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. Future research is necessary to evaluate the impact of coaching on practice change and patient outcomes.

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Background: The ''surgical personality'' is a mostly negative academic and cultural image of the surgeon as egotistical, paternalistic, and inflexible. Because of this image, surgeons have been viewed as resistant to change and some behaviors, vulnerability, for example, are viewed as ''suspect'' because they seemingly threaten professional competency. We report on exit interviews of surgeons who participated in a coaching program and demonstrate how their narratives challenge the surgical ''personality'' and forge an evolving and more open professional surgical identity. Methods: We interviewed n ¼ 34 bariatric surgeons at the end of a 2-year surgical coaching program. Transcribed interviews were analyzed in NVivo, computer-assisted qualitative data analysis software. Coding of transcripts was approached through iterative steps. We utilized an exploratory method; each member of our team independently examined 3 transcripts to evaluate emergent themes early in the investigation. The team met to discuss our independent themes and develop the codebook collectively. We created a descriptive framework for our first round of coding based on emerging themes and employed an interpretive framework to arrive at our themes. Results: Three major themes emerged from our data. Participants in this study discussed the ways that participation in the coaching program initially conflicted with their identity as a competent professional. Surgeons were acutely aware of how participation might have destabilized their surgical identity because they might be viewed as vulnerable. Despite these concerns about image, surgeons found impetus for improvement because of poor outcome scores or because they desired early career affirmation. Finally, surgeons report that the safe spaces of intentional coaching contributed to their ideas about how surgeons, and ultimately surgery, can change. Conclusions: Participation in a coaching program challenged how surgeons thought of themselves in relationship to social and peer expectations. Our results indicate that surgeons do feel peer and social pressures related to identity but are much more complex and nuanced than has been previously discussed. The safe space of intentional coaching allowed participants to practice vulnerability without the pressures of sometimes caustic professional norms. Participants in this study viewed coaching as the way to improve the culture of surgery.

eer surgical coaching is an approach to continuous professional development that uses adult learning theory to support a surgeon's individual performance improvement. [1][2][3][4] In peer surgical coaching, a practicing surgeon is paired with a trained surgeon coach. This partnership uses coaching sessions for collaborative analysis and constructive feedback to improve technical, cognitive, interpersonal, and stress management skills through goal setting and action planning. These coaching interactions provide an evidencebased approach to practice change. [1][2][3][4] The success of this approach to continuous professional development requires adherence to coaching principles. However, to our knowledge, there is currently no tool to assess a surgical coach's performance during a coaching session as mea-sured by adherence to coaching principles. Without an instrument to evaluate a surgical coach, it is challenging to determine the quality of a coaching session or provide formative feedback to coaches on their performance. We aimed to fill this gap by developing and evaluating the validity of the Wisconsin Surgical Coaching Rubric (WiSCoR), a novel tool for assessing coach performance during a single peer surgical coaching session. MethodsBuilding off the Wisconsin Surgical Coaching Program's (WSCP) framework, core competencies for surgical coaching were IMPORTANCE Surgical coaching continues to gain momentum as an innovative method for continuous professional development. A tool to measure the performance of a surgical coach is needed to provide formative feedback to coaches for continued skill development and to assess the fidelity of a coaching intervention for future research and dissemination.OBJECTIVE To evaluate the validity of the Wisconsin Surgical Coaching Rubric (WiSCoR), a novel tool to assess the performance of a peer surgical coach.DESIGN, SETTING, AND PARTICIPANTS Surgical coaching sessions from November 2014 through February 2018 conducted by 2 statewide peer surgical coaching programs were audio recorded and transcribed. Twelve raters used WiSCoR to rate the performance of the surgical coach for each session. The study included peer surgical coaches in the Wisconsin Surgical Coaching Program (n = 8) and the Michigan Bariatric Surgery Collaborative coaching program (n = 15). The data were analyzed in 2019. INTERVENTIONS OR EXPOSURESUse of WiSCoR to rate peer surgical coaching sessions.MAIN OUTCOMES AND MEASURES There were 282 WiSCoR ratings from the 106 coaching sessions included in the study. WiSCoR was evaluated using a framework, including inter-rater reliability assessed with Gwet weighted agreement coefficent. Descriptive statistics of WiSCoR were calculated.RESULTS Eight coaches (35%) and 11 coachees (29%) were from the Wisconsin Surgical Program and 15 coaches (65%) and 27 coachees (71%) were from the Michigan Bariatric Surgery Collaborative. The validity of WiSCoR is supported by high interrater reliability (Gwet weighted agreement coefficient, 0.87) as well as a weakly positive correlation ...

