A Developmental Approach to Internal Medicine Residency Education: Lessons Learned from the Design and Implementation of a Novel Longitudinal Coaching Program
Open accessAbstract
BACKGROUND: Resident physicians' achievement of professional competencies requires reflective practice skills and faculty coaching. Graduate medical education programs, however, struggle to operationalize these activities. OBJECTIVE: To (1) describe the process and strategies for implementing an Internal Medicine (IM) resident coaching program that evolved in response to challenges, (2) characterize residents' professional learning plans (PLPs) and their alignment with EPAs, and, (3) examine key lessons learned. DESIGN: The program began in 2013 and involved all postgraduate years (PGY) residents (n = 60, 100%), and 20 faculty coaches who were all IM trained and practicing in an IM-related specialty. One coach was linked with 3-4 residents for three years. Through 1:1 meetings, resident-coach pairs identified professional challenges ('disorienting dilemmas' or 'worst days'), reviewed successes ('best days'), and co-created professional learning plans. Typed summaries were requested following meetings. Coaches met monthly for professional development and to discuss program challenges/successes, which informed programmatic improvements; additionally, a survey was distributed after three program years. Data were analyzed using quantitative and qualitative methodologies. RESULTS: Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work-life balance, career planning, teaching skills, and research/scholarship. The most-frequently mapped topics included: PGY1 - leading and working within interprofessional care teams (EPA 10), research and scholarship, and work-life balance; PGY2 - improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 - lifelong learning (EPA15); career planning was common across all years. CONCLUSIONS: Lessons learned included challenges in coordination of observations, identifying disorienting dilemmas, and creating a shared mental model between residents, faculty, and program leadership. The coaching program resulted in professional learning plans aligned with IM EPAs, in addition to other professional development topics. Operationalization of aspects of these results can inform the development of similar programs in residency education.
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Written from the paper’s full text.
TL;DR
This paper describes the design, implementation, and iterative modification of a longitudinal coaching program for Internal Medicine residents at Penn State College of Medicine, pairing all 60 categorical residents with 20 faculty coaches. Residents’ professional learning plans mapped to all 16 Internal Medicine EPAs plus four additional themes, while key lessons concerned direct observation, identifying disorienting dilemmas, and creating a shared mental model among stakeholders.
Key findings
- From 119 resident–coach meeting summaries submitted by 65 unique residents (81%), 323 disorienting dilemmas/professional learning plans mapped to all 16 EPAs and four additional themes: work–life balance, career planning, teaching skills, and research/scholarship.
- Most frequently discussed topics varied by year: PGY1 — EPA10 leading/working within interprofessional teams (18/108, 17%), work–life balance (17/52, 33%), career planning (16/52, 31%), research/scholarship (15/52, 29%); PGY2 — EPA15 lifelong learning (19/90, 21%), EPA13 improving quality of care (15/90, 17%), career planning (15/38, 40%), research/scholarship (14/38, 37%); PGY3 — EPA15 (11/21, 52%) and career planning (8/14, 57%).
- After three years, surveys were completed by 14/60 residents (24%) and 12/20 faculty (60%); key lessons included challenges coordinating authentic direct observations, difficulty identifying disorienting dilemmas, and the need for a shared mental model among residents, coaches, and program leadership.
- The program was modified after six months to rely less on direct observation and more on residents’ self-assessment, rotation evaluations, and facilitated reflection/goal-setting.
Methods
- Single-center implementation at Penn State College of Medicine’s Internal Medicine residency beginning in 2013; all categorical residents (n = 60) were matched with 20 faculty coaches, each coaching 3–4 residents across PGY1–3, with 5% effort support per coach.
- Resident–coach pairs met approximately every 6–8 weeks, used “disorienting dilemmas” and “best/worst days” to co-create professional learning plans, and submitted typed summaries; coaches met monthly for faculty development and program improvement, and an anonymous electronic survey was sent after year three.
- Hybrid qualitative analysis: deductive thematic analysis for the 16 EPAs plus inductive identification of emergent themes; two investigators independently coded all email summaries, resolved discrepancies, and examined frequencies. Survey responses were analyzed by two investigators.
Limitations
- Stated in the paper: submitted meeting summaries were low, conservatively estimated to capture at least 14% of resident–coach interactions; meetings occurred less often than the ideal of approximately seven per year; residents did not always initiate summaries; the program was single-center; 5% FTE support may not be replicable; and the paper describes implementation features without reporting impact on resident behaviors or practice.
