Operate with Zen

18. Mindful Coaching with Rob Kramer and Dr. Kara Penfield

October 31, 2021 Phil Pierorazio Season 2 Episode 6
Operate with Zen
18. Mindful Coaching with Rob Kramer and Dr. Kara Penfield
Show Notes Transcript

Rob Kramer, PCC and Kara Penfield, PhD are founders of the Spiro Coaching Institute and the Academy for Academic Medical Center Coaching Program.  Together they have a tremendous history and experience coaching executives and other professionals in healthcare.   Coaching, interactions with colleagues, and professional development are discussed in a framework of mindfulness.  Find out more about coaching, Spiro, or the AAMCC program at: https://www.spirocoaching.com/.  (Music Credit: Sunshine, Simon Jomphe Lepine.)

Phillip Pierorazio:

My name is Phil Pierorazio and I'm a urologic oncologist, a surgeon. Like many of you, I absolutely love what I do, and I would not choose another profession. But I've struggled professional identity, practice efficiency and wellness over the years. operate with Zen is a podcast designed to explore a mindful approach to surgery and to being a surgeon. By discussing these struggles and mindful solutions, I hope together we can create a community of strong and healthy surgeons enjoy. All right, welcome to operate with Zen. I have two very special guests. With me today, have Kara Penfield and Rob Kramer. And I'm going to ask them to introduce themselves. So Kara, why don't you go first.

Kara Penfield:

So thanks for having us. My name is Kara Penfield. I'm an executive coach and a leadership development specialist. I actually spent my professional childhood working for the Walt Disney Company. And so started to get my sense of how to lead from, from I'd say the best or at least the mouse, and then went back to grad school. I'm a psychologist by education spent a lot of time working in K 12 education and higher education as a psychologist and assessment specialist. And also leading large teams. As an executive coach, I have found my favorite place to coach is academic medicine and higher ed, working with the complexities of of the environments that you navigate all the time. Thanks, Rob.

Rob Kramer:

I'm Rob Kramer, I started mindfulness practice in 1991. And set me on a course of the work I continue to do today. started my professional career in healthcare, doing professional development work, and then in higher education at a couple different universities. Before pivoting and becoming a full time executive coach with my own practice, well, I've been doing executive coaching since 2001, started a full time practice in 2010. And mindfulness has always been a deep part of the work that I do there. And much like Cara, primarily coach in AMCs, and higher education.

Phillip Pierorazio:

Wonderful. So I got to meet Rob, and Cara through the spiral coaching model, which was the the Academy of academic medical center coaching, I always make sure I get that, right. And as many of you know, I became interested in kind of coaching and developing not only myself, but my junior faculty and colleagues over the last year or so. And I really found this program to be exceptional and aligned with my interest in mindfulness. So Rob, and Cara, were two of my teachers and mentors, and I learned a lot from them and continue to learn a lot from them, as we continue to do some continuing education through their program. So thank you both for being here today and talking with our audience. So we'll get right into it. Why do we need coaching in academic medicine? And Rob, why don't you lead us off here?

Rob Kramer:

It's a great, great question, Phil. You know, having come up through healthcare and higher ed, I saw the gap of well, at any stage of career, but certainly new leaders and rising leaders being thrust into these roles in a MCS and in health care without a whole lot of support. The joke that I make is, you know, they're certified smart, they're MDs, they're PhDs, they're MBAs. So they can take on these roles. It's no problem, they can just do it, you know, they'll figure it out. Or they've got enough smarts or they've demonstrated enough Saturday, doing great clinical work, or great research work or whatever. It's been great teaching, but really not having the tools. And then the pressures in academic medicine of of people having to show that they know what they're doing, you know that that there's a constant tension, I think in that culture, that is, you have to demonstrate your chops, and you have to show that you're smart, and you have to show you know what you're doing. And it's actually in some ways, this is my words, no one has said this, but a sign of weakness. If you can't demonstrate you can, you know, run with the guns and do it. And, and I had seen coaching emerging. I first learned about coaching in the late 90s. And I was a center director and thought it was kind of this whatever flavor of the month but found incredible impact from it. So that's when I really got curious and interested into it more and saw the impact that coaching has on developing people on Helping people have a safe space to talk confidentially about stuff they might not share anywhere else and take a step back in brief, and put all their junk on the table and say, here's what I'm grappling with. Here's what I want to do better. Here's where I have no idea what I'm doing. You know, a thing I tell people a lot, Phil, when I coach, I coach a lot of like, hospital CEOs, and C suite executives, chairs. And I always tell people, I could probably put five bucks down when I'm starting with the new client, that there's a 60 to 70% chance that this client will disclose at some point, feelings of imposter syndrome. During our work. There's just so many people, Karen, I included, I don't wanna speak for Kara. But you know, at some point, you feel like you're faking it till you make it. And, and so the pressures that MDS have or administrative leaders have or executives have where they're supposed to know what they're doing is monstrous. And so the chance to have that safe space to kick it around, look at themselves, look at their choices make better choices that have different impact than what the results have been that they're getting. The payoff is, is immense. You know, I came up through training and organizational development. And I still think to this day, the most sustained positive change I've seen for people is through the result of coaching.

