How Coaching Actually Works: A Session-by-Session Look
The Black Box Problem
Most physicians I work with have never been coached before. They have been mentored, advised, supervised, and evaluated. But coached? That is new territory.
And because it is new, there is a natural skepticism. What actually happens in a coaching session? Is someone going to tell me to visualize my goals? Are we going to do breathing exercises?
I get it. I would be skeptical too. So let me walk you through what this actually looks like, session by session, from the first conversation to the point where you do not need me anymore.
Before We Start: The Discovery Call
Every coaching engagement begins with a conversation that is not really a session. It is a mutual interview. I am trying to understand what is going on in your career. You are trying to figure out if I am someone you can be honest with.
This call usually lasts about thirty minutes. I will ask you what brought you here. Not the polished version. The real one. Maybe it is a promotion that did not happen. Maybe it is the slow realization that you are building someone else's vision instead of your own. Maybe you are just tired and cannot name why.
There is no commitment after this call. If we are not the right fit, I will tell you. If we are, I will explain what the next few months could look like.
Month One: Mapping the Terrain
The first few sessions are about getting clear on where you actually stand. Not where your CV says you stand. Where you stand.
Session one is the deep dive. I ask a lot of questions. About your role, your department, your goals, the things you have been avoiding. We are not solving anything yet. We are laying things out on the table so we can see what we are working with.
Sessions two and three start to sharpen the focus. Most physicians come in with a general sense of dissatisfaction or ambition, but the real issue is usually buried a few layers down. Someone who says "I want to be a division chief" might actually need to figure out why they cannot say no to low-value committee work. Someone who says "I am thinking about leaving" might actually need to renegotiate their protected time.
By the end of the first month, we have identified one or two core areas to work on. Not a ten-point plan. One or two things that, if they shift, change everything else.
Month Two: Doing the Work
This is where coaching earns its keep.
Each session follows a loose structure. You bring what is alive for you that week. Sometimes that is a specific situation — a difficult conversation with a chair, a grant deadline that is forcing a priority decision. Sometimes it is a pattern you have noticed since our last session.
I listen. I ask questions. Not softball questions. The kind that make you pause and say, "I have not thought about it that way." Marshall Goldsmith, one of the most respected executive coaches in the world, writes in What Got You Here Won't Get You There that the behaviors that made you successful as a clinician-scientist can become the very things that hold you back as a leader. That tension shows up in almost every engagement I have.
Between sessions, you are not just waiting for our next call. I often suggest small experiments. Try saying no to one request this week. Have that conversation you have been putting off. Draft the email but do not send it — bring it to our next session and we will look at it together.
The work happens between sessions. The sessions are where we make sense of it.
Month Three: Momentum and Adjustments
By the third month, something has usually shifted. It is not always dramatic. Sometimes it is a physician who finally articulated their niche and started turning down projects that do not fit. Sometimes it is someone who had a conversation with their department chair that they had been avoiding for two years.
This is also when we recalibrate. I will ask directly: Is this working? Are we focused on the right things? Your answer matters more than my assessment.
Some engagements pick up speed here. The early work has cleared the fog, and now we are executing — building a leadership case, preparing for a negotiation, designing a career plan that is actually yours.
Others slow down intentionally. The shift that happened was bigger than expected, and we need time to let it settle before we push further. Both are fine. Coaching is not a race.
Months Four Through Six: Integration
If we continue past three months, the work changes character. Early sessions are about discovery and disruption. Later sessions are about integration and sustainability.
The questions shift. Instead of "What do you want?" we are asking "How do you protect what you have built?" Instead of "What is the hard conversation?" we are asking "How do you make hard conversations a habit instead of an event?"
Henry Kimsey-House and his co-authors describe this well in Co-Active Coaching. They write about coaching as a process that moves from awareness to choice to action. The later months are where choice becomes second nature. You stop needing me to ask the question because you have started asking it yourself.
That is the goal. A good coaching engagement ends with you not needing a coach.
What Sessions Actually Feel Like
I want to be honest about this part. Coaching sessions are not always comfortable.
Sometimes you will leave a call feeling energized and clear. Other times you will leave feeling unsettled because we surfaced something you were not ready to look at. Both are signs that the work is real.
What sessions should never feel like is a lecture. I am not teaching you leadership theory. I am not giving you a reading list. I am helping you think more clearly about your own career so you can make better decisions with more confidence.
You talk more than I do. That is by design.
How Progress Gets Tracked
I do not use scorecards or dashboards. Academic medicine has enough metrics.
Instead, I track progress through the quality of the questions you ask. Early in an engagement, the questions tend to be external: "How do I get promoted?" or "What should I do about this colleague?" Later, they become internal: "What do I actually want from this role?" or "Why does this keep happening?"
That shift — from external to internal — is one of the most reliable indicators that coaching is working.
We also revisit your original goals periodically. Not to grade you, but to see if the goals themselves have changed. They often do. That is not a failure. It means you are thinking more clearly than you were three months ago.
What This Looks Like in Practice
A typical engagement with me is six to twelve sessions over three to six months. Sessions run forty-five to sixty minutes. We meet every two to three weeks, depending on what is happening in your world.
Some physicians continue beyond six months, especially during major transitions — a move to a new institution, a step into a leadership role, a shift in clinical focus. Others complete their work in three months and move on. There is no standard timeline because there is no standard career.
If You Are Curious
If you have been thinking about coaching but were not sure what you would be signing up for, now you know. It is not mysterious. It is not therapy. It is structured, honest conversation about your career with someone who understands academic medicine.
If that sounds useful, individual coaching is where most people start. We will have a conversation, figure out if we are the right fit, and go from there.
