Exploring peer coaching needs in a pediatrics residency program with faculty coaching

Abstract

Background

Academic coaching in graduate medical education utilizes observation and individualized goal setting to promote self-directed learning and performance improvement. Most academic coaching models are hierarchical (i.e., senior coach and junior coachee). Peer coaching is a unique growth opportunity for academic coaching. However, facilitators and barriers to implementing peer coaching, as well as which clinical and professional domains could be most helpful, remain undefined. We aimed to explore the current attitudes, promoters, and barriers of peer coaching among pediatric residents participating in academic coaching.

Methods

We conducted a cross-sectional descriptive study of all pediatric and child neurology residents at a freestanding children’s hospital in 2025. Residents were anonymously surveyed on their current understanding, use of, and desire for further development of peer coaching. Residents were also allowed to indicate preference for a faculty or peer coach in thematic areas amenable to academic coaching.

Results

A total of 23/37 residents (62%) responded and represented all post-graduate years. Most respondents (70%) indicated prior participation in peer coaching, as coach or coachee, in a clinical setting. 73% reported peer coaching as a favorable experience and 86% expressed a desire for additional peer coaching training. Residents preferred peer coaches in thematic areas pertaining to time management (59%) and wellness (45%).

Conclusions

Peer coaching may be acceptable to pediatric residents for augmenting faculty-led academic coaching programs and curricula focused on time management and wellness as opposed to clinical skills may be most welcomed. Programs should support the scheduling of coaching activities and ensure time is available to overcome barriers perceived by trainees.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09874-5.

Introduction

Academic coaching, defined as a relationship that facilitates learners achieving their fullest potential through review of objective assessments, assisting in goal setting, and helping the learner to be accountable and self-reflective, is an emerging approach to self-directed learning and guided performance improvement within graduate medical education (GME) [1]. Master adaptive learning is a key framework supported by academic coaching with the goal of assisting trainees in using metacognition to work through the stages of learning – planning, learning, assessing, and adjusting [2]. Academic coaching can improve resident perception of feedback relating to clinical reasoning, communication skills, professional identity, and goal setting [3, 4]. Participating as a coach provides similar benefits with regards to professional identity, engagement in academia, and career satisfaction [5]. While most academic coaching models typically involve a hierarchical coaching relationship (i.e., senior coach and junior coachee), peer coaching offers a unique opportunity to supplement and address challenges of hierarchical coaching programs (i.e. perceived lack of psychological safety, insufficient number of coaching faculty).

Peer coaching can be defined as an academic coaching relationship between colleagues with a similar level of training or experience. Clinical peer coaching between residents has been explored as an approach to enhance and streamline feedback between trainees [6]. Preliminary efforts suggest implementing peer coaching programs in GME may improve Accreditation Council for Graduate Medical Education (ACGME) milestone-based skills including application of evidence-based medicine and interprofessional care coordination [7]. Additionally, peer coaching has been used to improve surgical resident technical skills [8] as well as medical student pre-rounding performance [9].

While these findings have identified peer coaching as a potentially useful tool for GME programs in supporting lifelong learning and professional development, there remains a paucity of evidence to universally guide successful development and implementation of peer coaching programs. Specifically, the domains in which peer coaching may have the greatest impact or be the most well received among residents have yet to be established. Furthermore, a description of facilitators and barriers to implementing peer coaching in GME programs remain poorly defined. Accordingly, as an important and necessary first step, we aimed to assess the current attitudes, promoters, and barriers of peer coaching among pediatric residents participating in academic coaching. We hypothesized that residents would express interest in expanding their peer coaching skills and not having sufficient time for coaching activities would be a prominent barrier among respondents.

Methods

Setting and participants

We conducted a single-center, cross-sectional, descriptive study of residents within a pediatrics residency program with 12 categorical and 1 child neurology resident positions per post-graduate year. Primary clinical training occurs for trainees at a freestanding children’s hospital and associated outpatient clinics. Participants included categorical pediatrics residents and child neurology residents completing their preliminary pediatric training. The pediatrics residency program has a longitudinal Pediatric Resident Coaching Program in which residents are paired with a dedicated faculty coach who provides support through clinical and educational observations and informal coaching meetings across all three years of residency training. Through this program, residents receive approximately 5 h of introductory training on core coaching concepts and are introduced to the principles of peer coaching. The educational content was provided by core coaching program faculty following a standardized curriculum with minimal changes during the study period.