Phillip Pierorazio:

That's great. You know, I said a little differently. I think one of the observations I have from being an academic medical center my whole career, is we see some of these people in leadership, and they're wonderful people with the skills that made them wonderful academic physicians do not necessarily translate into academic leadership. And they're never given those tangible skills. As you said, they did really well at getting grants and writing papers. So they should do really well at cultivating faculty and organizing budgets. There's a big disconnect there. And I think there's a huge, huge role for this. Karen, did you have additional thoughts?

Kara Penfield:

Well, I guess a couple coaching can serve both as sort of intervention and prevention. And as a psychologist, I always sort of enter things from interactions from that perspective. Everyone who works in academic medical centers, physicians, surgeons, administrators, nurses, the whole gamut, you all are dealing with enormous pressures, and lacking the luxury of a little bit of time for reflection and preparation. And so coaching can be I certainly have clients who have been long with me long term, and they will send me a text or an email and say, Do you have time like, this is a sort of I have a fire right now? Can you help me, and that's more of an intervention type of conversation that we're having. But the conversations that I have every month with my long term clients and giving them the space to sit and prepare for what they want to talk about, reflect how they've been showing up in the world, consider the obstacles or opportunities for showing up more effectively. And that impacts them if they have aspirations for or are in positions of, you know, technical leadership, it within an organization. But also if you're working in the operating room, if you are meeting with a patient, one on one, or patients families, if you are trying teachings, a group of students, you have residents who were relying on you to get them from where they were to where they need to be. Every one of those people benefits from having a little bit of time to focus on who they are and how they want to show up even better than they have. Cool, can

Rob Kramer:

I add something on to that? Please do something that Kara mentioned there in the beginning that I think is criticals. You know, in our work in education, one of the jokes in higher ed is the pressure so high because the stakes are so low. But in academic medicine, pressure's high, because the stakes are high literally is there's no joke about life and death. And so when you're dealing with stakes like that, there's there's ever present tension, and there's ever pressing concern, and there is ever present stress and, and we're seeing it in higher ed now the immense amount of fatigue and burnout, suicide, right, all of that it's coming to a head right now. And without the tools and resources to help people really process what's happening to them. You know, that there's a big loss and a big gap there.

Phillip Pierorazio:

Yeah, I think it's a really important point. And I think we have a huge opportunity. Now as we see all of this stress and burnout coming to light, that these interventions are really needed. And this should be a normal part part of our process, a normal part of our development where it used to be kind of, you know, the dogma was you really in medicine, you got coached when you needed remediation, right? If you had a behavioral problem or you weren't developing properly, then you Got a coach. But I think there's a lot of benefit. I know I've personally seen it. But there's a lot of benefit to being coached kind of early on, and helping develop those skills. And as you said, Kara, the the space to reflect the space to think about these things, and develop in a mindful, a mindful way, we'll get more into mindfulness. But to make it a little concrete for the audience can go to you first Aircar, can can you give us some concrete examples without divulging names of people or institutions, but just kind of benefits that you've seen in as a coach, to your coaches and how you've seen them improve?

