Association of a Statewide Surgical Coaching Program With Clinical Outcomes and Surgeon Perceptions

Abstract

Objective:To assess risk-adjusted outcomes and participant perceptions following a statewide coaching program for bariatric surgeons.Summary of Background Data:Coaching has emerged as a new approach for improving individual surgeon performance, but lacks evidence linking to clinical outcomes.Methods:This program took place between October 2015 and February 2018 in the Michigan Bariatric Surgery Collaborative. Surgeons were categorized as coach, participant, or nonparticipant for an interrupted time series analysis. Multilevel logistic regression models included patient characteristics, time trends, and number of sessions. Risk-adjusted overall and surgical complication rates are reported, as are within-group relative risk ratios and 95% confidence intervals. We also compared operative times and report risk differences and 95% confidence intervals. Iterative thematic analysis of semi-structured interviews examined participant and coach perceptions of the program.Results:The coaching program was viewed favorably by most surgeons and many participants described numerous technical and nontechnical practice changes. The program was not associated with significant change in risk-adjusted complications with relative risks for coaches, participants, and nonparticipants of 0.99 (0.62–1.37), 0.91 (0.64–1.17), and 1.15 (0.83–1.47), respectively. Operative times did improve for participants, but not coaches or nonparticipants, with risk differences of –14.0 (–22.3, –5.7), –1.0 (–4.5, 2.4), and –2.6 (–6.9, 1.7). Future coaching programmatic design should consider dose-complexity matching, hierarchical leveling, and optimizing video review.Conclusions:This statewide surgical coaching program was perceived as valuable and surgeons reported numerous practice changes. Operative times improved, but there was no significant improvement in risk-adjusted outcomes.

Reciprocal peer coaching for practice improvement in surgery: a pilot study

“…Therefore, it may be more desirable to encourage all participants to serve as both coaches and coachees, but not necessarily with the same partner depending on their individual goals and skill sets. This model may also serve to reduce issues of hierarchy which can be a barrier to coaching participation [7,15,31,32].…”

The role of teamwork and non-technical skills for improving emergency surgical outcomes: an international perspective

“…The goals of SCOPE are to implement a department-wide surgical coaching program where attending surgeons (“coaches”) coach other peer surgeons (“coachees”) to (i) enable deliberate practice and continuous professional development, and (ii) improve technical and non-technical skill performance. As coaching is still emerging in surgery, there are important questions to be answered such as how to train peer coaches most effectively, what mechanism should be used to match coach and coachee, and which metrics should be used to evaluate surgical coaching [ 58 ]. As surgical coaching expands, it is a clear forum to discuss and improve skills that will improve patient safety throughout surgical careers.…”

Surgeons, Go Find a Coach

“…Over the last several years, however, multiple peer coaching programs have provided encouraging evidence that coaching can fill this long-standing void. As Greenberg et al further demonstrate in this issue of Annals, surgeons find coaching a valuable method for technical and nontechnical skill development, providing further evidence for widespread implementation 1 …”

“…As Greenberg et al further demonstrate in this issue of Annals, surgeons find coaching a valuable method for technical and nontechnical skill development, providing further evidence for widespread implementation. 1 Capitalizing on the statewide Michigan Bariatric Surgery Collaborative (MBSC), Greenberg et al identified surgeons with the lowest rates of complications of the 2 years before the study and trained them in principles of effective coaching. Self-selected MBSC members (''coachees'') were paired with one of the trained coaches, whereas the ''nonparticipating'' members who met the case volume inclusion criteria were used as a control group.…”