- Evident from the text: there was no comparison or control group, survey response rates were low for residents (24%), and the reduced focus on direct observation limited the coach’s ability to assess entrustment.
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- Findingown data
For PGY2, the most frequently mapped topics included improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship.
“The most-frequently mapped topics included: PGY1 – leading and working within interprofessional care teams (EPA 10), research and scholarship, and work–life balance; PGY2 – improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 – lifelong learning (EPA15); career planning was common across all years.”
Quote in the paperNot a substantial claim- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Findingown data
For PGY3, the most frequently mapped topic was lifelong learning (EPA15).
“The most-frequently mapped topics included: PGY1 – leading and working within interprofessional care teams (EPA 10), research and scholarship, and work–life balance; PGY2 – improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 – lifelong learning (EPA15); career planning was common across all years.”
Quote in the paperNot a substantial claim- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Findingown data
Sixty-five unique residents (81%) submitted at least one summary containing a disorienting dilemma and/or PLP during the review.
“Sixty-five unique residents (81%) submitted at least one summary containing a disorienting dilemma and/or PLP during our review.”
Quote in the paperNot a substantial claim - Findingown data
Resident-coach discussions were dynamic and changed throughout the course of residents' training.
“Resident–coach discussions were dynamic and changed throughout the course of residents’ training.”
Quote in the paperSubstantial claim - Findingown data
Career planning was a common topic across all postgraduate years.
“The most-frequently mapped topics included: PGY1 – leading and working within interprofessional care teams (EPA 10), research and scholarship, and work–life balance; PGY2 – improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 – lifelong learning (EPA15); career planning was common across all years.”
Quote in the paperNot a substantial claim- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Findingown data
A total of 323 disorienting dilemmas with PLPs were identified.
“We identified a total of 323 disorienting dilemmas with PLPs mapped across all 16 EPAs, and four additional themes: (1) work–life balance, (2) career planning, (3) teaching skills, and, (4) research/scholarship [28,29].”
Quote in the paperNot a substantial claim0 of 2 sources checked- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Findingown data
For PGY1, the most frequently mapped topics included leading and working within interprofessional care teams (EPA 10), research and scholarship, and work-life balance.
“The most-frequently mapped topics included: PGY1 – leading and working within interprofessional care teams (EPA 10), research and scholarship, and work–life balance; PGY2 – improving quality of care (EPA 13), demonstrating personal habits of lifelong learning (EPA15), and research and scholarship; PGY3 – lifelong learning (EPA15); career planning was common across all years.”
Quote in the paperNot a substantial claim- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Findingreasoning
Based on the suggested frequency of resident-coach meetings (approximately seven times/year) and number of residents in our program, the data conservatively accounts for at least 14% of the resident-coach interactions that occurred during the study.
“Theoretically, based on the suggested frequency of resident–coach meetings (approximately seven times/year) and number of residents in our program, we conservatively estimate our data accounts for at least 14% of the resident–coach interactions that occurred during the study.”
Quote in the paperNot a substantial claim - Findingnone given
Proactive transparency by the program and coaches about the relationship with CCC preserved a safe environment for honest discussions.
“More importantly, proactive transparency by the program and coaches about the relationship with CCC preserved a safe environment for honest discussions.”
Quote in the paperSubstantial claim - Findingnone given
Residents and coaches often had different expectations of the program.
“Additionally, residents and coaches often had different expectations of the program.”
Quote in the paperSubstantial claim - Findingown data
Factors limiting direct observations included resident perceptions that observations hindered workflow.
“Factors limiting these observations included 1) resident perceptions that observations hindered workflow”
Quote in the paperSubstantial claim - Findingown data
During PGY3, the most-commonly discussed dilemmas/PLPs aligned with demonstrating professional habits of lifelong learning (EPA15) and career planning (Theme 2).
“During PGY3, most-commonly discussed dilemmas/PLPs aligned with demonstrating professional habits of lifelong learning (EPA15) and career planning (Theme 2).”
Quote in the paperNot a substantial claim - Findingown data
Residents and coaches had challenges in identifying disorienting dilemmas.
“Residents were occasionally frustrated by the request to identify disorienting dilemmas when they perceived none had occurred. This also became a challenge for coaches, as some meetings were less productive when no challenge was identified and discussed.”
