J. C. Pradarelli1,4, M. Delisle2,4, A. Briggs3, D. S. Smink1, S. J. Yule1,5 1Brigham And Women’s Hospital,Surgery,Boston, MA, USA 2University of Manitoba,Surgery,Winnipeg, MB, Canada 3Dartmouth Medical School,Surgery,Lebanon, NH, USA 4Ariadne Labs,Boston, MA, USA 5STRATUS Center for Medical Simulation,Boston, MA, USA
Introduction: Opportunities to improve surgical performance are limited for practicing surgeons; surgical coaching is one strategy to address this need. To develop peer coaching programs that integrate with surgical culture, a better understanding is needed of how surgeons routinely discuss performance in an operative context. The aim of this study was to identify examples of naturalistic coaching behavior among practicing surgeons operating together by categorizing intraoperative discussion with existing coaching principles.
Methods: As part of a “co-surgery” quality improvement program, 20 faculty surgeons at a single academic hospital were randomized into 10 co-surgery dyads, comprising an “attending” and an “assistant” surgeon, who performed 1 operation together. Intraoperative discussion was transcribed in real time. De-identified transcripts were co-coded systematically by 2 researchers. Deductive reasoning was applied to categorize data into themes based on existing principles of surgical coaching: 1) self-identified goals, 2) collaborative analysis, 3) constructive feedback, and 4) peer learning support. Surgical coaching principles were cross-referenced with surgical coaching content, including technical skills (respect for tissue, exposure, instrument handling, time and motion, and flow of operation) and non-technical skills (situation awareness, decision-making, communication/teamwork, and leadership). A c-coefficient was calculated to assess the strength of the association between pairs of themes (range 0 to 1, with 0 meaning no co-occurrence and 1 meaning that the themes always occurred together).
Results: Overall, 44 coaching examples were identified in 10 operations. Of the 4 principles of surgical coaching, only self-identified goals and collaborative analysis were identified consistently in naturalistic conversations between two practicing surgeons in the operating room. Self-identified goals were most associated with discussions regarding “instrument handling,” “tissue exposure,” and “flow of operation” for technical skills (c-coefficient: 0.14, 0.17, 0.15, respectively) and “situation awareness” for non-technical skills (0.13). Collaborative analysis was most strongly associated with discussions regarding “respect for tissue” and “flow of operation” for technical skills (0.42 and 0.38, respectively) and “communication/teamwork” for non-technical skills (0.52).
Conclusion: In naturalistic conversations between practicing surgeons in the operating room, numerous examples of innate coaching behavior were identified that focus on intraoperative performance, including self-identified goals and collaborative analysis. However, prominent gaps were also observed in the natural behavior of surgeons with respect to coaching principles. For example, constructive feedback and peer learning support were rarely, if at all, identified. Surgical coaching programs will need to address these gaps to train surgeons as effective surgical coaches.