Interventions

We designed a survey to explore the current impressions of, use of, and barriers to peer coaching within our Pediatrics Residency Program. As a validated survey to address our study needs did not exist, we created a survey under the guidance of experts in medical education who serve in GME leadership roles within our institution. First, we conducted a thorough review of existing peer coaching literature to identify domains in which peer coaching has been studied in GME, which broadly included academic performance, clinical skill development, professional identity formation, and well-being. With this in mind, we chose to classify our domains under these same pillars and anchor them to ACGME Core Competencies and General Pediatrics milestones allowing for a measurable, learner-centered approach. We also reviewed common barriers to coaching programs that have been described in the literature when crafting our survey questions. The survey included a definition of peer coaching, and residents were anonymously surveyed on their current understanding of, use of, and desire for further training in peer coaching. Participants were first asked about their current experience with coaching and interest in further developing peer coaching skills. They were then asked to indicate perceived barriers to peer coaching. The survey concluded with a matrix to denote preference of coach (faculty, peer, or no preference) for several domains of coaching, (i.e. communication skills, career planning, wellbeing). We aimed to create the survey to align with Kern’s six-step approach to curriculum development [10].

The survey questions utilized a combination of Likert-type scales, numerical responses, and open-ended questions. We piloted the survey with two chief residents with prior exposure to coaching during their residency training and met with them individually to obtain their feedback. Minor linguistic modifications to the survey were made to enhance clarity. The final survey was distributed using REDcap (Research Electronic Data Capture) [11] between March and May 2025. Weekly reminders were sent and quick-response codes placed in resident workrooms and educational classrooms were utilized to increase the response rate.

Analysis of outcomes

Survey responses were summarized in aggregate and reported as counts and percentages (categorical data) or medians and interquartile ranges (IQR) (numerical data). Data are presented for the entire cohort of respondents and by post-graduate year (PGY). To facilitate sharing of the results, responses from the Likert scale questions were categorized based on the directionality of the response with relation to ‘neutral’ (example: ‘Extremely unconfident’ and ‘Somewhat unconfident’ are described as ‘unconfident’; ‘Extremely confident’ and ‘Somewhat confident’ are described as ‘confident’). All analyses were conducted in RStudio (R version 4.4.2). Data visualization was performed with the ggplot2 (version 3.5.2) and likert (version 3.5.1) packages. Due to the descriptive nature of this study, statistical comparisons were not performed.

IRB statement

This study and its procedures were approved by the Johns Hopkins University Institutional Review Board. All participants were informed of study activities through electronic recruitment materials. A waiver of documented consent was granted for this study in compliance with the United States Federal Policy for the Protection of Human Subjects.

Results

Survey respondents

A total of 23/37 residents (62%) responded and represented all post-graduate years. Respondents included 7/13 (54%) PGY-1 residents, 9/12 (75%) PGY-2 residents, and 7/12 (58%) PGY-3 residents. Resident participants were primarily female 20/23 (87%) (Table 1).

Table 1.

Demographic, prior coaching experience, and trainee perceptions of peer coaching by post-graduate year

