Surgical Coaching for Individual Performance Improvement
Surgical Coaching for Individual Performance Improvement
The technical skill of individual surgeons is an important determinant of surgical outcomes, at least for bariatric surgery. In a recent study in The New England Journal of Medicine, Birkmeyer and colleagues provide evidence that there is wide variation in technical skill among practicing surgeons and that this variation correlates with outcome. The authors conclude that new approaches to improving individual performance are needed and one-on-one coaching has potential to fill this role. The concept of coaching for performance improvement has been recently described in a variety of health care settings, but it is not well developed and experience is limited.
Surgical coaching has the potential to address limitations in our current approach to continuing medical education, which does not incorporate the critical concepts of adult learning theory. Adults learn best as active participants in learning that builds on individual needs, is tailored to past experiences, and has direct applicability to their daily activities. Adult learners should participate in the identification of their own goals and have the opportunity to practice what is learned through self-reflection coupled with constructive feedback.
The importance of self-reflection is emphasized by K. Anders Ericsson, who advocates for deliberate practice. Ericsson examines this concept for physicians, suggesting that most clinical practice does not include the critical aspects of deliberate practice, namely, the identification of areas for improvement by reflection on performance, followed by intentional adjustments in approach and evaluation of the resultant impact. This deficiency leads many practitioners to plateau in a state of proficiency. In contrast, professionals in other disciplines use coaches to facilitate deliberate practice and continued performance improvement, even among the most elite experts.
To further develop the concept of surgical coaching, we examined features of coaching in other disciplines through literature review and observation and interviews of prominent coaches. In what follows, we outline main themes and provide a conceptual framework to synthesize the critical elements.
Abstract and Introduction
Introduction
The technical skill of individual surgeons is an important determinant of surgical outcomes, at least for bariatric surgery. In a recent study in The New England Journal of Medicine, Birkmeyer and colleagues provide evidence that there is wide variation in technical skill among practicing surgeons and that this variation correlates with outcome. The authors conclude that new approaches to improving individual performance are needed and one-on-one coaching has potential to fill this role. The concept of coaching for performance improvement has been recently described in a variety of health care settings, but it is not well developed and experience is limited.
Surgical coaching has the potential to address limitations in our current approach to continuing medical education, which does not incorporate the critical concepts of adult learning theory. Adults learn best as active participants in learning that builds on individual needs, is tailored to past experiences, and has direct applicability to their daily activities. Adult learners should participate in the identification of their own goals and have the opportunity to practice what is learned through self-reflection coupled with constructive feedback.
The importance of self-reflection is emphasized by K. Anders Ericsson, who advocates for deliberate practice. Ericsson examines this concept for physicians, suggesting that most clinical practice does not include the critical aspects of deliberate practice, namely, the identification of areas for improvement by reflection on performance, followed by intentional adjustments in approach and evaluation of the resultant impact. This deficiency leads many practitioners to plateau in a state of proficiency. In contrast, professionals in other disciplines use coaches to facilitate deliberate practice and continued performance improvement, even among the most elite experts.
To further develop the concept of surgical coaching, we examined features of coaching in other disciplines through literature review and observation and interviews of prominent coaches. In what follows, we outline main themes and provide a conceptual framework to synthesize the critical elements.