Coaching Surgeons: Is Culture Limiting Improvement?
Coaching Surgeons: Is Culture Limiting Improvement?
Objective: To explore surgeons' perceptions of and potential concerns about coaching.
Background: 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.
Methods: This was a qualitative interview-based study using a constructivist grounded theory approach. Participants included 14 surgeons from University of Toronto–affiliated hospitals.
Results: 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).
Conclusions and Relevance: 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.
Recognizing the rapid advancements in medicine and the evidence that provision of care can often be substandard, many professional bodies have mandated physician engagement in formal ongoing learning activities. Continuing professional development (CPD) has been defined as "a process of lifelong learning in practice" and encompasses the development of managerial, social, and personal skills in addition to the advancement of medical knowledge. The traditional model of CPD assumes that physicians are self-directed learners and able to identify their own knowledge gaps, select appropriate educational activities to address these gaps, and incorporate newly learned material into their practice.
Several authors have pointed out flaws in the assumptions made about learners in the traditional CPD model. Furthermore, the effectiveness of traditional lectures and workshops in achieving practice change has been limited and inconsistent, leading many to suggest alternative formats of CPD. Thus, there has been increasing interest in elaborating and formalizing educational strategies that take place within the actual practice setting. One growing area of interest in this regard is the practice of coaching. Although coaching has had widespread uptake in athletics, the transfer of coaching to other professions such as teaching and medicine has met significant challenges. For example, some teachers have felt that coaching was used by administrators to standardize teaching and improve school ratings rather than to develop teachers. If coaching is to be a successful strategy for CPD in medicine, it must be willingly accepted and adopted by clinicians. The purpose of this study was to explore clinicians', and in particular surgeons', responses to the idea of having a coach in the operating room (OR) and to examine their concerns and sources of resistance.
Abstract and Introduction
Abstract
Objective: To explore surgeons' perceptions of and potential concerns about coaching.
Background: 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.
Methods: This was a qualitative interview-based study using a constructivist grounded theory approach. Participants included 14 surgeons from University of Toronto–affiliated hospitals.
Results: 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).
Conclusions and Relevance: 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.
Introduction
Recognizing the rapid advancements in medicine and the evidence that provision of care can often be substandard, many professional bodies have mandated physician engagement in formal ongoing learning activities. Continuing professional development (CPD) has been defined as "a process of lifelong learning in practice" and encompasses the development of managerial, social, and personal skills in addition to the advancement of medical knowledge. The traditional model of CPD assumes that physicians are self-directed learners and able to identify their own knowledge gaps, select appropriate educational activities to address these gaps, and incorporate newly learned material into their practice.
Several authors have pointed out flaws in the assumptions made about learners in the traditional CPD model. Furthermore, the effectiveness of traditional lectures and workshops in achieving practice change has been limited and inconsistent, leading many to suggest alternative formats of CPD. Thus, there has been increasing interest in elaborating and formalizing educational strategies that take place within the actual practice setting. One growing area of interest in this regard is the practice of coaching. Although coaching has had widespread uptake in athletics, the transfer of coaching to other professions such as teaching and medicine has met significant challenges. For example, some teachers have felt that coaching was used by administrators to standardize teaching and improve school ratings rather than to develop teachers. If coaching is to be a successful strategy for CPD in medicine, it must be willingly accepted and adopted by clinicians. The purpose of this study was to explore clinicians', and in particular surgeons', responses to the idea of having a coach in the operating room (OR) and to examine their concerns and sources of resistance.