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!
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:
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.
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
The Academy is pleased to announce that we provide continuing medical education credits (CMEs) for both surgeons receiving coaching and surgical coaches. Through a partnership with the American College of Surgeons, each coaching session will count as 1 hour CME for the surgeon and the Surgical Coach.
For a surgeon who is working with a surgical coach to improve their practice can earn up to 4 CMEs for a 3-month coaching engagement, and up to 8 CMEs for a 12-month engagement. For Surgical Coaches, the initial training course will provide 5.25 CME. A Surgical Coach can receive up to an additional 8 CMEs per year for coaching activities.
If you are interested in learning more about connecting with a Surgical Coach, or Surgical Coach training, Contact Us.
When I talk with friends outside of healthcare about what the Academy for Surgical Coaching does, this quote summarizes their unanimous reaction. They don’t need a randomized controlled trial to know that parachutes save lives when jumping out of an airplane. The Academy connects surgeons with trained Surgical Coaches to improve intraoperative performance — a concept with strong face validity.
When I talk with colleagues in surgery about surgical coaching, the responses are a bit more skeptical. “Show me the evidence that it works” is a common reaction. Another is, “Surgeons might not buy into this.” I’ve also had surgeons tell me, “I already get better every day” or “I already coach students and residents every day.” At times, the resistance is palpable for introducing coaching to the field of surgery.
In this brief report, I’ll review the rationale for coaching in surgery and summarize new evidence to support its implementation. We’ll cover the training of surgeons to become coaches, the implementation of surgical coaching programs, and the results of coaching programs for surgeons’ continuing professional development.
Like professional athletes, musicians, business executives, and others who routinely work with a coach, surgeons are highly trained professionals who perform specialized skills. What separates surgeons from other professionals are the higher stakes of the job — patients’ lives and well-being — and the fact that surgeons have to perform on a near daily basis with few opportunities for ongoing practice and feedback.
Achieving meaningful performance improvement is a major challenge for surgeons in practice. Although surgical trainees are immersed in an environment that supports the continual development of surgical knowledge and skills, this environment largely disappears once surgeons enter professional practice. With medical knowledge and technology advancing at a blistering pace, how can any surgeon be expected to keep up on their own for 30 years of professional practice after formal training?
Surgical coaching has emerged as an effective process for surgeons’ continuing professional development. In a surgical coaching partnership, a surgeon undergoes structured one-on-one reflections with a trained Surgical Coach to focus on individualized performance improvement efforts with longitudinal follow-up. Coaching embraces adult learning principles and is distinguished by a non-hierarchical relationship between the surgeon and the coach, which are especially welcomed features for surgeons in practice.
Stated simply, there are two major reasons why we need surgical coaching. The first is to avoid plateauing throughout long surgical careers. The second is to incorporate new procedures and technology safely into practice. From years of training to perform complex tasks during surgery, we develop routines to simplify our cognitive load — this is a normal human behavioral tendency. But continual improvement is difficult once these routines are established. Even the most famous surgeons risk plateauing once they hit a sweet spot midway in their careers. Surgical coaching provides valuable external perspective to enable us to maximize performance potential in a respectful manner for highly skilled professionals like surgeons.
Beyond merely keeping existing skills sharp, surgical coaching can improve the way we adopt new surgical techniques and technology. The field is always advancing, and surgeons need a better way to incorporate surgical innovations safely into practice. Previously, we surveyed 150 surgeons at 2 academic medical centers on their preferred methods for learning new skills in practice. Surgeons reported an interesting disconnect between the most effective methods for acquiring new skills and the methods they commonly chose to use. Specifically, while scrubbing into an expert’s case or doing self-study were most often used, few surgeons believed these to be the most effective way for them to adopt a new procedure or technology. This is a critical gap that surgical coaching can fill.
So, it makes intuitive sense that surgical coaching can help practicing surgeons perform better. But I know you still want to see the evidence. Fortunately, several recently published studies lend scientific credibility to the process by which the Academy for Surgical Coaching does coaching with surgeons.
