Academic Coaching to Enhance In-Training Examination Performance in Internal Medicine Residency

Setting and Problem

The rapid expansion of medical knowledge has made self-directed learning (SDL) essential for physicians to maintain competency and succeed in high-stakes assessments such as the Internal Medicine In-Training Examination (IM-ITE). Graduate medical education (GME) must prioritize fostering SDL skills in residents while preparing them for summative examinations. Academic coaching offers a promising approach to support these dual goals, helping residents set learning objectives, identify gaps, and develop action plans for SDL and examination performance.

This pilot study explores the role of academic coaching in enhancing SDL and IM-ITE outcomes. Grounded in Vygotsky’s Zone of Proximal Development and Gallimore and Tharp’s 4-stage model, the program provides evolving support that empowers residents to develop greater independence in their learning.¹ While academic coaching has gained attention in GME, its impact on SDL and summative performance remains underexplored. This study aims to address this gap and offer insights into designing effective coaching programs for residency training.

Intervention

Our academic coaching program, inspired by the American Medical Association Coaching Workshop, is a unique intervention aimed at improving SDL. All 79 residents participated in a 2-hour interactive workshop, with 26 academically at-risk residents (scoring below the 35th percentile on the IM-ITE) required to enroll in the coaching program. The workshop was designed to encourage residents to critique and develop SMART (specific, measurable, achievable, relevant, and time-bound) goals and create individualized learning plans (ILPs) for the academic year.

Thirteen faculty members volunteered as academic coaches after completing a faculty development session. Coaches met with their residents virtually or in person every other month, utilizing a coaching script with 14 prompts. Program leadership provided monthly check-ins to ensure ongoing engagement over the academic year.

Outcomes to Date

IM-ITE scores from 2021 (pre-intervention) and 2022 (post-intervention) were compared, along with perception questionnaires on SDL confidence, effort, importance, satisfaction, and frequency, to evaluate the program’s impact. Fifty residents (20 coached, 30 uncoached) had paired data for 2021 and 2022. The questionnaire was informed by the best practice guide on questionnaire design, and cognitive interviews using verbal probing techniques were completed prior to dissemination.² Data were analyzed using a 2-tailed paired samples t test in SPSS.

Coached residents improved their IM-ITE percent correct and percentile scores more than uncoached residents (see Table). These findings suggest a moderate to large impact of the coaching intervention on examination performance, highlighting the practical significance of academic coaching in improving high-stakes assessment outcomes.

Table Impact of Academic Coaching on IM-ITE Percent Correct and Percentile Scores: Coached vs Uncoached Residents

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Thirty of the 50 paired residents (60%) completed pre- and post-intervention perception surveys. Although no statistically significant changes were observed across the 5 surveyed domains (confidence, effort, importance, satisfaction, and frequency), perceptions did not decline despite the mandated coaching program. These results demonstrate that academic coaching can improve examination performance without negatively affecting residents’ attitudes toward SDL.

The program was well received by residents and faculty, with 100% participation in the initial workshop and strong faculty engagement, as evidenced by longitudinal relationships with their assigned residents. The structured, goal-oriented approach of SMART goals and ILPs, supported by ongoing coaching, provided a feasible and sustainable method for fostering SDL and improving examination outcomes.

Given its success, this coaching model is scalable and adaptable across GME programs. The framework can be modified to meet the needs of various specialties, and the low time commitment required for residents and coaches, along with the option for remote meetings, reinforces the program’s feasibility. The positive reception and significant impact on examination performance indicate that academic coaching is a practical and effective intervention that can be implemented across residency programs.