Quote in the paperSubstantial claim - Findingown data
At the program's start, residents, coaches, and CCC identified the need to differentiate stakeholder roles, as some viewed the coach as 'program police,' seeking to identify struggling residents.
“At the program’s start, residents, coaches, and Clinical Competency Committee (CCC) identified the need to differentiate stakeholder roles, as some viewed the coach as ‘program police,’ seeking to identify struggling residents.”
Quote in the paperSubstantial claim - Findingreasoning
The focus of resident-coach discussions often tended away from coaching towards traditional mentoring activities, including career planning and wellness.
“The focus of resident–coach discussions often tended away from coaching towards traditional mentoring activities, including career planning and wellness.”
Quote in the paperSubstantial claim - Findingreasoning
Delineation of clear expectations allowed high-yield interaction between CCC and coaching program.
“Delineation of clear expectations allowed high-yield interaction between CCC and coaching program.”
Quote in the paperSubstantial claim - Findingown data
Factors limiting direct observations included resident tendency to select low-complexity patients, limiting educational benefits.
“3) resident tendency to select low-complexity patients, limiting educational benefits.”
Quote in the paperSubstantial claim - Findingown data
Factors limiting direct observations included resident concern that coaches were summative 'evaluators' rather than facilitators of formative feedback.
“2) resident concern that coaches were summative ‘evaluators’ rather than facilitators of formative feedback”
Quote in the paperSubstantial claim - Findingown data
Later in residency, resident-coach discussions shifted away from EPAs towards more traditional mentoring topics, including research, fellowship applications, and professional transition into fellowship/practice.
“Later in residency, resident–coach discussions shifted away from EPAs towards more traditional mentoring topics, including research, fellowship applications, and professional transition into fellowship/practice.”
Quote in the paperSubstantial claim - Premisecitation
In 2012, the IM Residency Program at Penn State College of Medicine identified coaching for residents, specifically in achieving entrustment in EPAs, as an improvement area.
“In 2012, the IM Residency Program at Penn State College of Medicine identified coaching for residents, specifically in achieving entrustment in EPAs, as an improvement area [28,29].”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Trainees often interact with supervising physicians in short, fragmented rotations, limiting opportunities for meaningful coaching and trust-building.
“Trainees often interact with supervising physicians, in short, fragmented rotations, limiting opportunities for meaningful coaching and trust-building[24].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [24] source
Not checked in the free run.
- Premisecitation
Direct observation, feedback, and reflective practice are critical factors that enable the assessment of whether a learner can be entrusted.
“Critical factors that enable the assessment of whether a learner can be entrusted include direct observation, feedback, and reflective practice[9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] source
Not checked in the free run.
- Premisecitation
New education models required to achieve CBME are not well described.
“Although investigations into new education models are required to achieve CBME, these models are not well described [22,25–27].”
Quote in the paperSubstantial claim0 of 4 sources checked - Study design and conductnone given
Data collection was challenged by the fact that, even after productive resident-coach interactions, residents did not always initiate meeting summaries as requested.
“Our data collection was also challenged by the fact that, even after productive resident–coach interactions, residents did not always initiate meeting summaries as requested.”
Quote in the paperNot a substantial claim - Interpretationown data
Residents' ability to self-assess and identify disorienting dilemmas has been and continues to be a significant challenge.
“Residents’ ability to self-assess and identify disorienting dilemmas has been and continues to be a significant challenge.”
Quote in the paperSubstantial claim - Study design and conductown data
The number of submitted resident-coach meeting summaries was low, potentially decreasing the reliability of these findings.
“Most notably, the number of submitted resident–coach meeting summaries was low, potentially decreasing the reliability of these findings.”
Quote in the paperNot a substantial claim - Premisecitation
Residents' interactions with faculty supervisors are often fragmented in rotations, limiting sustained working relationships that allow for customized improvement of clinical skills.
“Ideally, direct observation would be performed by supervisors in clinical settings, but as has been previously identified, residents’ interactions with faculty supervisors are often fragmented in rotations, limiting sustained working relationships that allow for customized improvement of clinical skills [14,15].”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationown data
The four additional themes identified strongly suggest that residents desired their coaches work with them on areas not traditionally assessed by evaluators.
“Moreover, the four additional themes we identified strongly suggest that residents desired their coaches work with them on areas not traditionally assessed by evaluators.”
Quote in the paperSubstantial claim - Interpretationreasoning
The coaching model shows promise as one aspect of a multi-pronged program designed to examine these competencies.