A series of recent papers from the Harvard / Ariadne Labs Surgical Coaching for Operative Performance Enhancement (SCOPE) program fill in major evidence gaps for how to conduct surgical coaching effectively. These three articles report lessons from a formal surgical coaching program involving 46 practicing surgeons from multiple specialties within four Harvard-affiliated hospitals.
The first study, published in Annals of Surgery in July 2020, investigated how surgeons train to become a Surgical Coach and how they apply newly learned coaching techniques in real life. For all participants — including both the coaches and the surgeons receiving coaching — the Ariadne Labs team conducted 3-hour, in-person Surgical Coaching Workshops led by surgeons, a behavioral scientist, and an expert professional coach. The training curriculum published alongside this study was based on the Wisconsin Surgical Coaching Framework.
Coach training enables surgeons to adopt the mindset, core principles, and key skills of coaching (Figure 1), which contrasts with many of our experiences in traditional surgical training. Fundamentally, this training progresses from:
In the Harvard program, 90% of the participants who responded rated the training “good” or “excellent.” (This was in the context of an 82% response rate.)
Figure 1. Schematic of the curriculum for a Surgical Coach Training Workshop. Source: Pradarelli JC et al. Surgeons’ coaching techniques in the Surgical Coaching for Operative Performance Enhancement (SCOPE) program. Ann Surg 2020.
The core principles that Surgical Coaches must enact are goal setting, guided inquiry, constructive feedback, and action planning. When we studied audio recordings of surgeons and Surgical Coaches in real coaching sessions, we saw that coach training works. In a historical cohort of surgeons who did not receive dedicated coach training, surgeons demonstrated only two of the four core coaching techniques. With dedicated coach training, the current cohort exhibited all four core coaching principles. For surgeons looking for real-life examples of coaching techniques that Surgical Coaches have used with peer surgeons, check out Tables 2-4.
Participants received a Coach Playbook, and weekly email reminders kept coaching tips readily available for the new coaches. Although the core principles of coaching could clash with traditional surgical culture, this study showed that many surgeons are open to using non-hierarchical coaching techniques with surgeon colleagues. At the Academy for Surgical Coaching, we engage new coaches with this approach during our Surgical Coach Training courses.
Although the enthusiasm is high for surgical coaching, the existing literature offers little guidance for how a surgical coaching program should be run. The second paper from the Harvard SCOPE program, published in JAMA Surgery in October 2020, was an implementation study designed to address this evidence gap. Earlier, I mentioned cultural pushback about coaching for surgeons. Given those concerns, it was necessary to consider the nuances of surgical culture when instituting a surgical coaching program.
Specifically for this study, we sought to identify implementation recommendations from the surgeons and coaches who actually participated in the SCOPE program. Who better to know how to improve the program than the participants themselves?
We interviewed 23 of the 46 participants and analyzed their interview transcripts for common themes. We also asked participants to rate their coaching sessions using the Net Promoter Score, a 1-question rating used in business to measure customer experience and predict company growth. To interpret the surgeons’ implementation recommendations in the appropriate context, we compared interview responses from surgeons who gave high ratings (“Promoters”) with those who gave low ratings (“Detractors”) of their coaching sessions.
Interestingly, both coaches and surgeons receiving coaching generally agreed on key implementation factors for surgical coaching programs. These factors included how to optimize coach-surgeon relationships, how to facilitate productive coaching sessions, and how to do so in a way that respects surgeons’ culture of autonomy. What differed among participants was the ratings they gave their coaching sessions.
Promoters (those who gave high ratings) tended to experience the program aligned with how they would recommend the program be run. Detractors, on the other hand, had the same recommendations but personally did not experience the program as such. The biggest implementation takeaways are summarized in Figure 2.
From interviewing surgeons who participated in a peer surgical coaching program, we learned that the first coaching session is critical. Although coach-surgeon pairs can improve at coaching over time, stellar first sessions really set the tone for a positive experience in subsequent coaching sessions.
