Resident Coaching: A Path to Board Readiness

Background: Board exams are critical milestones in medicine, reflecting individual and programme performance. The In-Training Examinations (ITE), a nationally standardised assessment developed by the American College of Physicians, help identify residents at risk of failing the American Board of Internal Medicine examination. Declining first-time board pass rates at our institution highlighted the need for improved remediation efforts. Approach: To improve board performance, residents scoring below the 35th percentile on the ITE were paired with high-performing PGY3 residents and faculty coaches for mandatory bi-monthly sessions, which included ‘teach-the-teacher’ and board question review. Pre- and post-intervention ITE scores, board pass rates and survey data from trainees and coaches were analysed. Evaluation: Post-intervention, mean ITE scores rose from 57% (SD = 4.7) to 66% (SD = 5.2). Percentile scores, our more educationally relevant outcome, increased from the 24th (SD = 8.2) to the 37th percentile (SD = 21.8). Trainees reported significantly greater exam preparedness (p = 0.0002). Coaches felt less successful in their role post-intervention (p = 0.012) but gained confidence in diagnosing struggling learners (p = 0.008). Thematic analysis of open-ended surveys (100% response rate) revealed benefits, including dedicated study time, improved test-taking strategies, greater accountability and increased confidence. Implications: This intervention highlights the effectiveness of individualised coaching for remediation and fostering self-regulated learning. Unlike prior studies that focus on wellness or general support, our findings contribute early outcome data, ITE improvement, among at-risk residents. Significant improvements in ITE scores suggest personalised coaching can enhance medical education by prioritising relationships and accountability, with potential for broader implementation across all levels of training and diverse academic settings.