Criteria for Excellence | Chapter 8E: Coaching in family medicine residencies

Use coaching to strengthen resident learning, reflection, growth and professional development.

Authors: Deb Clements, MD; Hobart Lee, MD and Randy Pearson, MD

Why coaching matters in family medicine residency education

Family medicine has long been a leader in developing innovative educational resources for graduate training. In 2024, the Accreditation Council for Graduate Medical Education (ACGME) instituted new program requirements that underscore the dynamic role of family medicine education in helping residents develop master adaptive learning skills that will serve them throughout their professional careers.

In addition, new requirements for individualized learning plans (ILPs) are designed to help residents take ownership of the course of their education. The topics of master adaptive learning and ILP development are covered in other Criteria for Excellence chapters. Development of coaching skills is essential for equipping faculty to provide meaningful guidance in these areas and help ensure optimal educational outcomes for every resident. It can also enhance other aspects of faculty work, including scholarly activities and development of teaching skills and leadership abilities.

Understand the role and value of coaching in residency programs

Although coaching is a relatively new concept in medical education, most people have had contact with coaches in other areas, such as sports or the arts. Coaching has also been embraced within the business community.

When employed effectively in a residency program, coaching by faculty can help motivate residents to own their educational process by encouraging self-reflection, assessment and direction. It also fosters a mindset of continuous inquiry and self-motivated improvement that can persist throughout a learner’s career.

Distinguish coaching from advising and mentoring

Residency program faculty are familiar with their roles as advisors and mentors. A faculty advisor serves the program-centric function of tracking the resident’s progress based on ACGME Milestones, In-Training Examination (ITE) results and other measures of performance to ensure that programmatic requirements are being satisfied.

Mentorship involves a more personal relationship, with the faculty mentor offering their own experience as an example for the resident.

The role of a coach is not as familiar within the graduate medical education structure. Coaching is a resident-centric activity. It relies on each resident’s insights and an individualized agenda based on the resident’s short- and long-term career goals and self-assessment of their progress and educational deficiencies.

Implement coaching in a family medicine residency program

Resident advising and mentoring have traditionally been critical parts of medical education. Coaching can also be helpful in several areas within a residency program and can be implemented in a variety of ways.

Some programs may decide to have a single faculty coach champion who coaches all of the residents. This approach can be particularly advantageous for smaller programs with limited faculty and smaller residency cohorts. Coaching may be done one-on-one, but small-group coaching and resident peer coaching may also be beneficial to the program.

Best practices for implementing coaching in a residency program include providing training for faculty and giving them opportunities to practice before they begin coaching residents. Faculty development focused on coaching skills is critical to prepare them to do the following successfully:

  • Develop a relationship with the learner based upon mutual trust and vulnerability

  • Balance the self-directed nature of the interaction with progress toward achieving core outcomes

  • Encourage dialogue with the learner rather than a monologue by either party

  • Incorporate active listening and open-ended questions into the interaction

Ideally, a faculty coach champion would be available to give feedback and provide support for ongoing faculty development.

Residency programs should be sensitive to the additional time coaching requires. Advising or simply telling a resident what to do is fast but not particularly effective. By contrast, coaching requires time for questions, discussion and self-reflection. This takes longer but ultimately generates more meaningful change.

Residency programs should give faculty and residents protected time to meet for their coaching sessions. In addition, support for scheduling coaching sessions is recommended so that they do not happen spontaneously. Meeting with a resident between clinic patients, during a hurried lunch or right after they have been on call generally does not lead to in-depth discussions.

Before a coaching session, the resident should be asked to prepare for a productive conversation by either identifying topics for the coach to address or updating their ILP. Within the coaching construct, the resident is assumed to have the answers as they set their goals. The faculty coach’s role is to facilitate the resident’s self-reflective process.

Residency programs should establish appropriate boundaries for the coaching relationship. When coaching is used as part of remediation or to address other significant educational challenges, faculty should be advised to stay as neutral as possible, and the resident should be encouraged not to view the coaching as a punishment.

