The Role of Racial Identity in Coaching: A Grounded Theory Study of Coaches Outside of and Within Medical Education

Abstract

Background: What does skilled coaching look like when learners discuss diverse racial or ethnic identities, or when such diversity occurs within the coach-coachee dyad? Medical education literature is sparse, and the extensive business and wellness coaching literature does not account for physician identity formation or the inherent hierarchies in graduate medical education. Objective: To understand best practices for coaching racially and ethnically diverse learners through qualitative sampling of a range of expert perspectives. Methods: Using constructivist grounded theory, 2 groups, expert coaches outside of medicine and leaders of academic coaching programs within medicine, underwent sequential semistructured interviews using snowball sampling. Topics included the role of coach and coachee identity in coaching, whether racial or ethnic dyad diversity influences coaching, and errors a coach may make through inquiry or lack thereof. Using iterative inductive coding, final themes were identified, and a conceptual map was created. Results: In 2023, 16 subjects were interviewed (10 and 6 in each group). Five themes emerged from Group 1: (1) Contextually managing relationships; (2) Leveraging coaching competencies, in particular to create a trusted relationship; (3) Ongoing self-development; (4) Seeing the whole person; and (5) Selecting a coach with similar identity. Group 2 responses demonstrated 4 themes: (1) Intentionally building connection and rapport; (2) Navigating power differentials; (3) Acknowledging the lived experience; and (4) Exercising self-awareness. Conclusions: This qualitative study of coaching experts provides themes and best practices related to how identity, particularly underrepresented racial/ethnic identity, can be addressed skillfully in the graduate medical education coaching relationship.