Walk into any medical school or residency program today and you will find coaching everywhere. There are coaches for Step exams, OSCEs, research productivity, wellness, leadership, residency applications, and even “professional identity.” On the surface, this seems like progress, offering structured support, individualized feedback, and measurable outcomes. But beneath this expansion lies a more uncomfortable question. Are we replacing meaning-making mentorship with episodic, transactional coaching?
Coaching: what it does well
At its best, coaching in medical education is targeted, efficient, and performance-driven. It clarifies goals, offers tactical strategies, and delivers rapid feedback. A third-year student struggling with OSCEs, for example, works with a clinical skills coach who identifies gaps in encounter structure, provides transition scripts, and guides deliberate practice with immediate feedback. Within weeks, performance improves, anxiety decreases, and scores rise. This is coaching functioning as intended: bounded, technical, and outcome-focused. It excels in helping learners meet specific benchmarks, particularly in high-stakes, skills-based domains where structured guidance and repetition can translate quickly into measurable gains. At its best, coaching is targeted, performance-oriented, and efficient.
Where coaching begins to fail
Coaching begins to fail when it extends beyond skills into identity, meaning, moral formation, and humility, which are domains it is not designed to hold. By nature, coaching is time-limited, task-specific, and outcome-oriented. It excels at improving performance but lacks the structure for longitudinal development. It is not built to navigate moral uncertainty, cultivate professional values, or support identity formation over time. Yet, increasingly, medical education asks coaching to fill these deeper roles. In doing so, we risk overextending a useful tool into areas where it cannot fully succeed, leaving critical dimensions of professional growth insufficiently supported.
The quiet erosion of mentorship
Mentorship is quietly eroding in modern medical education, displaced by more transactional forms of support. Unlike coaching, mentorship is relational, longitudinal, and interpretive. It is not focused solely on performance, but on understanding and meaning making. A mentor does not just help a learner do better; they help them make sense of who they are becoming. Through ongoing dialogue and shared experience, mentorship transforms clinical encounters into personal and professional meaning. When this relationship fades, something essential is lost. The space where reflection deepens, identity forms, and medicine becomes more than a series of tasks, but a lived and understood vocation.
A case where coaching fails
A fourth-year student preparing for residency with multiple coaches (for personal statements, interviews, and specialty strategy). Each session is efficient and productive, generating polished outcomes. Yet she remains uncertain: why this specialty, what kind of physician she wants to become, and why success feels hollow. No coach addresses these questions; it is not their role. Months later, an attending casually asks, “Tell me about a patient who changed you.” That unstructured moment sparks reflection no coaching session had reached. That is mentorship.
The hidden curriculum of coaching culture
The rapid expansion of coaching in medical education is not neutral; it carries a powerful hidden curriculum. It suggests that every challenge has a technique-based solution, that success can be optimized through the right strategies, and that development can be modularized and outsourced. Over time, learners may begin to depend on external guidance rather than cultivating internal judgment. Their tolerance for uncertainty may diminish, and their professional identity may become fragmented across discrete achievements. In this model, students are continuously improved but not deeply formed. They become highly coached, skilled at meeting expectations, yet insufficiently grounded in meaning, purpose, and the reflective capacity required for sustained professional growth. The proliferation of coaching is not neutral. It carries a hidden curriculum.
Coaching vs. mentorship, not a zero-sum but a misalignment
This is not an argument against coaching; it addresses real needs in a complex educational system. However, a misalignment is emerging, a category error where coaching is used to solve problems of meaning and identity. When coaching begins to displace mentorship, medical education may become more efficient and measurable, but less human. The risk is not in coaching itself, but in overextending it into domains where reflection, relationship, and longitudinal guidance are essential for true professional formation.
If this trajectory continues, we risk producing physicians who perform well yet struggle with purpose, achieve milestones without narrative coherence, and excel in metrics while feeling disconnected from meaning. In essence, we may train competent clinicians who lack a grounded, integrated professional identity.
Rebalancing the system
The solution is not less coaching, but better alignment, right-sizing coaching within a broader ecology of professional formation. Medical education must intentionally preserve longitudinal mentor relationships, create spaces for reflection that are not driven by metrics, and foster conversations that prioritize meaning over performance. We should ask not only who is coaching the student, but who is walking with them over time, helping them interpret their experiences and growth. Coaching helps learners do better; mentorship helps them become better. Both are essential, but they are not interchangeable. If mentorship erodes, coaching alone will not suffice. Medicine is not merely a set of skills to optimize. It is a profession to inhabit, requiring identity, purpose, and sustained human connection.
Vijay Rajput is an internal medicine physician.
