Bridging the gap to future surgical success: Surgeon-coaches can help colleagues thrive

Max Wohlauer

What is surgical coaching? The Institute for Life Coach Training defines coaching as a professional relationship that helps people produce extraordinary results in their lives, careers, businesses or organizations, helping them to bridge the gap between where they are now and where they want to be.

The International Coach Federation defines coaching as a cooperative process between a coach and their “coachees,” who participate in a thought-provoking and creative process that inspires them to maximize their personal and professional potential.

Coaching has been applied to sport, music and business to optimize performance. It is worth noting that surgical performance involves technical, cognitive and leadership skills that are all coachable activities. Furthermore, improving a surgeon’s performance can improve quality and safety across the field in general. Programs that have stepped in to
fill this niche include the Wisconsin Surgical Coaching Program (WSCP). Founded by Caprice Greenberg, MD, and led by her and a team of surgical colleagues at the University of Wisconsin, the WSCP was developed to teach surgeons to become coaches to improve the technical performance of other surgeons.

The WSCP developed three distinct activities of a coach: goal-setting, encouraging/motivating and developing/guiding.

Coaching for surgeons targets performance improvement in three domains: technical skill, cognitive skill and non-technical skill. Examples of non-technical skills include situational awareness and mental readiness. Judgment and decision-making are examples of cognitive skills. With the American Board of Surgery implementing lifelong learning, self-assessment and evaluation of performance as requirements for maintenance of certification, surgical coaching is emerging as an effective strategy to meet these requirements. The WSCP developed a peer coaching program for practicing surgeons and, by doing so, uncovered insightful strategies to optimize performance. Additionally, coaching has been shown to help improve quality of life.

What is peer coaching?

Peer coaching is a type of coaching in which peers at a similar level of knowledge engage in an equal, non-competitive relationship, a particularly effective strategy for surgeons in practice.

A peer coach facilitates self- reflection, offers constructive feedback, guides action planning and provides support for implementing and then evaluating changes in practice.

What is the process for becoming an expert?

Nobody becomes an expert without extensive, exhausting practice. At the same time, putting in the sweat equity does not guarantee that one becomes an expert.

While the most frequent explanation is that, on a professional level, skill acquisition is limited by an individual’s innate talent, Swedish psychologist K. Anders Ericsson describes the importance of deliberate practice in professional development.

Ericsson’s research suggests that highly motivated professionals have more influence on elevating their attained performance levels than was previously imagined. Skill acquisition is a conscientious and orderly process. Expert performance is mediated by complex integrated systems of execution, monitoring, planning and analyzing performance. This makes deliberate practice an effective strategy to improve performance.

How does an average performer reach the level of an expert?

During the first phase of learning, novices try to understand the activity and focus on avoiding making a mistake. With additional experience, in the middle phase of learning, mistakes become less frequent and movements smoother, and the movements become automatic.

As a result of more automated movements, the learners lose conscious control over the execution of the skill, making intentional modifications more difficult. Coaches can be particularly effective at this level. Expert performers have reached a level of training and can reproduce their superior performance in everyday practice.

What are the barriers and benefits of seeking a coach?

Atul Gawande described the awkward moment he introduced his patient to his surgical coach. The willingness to receive help is outside the cultural norm for most surgeons, who are expected to show strength rather than vulnerability.

The desire to optimize performance ultimately overcomes the fear of showing vulnerability in coaching program participants. Having a coach is a way for surgeons to engage in deliberate practice in a safe space, free from the vulnerability of the behavior being judged by patients or peers.

In addition to optimizing performance, coaching can improve well-being. In a recent study, participants in a professional coaching program showed a significant reduction in emotional exhaustion and overall symptoms of burnout. Progress is inevitable, and the field of vascular surgery is moving forward rapidly.

Whether optimizing surgical performance or enhancing well-being, coaching is an established technique in order to spark professional development. Why haven’t we thought of this sooner?

Max Wohlauer is a member of the SVS Wellness Task Force.


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