Number of respondents (%)*	Total N = 23 (100)	PGY-1 N = 7 (30)	PGY-2 N = 9 (39)	PGY-3 N = 7 (30)
Gender**
Female	20 (87)
Male	2 (9)
Prefer not to answer	1 (4)
In the past 6 months, I have been coached in a(n)
Clinical Setting	20 (87)	6 (86)	9 (100)	5 (71)
Educational Setting	16 (70)	6 (86)	5 (56)	5 (71)
Other Setting	20 (87)	6 (86)	7 (78)	7 (100)
In which settings have you coached a peer?
Clinical	16 (70)	3 (43)	7 (78)	6 (86)
Non-clinical	15 (65)	4 (57)	4 (44)	7 (100)
Not sure	1 (4)	0 (0)	1 (11)	0 (0)
In which settings have you been coached by a peer?
Clinical	16 (70)	4 (57)	7 (78)	5 (71)
Non-clinical	16 (70)	5 (71)	4 (44)	7 (100)
Not sure	1 (4)	0 (0)	1 (11)	0 (0)
Trainee confidence with distinguishing coaching from other professional support roles, median (IQR)
1 = Extremely Unconfident, 2 = Somewhat Unconfident, 3 = Neutral, 4 = Somewhat Confident 5 = Extremely Confident
Coaching from advising	4 (3.5, 4.5)	4 (3.5, 4.5)	4 (3.5, 4.5)	4 (3.5, 4.5)
Coaching from mentoring	4 (3,4)	4 (3,4)	4 (3,4)	4 (3,4)
How favorable is your view of peer coaching
1 = Extremely Unfavorable, 2 = Unfavorable, 3 = Neutral, 4 = Somewhat Favorable, 5 = Extremely Favorable
	4 (3.5,4)	4 (3.5,4)	4 (3.5,4)	4 (3.5,4)
Interest in further developing coaching skills
1 = Extremely Uninterested, 2 = Uninterested, 3 = Neutral, 4 = Somewhat Interested, 5 = Extremely Interested
	4 (4,5)	4 (4,5)	4 (4,5)	4 (4,5)

*When applicable

**Self-identified gender not displayed by PGY to avoid potential identification of participants

Coaching experience

Overall, residents identified that faculty coaching, as required by the residency coaching program, is occurring in all PGY classes in clinical (20/23, 87%), educational (16/23, 70%) and other (20/23, 87%) settings. Residents across all PGYs expressed confidence in being able to distinguish coaching relationships and behaviors from advising (17/23, 74%) and mentoring (16/23, 70%) relationships (Table 1).

Most respondents (17/23, 74%) indicated participation in peer coaching, as coach or coachee, in a clinical setting prior to completing the survey. Among all residents, 17/23 (74%) reported peer coaching as a favorable experience, and 20/23 (87%) expressed a desire for additional training in peer coaching (Table 1).

Coaching barriers

Residents reported several perceived barriers to peer coaching within their training. “Lack of time” (17/23, 74%), “Lack of training” in peer coaching (14/23, 61%), and “Difficulty with scheduling meetings” (13/23, 57%) were the most frequent self-reported barriers to performing peer coaching (Fig. 1). “Feels Unimportant” was the least reported barrier across all PGYs. Overall, PGY-1 respondents tended to report fewer barriers than PGY-2 and − 3 residents. PGY-3 respondents also noted “Difficulty distinguishing the role from mentor/advisor” as one of the most frequently perceived barriers (5/7, 71%).

Fig. 1.

Proportion of trainees reporting individual barriers to participating in peer coaching by post-graduate year (PGY)

Coachee preferences

Residents indicated a preference between faculty or peer coaches for several domains relevant to academic coaching. Residents preferred to be coached by faculty in domains such as evidence-based practice (21/23, 91%), clinical reasoning (20/23, 87%), physical exam skills (19/23, 83%), and medical knowledge (18/23, 78%). Residents indicated a preference for peer coaches in domains such as time management (14/23, 61%) and wellness (11/23, 48%) (Fig. 2). Preferences stratified by PGY are provided in Supplemental Figs. 1–3. When visually comparing preferences between PGY cohorts, PGY-3 residents appeared to have a greater number of domains with “No preference” indicated between faculty or peer coaches.

Fig. 2.

Trainee preference between peer or faculty coaching for different domains amenable to coaching, as percentages (N=23)

Discussion

We demonstrated that, in a pediatric residency program where trainees participate in hierarchical academic coaching with faculty coaches, all residents expressed interest in further developing peer coaching skills. This is an important finding in the context of GME’s overall goal of developing master adaptive learners to facilitate lifelong learning. Additionally, our findings suggest that there are certain domains, including time management and wellbeing, that may be preferable for peer coaching efforts in comparison to more traditional hierarchical coaching in academia.

In our study, we found that pediatric residents are overall interested in peer coaching training. Prior literature demonstrates that residents from internal medicine, family medicine, and pediatrics are interested in peer coaching and that practical strategies and coaching techniques can be taught [6, 7]. Our study expands upon the current literature in that it explores interest in further developing peer coaching skills within a pediatric training program that already has an established longitudinal faculty coaching program. Understanding basic coaching techniques and experiencing firsthand the benefits of their other coaching relationships may make our residents more open to expanding their peer coaching training and have implications for the design of peer coaching curricula.