urgical coaching is a partnership between a trained surgeon coach and a surgeon coachee. Together, they use collaborative analysis and constructive feedback to set goals and make action plans to promote performance improvement in technical and nontechnical skills. 1 Successful surgical coaching programs have been implemented for medical students, residents, and practicing surgeons. [1][2][3][4][5][6][7][8] This success has added to the growing enthusiasm for creating surgical coaching programs for professional development.While there is rising interest in building surgical coaching programs, it remains unclear how to select effective surgical coaches. The selection of coaches is a crucial step in the creation of a coaching program as the program's success relies on the effectiveness of its coaches. 8 The Wisconsin Surgical Coaching Framework identifies important characteristics of coaches that include strong interpersonal and communication skills, adaptability, advanced experience and skill level, and the ability to get into the coaching mindset. 1,8 While these qualities provide insight into basic coaching skills, there is no objective method to select effective surgical coaches.Consequently, the objective of this study was to identify an objective measure to determine who will be an effective surgical coach. Given that interpersonal and communication skills are important for surgical coaches, we hypothesized existing behavioral assessments, including the Myers-Briggs Type Indicator (MBTI) and the Life Styles Inventory (LSI), could be used to identify effective surgical coaches. [9][10][11][12][13][14] We had the following specific hypotheses: (1) the MBTI profile for an individual coach would not be associated with coach performance as all types are considered equal, (2) higher LSI IMPORTANCE While interest in surgical coaching programs is rising, there is no objective method for selecting effective surgical coaches.OBJECTIVE To identify a quantitative measure to determine who will be an effective surgical coach. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study included coaches and coachees from 2 statewide peer surgical coaching programs: the Wisconsin Surgical Coaching Program and the Michigan Bariatric Surgical Collaborative coaching program. Data were collected from April 2014 to February 2018, and analysis began August 2018. INTERVENTIONSThe Myers-Briggs Type Indicator was administered to coaches and coachees, and the Life Styles Inventory was administered to surgical coaches before their first coaching session. MAIN OUTCOMES AND MEASURESCoach performance in the first coaching session and all coaching sessions using the Wisconsin Surgical Coaching Rubric.RESULTS Twenty-three surgical coaches and 38 coachees combined for a total of 65 unique pairs and 106 coaching sessions. Overall, 22 of 23 coaches (96%) and 32 of 38 coachees (84%) were men. An increase in a coach's Life Styles Inventory constructive style score correlated with an increase in overall coach performance for the first coaching s...

In February 2019, the American Board of Medical Specialties (ABMS) released the final report of the Continuing Board Certification: Vision for the Future initiative, issuing strong recommendations to replace ineffective, traditional mechanisms for physicians' maintenance of certification with meaningful strategies that strengthen professional self-regulation and simultaneously engender public trust. The Vision report charges ABMS Member Boards, including the American Board of Surgery (ABS), to develop and implement a more formative, less summative approach to continuing certification. To realize the ABMS's Vision in surgery, new programs must support the assessment of surgeons' performance in practice, identification of individualized performance gaps, tailored goals to address those gaps, and execution of personalized action plans with accountability and longitudinal support. Peer surgical coaching, especially when paired with video-based assessment, provides a structured approach that can meet this need. Surgical coaching was one of the approaches to continuing professional development that was discussed at an ABS-sponsored retreat in January 2020; this commentary review provides an overview of that discussion. The professional surgical societies, in partnership with the ABS, are uniquely positioned to implement surgical coaching programs to support the continuing certification of their membership. In this article, we provide historical context for board certification in surgery, interpret how the ABMS's Vision applies to surgical performance, and highlight recent developments in video-based assessment and peer surgical coaching. We propose surgical coaching as a foundational strategy for accomplishing the ABMS's Vision for continuing board certification in surgery.

Objective: The purpose of this study was to measure the efficacy of a novel faculty and resident educational bundle focused on development of facultyresident behaviors and entrustment in the operating room. Summary Background Data: As surgical training environments are orienting to entrustable professional activities (EPAs), successful transitions to this model will require significant faculty and resident development. Identifying an effective educational initiative which prepares faculty and residents for optimizing assessment, teaching, learning, and interacting in this model is critical. Methods: From September 2015 to June 2017, an experimental study was conducted in the Department of Surgery at the University of Michigan Health System (UMHS). Case observations took place across general, plastic, thoracic, and vascular surgical specialties. A total of 117 operating room observations were conducted during Phase I of the study and 108 operating room observations were conducted during Phase II following the educational intervention. Entrustment behaviors were rated for 56 faculty and 73 resident participants using OpTrust, a validated intraoperative entrustment instrument. Results: Multiple regression analysis showed a significant increase in faculty entrustment (Phase I ¼ 2.32 vs Phase II ¼ 2.56, P < 0.027) and resident entrustability (Phase I ¼ 2.16 vs Phase II ¼ 2.40, P < 0.029) scores following exposure to the educational intervention. Conclusions: Our study shows improved intraoperative entrustment following implementation of faculty and resident development, indicating the efficacy of this innovative educational bundle. This represents a crucial component in the implementation of a competency-based assessment framework like EPAs.

ou never let a serious crisis go to waste. And what I mean by that is that it's an opportunity to do things you think you could not do before." Rahm Emanuel, Former Mayor of Chicago. Be TrustworthyTell the truth without minimization or exaggeration. Use reliable and credible sources of data. Be a calm, nonanxious presence. Embrace uncertainty when you are not the expert.