Mutabdzic Dorotea, Mylopoulos Maria, Murnaghan Michael Lucas, Patel Priyanka, Zilbert Nathan, Seemann Natashia, Regehr Glenn, Moulton Carol-Anne
*Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada ‡The Wilson Centre, University of Toronto, Toronto, Ontario, Canada §SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada ¶Division of Orthopedics, Hospital for Sick Children, Toronto, Ontario, Canada ‖Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada **Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada ††Division of General Surgery, University Health Network, Toronto, Ontario, Canada.
Ann Surg. 2015 Aug;262(2):213-6. doi: 10.1097/SLA.0000000000001247.
To explore surgeons' perceptions of and potential concerns about coaching.
There is growing recognition that the traditional model of continuing professional development is suboptimal. This has led to increasing interest in alternative strategies that take place within the actual practice environment such as coaching. However, if coaching is to be a successful strategy for continuing professional development, it will need to be accepted by surgeons.
This was a qualitative interview-based study using a constructivist grounded theory approach. Participants included 14 surgeons from University of Toronto-affiliated hospitals.
Participants expressed 3 main concerns about coaching: questioning the value of technical improvement ("As you get older if you don't have the stimulation from surgery to get better or to do things that are different and you are so good at so much, why bother [with coaching]?" P009), worry about appearing incompetent ("I think it would be perceived as either a sign of weakness or a sign of inability" P532), and concern about losing autonomy ("To me that would be real coaching where it's self-identified, I'm motivated, I find the person and then they coach me" P086).
Coaching faces unique challenges in the context of a powerful surgical culture that values the portrayal of competency and instills the value of surgical autonomy. This study suggests that hanging on to these tightly held values of competency and autonomy is actually limiting the ways, and extent to which, surgeons can improve their practice.
探讨外科医生对指导的看法以及潜在的担忧。
人们越来越认识到传统的持续专业发展模式并不理想。这导致对在实际实践环境中开展的替代策略（如指导）的兴趣日益增加。然而，如果指导要成为持续专业发展的成功策略，就需要被外科医生接受。
这是一项基于定性访谈的研究，采用建构主义扎根理论方法。参与者包括来自多伦多大学附属医院的14名外科医生。
参与者对指导表达了3个主要担忧：质疑技术改进的价值（“随着年龄增长，如果没有手术带来的刺激让你变得更好或做不同的事情，而且你已经如此擅长很多事情，为什么还要麻烦[接受指导]呢？”P009），担心显得不胜任（“我认为这会被视为软弱或无能的表现”P532），以及担心失去自主权（“对我来说，真正的指导是自我认同、有动力，我找到那个人然后他们指导我”P086）。
在重视能力展现并灌输手术自主权价值观的强大手术文化背景下，指导面临独特挑战。本研究表明，紧紧秉持这些能力和自主权价值观实际上限制了外科医生改进其实践的方式和程度。
