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Original Investigation
October 14, 2020

Optimizing the Implementation of Surgical Coaching Through Feedback From Practicing Surgeons

Author Affiliations
  • 1Ariadne Labs, Brigham and Women’s Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Surgery, Massachusetts General Hospital, Boston
  • 4Department of Orthopedic Surgery, Boston Children’s Hospital, Boston, Massachusetts
  • 5Kansas Coaching Project, Center for Research on Learning, University of Kansas, Lawrence
JAMA Surg. Published online October 14, 2020. doi:10.1001/jamasurg.2020.4581
Key Points

Question  How can surgical coaching programs be implemented in a way that aligns with the professional culture of surgeons?

Findings  In this qualitative analysis of interviews with 23 practicing surgeons in a peer surgical coaching program, coaches and coachees agreed on key implementation recommendations, such as how to optimize coach-coachee relationships and facilitate productive coaching sessions. Despite consensus on their recommendations, surgeons tended to rate their coaching sessions positively if their own sessions aligned with these factors but negatively if their experiences were misaligned.

Meaning  These findings can help organizations implement effective coaching programs that enable meaningful continuous professional development for surgeons.


Importance  Surgical coaching is maturing as a tangible strategy for surgeons’ continuing professional development. Resources to spread this innovation are not yet widely available.

Objective  To identify surgeon-derived implementation recommendations for surgical coaching programs from participants’ exit interviews and ratings of their coaching interactions.

Design, Setting, and Participants  This qualitative analysis of the Surgical Coaching for Operative Performance Enhancement (SCOPE) program, a quality improvement intervention, was conducted at 4 US academic medical centers. Participants included 46 practicing surgeons. The SCOPE program ran from December 7, 2018, to October 31, 2019. Data were analyzed from November 1, 2019, to January 31, 2020.

Interventions  Surgeons were assigned as either a coach or a coachee, and each coach was paired with 1 coachee by a local champion who knew the surgeons professionally. Coaching pairs underwent training and were instructed to complete 3 coaching sessions—consisting of preoperative goal setting, intraoperative observation, and postoperative debriefing—focused on intraoperative performance.

Main Outcomes and Measures  Themes from the participants’ exit interviews covering 3 major domains: (1) describing the experience, (2) coach-coachee relationship, and (3) facilitators and barriers to implementing surgical coaching. Surgeons’ responses were stratified by the net promoter score (NPS), a scale ranging from 0 to 10 points, indicating how likely they were to recommend their coaching session to others, with 9 to 10 indicating promoters; 7 to 8, passives; and 0 to 6, detractors.

Results  Among the 46 participants (36 men [78.3%]), 23 were interviewed (50.0%); thematic saturation was reached with 5 coach-coachee pairs (10 interviews). Overall, coaches and coachees agreed on key implementation recommendations for surgical coaching, including how to optimize coach-coachee relationships and facilitate productive coaching sessions. The NPS categories were associated with how participants experienced their own coaching sessions. Specifically, participants who reported excellent first sessions, had a coaching partner in the same clinical specialty, and were transparent about each other’s intentions in the program tended to be promoters. Participants who described suboptimal first sessions, less clinical overlap, and unclear goals with their partner were more likely detractors.

Conclusions and Relevance  These exit interviews with practicing surgeons offer critical insights for addressing cultural barriers and practical challenges for successful implementation of peer coaching programs focused on surgical performance improvement. With empirical evidence on optimizing coach-coachee relationships and facilitating participants’ experience, organizations can establish effective coaching programs that enable meaningful continuous professional development for surgeons and ultimately enhance patient care.

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