Coach Class

A few months ago I swapped e-mails with Paul, a close friend and ex-partner from New York. Paul and I are in the autumns of our EMS careers—late November or early December, I’d say. We were discussing how hard it will be to leave. Is it possible, we wondered, to find another activity as stimulating as prehospital care, but without the physical challenges made even more formidable by age?

After reading “Personal Best,” Atul Gawande’s compelling piece about coaching in the Oct. 3, 2011 issue of The New Yorker, I think I might have an answer. Gawande, a surgeon, discussed the benefits of inviting a respected retired instructor to monitor his cases. Gawande credits that process—live observation of technique, followed by debriefing, critique and forward-looking strategy sessions—with lowering his complications rate and reinvigorating his practice.

Is there a need for coaching in EMS beyond certification-driven objectives? I think so. I know I would have been sharper with periodic practical tune-ups that went beyond review of the same skill sheets I’d mastered two or three years before. Even today, after almost 20 years in this industry, I’m sure there are aspects of my performance that could be improved through impartial observation by an experienced associate, followed by customized feedback.

Some would say EMS already provides coaches; they’re called preceptors or field training officers (FTOs). I disagree. Those titles imply senior-junior or teacher-student hierarchies. Newbies rarely get to pick their FTOs, nor do they have a say in the goals or scope of that interaction. Coaching veteran providers requires a different skill set than guiding novices through their earliest field interventions. For example, a good coach might lack limitless patience for rookie mistakes, while a good preceptor might find it hard to offer advice constructively and diplomatically to a coworker with as much or more experience. Consider those who carry the title coach in sports; they haven’t necessarily performed as long or as well as their charges. With so many media outlets competing for the attention of the coachable, I think modern coaches need exceptional communication skills more than been-there-done-that pedigrees. That’s fortunate for me, because I’ve never done a cric with a car key or started a central line in an elevator shaft.

Is coaching equivalent to mentoring? Similar, perhaps, but not the same. Coaching involves direct, ongoing oversight with real-time guidance. Mentoring is more of a passive activity, without mandate or even mention. I can imagine asking a trusted colleague to be my coach, but not my mentor. I doubt any of the mentors I’ve had in journalism, sports, engineering or EMS knew they were playing that role. (Thanks just the same, Stan, Neil, Glenn and Paul.)

A prerequisite to coaching is someone who wants to be coached. That might be trickier than it sounds. To those of you with more than a few years in this field, how willing are you to endure scrutiny and criticism of your work habits? Could you consider suggestions impersonally, in the spirit of well-intended quality improvement? Sometimes that’s hard for me, even when I know my patients or readers or clients would be the beneficiaries. My first reaction to recommendations is often, “But…” If I were coaching me, I’d put a stop to that.

Here’s what I’d want from a coach:

Distinguish style from substance. Doing things differently isn’t necessarily wrong; however, I’m willing to try almost anything to improve my performance that doesn’t lead to a court appearance or a YouTube video gone viral.

Don’t limit feedback to what you think I want to hear. I already know enough people who do that. I’m not saying I don’t like it sometimes. I just think positive reinforcement means a lot more when it’s balanced by constructive negatives.

Be of service. Your job is to help me. If you’re good at that job, you’ll meet your needs by sincerely addressing mine.

I wouldn’t be surprised if many retired EMTs and medics met those criteria. They’re occupational skills. We don’t forget how to do those things just because we’re on the sidelines. I hope I can leverage my share of life experience to help others in EMS long after my last paycheck.

Come see me in a few years. I’ll be the one with the patch that says Coach.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World Magazine’s editorial advisory board. Contact him at