Coaching Efficiency in Residency: From “Go Faster” to FOCUS

It’s 4:45 pm on a Friday. Two new patients have just arrived. A resident turns to you, flustered, and says, “I’ll try to go faster.” You reply, “We’ll be efficient!” But even as you say it, you wonder: Have we ever actually coached residents to be efficient?¹ In this context, efficiency does not refer to operational workflow or institutional productivity, but to how learners allocate attention and reasoning effort to what matters most. When approached deliberately, cognitive and clinical efficiency can do more than conserve time. It can improve patient safety, enhance collaboration, and contribute to professional satisfaction.

Health care systems are increasingly complex. In all domains, medical expertise grows alongside expanded interprofessional roles and evolving technologies. These changes have reshaped clinical work and increased pressure on learners.² Many residents internalize that perfection is expected: “It’s not a realistic expectation, but it’s one that the medical education system, that the health care system in general, has placed on us.”³ Some feel they must approach every task the same way, regardless of context, fearing that anything less than full execution compromises professionalism.

The Hidden Curriculum of Efficiency

Efficiency is implicitly demanded in clinical settings, often reduced to vague feedback such as “Good job, you were efficient!” Residents report being assessed and even praised for efficiency during rotations,⁴ yet they receive little structured guidance on how to enact the full range of physicians’ roles in an efficient and adaptable manner. This points to a hidden curriculum that praises speed and resilience without offering the scaffolding residents need (see Box).

Box. Coaching Efficiency: Common Pitfalls and Better Alternatives

• Pitfall: Equating efficiency with speed (“go faster”) Better: Emphasize aligning actions with patient needs and clinical priorities (“focus on”)

• Pitfall: Vague praise (“good job, you were efficient”) Better: Specific guidance (“you handled the case with focus and clear prioritization”)

• Pitfall: Prioritizing arbitrary time limits Better: Encourage context-sensitive decisions that privilege patient-centered outcomes

• Pitfall: Taking over tasks that are challenging for the learner Better: Support them by walking through decision points and showing what can be streamlined

• Pitfall: Avoiding emotionally complex or ambiguous cases Better: Frame these as opportunities to coach where learners lose the most time and need structured strategies

Efficiency also becomes the lens through which many physicians’ roles are judged in feedback. For example, communication and collaboration are expected to be brief and direct.⁵ Some residents report that time pressure undermines their ability to practice in ways that align with their values and training. When placed under pressure, residents report sacrificing patient-centeredness: “For the sake of time and efficiency, you don’t really have time to establish a real human connection.”³ This tension between system-driven pressure and humanistic care can erode professional identity and well-being.^3,6 A resident described this internal conflict poignantly: “My whole goal is to do the right thing for the patient…having to do it with speed and efficiency made it damn near impossible to do the right thing.”³ Residents seek role models who demonstrate how efficiency can coexist with humanistic care.

Without guidance, efficiency can push learners into survival mode. They fall back on incomplete strategies—choosing only the quickest tasks or steering clear of complex cases—not out of laziness, but out of uncertainty. Research shows that under time pressure, diagnostic accuracy declines,⁷ differential diagnoses become narrower,⁸ and prescribing errors increase.⁹ Even as new technologies powered by artificial intelligence promise to speed up clinical work, residents will still need coaching on where to focus their use, how to apply them, and for what purpose.

From Teaching to Coaching

As educators seek more intentional ways to support residents’ development of efficiency, personalized skills-based coaching offers a structured alternative to simply providing advice (eg, general time management strategies) or transmitting knowledge.¹⁰ Coaching emphasizes shared goals, learner agency, and iterative feedback grounded in clinical encounters.¹ Coaching junior residents has been associated with meaningful gains in their perceived self-efficacy¹¹ and consistent improvement in procedural skills.¹

Several evidence-based coaching frameworks can guide this work. The GROW model (Goal, Reality, Options, Will)¹² and the WOOP model (Wish, Outcome, Obstacle, Plan)¹³ offer practical scaffolding for brief but high-yield supervisory conversations that help residents clarify aims, recognize constraints, and commit to meaningful next steps.¹ These structures have been successfully used across the medical education continuum to support reflective practice, goal progression, and adaptive decision-making.^1,10

Supervisors coaching efficiency can translate these principles into clinical supervision through 3 core actions: explicitly framing the learning goal, directing the learner’s attention to what matters most, and scaffolding tasks to match the resident’s readiness. Our FOCUS model integrates these coaching principles into a unified approach to efficiency (see Figure). It synthesizes key elements of GROW and WOOP and adapts them to cognitive and clinical efficiency.

Figure.

The FOCUS Coaching Model of Clinical Efficiency and Alignment With Coaching Frameworks

Abbreviations: GROW, Goal, Reality, Options, Will; WOOP, Wish, Outcome, Obstacle, Plan.

From “Go Faster” to “Focus On”

Clinical efficiency relies on contextualized decision-making, cognitive clarity, and adaptive prioritization. Coaching efficiency means moving beyond time metrics. Too often, learners equate efficiency with speed, which can lead to rushed decisions and missed learning. We propose reframing efficiency as “focus on”: the purposeful allocation of attention and action to what matters most in the clinical encounter. It involves prioritizing based on goals, identifying what can be deferred or omitted, and streamlining effort without compromising care.

Rather than shielding learners from difficult cases, educators should help them approach complex psychosocial challenges with a clear frame and structured guidance, transforming challenges into meaningful learning. Supervisors can model how to reduce clerical load without compromising learning, such as by clarifying which tasks are essential for the learner to complete and which can be streamlined. These strategies are not shortcuts; they are expressions of clinical maturity. Supporting learners in navigating this balance is essential for developing adaptive expertise: an ability to flexibly apply foundational knowledge to novel and changing situations.¹⁴ These strategies are typically learned through role modeling at the bedside rather than from books or articles.

Adaptive Clinicians

The development of adaptive expertise depends on learners encountering a meaningful variation of novel, complex, or uncertain situations that stretch their existing knowledge and skills. The resulting discomfort, when appropriately scaffolded, should be viewed as a necessary element of growth. These moments of “productive struggle” (derived from the term productive failure)¹⁵ become powerful learning opportunities when framed with clear expectations, grounded in psychological safety, and supported by timely coaching.¹⁶ Coaching plays a critical role in regulating these moments from overwhelming to generative. Rather than shielding learners from the challenges of efficiency, we must guide them through it, to support both competence and adaptability.

We recognize that individual coaching cannot fully counterbalance systemic pressures—such as understaffing or productivity-driven policies—that compromise patient care. Institutions play a critical role in either undermining or enabling this work: workload design, protected teaching time, and explicit curricular goals can determine whether efficiency is modeled as mere speed or as thoughtful prioritization. In such contexts, teaching efficiency must be paired with critical reflection and, when appropriate, advocacy to resist structural forces that erode professionalism and well-being.

Coaching efficiency is not about cutting corners to gain speed, it’s about building clinicians who can think clearly under pressure, act purposefully, and stay connected to their patients. Let’s stop assuming efficiency will develop on its own. Moving from “go faster” to FOCUS, the intentional guidance we offer at 4:45 pm on a Friday is not just improving workflow, it is protecting our learners from burnout and our patients from care that is rushed rather than thoughtfully prioritized.^6-9