Four-Year Experience With Performance Coaching in Surgery: A Sustainable Framework at a Large Academic Medical Center.

Objective

To address high burnout and professional challenges among general surgery residents, attendings, and advanced practice providers (APPs) by implementing a sustainable, departmentally funded performance coaching framework designed to foster leadership, emotional regulation, and work-life integration.

Design

A four-year retrospective programmatic evaluation (academic years 2020-2021 through 2023-2024). The framework utilized core 1:1 confidential coaching sessions, all-resident group workshops (e.g., Executive Presence, Bailout Planning, Self Advocacy), departmental grand rounds (Change Management, Healthy Compartmentalization), and PGY-specific sessions (PGY-1 transitions, Leadership Lab). Participation was voluntary and promoted via announcements. Engagement metrics were tracked prospectively via session logs, and anonymized participant feedback was evaluated iteratively to refine curricular content.

Setting

Department of Surgery at a single large academic medical center located in the Northeast United States.

Participants

General surgery residents (PGY 1-5), attending surgeons, and surgical APPs. The eligible departmental pool expanded from 49 residents in Year 1 to 50 residents, 53 attendings, and 56 APPs in Year 4.

Results

From 2020-2024, allocated 1:1 coaching hours increased 47% (85 to 125), and total encounters grew from 41 (all residents) to 130 (59 resident sessions, 54 attending sessions, and 17 APP sessions). Qualitative themes revealed evolving role-specific needs: residents focused on strategies for task prioritization, difficult conversations, and expectation-reality gaps, showing increased self-awareness and proactive support-seeking over time; attendings addressed "golden handcuffs" (feeling constrained by career success), institutional change navigation, and professionalism, with growing openness to wellness; and APPs emphasized leadership development, burnout prevention ("burning the candle at both ends"), and role ambiguity, reporting actionable behavioral changes post-coaching. Strengths include an infused culture of wellness and the ability to promote coaching as added value to incoming trainees.

Conclusions

This four-year experience establishes a scalable performance coaching framework that enhances engagement and supports work-life integration across all departmental roles. The model begins with core 1:1 coaching and group workshops, uses monthly qualitative feedback to tailor content dynamically to emerging stressors, and expands organically through sustained participant buy-in. Academic institutions can adopt this blueprint to support retention, morale, and professional behaviors in surgical education, with year-over-year utilization growth serving as a primary marker of program value and cultural acceptability.