Ariadne Labs, Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA.
Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Surg Endosc. 2021 Jul;35(7):3829-3839. doi: 10.1007/s00464-020-07776-1. Epub 2020 Jul 8.
Evidence for surgical coaching has yet to demonstrate an impact on surgeons' practice. We evaluated a surgical coaching program by analyzing quantitative and qualitative data on surgeons' intraoperative performance.
In the 2018-2019 Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 practicing surgeons in multiple specialties at four academic medical centers were recruited to complete three peer coaching sessions, each comprising preoperative goal-setting, intraoperative observation, and postoperative debriefing. Coach and coachee rated the coachee's performance using modified Objective Structured Assessment of Technical Skills (OSATS, range 1-5) and Non-Technical Skills for Surgeons (NOTSS, range 4-16). We used generalized estimating equations to evaluate trends in skill ratings over time, adjusting for case difficulty, clinical experience, and coaching role. Upon program completion, we analyzed semi-structured interviews with individual participants regarding the perceived impact of coaching on their practice.
Eleven of 23 coachees (48%) completed three coaching sessions, three (13%) completed two sessions, and six (26%) completed one session. Adjusted mean OSATS ratings did not vary over three coaching sessions (4.39 vs 4.52 vs 4.44, respectively; P = 0.655). Adjusted mean total NOTSS ratings also did not vary over three coaching sessions (15.05 vs 15.50 vs 15.08, respectively; P = 0.529). Regarding patient care, participants self-reported improved teamwork skills, communication skills, and awareness in and outside the operating room. Participants acknowledged the potential for coaching to improve burnout due to reduced intraoperative stress and enhanced peer support but also the potential to worsen burnout by adding to chronic work overload.
Surgeons reported high perceived impact of peer coaching on patient care and surgeon well-being, although changes in coachees' technical and non-technical skills were not detected over three coaching sessions. While quantitative skill measurement warrants further study, longitudinal peer surgical coaching should be considered a meaningful strategy for surgeons' professional development.
目前尚无证据表明外科教练对外科医生的实践有影响。我们通过分析外科医生术中表现的定量和定性数据来评估外科教练计划。
在 2018-2019 年的外科手术操作绩效增强外科教练（SCOPE）计划中，我们招募了来自四个学术医疗中心的多个专业的 46 名执业外科医生，以完成三次同行教练会议，每次会议包括术前设定目标、术中观察和术后汇报。教练和学员使用改良的客观结构化评估技术技能（OSATS，范围 1-5）和外科医生非技术技能（NOTSS，范围 4-16）对学员的表现进行评分。我们使用广义估计方程来评估随着时间的推移技能评分的趋势，同时调整病例难度、临床经验和教练角色。在项目完成后，我们对个别参与者进行了半结构化访谈，分析他们对教练对其实践的影响的看法。
23 名学员中有 11 名（48%）完成了三次教练会议，3 名（13%）完成了两次，6 名（26%）完成了一次。调整后的平均 OSATS 评分在三次教练会议中没有变化（分别为 4.39、4.52 和 4.44；P=0.655）。调整后的平均总 NOTSS 评分在三次教练会议中也没有变化（分别为 15.05、15.50 和 15.08；P=0.529）。关于患者护理，参与者报告说团队合作技能、沟通技能以及在手术室内外的意识都有所提高。参与者承认，由于术中压力减轻和同行支持增强，教练可能会改善倦怠，但由于慢性工作负荷增加，教练也可能会加剧倦怠。
尽管在三次教练会议中没有发现学员技术和非技术技能的变化，但外科医生报告说同行教练对患者护理和外科医生的幸福感有很高的感知影响。虽然量化技能测量值得进一步研究，但长期的同行外科教练应该被视为外科医生职业发展的有意义策略。
