole day training session with Dr. Blair Stanley and Dr. Jenn Rogers on how to create a culture of peer coaching and support. This will also be recorded and offered on the UBC CPD website, in 8 – half hour lessons, which will work ideally for a one hour slot on academic day, with half an hour to watch the recording and half an hour to practice (with the buddy pairs) the concepts taught therein.
For me, we complete each session, I take notes on what worked well and what we can improve, so that we can create a template to offer on UBC CPD for any site that would like to make Peer Coaching a part of their program. We hope to offer the course on UBC CPD by March 2023 so that programs can start as soon as Match 2023 happens.
Just a note, this peer coaching and support is already happening in Strathcona Site, on Vancouver island! They are the poster child for Peer Coaching as they are already doing it, whereas we at South Surrey are still learning and trying to create the template for other learners.
I think the most important part of Peer Coaching is that, for the junior resident it helps them to feel supported and set relevant goals for their rotations, and for the senior resident it helps them realise how many things they have mastered in just one year and gives them a chance to practice being a mentor and coach. I am hoping to create, from the bottom up, a culture of support and life-long learning in the UBC medical program, that will extend to practicing physicians as we graduate.
You began wanting to implement this program at the start of your residency, which coincided with the COVID stresses and lockdowns and therefore fewer resident interactions. How was the journey from conception of the program to implementation? What have been some of the strongest points and benefits of this program that you and your fellow co-residents have seen and experienced?
I think the journey has been fairly difficult as at first many people in my program did not see how Peer coaching could be an important part of academic day, given that we have so many clinical topics to cover in that short time. Also, getting ethics approval for the project was lengthy and took many attempts. We have also found that some of the senior residents were not convinced of the value or participating, although that is changing over time. I am working to address this by finding out their concerns and adjusting the program to respect them.
We have also had difficulty involving the equity/diversity/inclusion piece of this project and are still working on that. Currently I hope to get guidance from the Anti-racism committee at UBC as to best steps to make sure this project is respectful of everyone, no matter their background.
The first day we had orientation, when we all got matching T-shirts, it was such a rush! It felt like we were part of a bigger team, rather than just struggling along as individuals! I think the strongest benefits have been seeing the residents begin to feel that they can count on each other. It’s not completely there yet, as we have only been doing this for a couple of months, but it’s really changed the feeling in the room when we have academic day. There is more support and more feeling of being included. The junior residents say they feel that the seniors have their backs, and that they know where they can go for help. The Juniors are also very close knit, I think in part from being connected from well before July 1, and they have their own social activities and are great supports for each other.
Our hope is that we will be able to increase resident support while we are only licenced for educational practice, but that this culture of support will continue after residency, so that physicians in BC can be more collaborative.
You recently received the Strategic Investment Fund Grant, which will allow you to put this initiative forward on the UBC CPD platform for other programs to use. First of all, congratulations! Second, do you have any words of advice for residents who may be interested in implementing Peer2Peer Coaching in their own programs?
Absolutely, don’t give up! If you feel your program is not giving enough time for interaction between junior and senior residents, refer them to our lessons on UBC CPD (or email me if you want to more sooner than March 2023) to help them see the research behind the effectiveness of Peer coaching. You can also contact residents at Strathcona site there this type of residents’ support has been in place for some time. Some of the ideas behind it are very simple and will not require much change to the program, such as having a resident check-in time for half an hour at the beginning of each academic day, and having some call protected social activities in the first month of residency so no one is left out due to a call shift. If the program and residents are interested in having a more structured interaction, there will be many cases and recorded lessons to work through on different topics with junior and senior coaching groups on academic days. It is designed to allow the program as much change as they want to make at a time, a little or a lot!
Lastly, is there anything else you’d like to share about Peer2Peer Coaching and your goals and dreams for it? Or, alternatively, are there any other initiatives that you’re interested in bringing forward to your program or hope to one day see?
I would really like to see this program in all of the medical training programs across BC, not just family medicine. I saw it work so well in Internal Medicine in New Jersey. The program there had such a feeling of team learning and caring. Some of the programs here in BC, such as pediatrics, are doing it already, and they say it really works to create cohesiveness and support. One of the things that I strongly believe in, is that we learn more when we teach than in any other learning situation—much more than just reading about a topic or watching someone else lecture on a topic. I have seen, in my training, situations where medical teaching (in the form of “PIMPING”) was terrifying and not conducive to learning. It did not create an environment where it felt safe to show any clinical gaps that I was hoping to address. I felt like I might be the only dummy in the room who didn’t know the answers, and I felt alone and like maybe the medical school made a mistake in letting me in. I have also been privileged to be part of teaching situations where I felt the preceptor knew me, liked me, and wanted me to show my best knowledge. These where the places where I felt I could really shine–I felt I could really bring out my learning from medical school and solidify it into real patient care that I will always remember!
I am also hoping that if we as residents learn to look after and teach each other, we will create more wellness and resiliency, which will extend to greater professional and personal satisfaction, and will ultimately allow us to be more compassionate in our care of patients. It will naturally create equity, and respect for diversity as we get to know each other and is the very definition of inclusion. Finally, I think that if residents work together, we will be more able to save our preceptor interactions for the common knowledge gaps that many of us do not know as residents. It will make our preceptor interactions more efficient and give the preceptors more satisfaction that they are addressing important knowledge gaps for all of us.