It is imperative for faculty in a coaching role not to provide therapy or serve as a resident’s primary care physician. If it becomes clear during the coaching process that a resident needs additional support for physical or mental health needs, their faculty coach should connect them to appropriate resources rather than personally addressing these needs.

Use coaching to support individualized learning plans

Coaching helps residents develop an effective process for self-assessment and learning, which will be crucial to support continued development throughout their careers. Implementing coaching in residency programs is especially beneficial now that all residents will have an ILP to facilitate their path through residency.

The Society of Teachers of Family Medicine (STFM) task force on competency-based medical education (CBME) recommends updating ILPs quarterly.1 Through coaching, faculty can help residents stay on track with their learning plans, making ILP development feel like a dynamic, continuous and iterative process in which each update builds on the last rather than being an isolated event.

Help residents set meaningful goals

ILPs often incorporate self-reflection on current performance and development of career goals. This may reveal gaps and overlooked areas that faculty can explore through coaching.

An ILP also involves setting personal goals, and it is a best practice to ask residents to develop at least one wellness goal. Residents may find a goal-creation framework—such as SMARTIE (specific, measurable, achievable, relevant, time-bound, inclusive, equitable) or WOOP (wish, outcome, obstacle, plan)—helpful as they self-reflect and develop competency-based targets for each quarter.

Residency programs should also use the ILP templates and tools​ developed by the STFM CBME Task Force.

Use coaching to strengthen self-reflection and growth

Faculty coaches can facilitate residents’ self-reflection by asking questions about their individual performance over the past quarter. Using coaching models that focus on what is working and positive (e.g., Appreciative Inquiry) can help residents reflect on their strengths and identify areas of success and growth.

Faculty coaches should also challenge residents to think critically about their progress and include growth opportunities and/or stretch goals for the next quarter in their ILPs.

Support resident career growth, professional identity and well-being

Faculty advisors and mentors often address career planning. Coaching can also help residents clarify their career aspirations and what is most important to them when choosing a future job.

With the high burden of debt, many residents default to choosing a job with the highest pay when other factors—such as purpose, legacy, work/life balance and meaningful collegial relationships—might be better markers of a successful work environment.

Use coaching to develop professional identity and career purpose

Coaching can be applied to help residents develop their skills in clinical reasoning, leadership and teaching, and it can also support professional identity formation and wellness. It has become increasingly important for residency programs to address these topics.

Traditional faculty advising and mentoring might focus on evaluations, ITE scores, elective planning and scholarly activities. While each of these areas is important, development related to professional identity formation is often overlooked.

Using a coaching model and concepts like “ikigai,” which is related to a person’s reason for being, faculty can help residents clarify their purpose and mission, leading to greater career satisfaction and lower risk for burnout. Through coaching conversations, faculty can feel more connected to their residents and foster deeper mentoring relationships based on shared values and beliefs.

Faculty development resources for coaching in medical education

Successfully incorporating a coaching approach—or a more formalized coaching program—into residency training requires faculty development. Faculty coaches must be skilled in remaining curious, asking appropriate questions, fostering an environment of psychological safety, and providing space for learners to identify their own goals and solutions.

A variety of resources are available to help residency programs develop coaching initiatives and support the personal and professional growth of faculty seeking more in-depth training in coaching.

Books

  1. Hammoud MM, Deiorio NM, Moore M, et al. Coaching in Medical Education. Elsevier; 2022.
    This handbook offers a practical framework for educators and administrators who want to implement or enhance coaching programs within medical schools. It covers operational considerations, case vignettes and best practices.
  2. Deiorio NM, Hammoud MM. Coaching in Medical Education: A Faculty Handbook. American Medical Association; 2017.
    This free PDF​ handbook from the AMA includes case vignettes, practical coaching structures and advice on program implementation.
  3. Schein EH, Schein PA. Humble Inquiry. 2nd ed. Berrett-Koehler Publishers; 2021.
    This book encourages honest, open interactions and shows how humility can overcome cultural, organizational and psychological barriers. Multiple examples and exercises are included in this edition.
  4. Simpson MK. Powerful Leadership Through Coaching: Principles, Practices, and Tools for Leaders and Managers at Every Level. Wiley; 2019.
    This book provides a comprehensive toolkit that leaders can use to enhance their coaching capabilities across organizational levels.
  5. Stanier MB. The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever. Page Two; 2016.
    In this simple and effective guide to using a coaching approach, the practice of coaching is divided into seven core questions.
  6. White D. Coaching Leaders: Guiding People Who Guide Others. Jossey-Bass; 2013.
    Author Daniel White offers strategies for coaching leaders, with insights from executive coaching experiences.

