Surgical coaching shows promise as an effective approach for implementing new technologies into surgical practice and demonstrates promise to improve the safe and effective use of industry products from device manufacturers. The Academy for Surgical Coaching worked with the Johnson & Johnson Institute to conduct a three-month comprehensive surgical coaching program. This program created 13 surgical coaches, who provided individualized feedback for 23 surgeons that had expressed interest in using products within the J&J Medical Devices portfolio. At the end of the program, surgeons significantly improved procedural confidence and progression towards their performance improvement goals. Surgical coaches and participants indicated that performance improvement coaching plays a pivotal role in the safe introduction of new technologies into surgical practice.
Surgical coaching is an emerging strategy for practicing surgeons to improve their clinical and operative performance, acquire news skills, and safely implement innovations into practice. When introducing new technologies into surgery, assuring the safe and effective use of industry products is the priority of both healthcare providers and industry partners. Operative video is a rich source of data to examine and improve performance using individualized feedback. Specifically, video-based surgical coaching embraces adult learning principles to tailor surgeons’ performance improvement efforts uniquely to their individual practice styles, which contrasts many existing methods of continuing professional development for surgeons. Although surgical coaching programs have demonstrated effectiveness in academic research programs, the impact of individualized coaching out in the real world, outside of research protocols, has been uncertain until now. Given the device manufacturers’ role in safely introducing surgical innovations into practice, industry partners should be key stakeholders in implementing surgical coaching. In this context, the Academy for Surgical Coaching (A4SC) worked with the Johnson & Johnson Institute to conduct a three-month comprehensive surgical coaching program for practicing surgeons across three surgical specialties within the DePuy Synthes and Ethicon businesses.
Surgical Coaches and Participants
Surgical coaches and participant recruitment began in June 2020 and the comprehensive coaching program ran through October 2020. These individuals were recruited from J&J Institute’s Professional Education surgical teams (spine, thoracic, and sports orthopedic surgery) across the United States. Surgical coaches were recruited from a cohort of expert surgeons, who had previously taught expert courses on behalf of the J&J Institute. Participants, surgeons receiving coaching, were recruited based on their expressed interest in working with a coach to learn the safe and effective use of products within the J&J Medical Devices portfolio (Fig. 1).
Fig 1. Design of our comprehensive coaching program to train coaches and enroll surgeon participants in surgical coaching.
Surgical coaches underwent a six-hour virtual training, led by the A4SC’s multi-disciplinary team of instructors, including both surgeons and professional coaches, to adopt the core principles and key skills of surgical coaching. This was followed by a two-hour, one-on-one practice session for the coaches to apply and practice these skills in a confidential setting with another coach and to receive feedback from an The Academy for Surgical Coaching instructor.
Coaching and Feedback Sessions
Surgical coaches were paired with up to three participants in the same clinical specialty, whereas individual participants received only one coach. Each participant-coach pair was instructed to have as many coaching sessions as deemed necessary by the participant over the 3-month duration of this pilot program. Due to the COVID-19 pandemic, all surgical coaching sessions were conducted via Zoom. Each session lasted approximately one hour. Coaching pairs were encouraged to focus on the surgeon’s technical, cognitive, interpersonal, and self-regulation skills in the operating room to establish the safe and effective use of products. At the end of each session, participants were encouraged to enter their improvement goals and next steps into an online surgical coaching platform developed by J&J Institute for monitoring and updating progress between sessions.
Participant performance in the coaching program was evaluated using electronic surveys to collect coach and participant self-assessments. These assessments included 8 questions evaluating procedural and technology confidence and goal progression. The pre-coaching or baseline assessment was administered during the first month and the post-coaching assessment was administered at the exit of the program. Open response was included at the end of the post-coaching assessment for further programmatic evaluation.
To evaluate whether self-assessed confidence and progress toward goal were improved after coaching, we used the nonparametric Wilcoxon Signed Rank Test with Pratt’s modification to compare change in scores before versus after coaching. Tests were one-tailed with a type I error rate of 5%.
Thirteen surgical coaches were trained using the The Academy for Surgical Coaching framework and 23 surgeon participants received surgical coaching. In total, 23 unique participant-coach pairs completed 59 coaching sessions (total 59 hours). Each pair completed between 1 and 6 sessions. Of the 13 coaches, 11 (85%) completed the baseline assessment and 11 (85%) completed the post-coaching assessment. Of the 23 participants, 13 (57%) completed the baseline assessment, and 14 (61%) completed the post-coaching assessment.