Surgeons emphasized how important it was for the coach-surgeon match to be a great fit. The first priority was establishing trust and mutual respect. Transparency about each other’s goals in the program were important to hash out before diving into coaching sessions. And in the early stages of surgical coaching, surgeons reported a better experience when the coach and surgeon were from similar clinical specialties.
Institutional leaders have an important role in optimizing surgical coaching for their surgeon colleagues by creating an environment that encourages coaching. This includes normalizing coaching activities among OR staff to negate the false perception that only “bad” surgeons need coaching.
Figure 2. Summary of implementation recommendations for surgical coaching programs. Source: Pradarelli JC et al. Optimizing the implementation of surgical coaching through feedback from practicing surgeons. JAMA Surg 2020 (online materials).
With these surgeon-informed experiential recommendations, the Academy for Surgical Coaching incorporates evidence-based best practices for implementing surgical coaching programs. Health care institutions and organizations benefit from the Academy team’s extensive experience running formalized coaching programs. This way, surgeons can receive the most effective intraoperative coaching experience available without reinventing the wheel.
Despite the growing popularity of surgical coaching, many still want to see evidence of downstream benefits for practicing surgeons. The third paper from the Harvard SCOPE program studied just that. To do so, we aimed to measure surgeons’ technical and non-technical skills. We also asked participants how they believed that surgical coaching affected their practice and well-being.
For the quantitative analysis of surgeons’ intraoperative skills, surgeons submitted self-assessments, and the coach submitted their own assessment of the surgeon’s technical and non-technical skills. Technical skills were assessed with a modified version of Objective Structured Assessment of Technical Skills (OSATS), and for non-technical skills the Non-Technical Skills for Surgeons (NOTSS) framework was used.
In this study we were unable to detect quantitative changes in surgeons’ technical or non-technical skill ratings over three coaching sessions. However, the ratings were subject to bias from the social and unblinded nature of the coaching relationships. This was evident from the average skill ratings that clustered at the maxima of the scales. The skills analysis was also underpowered and limited by missing data. A more objective measurement strategy — such as by using blinded video review — may have allowed us to detect quantitative improvements in surgeons’ skills.
To supplement the quantitative findings, we interviewed surgeons about their perceptions of how coaching affected their performance. Surgeons reported positive changes to their teamwork and communication skills, situation and self-awareness, and well-being. One surgeon reflected on how their relationship with the OR team improved, saying “I think my mindset has changed because it’s very obvious when someone’s watching that they’re paying attention to everything I’m saying.”
The coaches also felt like they improved their skills, even though the program was focused on surgeons receiving coaching. One coach said, “So I think in my mind a little bit before I speak, what’s the better way of using words like, ‘What did you think? … or, What went through your mind when you saw this?’ as opposed to ‘Why did you make something bleed?’”
Participants also recognized the potential for coaching to improve burnout due to reduced stress in the OR and improved camaraderie. Importantly, they also said if coaching were implemented poorly (such as if it were mandated), it could worsen burnout by adding to chronic work overload.
These findings show important benefits for surgeons who participate willingly in surgical coaching. While research studies have yet to quantify improvements in surgical skill or patient outcomes, early surgical coaching programs have captured surgeons’ perception that coaching can change their practice for the better. The Academy for Surgical Coaching exists to deliver these benefits directly to surgeons.
How you can get involved in surgical coaching
If you are not quite ready to engage with the Academy directly, we encourage you to keep surgical coaching on your radar by following us on social media:
Twitter | LinkedIn | Facebook | Instagram
Contact us to learn more! We look forward to working with you.
