Coaching as a Mechanism to Challenge Surgical Professional Identities

Abstract

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.

Formative Evaluation of a Peer Video-Based Coaching Initiative

“…This finding is consistent with other work describing the conflict between surgical coaching and surgeon professional identity and the cultural changes required for this type of peer-based collaborative learning. 2,13,14 Interviewees highlight the difficulties of developing successful coach-coachee pairings. Many participants expressed significant discomfort with even the temporary and randomly designated label of coachee.…”

Achieving and Maintaining Safety in Healthcare Requires Unwavering Institutional and Individual Commitments

“…The pressure of the deteriorating situation makes rescuing very challenging because it exposes weaknesses in relationships among team members stemming from expectation of task performance, trustworthiness, and self-respect. Eliminating weaknesses in relationships is crucial to improve the team's grasp of what is evolving and enhance its ability to rescue the situation/increase resilience [10][11][12].…”

“…Coaching the frontline members of the team to instill the awareness that failure can and will happen ("Preoccupation with Failure") reinforces the criticality of each individual in maintaining the safety of the complex system in which they live and work [10,40]. Coaching the surgeons and the anesthesiologists, for example, is critical because the OR is inhabited by hierarchical, mixed-gender clinical teams that are prone to conflict ranging from constructive differences of opinion to discord and distraction that ultimately jeopardize patient safety [44].…”

Encouraging the scale-up of proven interventions: Infrastructure development for the “Evidence-to-Implementation” award

“…The two innovations awarded E2I grants in 2018 were Tai Chi Prime (PI Betty Chewning; https://taichihealth.com/tai-chi-prime-overview/) [6] and the Wisconsin Surgical Coaching Program (PI Caprice Greenberg; https://surgicalcoaching.org/). [7][8][9][10] The 18-month award period ended for both programs on October 31, 2019. Both programs have undertaken substantial scale-up activities (described below) and now are expanding their markets through non-profit purveyors.…”