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.