Kara Penfield:

I really appreciate that you ask about the individual and the institution level, because they, they play into one another. When, when we rob and I with our businesses, enter an organization for the first time with the first leader, a lot of times that first leader isn't familiar with particularly familiar with coaching, maybe somebody recommended that they try coaching on and so they, they start to build a relationship with us, and they then start to really get a sense of, okay, this person has my confidence, I am trying, I'm figuring out better ways to show up. And by virtue of that conversation, it not only affects the particular challenge that they brought to our conversation for that coaching topic for the month, but they start to practice the skills that I'm practicing with them. And then those start to cascade out to the other people in the organization. And they talk about the coaching and the impact it's having and suddenly more people are talking about coaching. So the neatest experiences that I have had like the most concrete, or when I've entered one particular very large organization, that is high stakes in a different way than medicine. But we entered doing a couple coaching engagements for a couple key leaders. So key leaders said, You know what, my direct reports could benefit from this too. Do you have other? Do you have other coaches, so they don't have to be coached by the person by you because you coach me. And so then we bring in a bigger team. And then what happens is, those leaders start to ask questions about how they can use the coaching skills as leaders themselves. And so I Robin, Robin, I actually we're together part of a really big intervention where we delivered coaching to the majority of the key leaders in this large organization, and we delivered coaching skill development programs, to every member of the organization. And so then it becomes not only something that that an individual leader experience, but it becomes the way they communicate with one another.

Phillip Pierorazio:

Yeah, it's hugely important. I think there's a growing literature now that says one of the best ways to keep people happy at work, is to give them a sense of professional development, right? What are they trying to achieve? And when you develop a culture of coaching, you're all developing each other. I think that's incredibly insightful. Rob, did you have any examples you want to share?

Rob Kramer:

Yeah, and I love what Kara shared, because it really does change the way people engage with each other, the quality of conversations change, the ability to come from a place of curiosity, rather than telling or blaming, starts to show up. Decision making happens differently. Thoughtful engagement starts to show up. There's certainly times where it's rush, rush, rush, right? Sometimes the house is on fire. And even then they start to learn the skills of you can still do a post mortem, after the rush, rush rush and say, how do we handle ourselves through that? And what could we have done better? And all that starts from starting to learn these ways of thinking differently and engaging differently with oneself or with others or with organization? So for me it just as an example, I'm thinking about, you know, one of the reasons I love working with with the higher level executives is because of the trickle down effect. When you see the impact, for example a dean has, through coaching and the work they've done on themselves. It absolutely affects the way they guide their direct reports, the way they talk to their faculty, the way they engage students. You just you see it, it's visible, it's tangible, the feedback is visible. You know, we'll do 360 assessments after working together for six to 12 months and you'll see the results of that work. And so the impact of helping one in a place of influence starts to help 10s if not hundreds, as it trickles out and down. To me that's a huge payoff, especially in academic medicine, where the stakes, again, are so high and the pressures are so high for senior executive to show up and actually see other people and pause and hear other people and demonstrate their genuine interest in others. Be thoughtful, be mindful that just, you see the payoff that that has hugely rewarding.

Phillip Pierorazio:

Is it bring it to a great point, Rob? And who here to say who or what situations really lend themselves to coaching? So you mentioned the executive and kind of a trickle down model. But who out there also really needs a coach or could benefit from coaching? How do you kind of identify those people?

Rob Kramer:

Right question, I almost uniformly now say whenever someone gets promoted up to a new role that they haven't experienced before, that's a great time to get a coach. Because the the expanded growth is huge for the person to figure out that job. You want them to do it, hopefully, I assume if someone gets promoted, they want them to be successful. So giving them a coach, it's like a sports metaphor. You know, a lot of high end, super elite athletes still work with a coach, because take a pitcher in baseball, you know, they're still fine tuning their game, they're still working with the psychological side of how do I stay sharp, under pressure? How do I stay focused when I'm not having my best day. And, and so regardless of the level, the use of a coach is the ability to have a place to work through my stuff, as I'm learning and growing and stretching and being pushed. So that's one place I always, almost always now say promote during a promotion, new level up great time for a coach, when someone's going through transitions of some kind or another, whether they be life transitions, or professional transitions. Phil, for example, moving from one institution to another. Whether or not a promotion is involved years in also includes promotion, but even just moving to an institution and trying to understand the new culture and what's appropriate and what's not. And how do I, who do I trust and great place to have a safe space to talk with a coach?

Phillip Pierorazio:

Or anything you would add? Or, you know, when people are thinking about should I get a coach things that should be on their mind?

