Elsevier

Surgery

Volume 158, Issue 5, November 2015, Pages 1168-1191
Surgery

Education
Systematic review of coaching to enhance surgeons' operative performance

https://doi.org/10.1016/j.surg.2015.03.007Get rights and content

Background

There is increasing attention on the coaching of surgeons and trainees to improve performance but no comprehensive review on this topic. The purpose of this review is to summarize the quantity and the quality of studies involving surgical coaching methods and their effectiveness.

Methods

We performed a systematic literature search through PubMed and PsychINFO by using predefined inclusion criteria. Evidence for main outcome categories was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the Medical Education Research Study Quality Instrument (MERSQI).

Results

Of a total 3,063 articles, 23 met our inclusion criteria; 4 randomized controlled trials and 19 observational studies. We categorized the articles into 4 groups on the basis of the outcome studied: perception, attitude and opinion; technical skills; nontechnical skills; and performance measures. Overall strength of evidence for each outcome groups was as follows: Perception, attitude, and opinion (Grading of Recommendations Assessment, Development, and Evaluation: Very Low, Medical Education Research Study Quality Instrument [MERSQI]: 10); technical skills (randomized controlled trials: High, 13.1; Observation studies: Very Low, 11.5); nontechnical skills (Very Low, 12.4) and performance measures (Very Low, 13.6). Simulation was the most used setting for coaching; more than half of the studies deployed an experienced surgeon as a coach and showed that coaching was effective.

Conclusion

Surgical coaching interventions have a positive impact on learners' perception and attitudes, their technical and nontechnical skills, and performance measures. Evidence of impact on patient outcomes was limited, and the quality of research studies was variable. Despite this, our systematic review of different coaching interventions will benefit future coaching strategies and implementation to enhance operative performance.

Section snippets

Search strategy

A systematic literature search was conducted using the databases PubMed (1809 to 11/18/2013—note that records are selective from 1809 to 1965; from 1966 to present, records are comprehensive), and PsychINFO (1597 to 11/18/2013—note that comprehensive coverage starts from the 1880s). Search terms “coaching,” “mentoring,” “debriefing,” “non-technical skills,” “leadership,” “decision making,” “situation awareness,” “learning,” “communication,” “teamwork,” “technique,” “technical skills,”

Results

A flow diagram of the search results is illustrated in Fig. The initial search yielded a total of 3,063 articles. After duplicates and non-English articles were removed, 2,306 articles remained. Once the aforementioned inclusion/exclusion criteria were applied, 58 articles were selected for the full text review. After this, a total of 23 articles were selected for analysis.6, 9, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37

Discussion

Surgical coaching supports deliberate practice and skill acquisition at all levels of training and practice. As this concept continues to receive attention,7, 8 it is necessary to reflect on the new paradigm of surgical coaching as it pertains to the current surgical culture and needs. Therefore, we systematically reviewed coaching interventions in surgery to help evaluate and summarize key learning concepts that are currently available. Although variable in their quality based on GRADE and

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