Sincerely,
Jason
Jason C. Pradarelli, MD, MS
Medical Director | Academy for Surgical Coaching
Formerly a Safe Surgery Fellow | Ariadne Labs
The Academy wrapped up our first fiscal year on October 31, 2020. After launching in December 2019, the Academy has rapidly grown our team, formed new partnerships, and equipping surgeons with Surgical Coaches. Some highlights include:
Surgeons, researchers, educators, innovators, and improvers of all kinds… Welcome! This is the official blog of the Academy for Surgical Coaching. The Academy is a not-for-profit organization that empowers surgeons through surgical coaching to improve clinical performance, well-being, and patient care.
Through our blog, we aim to give you informative, easy-to-read entries about surgical coaching and related topics for surgeons such as professional development, continuing education, continuing certification, performance improvement, coaching evidence updates, and much more. Our work in surgical coaching is grounded in a decade of scientific research, and thus our writing reflects this critical lens.
We’ll start by covering the basics of what surgical coaching is and what a Surgical Coach actually does. For those interested in diving deeper, future posts will review topics related to the business, learning theory, and technology that supports surgical coaching. Importantly, we want to hear from YOU about what you’d like to learn from us. Submit your requests here.
Surgical coaching is a process for surgeons’ professional development that is characterized by a partnership between a surgeon and a trained Surgical Coach. Through structured, longitudinal, one-on-one reflections with a Surgical Coach, surgical coaching engages surgeons to focus on individualized performance improvement efforts. Coaching is different from teaching or mentoring in that it requires both individuals to put aside the traditional hierarchical mindset in surgical education and function as equal partners.
Surgical coaching fills a major gap in professional development opportunities for practicing surgeons. Other existing forms of learning in practice include didactic sessions, weekend courses, or self-study, which are often limited for surgeons as one-time events with minimal follow-up and little ability to tailor to one’s own practice, which can lead to erratic translation into practice. Coaching, on the other hand, embraces adult learning principles with frequent, spaced learning, timely feedback, and analysis of gaps to focus improvement efforts.
In an enlightening call to action in 2019, the American Board of Medical Specialties issued its Vision for the Future of Continuing Board Certification. The report urges member boards, including the American Board of Surgery, to replace the ineffective, traditional mechanisms for recertification with meaningful strategies that emphasize professionalism, formative (i.e. continuous, low-stakes) rather than summative (i.e. one-time, high-stakes) assessment, lifelong learning, and improvement in practice. These characteristics for ideal professional development activities couldn’t have been a more perfect description of what surgeons experience when working with a Surgical Coach.
Surgical Coaches are practicing surgeons who undergo dedicated training to adopt the core principles and key skills of coaching. In a surgical coaching partnership, a Surgical Coach guides a peer surgeon to improve their performance by using effective communication skills and an empowering approach to support the surgeon’s goals. The Academy runs coach training courses several times throughout the year.
Through coach training, a Surgical Coach learns to facilitate goal setting with a surgeon, ask powerful questions to spark reflection from the surgeon, provide constructive feedback in a respectful manner, and guide action planning to help the surgeon define concrete next steps to improve. After coach training, Surgical Coaches are eligible to be matched up with surgeons who approach the Academy looking to work with a coach.
At the Academy, surgical coaching engagements range from 3 to 12 months in duration, depending on the individual surgeon’s performance goals and timeline. Each coaching session lasts about 1 hour, in which the coach and surgeon meet virtually to discuss the surgeon’s progress toward their goals. While the surgeon receiving coaching is the decision maker in this professional development process, the coach is responsible for supporting the surgeon to implement the practice changes discussed during their coaching sessions.
In the spirit of coaching, a Surgical Coach is also expected to improve their own coaching skills. To realize this cycle of continual improvement, the Academy supports our coaches’ development with ongoing feedback and coaching resources. In this way, we are always improving and supporting surgeons’ performance improvement efforts.
If you are not quite ready to engage with the Academy directly, we encourage you to keep surgical coaching on your radar by following us on social media:
We are an enthusiastic group with an eye for evidence-based implementation of surgical coaching. Contact us to learn more! We look forward to working with you.
Sincerely,
Jason
Jason C. Pradarelli, MD, MS
Medical Director | Academy for Surgical Coaching
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