In this week’s episode, Jon’s topic du jour is “A Statewide Surgical Program Provides Opportunity for Continuous Professional Development.” A report on an innovation, published on PubMed, this study looks at peer-to-peer coaching to maintain competence in surgeons and in practice!
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KeyLIME Session 152 – Article under review:
Listen to the podcast
Read the episode abstract here.
Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, Frasier LL, Brys NA, Dombrowski JC, Wiegmann DA; Wisconsin Surgical Coaching Program. A Statewide Surgical Coaching Program Provides Opportunity for Continuous Professional Development. Ann Surg. 2017 Jun 22. [Epub ahead of print]
Reviewer: Jon Sherbino (@sherbino)
I have a confession to make. Maybe confessing a #meded shortcoming in front of “thousands” of my closest friends is a bad idea. But here I go… My continuing professional development is passive. Ok.. that doesn’t seem like a shocking statement. But reflect for a moment. For the 15+ years of my post-secondary education, I was routinely observed, critiqued, and assessed. For the 10+ years of practice, I have had a single observation (of my medical records). I have maintained competence based on self-assessment of my needs. And if you know the self-assessment literature, you can quickly see the flaw in my reasoning. And to further worsen my design, I have had no outcomes assessed to see if my interventions (lectures, podcasts, readings, courses etc.) have changed my practice. Sheesh. I’m going to stop with the confession…
The topic of this study, looks at peer-to-peer coaching to maintain competence in surgeons! in practice!! And it challenges current, common designs in CPD. If you want to learn about next-level CPD, this is the paper!
“We sought to develop and evaluate a video-based [peer] coaching program for board-eligible/certified surgeons.”
Type of Paper
Report of an innovation
Key Points on Methods
Coaching is defined by the authors as: “a partnership… which facilitates the pursuit of self-identified goals through collaborative analysis, peer support and constructive feedback.” Peer coaching is “ a distinctive type of coaching in which peers at a similar level of knowledge engage in an equal, non-competitive relationship.”
A 4-hour coach training session was developed, including manual and videos based on best practices from the literature and semi-structured interviews of successful coaches outside of medicine.
Peer nominations from state-wide surgical society to identify coaches (n=8) and self-nomination for participants (n=11). Pairings ensured no same institutional or “market” competitor.
A video recording of a operation was shared (secure access) between participant and coach for a one-hour coaching session. There was quarterly interaction for 1 year.
Iterative thematic analysis of recorded coaching sessions, using previously derived surgical coaching framework (technical, cognitive, interpersonal, stress management).
A coaching-effectiveness rubric (building rapport, using inquiry, providing feedback, goal setting) was validated by analyzing each sessions on a 5-point Likert scale by 5 study authors.
Satisfaction survey, interviews and focus groups performed as part of program evaluation.
Participants varied in experience (<5 to >15 years), practice setting (private, academic and rural), and specialty (general and subspecialty surgery). Coaches had >15 years’ experience and a diversity in practice and specialty type.
6 participants identified interpersonal skills (3 leadership,3 clinical teaching) and 3 identified technical goals as a primary focus.
A third of the time was spent discussing multiple performance domains simultaneously, suggesting an interconnectedness of intraoperative performance. (50 percent of the time focused on a single domain, while the remainder of the time was on relationship building and the logistics of the coaching session.)
Self-report and participant assessment of coaching effectiveness was high (mean >4 out of 5), while expert scoring was moderate 3 out of 5.
Barriers to participation were mainly logistical, relating to scheduling and technical challenges with recording surgeries. No pair was able to complete the entire program as designed.
The authors conclude…
“This is the first report of cross-institutional surgical coaching for the continuous professional development of practicing surgeons, demonstrating perceived value among participants, as well as logistical challenges for implementing this evidence-based program.”
“…our current approach to continuous professional development in surgery relies heavily on didactic training sessions. There are limited venues for collaborative learning or formative evaluation, which are known to facilitate practice change in adult learners. 26 Video-based peer surgical coaching is a promising approach for addressing these issues.”
Spare Keys – other take home points for Clinician Educator
- The study received REB approval for program evaluation, although the program itself was exempt as a quality improvement project.
- The high degree of satisfaction with the program should come as no surprise.
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