Kara Penfield:

Yeah, well, an additional group that I would, I would add to that, Phil is people who feel like they're ready for something new. And they don't know exactly how to get from where they are to where they could potentially go, they don't even maybe know where they aspire to go. And so having somebody to sort of reflect with and challenge part of my job as a coach is to challenge the assumptions, the stories that somebody is made up, this is my only chance or people are interrupting my ability to be successful because of this or that. And so building a relationship with them, where we can really explore whose story is that? And is it a legitimate story? Are there other stories? So I think people who have aspirations of doing something new, all of us have reached a point, you know, at some point in our careers where, okay, I've figured this out, like, now I found my groove, I can do whatever it is that I do. But now I want something in addition to that, what's the next step? So I love coaching in that space? As far as the question you asked Phil, about what to consider when you're looking into getting a coach, I think the first thing to consider is, coaching is a form. You mentioned this earlier of leadership development, and and I guess, professional development, but it's isolated, it is targeted specifically to your needs. If I were coaching you, you would say, you know, these are the 123 things that I want to work on in this order. And so we can really focus with our conversations and resources that we bring to those, those targeted areas that you've identified. So thinking about things like what what, what might I want to talk to my coach about? And what are the qualities of a person that I would look for in a coach that I that could help me that I could build a relationship with, and feel comfortable being challenged by and supported by So what type of person really helps me grow? And then thinking about how much time do I do I want to dedicate to this

Phillip Pierorazio:

really important point, so I'm gonna progress the question a little bit. We talked about the coachee. And I'm gonna ask you guys a little bit about coaches now. And you both of you are phenomenal coaches. I've had that experience and seeing that experience. And Rob, I'm sure you remember this. I bet you lead multiple sessions like this, but one of the first most poignant analogies I remember you sharing in our coaching session with the Dean Smith is Bobby Knight coaching styles and I will kind of belabor the story. But if you want to tell the full story, you can, but basically, both had arguably, it for at least a period. They're equivalently successful careers, if you look at Final Fours and champion system and such. And then dean Smith's kind of retired with his former players, loving him and loving who he was, and the Chapel Hill program continues to flourish and grow, where Bobby knights career ended in a very different way. And the question you posed is, what kind of coach do you want to be? What kind of legacy do you want as you move forward? So not all of us are meant to be coaches, not all of us are meant to be great coaches. As you're developing coaches, what are you looking for? Who do you how do you kind of help steer that decision making process?

Rob Kramer:

I'm gonna call quick timeout, as we're developing coaches, like for our firm, or developing people to be leader coaches, yeah, developers should be leader coaches.

Phillip Pierorazio:

Yeah.

Rob Kramer:

You know, I've drunk the Kool Aid, Phil. So to me, the tools embedded within coaching are universally useful for anybody, you don't have to have a business card that has a management job title on it to say, Oh, now you should learn coaching, to have universally strong conversations, to understand how to influence your boss to get along better with your colleagues to make your clinic run smoother, to make your research project go better, to be a better Pei, to be a better teacher to residents. Any of those situations be a better nurse to be a better administrator, understanding and utilizing the foundational premises of coaching, have positive impact in any of those situations, any of those situations. So, again, I'm I'm speaking, having drunk the Kool Aid for 20 years, because I've seen the results of having worked internally, and using the skills as an executive coach to help others grow and develop. So, you know, in a blanket way, I'll say, everyone. Now, readiness is a huge part of it. Are there people who have a readiness to willingly want to look at it and go, Oh, how can I utilize these tools for myself in my own growth? How can I use them in the way I have conversations with others? You know, do I have a readiness and a willingness to want to try that? Or do I see it as one of those jargony things and whatever, bla bla bla bla, and I'm going to kind of poopoo it, right? And so that's their challenge to cross if that's how someone views coaching. So be it the ones that have an interest or intrigue can gravitate towards and start to use it. And then the hope becomes, and when you're changing culture, and more and more people see the value and start to gravitate and others finally, come on in. Wow, that's feels really skyrocketing. What the heck's he doing because I'm still stalling in my career. And, you know, one of the things he's doing is having better conversations with people. And I see him developing other future leaders and right, I'm still stuck doing what I'm doing, whatever someone's aspirations might be, you know. So it starts with mindset. Do I want the best for myself? Do I want the best for others to want the best for my organization? And if you can answer yes to at least a couple of those, I think you'll find coaching to be hugely helpful.

