Introduction

In recent years, medical schools and residency programs have employed coaching techniques to work with students requiring additional support and, in some cases, to support transitioning from medical school to residency, or professional development as a whole.^1-3 Additionally, the value of peer teaching has become recognized as a bidirectional method of improving knowledge and learner motivation, recognizing education as a core task in healthcare, and adding graded responsibility as part of competency based medical education.^{4, 5} At the University of South Florida (USF), we noted an opportunity to provide directed support to students in their final year of medical school to smooth the transition to residency while promoting near-peer education and supervision. Thus, we implemented a longitudinal Residents As Coaches (RAC) program to support final year medical students intending to apply to Internal Medicine.

Program Content

The RAC program was created with a twofold goal: 1. to assist medical students in the development of core skills that are fundamental in the field of internal medicine and 2. to provide near-peer support in transitioning to residency. The EPAs, developed collaboratively by our clerkship, acting internship, and residency program leadership, focus on six high-yield topics: applied bacteriology, initiation of urgent or emergent care, manage difficult conversations, discharge a patient, perform procedures pertinent to internal medicine, and demonstrate clinical reasoning mastery. Students in this program are paired with an internal medicine resident who serves as their coach. In this unique role, resident coaches work alongside their coachees to help them construct goals related to their clinical training and residency application process, assess progress, and aid in content mastery. The process of goal setting and performance assessment requires medical students to practice self-reflection—a key component of Problem Based Learning and Improvement. Since the program’s inception in 2020, the coaching curriculum has become more robust. The coaches receive instruction on SSEPA curricular content, understanding the difference between coaching and mentoring, sample coaching models, goal setting, tips on becoming a successful coach, promoting diversity, and addressing challenges. When we started this program, the program supported 22 medical students with four resident coaches. During the second year, 13 coaches supported 39 students. This year, the program has grown to a total of 50 students and 26 coaches.

Program Evaluation

To assess the impact of our program, we solicited quantitative and qualitative feedback from students and residents. We performed retrospective pre-post surveys regarding confidence using a Likert scale (rated 1 = not confident at all and 5 = very confident). After the first year, we received responses from 10 out of the 22 students. Students indicated that their coaches helped improve their confidence in all of the EPAs with the exception of applied bacteriology. Overall confidence in SSEPAs increased from 3.45 to 4.38. Qualitative responses revealed that students felt the program provided a safe space for learning and improving clinical skills. Additionally, students felt that coaches were an asset in the residency application process. Feedback for improvement was that students would be paired with coaches earlier in the year and the request for more frequent meetings with coaches. During the second year, 21 student responses were received. In this survey, students reported that coaches helped to improve their confidence in all six EPAs. Overall confidence in SSEPAs increased from 3.62 to 4.43. Students felt that coaches helped them to identify their strengths and weaknesses and aided them in the residency application process. One student stated, “I think the emphasis on teaching and learning helped me develop my identity as an internist because an internist is a lifelong learner and teacher.” Some identified opportunities for improvement included being paired with someone who shared common interests. Since the start of the program, we have also seen a large growth in the number of coaches in the program from 4 to 26 coaches. We attribute this increased interest and involvement to a growing awareness of the program and to prior coaches’ positive experiences.

Discussion

The RAC program provides a supportive platform by which medical students can critically evaluate their strengths and weaknesses to develop and achieve their personal and professional goals. During the fourth year of medical school, students are often interacting with faculty and staff that evaluate their performance. These evaluations may be summative and used to determine how an applicant is portrayed to future residency programs. Thus, it can be challenging for students to vocalize that they may be struggling with an area of content. The unique relationship of near peer coaching provides a non-judgmental, non-evaluative environment by which students are encouraged to evaluate both their strengths and weaknesses to develop their skills. One student remarked, “I was able to develop a close relationship with my coach and received directed feedback on my clinical skills during my AI.” In addition to goal setting and self-reflection, resident coaches engage in active teaching opportunities through one-on-one teaching, development of problem-based videos, and content lectures. One highly regarded aspect of the RAC program is the support that coaches provide as medical students navigate through the residency application and interview process. Residents provide information from personal experience on various topics, including how to impress during the acting internship, provide tips for couples matching, excel at virtual interviews, and create rank lists. One student commented, “My coach would reach out to me periodically before, during, and after my AI, and I found that extremely helpful. She was able to answer questions regarding rotations, the match process, and EPA topics.” Students also enjoyed the holistic approach of coaches who focused on wellness and life outside of medicine, “It was a nice fit for me to have a coach that was relatively laid back and we also tended to discuss things outside of medicine.” From a resident perspective, the ability to coach medical students one on one allows them to educate and train students who may subsequently become the internal medicine interns on their team. In doing so, we begin to develop trust and confidence that students have mastered the foundational knowledge necessary to take on the responsibilities of an intern. Utilizing resident coaches helps to fill the knowledge gaps and support the medical school faculty in addressing students who may be struggling with content. Reducing the need for faculty, gives the university a cost-conscious approach while still supporting the objectives of the ACGME and LCME.

Conclusion

The Residents As Coaches program provides a unique opportunity for students matriculating through their final year of medical school as students receive support regarding the residency application/interview process, guidance on self-assessment and goal setting and assistance in mastering clinical skills. This non-evaluative, non-judgmental environment allows medical students to perform honest self-evaluation of their strengths and weaknesses. In doing so, students can create specific goals and work with coaches to achieve mastery of these skills prior to the start of residency. Through this process we support students in mastering SSEPAs and aid in the transition to residency. In doing so, we help to foster the development of confident and competent internal medicine interns.