Developing a self-determination theory-informed coaching framework for the transition to residency

To develop and content-validate a consensus-based, Self-Determination Theory (SDT)-informed single-session coaching framework for the transition from medical school to residency (TTR).

We conducted a modified Delphi study with 13 medical educators from 11 U.S. medical schools, purposively sampled for diversity of geography, institutional type, and coaching infrastructure. Eligibility required experience coaching in medical education. Using a nominal group technique, panelists generated 125 prompts and 12 skills across the coaching arc (opening, exploring, planning, closing). Duplicates were consolidated by consensus rules. In Round 1, panelists rated items on a 1-10 scale; consensus was >80% rating 9-10. In Rounds 2-3, binary yes/no voting determined inclusion or exclusion. Quantitative analysis included medians, interquartile ranges, and Kendall's coefficient of concordance (W) for Round 1. Qualitative comments were analyzed with rapid content analysis to guide revisions.

All panelists completed each round (100% retention). In Round 1, 17 questions and 2 skills met consensus (median = 9, IQR 0-1; W = 0.78). Round 2 retained 2 questions and 1 skill, and excluded 62 items. Round 3 added 6 questions and 1 skill, yielding a final framework of 25 prompts and 4 skills. Prompts were distributed across phases (opening 5, exploring 9, planning 7, closing 4) and mapped to SDT needs (autonomy 9, competence 8, relatedness 8). Panelists affirmed clarity, feasibility, and acceptability for non-coach faculty.

This consensus-derived framework provides a pragmatic, SDT-grounded tool for coaching at the TTR. Future studies should evaluate feasibility, fidelity, and learner outcomes.