Phillip Pierorazio:

Tara, do you drink the Kool Aid too? Is everybody Oh, my

Kara Penfield:

goodness. Did I ever and you know, interestingly, felt like my what got me here was I started in one when I was in grad school, and I was studying to be a psychologist and I was doing my training as a therapist, I worked at a crisis and suicide center, on the phones, and in Gainesville, Florida, they have this amazing lateral County has this amazing care team that goes out and they work with law enforcement to do death notifications, and work with people who are suicidal work with people who have families who have lost someone to suicide. And the the skills that I learned way back then, are very, almost the same as the skills that we use in coaching. It's about establishing a relationship and asking open ended questions and not assuming that I know what's going on for the other person. But coming from a place of curiosity, tell me, tell me your story. Tell me your truth. Helping people see the strength and opportunities that they have, and then helping people come up with a plan. And so I started drinking the Kool Aid long before I had any idea that this is where I would end up and I do believe that having deeper conversations I use these these these skills at the grocery store. I use these skills as a parent I use these skills with surgeons. I use these skills with CEOs of companies and with middle managers and and so I have drunk the Kool Aid I believe strongly and I think that one of the things that maybe you watched happen in, in the program you attended is that people, they're curious. So they're going to dip their toe in, and then we teach a few skills. And then we, you know, say goodbye for a day or two, we come back together. And in that time, you apply just those first simple skills. And people immediately notice a difference in the conversations they're having with people with others. And as you build skills, those relationships expand and the depth of the conversations expand and the fluency of the skills develop develops, so then it becomes natural, as opposed to sort of awkward a different.

Rob Kramer:

One thing I would add to that Phil, that's really critical is coaching is not a kumbaya, tool. Coaching, it's powerful, it's relational. And it's mission driven. And it's, it's performance driven. And it's goal oriented. And it's outcome oriented. So it's generative, and its strategic at the same time. It's relational. And its objective, it's some kind of hits the many dichotomies. And yet it's such a simple tool. And you look out on the outside you go, I can do that. That's so simple, you start practicing, oh, wow, this is actually harder than I thought it was, as you learned in the coaching program, to get out of our own way. And yet, the payoff hits lots of different areas. So I don't want the listener just to think, Oh, this is just to build relationships. So your likability factor goes up, and I don't care, blah, blah, there's so much more going on, in terms of guiding and leading and changing an organization and making things work better.

Phillip Pierorazio:

Yeah, I can certainly attest to that it is, in a wonderful way, incredibly taxing to be a coach, I mean, the to be very attentive and, and in the moment and present with your Kochi is can be incredibly draining, but in a wonderful way. And you're right, it's not only because you're listening, you can have a conversation with anybody. It's not just having a conversation, it's directing the conversation, allowing them to direct the conversation, kind of building things out and really allowing that person to develop. And to your other point, Kara. I agree, the skills and the practice of being a coach has made me a better colleague, when I'm not coaching, I hope and think it's made me a better husband and father, by being more open minded and receptive and non judgmental. And obviously, there, there are times in life where you need to be judgmental, and, and have all things but also recognizing when you can be open minded and when you can't be. So I think these are all really wonderful skills, and teaches you how complex coaching really is. It's not just a conversation. So I want to delve a little bit into coaching. And you guys have a mindful approach to coaching with really, which really resonated with me. And I think will resonate with a lot of people as they start to understand this concept. So, Karen, you want to walk us through a little bit of framework of mindful coaching? And what does that mean, we touched on it, kind of briefly, we've talked about space and reflection and open ended questions, but give us the framework.

Kara Penfield:

And I'd love to and definitely Rob will build on this. I when I think about mindfulness and coaching, I think about it for both both players. So the coach and the client or the direct report whomever you're having the conversation with, for me as a coach, mindfulness is key to my ability to, as you just said, be present with somebody else and turn off all the noise. So that I don't, not only don't I mean, I have my phone turned off right now. So I'm not going to get a call. But I'm also not worried about it. So to be fully present as a coach, and is key because I need to hear what you say I need to ask questions that are the product of what's important to you. And I need to make sure that I'm not too present in the conversation. Because if if I am not practicing mindfulness, and I'm in if I haven't that day, if I haven't practiced yoga, which for me is the way I access my more Mindful self. I don't I may not be so aware of how much I'm inserting myself into the conversation. So mindfulness allows us to be aware of others and ourselves. And that's key. Because if I start to insert my suggestions when somebody is has come to me asking me to be their coach, then I'm not in service to them. If they've asked me to tell them how to solve a problem, because it's time sensitive, I can do that. But when they asked me to coach, I need to be aware of how I'm showing up. Mindfulness for for my clients, when I'm coaching them is also about those quick moments that Even quick moments that you take to ground and quiet the noise for yourself. So oftentimes we're in a coaching conversation, we'll start by asking on a scale of one to 100. How present are you right now? And based on their response to that, what would it take to dial that up a little bit, what it what hat, what needs to happen now, so you can be more present for yourself in this conversation. And so perhaps we'll just do deep breathing for a couple minutes, maybe it will be that we're just going to both turn off our cameras and commit that we're not going to be distracted. Or sometimes I have one client who's a physician, and he just rattles off. Well, I'm not present right now. Because ABCD and, and then he's, it's out of his head, and he doesn't have to hold on to it anymore. And so the practice of mindfulness in coaching is important for the benefit of that work that we're going to do together in that hour or 30 minutes that we have. But it's also important because it starts to remind that person that, oh, I can do this. I can do this between meetings, I can, I can find five minutes on my way to see that next patient to just quiet the noise so it can be more present for that person. I think those are a few of the reasons.