Peer-reviewed articles

  1. Tippit TL, Chi I, Servey JT. A model curriculum for new faculty coaches in
    undergraduate medical education. J Med Educ Curric Dev. 2024;11:23821205231217896.
    This article details the development, implementation and early evaluation of a curriculum designed to train faculty members as coaches in undergraduate medical education settings.
  2. Richardson D, Landreville JM, Trier J, et al. Coaching in competence by design: a new model of coaching in the moment and coaching over time to support large scale implementation. Perspect Med Educ. 2024;13(1):33-43.
    The authors describe a coaching model developed by the Royal College of Physicians and Surgeons of Canada that emphasizes two distinct coaching roles—coaching in the moment and coaching over time—to support postgraduate medical education.

  1. 1. University of Washington (UW) School of Medicine – Faculty Development Through Coaching​
    The UW School of Medicine offers individual and group coaching programs led by International Coaching Federation (ICF)-trained coaches that focus on faculty growth, resilience and leadership development.
  2. Duke University School of Medicine – Executive Coaching​
    Duke's Office for Faculty sponsors coaching engagements for faculty members, including 360-degree assessments and one-on-one sessions, aimed at professional development across various career stages.
  3. University of Arkansas for Medical Sciences College of Medicine –
    Executive Coaching​
    This executive coaching program supports faculty’s personal and professional growth, with coaches trained and credentialed through the ICF.
  4. Anne Burnett Marion School of Medicine at Texas Christian University – Coaching Initiatives​
    This program offers personalized executive coaching to faculty and staff, aiming to enhance academic excellence and professional performance by developing leadership and management skills.

The following tools can help faculty develop a coaching mindset and structure coaching conversations effectively:

  • GROW Model – Guides goal-setting and problem-solving discussions using the structured GROW (goal, reality, options, will) framework
  • SMART goals tool – Often used in academic coaching sessions to help learners create specific, measurable, achievable, relevant and time-bound goals
  • 360-degree feedback – Used in coaching to help faculty and learners gain insight into performance from peers, students and supervisors
  • Appreciative Inquiry framework – Focuses on identifying strengths and past successes to serve as a foundation for growth and change
  • Motivational interviewing – Adapted for academic coaching to facilitate learner reflection and intrinsic motivation
  • Mindset and self-compassion tools – Help faculty and learners reframe failure and stress; based on work by Carol Dweck and Kristin Neff
  • WOOP framework – Introduces learners to goal-setting by using WOOP (wish, outcome, obstacle, plan) to explore obstacles and barriers

  • Stanford Coaching Framework: Structured program that includes foundational coaching training, role-plays and self-assessment tools; often used in faculty development
  • Coaching in Medical Education Toolkit: Resource from the Association of
    American Medical Colleges that offers sample curricula, competency frameworks and implementation guides; available at www.aamc.org​
  • ICF-aligned coach training programs for medical educators: Internal faculty development programs at institutions including Duke University, University of California, San Francisco and UW that use elements of ICF competencies
  • Coaching for Professionalism curriculum: Developed to help faculty use
    coaching approaches in professionalism remediation

  • Coaching log templates (e.g., Google Sheets, REDCap) – Used to track coaching sessions, learner goals and follow-up actions
  • Coaching apps and AI assistants (e.g., BetterUp, CoachAccountable) –
    Commercial platforms used by some institutions to augment their coaching
    programs
  • E-portfolios with coaching notes – Used in CBME to align learner reflection and coaching documentation

References

1. Tulshian P, Montgomery L, McCrory K, et al. National recommendations for
implementation of competency-based medical education in family medicine. Fam Med. 2025;57(4):253-260.

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