Coaching in GME: Lessons Learned From 3 Unique Coaching Programs Open Access

The EMRC program implemented a competency-based coaching model using specialty-specific entrustable professional activities to promote trainee progression toward competency.¹⁷  Coaching sessions with faculty coaches, who varied across 6 sites and included EMRC associate program directors (APDs), non-EMRC institution-based coaches, and core faculty, were guided by individualized learning plans. Some sites separated coaches from formal assessors to ensure psychological safety, while others combined roles to better align coaching with competency committee processes.

The TRA program focused on optimizing clinical performance and facilitating the transition from undergraduate medical education (UME) to GME through a structured “warm handoff” from UME advisers to GME coaches across multiple specialties (internal medicine, OB/GYN, emergency medicine, pathology, and orthopedic surgery). Based on the existing structure of each residency, faculty held different primary roles as educators, including core faculty and program directors. Following a coaching development program, faculty coached trainees in semistructured meetings from the Match through the end of postgraduate year 1.

The OB/GYN RRR initiative targeted the transition to residency for incoming OB/GYN interns across 112 university programs and 59 community-based programs by offering faculty coaching training and aligning coaching efforts with a unified Readiness for Residency curriculum. Coaches in the RRR program included program directors, APDs, faculty, chief residents, and nonclinical program managers, with an emphasis on addressing professional development, well-being, and work-life integration to support the residency transition.¹⁸ 

Comparing these 3 projects demonstrates that context must drive the design and implementation of coaching programs. We encourage those designing a coaching program to ask the following questions that emerged during discussions among the authors as they analyzed these programs: What are the program objectives? Which residents will be coached? Which faculty will do the coaching? What is the expected focus of coaching meetings? The Table outlines these considerations for the EMRC, TRA, and RRR coaching programs.

The varying aims, structures, and successes of these coaching programs affirm the potential that coaching offers to address a range of GME needs. Some of these successes include enhanced well-being and professional fulfillment, development of adaptive learning skills, and enhanced clinical competency. Even with the robust financial support from the AMA Reimagining Residency initiative and enthusiastic support from grant and institutional leaders, the obstacles encountered by these projects offer lessons to inform future efforts to integrate coaching into GME.

Transitioning from the structured learning of medical school to the autonomy of residency requires a shift in mindset—from relying on teachers for answers to developing self-directed, lifelong learning habits. By asking questions and providing the tools for trainees to identify their own solutions, coaches can help residents develop self-directed learning skills.^14,15  Effective coaching programs must balance structured guidance with learner autonomy, by considering factors such as learner readiness, program goals, and institutional support. Because coaching is coachee-driven, early trainee engagement is a critical input to its success. While voluntary participation in coaching may seem appealing, we found that engagement often develops through positive coaching experiences. Early coaching should be encouraged or possibly mandated for all new residents, with continued participation based on individual needs. When implemented effectively, coaching helps learners integrate performance-based data and feedback to guide their professional growth. Ultimately, continued elective engagement should be considered an outcome of a well-designed coaching relationship.²⁰ 

Selecting the right coaches requires careful consideration of several factors, including accessibility, interest, skills, and additional roles in assessment and supervision. Accessibility involves both the logistical aspects of scheduling and the coach’s existing relationships with residents. Whereas the TRA project did compensate coaches, the EMRC and RRR projects did not. Although many education-minded faculty at the institutions were willing to volunteer their time and expertise, lack of compensation is a barrier for busy faculty and makes sustainability of a coaching program difficult.

Given resource constraints, it is often impractical to hire dedicated coaches. One solution may be to repurpose funds (or faculty bandwidth) for existing mentorship programs. Mentors are often assigned by training programs to support residents, but true mentorship requires alignment of resident and faculty interests. Residents often begin training too undifferentiated to make effective use of formal mentorship programs.^21,22 

Alternatively, we can incorporate coaching by training existing education faculty in the coaching skills of active listening, thoughtful questioning, and constructive feedback. Faculty in leadership roles possess a deep understanding of residents’ experiences and goals and are highly motivated to support their development. However, their involvement in assessment and program oversight may compromise the psychological safety needed for open and vulnerable coaching conversations.

Ultimately, the best coaching structure fosters consistent and meaningful engagement between residents and coaches. Programs should focus on optimizing these connections by aligning coaching assignments with the needs of both residents and faculty, recognizing that effective solutions will vary depending on the unique context of each training environment.

Practical constraints, such as demanding schedules, further influence the effectiveness of coaching. Trainees are unlikely to welcome a program intended to support their well-being that requires significant commitment outside of work hours, or that comes at the expense of other desirable educational or recreational activities. Explicit effort to structure coaching sessions at convenient times for trainees will increase the acceptability of these programs in GME.

Assessing the impact of coaching programs presents challenges due to variability in program structures, institutional contexts, and learner needs. Measuring outcomes is complex, as coaching is inherently individualized—residents focus on different aspects of professional growth based on their personal and career goals. Confidentiality of coaching relationships fosters psychological safety and vulnerability, but it further complicates traditional assessment methods.

Despite these challenges, evaluation is essential and should be guided by the specific goals of the coaching program. Whether the primary aim is to enhance clinical competency, improve organization, support career development, or promote well-being, assessment strategies should align with those objectives. Additionally, surrounding context and culture play a key role, so demonstrating the impact on the learning environment, trainees, and faculty doing the coaching are important to support a case for coaching in busy training programs.

In all 3 of our programs, the intended and actual focus of coaching differed slightly, with greater-than-anticipated attention to professional development and work-life integration. A well-designed evaluation framework acknowledges the flexibility inherent in coaching while ensuring meaningful outcomes can be tracked at both the individual and programmatic levels. Rather than viewing variability as a limitation, it should be embraced as a strength—allowing coaching programs to adapt to the diverse needs of learners.

Developing a coaching program is complex and requires many different choices: which residents, which faculty, which structure, which program aims, which outcomes. Coaching is a flexible and adaptive approach to develop self-directed, motivated, fulfilled physicians who engage in lifelong learning. Effective coaching requires time, frequent contact, and psychological safety, all of which must be balanced with coaches’ other GME responsibilities. Educators should lobby for the resources necessary to design and implement coaching in their unique contexts while maintaining flexibility, as the end product and impact may be broader than originally expected.