Phillip Pierorazio:

I know you have thoughts too

Rob Kramer:

hard, hard to be that one I could care. He had the thing I love about mindfulness. And I'd like to clarify. I know your podcast really talks about these aspects a lot. But that that's and we talked about this in the program, you took that it's we're not talking about what's become sort of pop mainstream mindfulness these days, we're talking about one's awareness of the present moment, starting with the easiest place to start, and the hardest, maybe is one self in the present moment. So it's not that you always find this perfect, quiet place. It's the ability to go wow, my, my, the noise in my head is really loud right now. That's fascinating. So rather than trying to shove it out, you just have curiosity about the noise. What's the noise about? So like care is example the physician who can download the things. You're asking them just, you know, let's clear the noise out. So what's the noise? Let's label it. And by doing that, it helps dissipate it. Or I'm feeling frustrated from that last meeting I just had with that. CFO, and I'm not sure what's going on, you know. And so let me just be mindful about myself. Why am I frustrated? What's raising my blood pressure and a couple simple questions can then start to raise one's awareness and mindfulness in the moment is happening. To me, mindfulness can come in lots of shapes and forms. It doesn't have to be meditating on a cushion, which is what also people generically think that's what if you're doing mindfulness, you're meditate, quote, unquote, meditating, but I love what I call mindfulness in action. I like being present to noticing what I'm doing when I'm washing the dishes. I'm having a growing trend with clients right now. Because everyone's so zoom, fatigued that we'll do. Walk and Talk coaching sessions, we'll both be on headsets. And we'll both take a walk, even though we're in different cities. And we'll walk while we coach and just the physical activity helps someone clear out the distraction and be more present in the moment, mindful of how they're feeling and how they're thinking about situations. And so it's really different for everybody what it means to be mindful. And in the application of mindful coaching, I would really support everything Kara said, It's good coaching, the foundation is is to be present. And if you're not present, if my mind is distracted, if I'm not fully present with you, Phil, while you're talking, I'm not giving you the full benefit of what a coaching conversation should look like. And so part of my work is to develop myself, you know, one of the slogans, Karen, I kick around is good human, better humans make better coaches. And so the more I'm developing myself, I'll speak just for my own career, the more I've worked on myself as a person, the better I've been to simply just show up and be on a coaching call, one to one ratio. And so it's a constant practice of developing oneself.

Phillip Pierorazio:

Yeah, I agree. And, you know, mindfulness really is in the eye of the beholder. And I think there's certain core themes, that whether you're working on your own mindfulness practice, or mindful coaching, or whatever it may be, right, it's being present in the moment. And when you're coaching, it's with that person. It's an important hugely important component of self awareness. And I think one of the other aspects that you guys really push forward and train is the beginner's versus the expert mind. And in medicine, we are trained to be the expert. We are expected to be the expert and to have the answer whether or not we have it. And I think really bringing back and saying, first of all, it's okay to have a beginner's mind and be curious and try and seek out other solutions and other answers. But it's okay to own that too. And say, I don't have the answer here. But let's figure out what we do know and work together. And I think that's a hugely important component of mindfulness and of your mindful coaching program.

Rob Kramer:

I think you just said something critical. Phil, which is someone having the courage to say, who's living through the lived solely out of expert mind is to have the courage to suddenly say, I don't know the answer to that. I don't know, what's the best way to handle that. And, and to me, that's an act of courage. But it starts with mindfulness to recognize, oh, you know, I really don't I want to, I want to do something different, because I'm recognizing in the moment, that's not the most helpful way to engage in this conversation. So that that goes back to mindfulness as well, you know, mindfulness before courage. So I just want to point that out to the listener, because I think you've raised something really, really important there.

