Three interesting pieces came across our desk this Winter, providing new perspectives on Surgical Coaching.

OBGyn Coaching

Megan Orlando and Surgical Coach and Academy VP, Cara King, published an opinion piece in the American Journal of Obstetrics and Gynecology with an update on the current evidence supporting surgical coaching as a method for performance improvement by obstetricians and gynecologists. They conclude:

With significant variations across Obstetrics and Gynecology training programs and an ever-changing landscape of new surgical challenges and technologies, there is a need for innovation to optimize surgical performance. The [American Board of Medical Specialities] has created specific recommendations on how continuing certification must change. Surgical coaching offers an opportunity to help meet those recommendations by tailoring practice change to individual surgeons through goal-setting, self-reflection, and ongoing feedback. We believe implementation of surgical coaching in Obstetrics and Gynecology has the potential to improve performance, provide lifelong learning, and promote excellence in patient care.

International Surgical Coaching Survey Results

Surgical Coach and practicing surgeon Sofia Valanci-Aroesty and colleagues at McGill University published findings from their international survey of surgeons about their attitudes toward peer coaching and the design of future coaching programs. We have been following this work from its inception and were eager to learn what they found. The three most interesting findings were:

  • 53% of respondents were aware of peer coaching, and 84% willing to participate in a peer coaching program.
  • The most important program elements were  feedback kept private and confidential (63%); opportunity to provide feedback to the coach (59%); personalized goal setting (58%); and the option to choose one’s own coach (49%).
  • As always, the most common barrier to participation was logistical constraints (79%).

These survey findings bring forward an interesting gap. Surgical coaching is available to all surgeons through the Academy for Surgical Coaching. How do we get the word out to more surgeons?

Surgical Coaching Increases Retention

The Cleveland Clinic has an internal coaching program that includes surgeon coaching. We were thrilled to see their program featured in Becker’s Hospital Review, an important trade magazine for hospital executives. They surveyed coaching program participants and asked “To what degree has your participation in the Center for Excellence in Coaching and Mentoring programming contributed to your decision to stay at Cleveland Clinic?” Of the 500+ participants in their coaching program, 197 said that the coaching program influenced their decision to stay. Based on the cost of turnover and the annual emoployee’s salary, “they have calculated a potential cost savings of more than $133 million attributed to program participation.” This figure contributes to the ongoing discussion of the indirect cost savings from supporting healthcare professionals’ development and wellness.

References

Orlando MS, Greenberg CC, Pavuluri Quamme SR, Yee A, Faerber AE, King CR. Surgical coaching in Obstetrics and Gynecology: an evidence-based strategy to elevate surgical education and promote lifelong learning. Am J Obstet Gynecol. 2022 Feb 14:S0002-9378(22)00105-3. doi: 10.1016/j.ajog.2022.02.006. Epub ahead of print. PMID: 35176285.

Valanci-Aroesty, S., Feldman, L.S., Fiore, J.F. et al. Considerations for designing and implementing a surgical peer coaching program: an international survey. Surg Endosc (2021). https://doi.org/10.1007/s00464-021-08760-z

Gleeson C. How Cleveland Clinic has saved $133M in physician retention. Beckers Hosp Rev. 2021 Nov 23. Available online: https://www.beckershospitalreview.com/hospital-physician-relationships/how-cleveland-clinic-has-saved-133m-in-physician-retention.html

 

In this recent episode of the Audible Bleeding podcast, Carlos Bechara, a Surgical Coach and vascular surgeon, has a coaching conversation with William Shutze, vascular surgeon, about managing all of the demands on his time. 

“As I become more involved in my career, the demands on my time are increasing. However, I have noticed it is taking time away from being able to focus on my patients. I delegate to trainees and nurse practitioners, but sometimes things are slipping through that are not helping my patients.”

William and Carlos also discuss the Society for Vascular Surgery Coaching Program, in partnership with the Academy for Surgical Coaching. 