“Thus, the coaching model shows promise as one aspect of a multi-pronged program designed to examine these competencies.”
Quote in the paperNot a substantial claim
- Classified as probably not a substantial claim. 22
- May combine two claims. 29
Classified as probably not a substantial claim.
Findingown dataA total of 119 resident-coach meeting summaries were examined.
“To characterize the disorienting dilemmas and PLPs, we initially examined data from submitted meeting summaries, which included a total of 119 resident–coach meeting summaries.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataPGY1 meeting summaries numbered 51, with 160 coding references.
“The frequencies by year included: PGY1 = 51 meeting summaries (160 coding references); PGY2 = 48 summaries (128 coding references); PGY3 = 20 summaries (35 coding references).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataPGY2 meeting summaries numbered 48, with 128 coding references.
“The frequencies by year included: PGY1 = 51 meeting summaries (160 coding references); PGY2 = 48 summaries (128 coding references); PGY3 = 20 summaries (35 coding references).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataPGY3 meeting summaries numbered 20, with 35 coding references.
“The frequencies by year included: PGY1 = 51 meeting summaries (160 coding references); PGY2 = 48 summaries (128 coding references); PGY3 = 20 summaries (35 coding references).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDuring PGY1, the most-commonly discussed dilemmas/PLPs aligned with leading and working within interprofessional health-care teams (EPA10), research/scholarship (Theme 4), career planning (Theme 2), and work-life balance (Theme 1).
“During PGY1, most-commonly discussed dilemmas/PLPs aligned with leading and working within interprofessional health-care teams (EPA10), research/scholarship (Theme 4), career planning (Theme 2), and work–life balance (Theme 1).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDisorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work-life balance, career planning, teaching skills, and research/scholarship.
“Disorienting dilemmas and professional learning plans mapped to all 16 EPAs and four additional themes: work–life balance, career planning, teaching skills, and research/scholarship.”
- Also stated in: § Disorientating dilemmas, professional learning plans, EPAs · plain
“We identified a total of 323 disorienting dilemmas with PLPs mapped across all 16 EPAs, and four additional themes: (1) work–life balance, (2) career planning, (3) teaching skills, and, (4) research/scholarship [28,29].”
Quote in the paperSubstantial claim0 of 2 sources checked- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
- Also stated in: § Disorientating dilemmas, professional learning plans, EPAs · plain
May combine two claims.
Findingown dataLessons learned included challenges in coordination of observations, identifying disorienting dilemmas, and creating a shared mental model between residents, faculty, and program leadership.
“Lessons learned included challenges in coordination of observations, identifying disorienting dilemmas, and creating a shared mental model between residents, faculty, and program leadership.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenInformal feedback from the coaches suggests that the data capture a larger proportion of the meetings that took place.
“However, informal feedback from the coaches suggests that our data capture a larger proportion of the meetings that took place.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDirect observations by coaches were challenging to coordinate and infrequently occurred.
“Our initial plan was to ground relationships in observations performed by coaches, allowing for feedback and subsequent reflection-on-practice[30]. However, this model met significant challenges in the early months. Coaches struggled to find mutually available times for observation, and as a result, infrequently observed residents.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDuring PGY2, the most-commonly discussed dilemmas/PLPs aligned with improving quality of care (EPA13), demonstrating personal habits of lifelong learning (EPA15), research/scholarship (Theme 4), and career planning (Theme 2).
“During PGY2, most-commonly discussed dilemmas/PLPs aligned with improving quality of care (EPA13), demonstrating personal habits of lifelong learning (EPA15), research/scholarship (Theme 4), and career planning (Theme 2).”
Quote in the paperSubstantial claimMay combine two claims.
FindingreasoningThe relationship with program leadership has become increasingly beneficial in both directions, with opportunities for resident advocacy by coaches, and coaching interventions based on CCC feedback to resident-coach pairs.
“The relationship with program leadership has become increasingly beneficial in both directions, with opportunities for resident advocacy by coaches, and coaching interventions based on CCC feedback to resident–coach pairs.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn our experience, residents variably possess self-directed learning, self-reflection, and self-assessment skills, and this was manifest in residents' struggles to identify disorienting dilemmas.
“In our experience, residents variably possess these skills, and this was manifest in residents’ struggles to identify disorienting dilemmas.”
Quote in the paperSubstantial claimMay combine two claims.