Kara Penfield:

Yeah, and doesn't that to Phil have impacts on patient care? Like, there's a lot of research out there to suggest that if a physician steps into a room with a patient and makes up at, you know, decides, in the first five words that they know, he or she knows what's going on, can often miss really important parts of what's going on for the patient and what the right approach to care is going to be.

Phillip Pierorazio:

Yeah, there's, there's growing literature here, and it's all kind of in that realm of circumstantial evidence. But if you put it all together, I think it sends a really powerful message. Some of the literature says if you don't ask open ended questions, or you present yourself as the expert patients aren't going to open up to you. And so you may miss really important diagnoses or really important signs or symptoms that they want to share with you. Some of it is that we miss a connection with them. You know, just kind of practically but, but tangibly, that connection is a lot of the therapeutic relationship, right is in how you relate to people that can lower anxieties, it can lower uncertainty about illness, it, you know, I, I'm probably going out on a limb to say that it can affect long term outcomes. But I think there certainly is something to be said about therapeutic relationship and the confidence people have in each other. And the other part of it is, there's a whole concept of laughs versus perceiving perceived time. And there's lots of things you can do to make the perception of time you spend with a patient, much, much, much longer, sitting at the same level, at the bed, making eye contact, having pauses, and just letting the space be letting the time be, not always having to interject it with something expert, or smart just sitting there and taking in the space and the time, builds huge relationships, and I, it's something I pay more attention to now, it's something I honestly I previously did. But I found it incredibly validating to understand that this was a mindful approach to a patient relationship. And it can be incredibly impactful. And another thing I learned from one of our senior senior surgeons, when I was when I was training was, you know, a lot of follow up appointments are 32nd things. Yeah, your labs look good, your incisions look great, right? But you could kick them out in 30 seconds, and you basically covered what you need to cover. But if you sit there and you ask, well, what's going on with your family, how your kids doing? I remember you're a Orioles fan, or a Yankees fan, or whatever it may be. And you sit there and you have a two minute conversation about something that has nothing to do with medicine, that builds tremendous relationships and rapport and, and helps really establish a practice and build more patients. So those are all mindful approaches to medicine. I don't know if you guys have had any other experiences or examples that you've seen.

Rob Kramer:

One of the foundations that Kara and I used in the development of our coaching academy, when we looked at the mindfulness aspect was the work of Ronald Epstein, who's a oncologist and psychiatrist at Rochester Medical Center. Yep. And we recommended a book to you all called attending, highly recommend it to your listeners really, really recommended. He published his first paper around mindfulness in healthcare in 1999. And it got a whole lot of attention. So he became much more curious about it and did some more of his own research. And then that book attending I think, came out in 2016, or 2017. So still pretty modern and relevant. And is literally exactly what you describe lends the fill the lens of how providers can use mindfulness as part of their everyday work, especially in the clinic but expands to other all other aspects of work as well. So really a foundational piece that Kara and I utilize as we're developing our program and thinking about how to instill mindfulness into the the pedagogy. So anything you'd add on that, Kara.

Kara Penfield:

No, I think you think you said that really well.

Phillip Pierorazio:

but it's it's a perfect segue into the program. So the Academy for academic medical center coaching is now available in its second iteration. I guess I was a benefit of one of the kind of first cohorts here. But I'd like you guys to tell the listeners in the audience about the program, and I'm sure we'll find some interested parties out there. Rob,

Rob Kramer:

all right. This is a conversation we've been having for years. Because there's lots of coaching academies that exist out there. When I first got into coaching, literally, well, the the governing body for professional coaching, probably the largest governing organization is the International Coach Federation. And they'll certify coaching programs. And so that's a big credentialing marker is for those listeners out there. If you're looking for training ICF, or coaches who are ICF approved also means there's a level of credentialing. That's noteworthy. But when I first started, there were maybe a dozen programs listed on their website of credential programs. And now there are hundreds, I don't even know how many hundreds of programs all over the world. And in our work coaching in academic medical centers, we did research and could literally only find two other programs that were sort of about health care and coaching. But absolutely nothing about academic medical center and coaching. And we saw this gap. And this need where it's such a hugely important sector, and impacts so much our you know, the growth of knowledge and understanding about healthcare, science and research, the impacts of learning that are happening in the moment, you know, these large health centers that are around the country, hundreds of them, and the complexity of what happens inside those medical centers. So to just come, and I've seen people who come out of AMCs, say, Oh, I found coaching, and so I went found this program, and then they have to translate 75% of it back to their world. We said, let's create something that's just specifically for this population, with faculty and coaches who understand and are part of this population. And that's what we set out to do. And, and thus far knock on wood has gotten good attention, and, and good feedback, meeting wonderful people like you, Phil, because I think the need is growing as people see the value of coaching. And we're trying to provide the service at the right time for folks like you that want to benefit from it, and can learn the skills in the context of your own working world, not having to learn it from a corporate standpoint, or any other standpoint, but specifically, understanding the lens of what's life like in academic medical centers. So that's where we start out and set from and it's still a voyage, we're still tweaking and adapting as we go.

