More than talking tough at the coffee machine
After three years mainly theory and skillslab practicals, then finally on the job during the master’s in Medicine. A great, but also intensive and challenging time. Medical interns record their experiences in a portfolio and discuss their progress with a mentor. Since this academic year, they also have reflective meetings with other interns about the hierarchy, responsibilities and uncertainties, the long days, the setbacks and successes. Under the supervision of a coach, no judgement, no hierarchy. Peer coaching, in other words – also known as ‘intervision’.
Skillslab coaches Anke Smeenk, Ingrid Caubergh and Valerie van den Eertwegh came up with a solution: intervision meetings in the master’s in Medicine. The initiative was launched in October 2018 with 44 groups, each composed of around seven interns. The groups come together regularly to share and evaluate their experiences, under the supervision of a coach.
All internship rotations have made available two timeslots of 1.5 hours for the intervision meetings. The groups meet four times per year (12 times in total during the master’s programme).
Intervision consists of a structured conversation between people who are working or training in the same field, but do not work side by side. Together they discuss the work they do and any problems that arise, with a view to increasing all parties’ expertise and improving the quality of their work.
“Most students find the master’s fun, but also a bit scary”, Caubergh explains. “They’re all in the same boat, so it’s nice to share things, identify with one another’s stories, give each other tips and support. They don’t know what’s expected of them during an internship. Should they be assertive and speak up, or should they just listen? What’s normal?” Van den Eertwegh gives an example: “One intern almost fainted in the operating theatre; is that weak or normal? These are all things they’d rather not discuss with their workplace supervisor. They feel insecure, or they don’t want to bother their supervisor, or draw attention to their weaknesses from the person who has to assess them. So we deliberately decided to not have them assess one another during the intervision. That way they can just be vulnerable and talk openly and honestly.”
Support and awareness
But intervision is more than a support group. “Talking to one another about their experiences also makes them more aware of their own behaviour”, Van den Eertwegh explains. “By asking themselves ‘how would I have reacted?’ and ‘would I do things differently next time?’ they translate the case to their own behaviour. The process raises their awareness and enhances development. The coaches are there to facilitate, not to teach.” Caubergh adds: “As a coach, you ask questions to facilitate the group process or deepen the discussion. The idea is to go beyond the kinds of tough talk you hear around the coffee machine. It’s not about asking them to do it like this or like that next time; it’s about personal and professional development.”
“Intervision is not intended to replace discussions between interns and their mentor or workplace supervisor, but to complement them”, Smeenk says. “Students learn a lot in the workplace and from feedback from their mentor. Intervision has the additional benefit that supervisors and mentors, but also study advisers, lecturers or a portfolio committee, can now suggest to students that they discuss a particular case during the intervision meeting. In that way we can reinforce one another.”
Intervision makes use of incident method, which consists of four steps. First, a student introduces a case about a difficult situation or interaction; something that is currently going on or that has stayed with them emotionally. The student describes the case, then asks “How can I …?” Next, the other group members gather facts by asking questions, without judging or offering opinions or advice. Third, the group analyses the core of the problem. The student who introduced the case does not participate in this part of the process, but indicates at its conclusion how he/she wants to proceed. Finally, each group member gives advice to the student, and writes down for themselves the insights they have obtained.
“We opted for this method because it’s widely used in healthcare”, Smeenk says. “In their future work as doctors or specialists, our students will have to reflect on their actions, probably using this method. So it’s advisable that they learn to engage in continual self-reflection early on in their basic training, preferably using incident method. This will stand them in good stead when it comes to intervision and reflection.”
The great thing about these intervision meetings is that you notice that you are not the only one who encounters various ‘problems’. It soon becomes clear that you are not the only one who doubts himself occasionally or has a difficult working day. However, it goes further than just sharing experiences. You hear from other interns who dealt with similar situations in a completely different way; it can be very enlightening to talk about that with each other. This way every student can get out of it what applies to him/her. Normally, you talk to your fellow students about daily activities and experiences in the workplace as well. However, this often remains superficial. During the intervision meetings, an attempt is made – via a fixed structure - to gain more depth in the issues. This is steered in the right direction with the help of our coach. If we are on the right track, the coach is in the background. However, if we stray or do not get any further, the role of the coach becomes bigger.
Wanted: new coaches
One cohort of students has already started the intervision meetings: 44 groups in total, supervised by 15 coaches. When three cohorts are up and running the number of groups will increase to 120 or 130, which means more coaches will be needed. If you are interested and have prior experience with intervision or group supervision, please contact Anke Smeenk (anke.smeenk[at]maastrichtuniversity[dot]nl).