FindingcitationDespite significant investment, the program struggled to pragmatically ensure all three components of entrustment - direct observation, feedback, and reflective practice - were fully integrated into the coaching program, with direct observation posing a unique logistic challenge.
“Despite significant investment, we struggled to pragmatically ensure all three components of entrustment – direct observation, feedback, and reflective practice – were fully integrated into the coaching program, with direct observation posing a unique logistic challenge [3,50].”
Quote in the paperSubstantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingnone givenThe program had 5% departmental FTE support for coaches, which is a substantial input of resources that may not be replicable at other institutions.
“We had 5% departmental FTE support for coaches, which is a substantial input of resources that may not be replicable at other institutions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
PremisecitationThese activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information and provide customized appraisal and feedback.
“Collectively, these activities are best achieved through longitudinal relationships with faculty who assimilate various sources of information (e.g., direct observation, multisource feedback) and provide customized appraisal and feedback, facilitating an exploration to identify improvement areas [13–20].”
Quote in the paperNot a substantial claim0 of 8 sources checked- cites [13] source
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- cites [14] source
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- cites [20] source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThe two investigators then independently coded the remaining data and resolved all coding discrepancies through discussion and arbitration.
“The two investigators then independently coded the remaining data, met again to resolve all coding discrepancies through discussion and arbitration.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataSurvey responses were analyzed by two investigators, and all investigators agreed upon results.
“Survey responses were analyzed by two investigators (J.S.M-H., D.R.W.), and all investigators agreed upon results.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataAfter coding half the data, the two investigators jointly identified and agreed on additional themes and refined their coding scheme for the EPAs.
“After coding half the data, the two investigators came together to jointly identify and agree on additional themes, as well as refine their coding scheme for the EPAs.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationGraduate medical education programs struggle to operationalize these activities and frequently lack sufficient infrastructure to support longitudinal relationships between trainees and faculty.
“However, graduate medical education (GME) programs struggle to operationalize these activities, and frequently lack sufficient infrastructure to support longitudinal relationships between trainees and faculty [13,22,23].”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationTo achieve CBME outcomes, residents must develop deliberate reflective practice skills, which are necessary for critical thinking, professionalism, and continuous professional development.
“To achieve CBME outcomes, residents must develop deliberate reflective practice skills, which are necessary for critical thinking, professionalism, and continuous professional development [5–8].”
Quote in the paperSubstantial claim0 of 4 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationTwo investigators independently analyzed all email summaries, each coding half of the data.
“Two investigators (J.S.M-H., K.L.K.) independently analyzed all email summaries [38,39].”
- Also stated in: § Coaching program · plain
“Each investigator independently coded half of data.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [38] source
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- cites [39] Boyatzis RE, 1998
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- Also stated in: § Coaching program · plain
May combine two claims.
Interpretationown dataThe coaching program resulted in professional learning plans aligned with IM EPAs, in addition to other professional development topics.
“The coaching program resulted in professional learning plans aligned with IM EPAs, in addition to other professional development topics.”
Quote in the paperSubstantial claim- Rests on an assumption: The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Interpretationnone givenEven lacking direct observation, the focus on EPAs brought these competencies to the forefront of residents' minds, which is reflected in the frequencies of EPAs discussed in resident-coach meetings.
“Even lacking direct observation, we suspect this focus on EPAs brought these competencies to the forefront of residents’ minds, which is reflected in the frequencies of EPAs discussed in resident–coach meetings.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
Interpretationnone givenThe focus on EPAs in the resident-coach interaction likely increased residents' attention to these learning areas.
“Nevertheless, it is important to note that our focus on EPAs in the resident–coach interaction likely increased residents’ attention to these learning areas.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
PremisecitationThis requires significant changes, such as designing GME programs that link residents with faculty over longer time periods, faculty development in coaching skills, reconsidering clinical faculty roles, and examining the balance between clinical service and education requirements.
“This requires significant changes, such as designing GME programs that link residents with faculty over longer time periods, faculty development in coaching skills, reconsidering clinical faculty roles, and examining the balance between clinical service and education requirements [13,46,52].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [13] source
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- cites [46] source
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- cites [52] source
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- Rests on an assumption: Clinical productivity pressures increasingly push faculty to meet revenue benchmarks, which can be at odds with authentic coaching of residents in CBME frameworks.
May combine two claims.
PremisecitationResidents must possess self-directed learning, self-reflection, and self-assessment skills, which is lacking in some trainees.