Additional evidence showing the benefits of Surgical Coaching was recently published in Annals of Surgery. This NIH-funded study was a collaboration between the Michigan Bariatric Surgical Collaborative and members of the Academy team. We asked if surgical coaching improved surgeon operative performance. We found that surgical coaching helped reduce surgeon operative time, reducing average operative time from 92.5 minutes down to 78.5 minutes, a difference of 14 minutes (15%).

Figure of research results showing change in operative time before and after surgical coaching

What was the program?

The setting was the Michigan Bariatric Surgical Collaborative (MBSC), a state-wide network of surgeons that share details about their practice to improve surgical care for patients. In 2015 to 2018, in collaboration with the Academy for Surgical Coaching cofounders Caprice Greenberg and Sudha Pavuluri Quamme, MSBC rolled out a coaching program to improve operative performance.

Who Participated in the Program?

The top-performing surgeons in MSBC were selected to receive surgical coach training. The remaining MSBC-enrolled surgeons were invited to participate and receive coaching. In total, the program trained 14 Surgical Coaches, enrolled 26 surgeon participants, and analyzed a panel of 24 surgeons who met the inclusion criteria to serve as a non-interventional control. The Surgical Coaches and surgeon participants met, on average, for six 1-hour coaching sessions. Outcomes were evaluated through participant feedback and systematic collection of procedural data within the MSBC.

What do these results mean? 

This program was the largest clinical study of the benefits of surgical coaching to date, and one of the first interventional studies of Surgical Coaching to evaluate short-term operative outcomes. This research adds to the body of Surgical Coaching literature that has demonstrated that Surgical Coaching is feasible and acceptable for busy surgeons in practice (1, 2), has a high perceived value for professional development (1, 4), can increase safe adoption of new beneficial techniques (3), can improve teamwork, communication, and awareness in OR (4, 5), has potential to improve surgeon well-being and patient outcomes (4, 5).

  1. Greenberg CC, et al. A Statewide Surgical Coaching Program Provides Opportunity for CPD. Ann Surg. 2018; 267(5):868-73
  2. Pradarelli JC, et al. Surgeon’s Coaching Techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) Program. Ann Surg. 2020. Online
  3. Greenberg JA, et al. A structured, extended training program to facilitate adoption of new techniques for practice surgeons. Surg Endosc. 2018;32(1):217-24
  4. Pradarelli JC, et al. Surgical Coaching for Operative Performance Enhancement (SCOPE): skill ratings and impact on surgeons’ practice. Surg Endosc. 2020. Online
  5. Greenberg CC, et al. Association Between Surgeon Technical Skills and Patient Outcomes. Ann Surg. 2021;155(10):960-8

New Customized, Peer-to-Peer Coaching Program Fills Gap in Health and Wellness Intervention for Vascular Surgeons

Rosemont, Ill., April 7, 2021 – The Society for Vascular Surgery (SVS) and the Academy for Surgical Coaching today announced a partnership to develop a first-of-its-kind coaching program that strengthens wellness support for vascular surgeons. Studies have demonstrated that physicians across specialties are experiencing an increase in burnout, anxiety, depression and suicidal ideation. This is due to the rewarding, yet demanding, nature of their work and the barriers preventing them from providing optimal patient care.

Research conducted by the SVS Wellness Task Force has reinforced and replicated many of these findings within the specialty of vascular surgery. With this new program, customized to vascular surgery, SVS aims to address the triggers of burnout and provide wellness support through coaching intervention.

“We are excited about our partnership with the Academy for Surgical Coaching and consider it a shining example of how we are listening and responding to our members regarding wellness initiatives,” said Dawn Coleman, MD, co-chair of the SVS Wellness Task Force. “We believe we are one of the first medical societies to take the translational step from studying and discussing the issues to providing service and support for members.”

Initially, SVS hopes to recruit and train a dozen vascular surgeons to become certified surgical coaches, each of whom will be paired with as many as two vascular surgeons seeking support for a three-month period. Over the course of a year, it is hoped each surgical coach will work with up to four SVS members. SVS will expand the program if evaluation demonstrates success.