Similarly, perceived barriers to peer coaching should be taken into consideration when developing future curricula and programming. It is unsurprising that lack of time is noted by residents to be the most common barrier, as scheduling observations and meetings on top of an already busy clinical schedule may be daunting to many trainees. However, it has been demonstrated that aligning peer coaching with resident elective time has led to more manageable time commitments when compared to faculty coaching [7]. We noted that upper-level residents more frequently identified barriers than PGY-1 respondents, which may suggest that barriers vary by class year as responsibilities and involvement in other professional and scholarly projects evolve. For programs to be implemented successfully, it may be beneficial to start engaging in peer coaching efforts early in one’s training. Interestingly, although our residents overall felt confident in their ability to differentiate coaching from other professional support roles, PGY-3 residents also denoted difficulty distinguishing the role as one of their top barriers. This may suggest that there is a disconnect in being able to define the role contextually and participating in the role operationally as residents in later stages of training have taken on multiple support roles (i.e. mentor, advisor, coach) concurrently. This may align with prior literature that notes clarity of expectations as a barrier to peer coaching [7]. As trainees progress, it may be beneficial for ongoing practice and feedback to sharpen their coaching skills.

We also highlighted that time management and wellbeing are domains in which our residents prefer being coached by a peer. Targeting certain ACGME milestones and correlating them with coaching activities may be useful in improving milestone ratings for both the coach and coachee. Time management skills have been identified as a remediation target for trainees in GME programs [12]. However, studies specifically looking at the ability to develop resident-level (or residency) peer coaching programs to improve time management skills are lacking. Overall, understanding what residents want out of a peer coaching relationship can pave the way for more robust and useful interactions, workshops, and the development of future peer coaching programs. It is important to note that the domains in which a resident finds peer coaching to be most helpful may change over the course of their training. Interestingly, PGY-3 residents more frequently showed no preference in by whom they were coached compared to PGY-1 and − 2 residents. This may reflect indifference, as they gain more experience with coaching and can appreciate benefits from both faculty and peer coaching experiences. Alternatively, they may identify as near-peers to faculty coaches as they approach graduation and gain confidence in their readiness for independent practice. This perception of being more near-peer with faculty may also shift the domains perceived to benefit from coaching relationships. Finally, resident preference for faculty in several domains suggests that residents may perceive expertise as an important qualification for a coach. Given that successful coaching at its core only requires skill in supporting others to identify their own solutions, this highlights an additional area for development among trainees.

Our study is not without limitations. First, as a single-center study with a more limited sample size, our findings may lack generalizability across all pediatric residency training programs, specifically those without faculty coaching programs already in place. Additionally, our survey response rate of 62% failed to capture the opinions and experiences of all our residents. However, we nonetheless had representation from a majority of all PGY classes, and thus our observations were likely representative of each training level. Another limitation of our study was that our survey lacked formal testing of several domains of validity, the result of which we attempted to mitigate by incorporating medical educator expert input and pilot testing among relevant users to assess clarity and comprehensibility. Finally, the Likert scale and multiple-choice design of our survey questions prohibited us from drawing conclusions about why residents may feel the way they feel about peer coaching.

Ultimately, our work demonstrated that there is a desire for additional peer coaching training and implementation within our pediatric residency program. Peer coaching skill development programming should focus on wellness, time management, and interpersonal communication skills with ongoing investment in faculty coaching for skills such as clinical reasoning, evidence-based practice, physical exam skills and career planning. Future studies directed at the implementation of peer coaching programs and their impact on resident performance, professional identity formation, and commitment to lifelong learning are needed.

Abbreviations

GME

Graduate medical education

ACGME

Accreditation Council for Graduate Medical Education

REDcap

Research Electronic Data Capture

Authors’ contributions

E. A. S. and J. M. M. wrote the main manuscript. J.M.M. prepared Figs. 1 and 2 and supplemental figures 1-3. All authors contributed to and reviewed the manuscript.

Funding

Not applicable.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study and its procedures were approved by the Johns Hopkins University Institutional Review Board. In accordance with the Declaration of Helsinki, all participants were informed of study activities through electronic recruitment materials. A waiver of documented consent was granted for this study in compliance with the United States Federal Policy for the Protection of Human Subjects.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.