“Residents, therefore, must possess self-directed learning, self-reflection, and self-assessment skills, which is lacking in some trainees [9,41,42].”
Quote in the paperSubstantial claim0 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe transition from less granular, 'time-based' assessments to CBME and entrustment requires more direct workplace-based observations of trainees, provision of high-quality feedback, and use of highly reliable assessment tools, all of which require transformation in processes, resources, and faculty expectations.
“The transition from less granular, ‘time-based’ assessments to Competency-Based Medical Education (CBME) and entrustment requires more direct workplace-based observations of trainees, provision of high-quality feedback, and use of highly reliable assessment tools, all of which require transformation in processes, resources, and faculty expectations [13,46–48].”
Quote in the paperNot a substantial claim0 of 4 sources checked- cites [13] source
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- cites [46] source
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- cites [47] Holmboe ES, 2018
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- cites [48] Chopra V, Arora VM, Saint S. Will You Be My Mentor?—Four Archetypes to Help Mentees Succeed in Academic Medicine. JAMA Intern Med. 2018;178(2):175–176. source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationThere is a pressing need to transform clinical learning environments at the systems level to allow for longitudinal faculty coaching to meet these needs.
“Regardless, there is a pressing need to transform clinical learning environments at the systems level to allow for longitudinal faculty coaching to meet these needs[51].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] source
Not checked in the free run.
- Rests on an assumption: Clinical productivity pressures increasingly push faculty to meet revenue benchmarks, which can be at odds with authentic coaching of residents in CBME frameworks.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenMeetings were challenging to schedule, thus occurring less frequently than the 'ideal' of approximately seven/year.
“Meetings were challenging to schedule (thus occurring less frequently than the ‘ideal’ of approximately seven/year).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
InterpretationreasoningThe shift away from EPAs may have been due to lack of direct observation opportunities, a culture less accustomed to coaching behaviors, and/or a previously undiscovered need for residents to have an outlet for non-threatening conversations about work-life balance, wellness, and career development.
“This shift away from EPAs may have been due to lack of direct observation opportunities, a culture less accustomed to coaching behaviors, and/or a previously undiscovered need for residents to have an outlet for non-threatening conversations about work–life balance, wellness, and career development.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe modifications to address challenges in identifying disorienting dilemmas allowed for less-scripted, open-ended dialogue between resident and coach, challenged residents to identify PLPs, and created greater accountability for follow-up with the coach.
“This allowed for less-scripted, open-ended dialogue between resident and coach, challenged residents to identify PLPs, and created greater accountability for follow-up with the coach.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe single-center implementation suggests modifications would be required for use in other settings.
“An additional limitation to consider is that the single-center implementation suggests modifications would be required for use in other settings.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningA shared mental model for the coaching role must exist amongst all stakeholders.
“A shared mental model for coaching role must exist amongst all stakeholders”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductnone givenThe paper describes implementation features and does not report the impact on residents' behaviors or practice.
“Lastly, we describe implementation features and do not report the impact on residents’ behaviors or practice.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningThe change to focus less on direct observation limited the coach's opportunities to assess whether a learner could be entrusted, thereby diminishing one of the key goals of the program.
“However, this change limited the coach’s opportunities to assess whether a learner could be entrusted, thereby diminishing one of the key goals of the program.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationCompared to 'time-in-seat' education, CBME requires collaboration between resident and coach, with responsibility on the learner to be active in reflecting, assessing, and developing PLPs.
“Compared to ‘time-in-seat’ education, CBME requires collaboration between resident and coach, with responsibility on the learner to be active in reflecting, assessing, and developing PLPs[9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] source
Not checked in the free run.
The paper relies on this without support.
The submitted meeting summaries are representative of the disorienting dilemmas and PLPs discussed in all resident–coach meetings.
“Sixty-five unique residents (81%) submitted at least one summary containing a disorienting dilemma and/or PLP during our review.”
“we initially examined data from submitted meeting summaries, which included a total of 119 resident–coach meeting summaries.”
The paper relies on this without support.
The lessons learned from this single-institution coaching program are transferable to other residency programs.
“Operationalization of aspects of these results can inform the development of similar programs in residency education.”
The paper relies on this without support.
Residents' self-identified disorienting dilemmas and professional learning plans reflect their actual professional learning needs.
“Prior to meetings, residents were asked to reflect on their clinical rotations and self-identify improvement areas.”
“The expected outcome of each meeting was a PLP that was focused on an EPA (if applicable), or other area of learning need as articulated by the resident.”