“Our experience shows surgeons love working with surgical coaches because it changes the way they think about their practice,” said Caprice Greenberg, MD, MPH, the president and co-founder of the Academy for Surgical Coaching. “The coaching sessions will focus on identifying challenges, setting goals and pushing for continuous improvement. Surgeons can discuss operative performance, leadership skills, clinical judgement or self-regulation. The surgical coach is there to support vascular surgeons to achieve their individualized and self-identified goals.”

As practicing vascular surgeons themselves, the surgical coaches will be well positioned to help their colleagues manage professional challenges and ultimately increase job satisfaction. Additionally, peer-to-peer support will help minimize the isolation associated with vascular surgery and destigmatize the culture of “complacent suffering.”

“We want to make sure we address the inherent issues, such as emotional exhaustion and depersonalization, that might be contributing to burnout among vascular surgeons,” said Niten Singh, MD, co-designer of the program. “We will focus on these issues first.”

Vascular surgeons are highly trained specialists focused on prevention and treatment of vascular disease, affecting the veins and arteries in every part of the body, excluding the brain and heart. Vascular surgery is the only specialty trained to deliver comprehensive care, across the full spectrum of treatment options from medical management, to minimially invasive intervention, to open surgery.

Funding support for this program is made possible in part by a grant from W.L. Gore & Associates, Inc., as part of the SVS Quality Practice Block Grant program.

About the Society for Vascular Surgery

The Society for Vascular Surgery is the leading not-for-profit, professional medical society on establishing causes and treatments for vascular disease. SVS seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness and is composed of specialty-trained vascular surgeons who are dedicated to providing comprehensive care for vascular disease. For more information visit www.vascular.org. Follow the SVS on Facebook @VascularHealth, Twitter @VascularSVS and Instagram @societyforvascularsurgery.

About The Academy for Surgical Coaching

Coaches support athletes, musicians and teachers to go from being great to being world-class. The Academy for Surgical Coaching is changing the way surgeons learn through partnerships with Surgical Coaches. Surgical Coaches are surgeons with additional training in guiding surgeons to develop new ways of thinking about surgery and improving their practice through goal-setting, action-planning and follow up. The Surgical Coaching program was developed through academic research in collaboration with major academic medical centers and has been proven in clinical trials to change the way surgeons do surgery. The Academy for Surgical Coaching trains surgeons to become Surgical Coaches, pairs surgeons with Surgical Coaches, and manages coaching programs. The Academy for Surgical Coaching has trained over 130 Surgical Coaches and conducted over 300 hours of surgical coaching. The Academy for Surgical Coaching is a 501(c)(3) nonprofit organization. For more information visit https://surgicalcoaching.org.

Many surgeons reach out to the Academy with the preexisting belief that a Surgical Coach is supposed to give them advice. Or tell them what they’re doing wrong. Or tell them what to do instead of what they’re currently doing.

These assumptions are wrong.

While Surgical Coaches are not forbidden from giving advice, advice-giving is a small part of the Surgical Coach’s toolkit. You might ask, why wouldn’t a coach give advice? The answer is because working with a coach is different from calling a consult or talking to a mentor. A consultant or mentor can offer quick advice, but that undermines the principles of adult learning. And real, continuous learning — not quick answers — is the essence of professional development for surgeons. 

The International Coaching Federation, the world’s largest professional coaching organization, defines coaching as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.” Advice, by itself, limits creativity because the answer is already provided. 

As such, Surgical Coaches are taught during their training to give less advice. Rather, we have them practice asking more questions to unlock a surgeon’s potential to maximize their own performance. Instead of telling you what to do to get better, a skilled Surgical Coach asks questions to allow you to identify the answers to your own challenges. After all, you know your practice best, and you’ll only change your practice patterns if you decide to do so.