Surgeon Participant Self-Assessments
Participants marginally improved their self-assessed confidence in the procedure (Pre-coaching mean score = 2.88, post-coaching mean score = 3.56, p = 0.056). Surgeons significantly improved their self-assessed confidence in using technology (Pre-coaching mean score = 2.75, post-coaching mean score = 3.63, p = 0.041). Surgeons also made significant progress toward achieving their goal after coaching (Pre-coaching mean score = 2.1, post-coaching mean score = 3.2, p = 0.009) (Fig. 2).
Fig 2. Surgeon participant procedural and technology confidence and goal progression changes from pre- to post-coaching intervention.
Specifically, ten surgeons have completed both pre- and post-coaching assessments. Compared to baseline, by the end of the program, 6 of 10 surgeons reported increased confidence to effectively perform the procedure they selected (Fig 3, Fig 4, Fig 5), 4 had unchanged confidence ratings, and none reported decreased confidence. Regarding the effective use of surgical technology, 8 of 10 surgeons reported increased confidence, 1 had unchanged confidence ratings, and 1 reported decreased confidence. Regarding the surgeons’ progress towards achieving their performance goal, 7 of 10 surgeons reported achieving their goal, 3 reported no change, and no surgeons reported losing progress over the course of the 3-month coaching program.
Evaluating the coaching program as a whole, 10 of 11 (91%) coach respondents and 9 of 12 (75%) of participants reported that this surgical coaching program was more valuable for professional development compared to other industry-sponsored continuing education activities; 3 surgeons reported it was equally as valuable, and 1 coach reported it as less valuable.
Surgical coaches said that the highlight of the program was “helping a peer, sharing insight and experience” and even “reflecting on my own learning processes…from different viewpoints.” One participant reported that surgical coaching was the “only program that allows you to focus on the personal pitfalls, which never get discussed in [traditional] courses.” At the end of the program, 11 of 11 (100%) coach respondents and 9 of 12 (75%) participants expressed a desire to continue participating in surgical coaching.
This Academy for Surgical Coaching and J&J Institute effort to (1) innovate education in surgery and (2) improve the safe and effective use of J&J Medical Device products was a success. The Academy for Surgical Coaching helped to establish a comprehensive surgical coaching program in an industry environment, which created 13 surgical coaches trained using evidence-based principles in surgical coaching and enrolled 23 practicing surgeons that were interested in the J&J products. During the coach-participant engagements, a surgical coach worked with a surgeon to understand their knowledge and procedural gaps and define goals to improve their skills. At the end of the coaching program, the surgeon participants demonstrated improved procedural confidence and progression towards their goals. These participants felt more confident in the safe and effective use of J&J products in specific clinical settings, as procedural confidence and goal setting has been associated with improved operative performance. Additionally, both surgical coaches and participants reported that surgical coaching was significantly more valuable for surgeons’ professional development than other continuing education activities. A majority wanted these coaching engagements to continue after the end of the program and will seek future opportunities to participate in surgical coaching. This highlights a potential and significant demand for improving the current model of continuing professional development for surgeons in practice by using innovative educational strategies like surgical coaching for performance improvement. Further research is needed to examine the impact of coaching on patient outcomes as new technologies are introduced into surgical practice. In summary, the Academy for Surgical Coaching and the Johnson & Johnson Institute coaching program demonstrated a successful collaboration between surgical quality improvement organizations and industry for improving the safe and effective use of their products with the unified goal of helping to improve outcomes and surgical care for patients.
Citation: Faerber AE, Yee A, Pradarelli J, Pavuluri Quamme S, Dombrowski J, King C, Greenberg CC. (2021) An Academy for Surgical Coaching and Johnson & Johnson Institute Surgical Coaching Program Improves Procedural Confidence and Goal Progression. Academy for Surgical Coaching Whitepaper. Published 09Jul2021. Available Online at https://surgicalcoaching.org/evidence/an-academy-for-surgical-coaching-and-johnson-johnson-institute-surgical-coaching-program-improves-procedural-confidence-and-goal-progression/