The paper relies on this without support.
There is a lack of coaching by ward attendings and clinic preceptors.
“However, we designed this program based on the perceived lack of ‘coaching’ by ward attendings and clinic preceptors.”
The paper relies on this without support.
There is a need to enhance longitudinal relationships between residents and faculty.
“In response to our need to enhance longitudinal relationships between residents and faculty, we implemented a coaching program that supports residents’ professional development.”
The paper relies on this without support.
Clinical productivity pressures increasingly push faculty to meet revenue benchmarks, which can be at odds with authentic coaching of residents in CBME frameworks.
“With clinical productivity pressures, faculty are increasingly being pushed to meet revenue benchmarks, which can be at odds with authentic coaching of residents in CBME frameworks.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Mental health is a coaching measure.
“| Coaching measure | Mental health | [8,97,99] |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [8]
The Methods (Coaching program; page unavailable) include a health/wellness check-in during resident–coach meetings. The Discussion (page unavailable) also says wellness arose in those conversations, but describes it as a shift toward mentoring rather than a coaching measure. The paper does not identify mental health as a measured coaching outcome. (LLM, conf=0.83)
Experimental — accuracy not yet measuredResearch/scholarship is a resident/fellow outcome.
“| Research/scholarship | Resident/fellow | [8] | |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [8]
The Results section (page unavailable) identifies research/scholarship as a theme in residents’ coaching discussions and professional learning plans. It does not report measured research or scholarship outcomes, and the participants studied were residents, not fellows. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCoach characteristics are a factor in coach selection.
“| Coach selection | Coach characteristics | [8,49,145] | |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [8]
Career planning is a resident/fellow outcome.
“| Coaching outcomes | Resident/fellow | Career planning | [8,103,121] |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [8]
Confusion of coach definition (coach vs mentor) is a program barrier.
“| Coaching barriers | Program | Confusion of coach definition: coach vs mentor | [4,8,138] |”
From Coaching in undergraduate and graduate medical education: a scoping review of success factors, barriers, and outcomes (2026) · cites this paper as [8]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
PGY1 EPA2 percentage does not match its count
MinorTable 2 reports 7 of 108 PGY1 EPA references as 7%; the percentage is 6.48%, which rounds to 6% at the displayed precision.
Reported 7 · recomputed 6.481481
“EPA2: Manage care of patients with acute complex diseases across multiple care settings | 7 (7) | 5 (6) | -”
Resident survey response rate is overstated
MinorFourteen of 60 invited residents completed the survey, a response rate of 23.3%, which rounds to 23%, not 24%.
Reported 24 · recomputed 23.333333
“60 residents and 20 faculty invited, with 14 (24%) and 12 (60%) completing the survey, respectively”
PGY1 EPA11 percentage does not match its count
MinorTable 2 likewise reports 7 of 108 PGY1 EPA references as 7%, rather than 6% when rounded to a whole percent.
Reported 7 · recomputed 6.481481
“EPA11: Facilitate the learning of patients, families, and members of the interdiscplinary team. | 7 (7) | 2 (2) | -”
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- Authors
- Gonzalo, J. D., Wolpaw, D. R., Krok, K. L., Pfeiffer, M. P., & McCall-Hosenfeld, J. S.
- Affiliations
- Pennsylvania State University (US)
- Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Corresponding author
- Gonzalo, Jed D.
- ORCID
- Venue
- Medical Education Online
- Publisher
- Informa UK Limited
- Published
- 2019-01-01
- Volume
- 24
- Issue
- 1
- Pages
- 1591256
- ISSN
- 1087-2981 (ISSN-L)
- PMC
- PMC6442085
- OpenAlex
- W2925889027
- Cited by
- 39
- References
- 52
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 10 · 2023: 4 · 2022: 8 · 2021: 4 · 2020: 2 · 2019: 1
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Medical Education Online (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- American Medical Association
- Penn State Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Psychology › Social Psychology › Mentoring and Academic Development
- Social Sciences › Psychology › Applied Psychology › Coaching Methods and Impact
- Keywords
- internal medicine residency, faculty coaching, basic competencies, reflective practice, disorienting dilemma, professional development, work-life balance, career planning, lifelong learning, interprofessional care teams, program implementation
- MeSH terms
- Mentoring, Clinical Competence, Humans, Internal Medicine, Internship and Residency, Leadership, Surveys and Questionnaires, Program Evaluation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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