Although we need to distance our mental models of surgical coaching from sports, the closest thing to an accurate comparison between a Surgical Coach and an athletics coach is a tennis coach observing quietly in the stands. In Michael Lewis’s podcast about the rise of coaching, he interviews Timothy Gallwey, tennis coach and author of the 1974 book “The Inner Game of Tennis.” Gallwey’s interview describes his curious experiment of telling less and asking more — and how this led to dramatic improvements in his tennis players’ swings.

In surgery, a coach partners with a peer surgeon to improve surgical performance by asking insightful questions in a non-hierarchical manner. This starkly contrasts with residency or fellowship. Anyone who has been a surgical trainee has experienced the hierarchy of surgery and probably been told what to do quite often. All that “advice” may have led you to graduation, but let’s agree that most practicing surgeons do not wish to revert to their former selves in training.

Source: Memes Monkey, 28 Oct 2020.

A fundamental belief that Surgical Coaches hold is that they are not smarter or more talented or “better” than their coaching partner in any way. The coach and surgeon are considered equals in a coaching partnership. With this understanding, it makes sense that a Surgical Coach does not simply give advice, tell surgeons that they’re wrong, or tell surgeons what to do. Instead, they ask questions. And the power of a Surgical Coach’s questions rests in the surgeons themselves.

 

It can be confusing to understand what a Surgical Coach really does. We are happy to discuss in detail by phone or by email. Contact us to inquire further! We look forward to hearing from you.

 

Sincerely,

Jason

 

Jason C. Pradarelli, MD, MS

Medical Director | Academy for Surgical Coaching

In this continuation of myth-dispelling posts about Surgical Coaching, we take on the misconception that coaching is punitive. The idea that only “bad” surgeons need a coach is particularly perplexing to me, given the easy-to-make but not-entirely-accurate association I’ve observed between surgical coaching and sports coaching.

In sports, all athletes have a coach, not just struggling individuals. It goes without saying, then, that the best athletes also work with a coach. Michael Jordan, Serena Williams, Tom Brady, Mia Hamm, Roger Federer… all had or still have coaches throughout their careers. 

And it’s not that these superstars only worked with a coach occasionally. To the contrary, their coach was an integral part of every day on the job. None of these elite professionals said, “Well, I already get better every day, so I probably don’t need a coach.” In fact, they’d be at a competitive disadvantage if they didn’t have a coach.

The best performers, like Serena Williams, have coaches throughout their careers. Source: Chris Trotman/Getty Images North America, 2017, https://edition.cnn.com/2017/07/11/tennis/patrick-mouratoglou-serena-williams-pregnancy-wimbledon/index.html

 

Similarly, top performers in many fields outside of sports have a coach to help them push the limits of their performance. Business executives work with coaches to improve their leadership skills and better position their companies for growth. Vocalists and dancers such as Beyoncé can attribute at least part of their worldwide successes to coaching. Elite violinists like Itzhak Perlman appreciate the distinct advantage they have when an external ear lends critical feedback on their performance.

Teachers, like surgeons, have complex and unpredictable jobs that directly affect human lives. Instructional coaching has taken off recently to help teachers improve their classroom instruction for students. Many schools and entire school districts have embraced this concept and hired coaches specifically to support teachers in serving their students’ needs as best they can.

If elite performers in athletics, business, and music have coaches, and if everyday teachers get coaching to improve their performance, why wouldn’t surgeons do the same when the health and lives of patients are at stake? Surely, we surgeons want to get better for our own sake, but as competitive individuals by nature, don’t we also want to get a leg up on that practice down the road? The benefits of coaching on your practice are countless. Surgical coaching is not punitive; in fact, it should feel like punishment to not have a Surgical Coach.

 

I welcome responses of support or challenge to this myth about surgical coaching. Contact us to inquire further! We look forward to hearing from you.

 

Sincerely,

Jason

 

Jason C. Pradarelli, MD, MS

Medical Director | Academy for Surgical Coaching

The Academy for Surgical Coaching team recently published two articles for the American College of Surgeons (ACS) in February 2021. These publications highlight the significance of addressing surgeons’ continuing professional development even during the Covid-19 pandemic. Both emphasize the unique opportunity that the pandemic presents in revamping performance improvement efforts for practicing surgeons by embracing high-quality virtual learning strategies.

