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...
ImportanceAlthough longer times from breast cancer diagnosis to primary surgery have been associated with worse survival outcomes, the specific time point after which it is disadvantageous to have surgery is unknown. Identifying an acceptable time to surgery would help inform patients, clinicians, and the health care system.ObjectiveTo examine the association between time from breast cancer diagnosis to surgery (in weeks) and overall survival and to describe factors associated with surgical delay. The hypothesis that there is an association between time to surgery and overall survival was tested.Design, Setting, and ParticipantsThis was a case series study that used National Cancer Database (NCDB) data from female individuals diagnosed with breast cancer from 2010 to 2014 (with 5-year follow-up to 2019). The NCDB uses hospital registry data from greater than 1500 Commission on Cancer–accredited facilities, accounting for 70% of all cancers diagnosed in the US. Included participants were females 18 years or older with stage I to III ductal or lobular breast cancer who underwent surgery as the first course of treatment. Patients with prior breast cancer, missing receptor information, neoadjuvant or experimental therapy, or who were diagnosed with breast cancer on the date of their primary surgery were excluded. Multivariable Cox regression was used to evaluate factors associated with overall survival. Patients were censored at death or last follow-up. Covariates included age and tumor characteristics. Multinomial regression was performed to identify factors associated with longer time to surgery, using surgery 30 days or less from diagnosis as the reference group. Data were analyzed from March 15 to July 7, 2022.ExposuresTime to receipt of primary breast surgery.MeasuresThe primary outcome measure was overall survival.ResultsThe final cohort included 373 334 patients (median [IQR] age, 61 [51-70] years). On multivariable Cox regression analysis, time to surgery 9 weeks (57-63 days) or later after diagnosis was associated with worse overall survival (hazard ratio, 1.15; 95% CI, 1.08-1.23; P < .001) compared with surgery between 0 to 4 weeks (1-28 days). By multinomial regression, factors associated with longer times to surgery (using surgery 1-30 days from diagnosis as a reference) included the following: (1) younger age, eg, the adjusted odds ratio (OR) for patients 45 years or younger undergoing surgery 31 to 60 days from diagnosis was 1.32 (95% CI, 1.28-1.38); 61 to 74 days, 1.64 (95% CI, 1.52-1.78); and greater than 74 days, 1.58 (95% CI, 1.46-1.71); (2) uninsured or Medicaid status, eg, the adjusted OR for patients with Medicaid undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.30-1.39); 61 to 74 days, 2.13 (95% CI, 2.01-2.26); and greater than 74 days, 3.42 (95% CI, 3.25-3.61); and (3) lower neighborhood household income, eg, the adjusted OR for patients with household income less than $38,000 undergoing surgery 31 to 60 days from diagnosis was 1.35 (95% CI, 1.02-1.07); 61 to 74 days, 1.21 (95% CI, 1.15-1.27); and greater than 74 days, 1.53 (95% CI, 1.46-1.61).Conclusions and RelevanceFindings of this case series study suggest the use of 8 weeks or less as a quality metric for time to surgery. Time to surgery of greater than 8 weeks may partly be associated with disadvantageous social determinants of health.
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