Kara Penfield:

Yeah, I think one of the things that probably makes it, it is unique because it was designed for people who work in academic medical centers. So thinking about the complexity, the matrix reality of how success is achieved in AMCs. What then makes it unique is that all of our participants work in academic medical centers from across the country at this point. And so you spend time in conversation in large group settings, and in small, three to four people cohort, breakout settings, talking with other people who work in your world, in the world of academic medical centers, who are bringing real life challenges into the conversations and practicing one with one another. Practicing the use of the coaching skills on real life situations that are relevant to each of you. And as well. So Rob, and I spend a lot of time like we told you working in accurate medical centers, and all of the mentor coaches who work with the small groups also have a background in mindfulness and academic medicine. So all of our conversations are relevant.

Phillip Pierorazio:

Yeah, and I'll just, you know, for people who are interested, it's spiral coaching, calm, SPI RO coaching.com. That's the website. If you want to look more into it, please do and I will tell you, Yes, you learn tangible skills, you work on mindfulness, you learn a framework of coaching. But to your point about the colleagues, you work with diverse people from diverse backgrounds, from diverse medical centers from diverse geographic regions around the country, surgeons, people in HR, leadership CEOs, Dean's level, all in the same room with the same goals. You learn a tremendous amount from the people you're with and you build lasting relationships. I'm still in contact with my small group. We still do kind of follow up sessions. And it really is, I think one of the most valuable experiences in my academic medical career so far. And I encourage others, if you're at all interested in this, sign up for it, look into it, I beg your chair person to pay for it. It is a is a wonderful experience. And I think you'll only be a better person and a better member of your department or division or whatever it may be for participating.

Kara Penfield:

Thanks so much, Phil. We'd love to have them join us. Yes.

Phillip Pierorazio:

So we're getting short in time. And I always like to ask anybody else if there's anything else they'd like to share that we didn't get to cover anything you want to ask or talk about? Now's the opportunity, happy to talk about anything you guys may want to. I feel like we

Rob Kramer:

covered it, Phil, that was really a robust conversation. It got me all jazzed up. I'm all fired up now.

Phillip Pierorazio:

I like to repeat conversations. There's lots of other things. I hope to have you guys back to talk about care. We may be talking about yoga, we may be talking about how that impacts practice. Yes, you know, I become quite a yoga enthusiast myself.

Kara Penfield:

I know. I think it's awesome. Thank you. I, I hope that everybody and it is something we talked about in the program. And I always talk about in coaching, that everybody finds their yoga, which isn't to imply that everybody needs to some people's yoga is sailing or running or fishing regarding. But that thing that allows you to sort of find balance and strength, and flexibility are all relevant to to coaching, I think and also dancing more gracefully in the world, if you will with others.

Phillip Pierorazio:

And Rob, we've had lots of conversations about potentially how sports and medicine intersect and how there's absolute coaching possibilities there. So just gonna summarize some important things. I think there's I kind of jotted down through our conversation. You know, we talked about why coaching is so important in academic medicine and how leaders in academic medicine are not necessarily giving, given the skill set to develop into leaders. And so cultivating these skills are incredibly important. And we can do that through a mindful approach, which really involves being present in the moment, offering self reflection, using a beginner's mind. And by kind of starting with leadership, we can trickle these things down into our culture, into our medical culture and into our environment. And we can all be kind of better as we work together. People who should seek out coaching some particular times that may be good during promotions or transitions. Obviously, if you're in trouble and you need some remediation, a coach could be helpful. But really someone who's looking for something new, something has to kind of reinvigorate who they are and what they're doing. Maybe a perfect time to engage a coach. So I'd like to thank you guys again for sharing with the audience and sharing with me I like to thank everybody for listening to this episode of effortless and we'll talk to you soon