The ACS Women in Surgery Committee invited Caprice Greenberg, MD, MPH, president of the Academy for Surgical Coaching, to deliver the Olga M. Jonasson, MD, Lecture at Clinical Congress 2020. Read the edited transcript of her scintillating presentation, entitled “Never let a good crisis go to waste: Continuous professional development and COVID-19,” in the ACS Bulletin.

Additionally, our team collaborated to publish a new article in the ACS Resources in Surgical Education (RISE) series. Jason Pradarelli, MD, MS, Sudha Pavuluri Quamme, MD, MS, and Caprice Greenberg, MD, MPH, explore the practical aspects of assessing and improving surgical performance virtually. Read how we can improve continuing professional development for surgeons in the ACS RISE article.

Follow us for updates on new surgical coaching evidence, coach trainings, and coaching program possibilities on social media! 

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One of the biggest challenges we encounter at the Academy for Surgical Coaching is overcoming misperceptions of what a Surgical Coach actually does. Without having the right expectations, you’re at risk of disappointment if you’re a surgeon looking to work with a Surgical Coach.

Misunderstandings of what a Surgical Coach does commonly fall into the following themes: 

  1. an association with sports coaching, 
  2. a belief that “coaching” is punitive, 
  3. the expectation that your coach is supposed to give you advice, and 
  4. surprise upon learning that you are in charge of your own learning content. 

For the purpose of you having a great experience that matches your expectations, I am writing a series of posts to dispel myths about surgical coaching.

 

Myth Debunking Part 1: Your Surgical Coach Is (Likely) Not the Same as Your Former Sports Coach

For many surgeons, the first image that comes to mind when they hear the word “coach” is an athletics coach. And that’s not just the image of a random person. Frequently there is a vivid image of a man yelling at players from the sidelines, neck veins bulging. This stereotype of a coach drawing up plays on a clipboard, blowing a whistle at practice, and barking instructions at players is an effect of the availability heuristic. 

This is NOT how Surgical Coaches are expected to coach. Source: Gary Mook/ALLSPORT/Getty Images, 2018, https://www.espn.com/mens-college-basketball/story/_/id/23017830/bob-knight-indiana-hoosiers-firing-lesson-college-coaches

According to the Decision Lab, a behavioral science research firm, the availability heuristic describes our tendency to use information that comes to mind quickly and easily when making decisions about the future. The ease of drawing on this image of a yelling coach comes from widely televised sporting events, media coverage of coaches with extravagant post-game interviews, and perhaps your own experiences with your children’s or your former youth soccer coaches. 

For example, a common adage we encounter over the course of surgical training is that “surgery is a team sport.” While another stereotype that doesn’t apply to everyone, many surgeons are competitive individuals, and this personality trait often stems from a personal history of playing sports. Because of the frequency of images crossing our screens and the familiarity with our prior experiences, it is easy to erroneously associate all types of coaches with an athletics coach.

But this mental shortcut may lead you astray when you work with a Surgical Coach. Coaches in surgery don’t carry clipboards and whistles. They don’t yell at the surgeons with whom they work. They don’t simply tell you what to do. And they aren’t stereotypically men.

Surgical Coaches, on the other hand, are closer to professional coaches in business, education, or music. An effective Surgical Coach is a masterful communicator who asks insightful questions to understand your motivations and maximize your potential as a professional. Unlike the yelling coach on the sidelines, a coach in surgery creates a welcoming space for you to reflect on your practice away from the heat of the moment in the operating room. This approach creates the space necessary for genuine, adult learning.

Because of these fundamental differences, your Surgical Coach should be pleasantly different from a traditional sports coach.

 

I welcome responses of support or challenge to this myth about surgical coaching. Contact us to inquire further! We look forward to hearing from you.

 

Sincerely,

Jason

 

Jason C. Pradarelli, MD, MS

Medical Director | Academy for Surgical Coaching