Surgeons must perform at the top of their game day in and day out. So do athletes, singers, and other professionals, but a mistake in surgery has far greater ramifications than a fumble or a missed note.
Top performers in highly specialized fields get there with some combination of natural talent and hard work. But even the most elite — the Tom Bradys of sport, the Beyoncés of music — turn to coaches to help ensure their best performance. Should surgeons?
When you walk into a surgeon’s office you assume — quite reasonably — that she or he will provide you with the best care possible. As is true for all physicians, part of surgeons’ ethical duty is to help their patients and prevent or remove harm. Anything short of their best is unfair to patients and unethical for the surgeons as medical professionals.
Before starting their independent careers, surgeons undergo some of the longest and most demanding training regimens in medicine. Four years of undergraduate studies, followed by four years of medical school and at least five years — sometimes as many as nine — of post-graduate training in surgery and surgical subspecialties. During their training, general surgeons are required to assist in at least 850 operations spanning nearly every organ system in the body. They remove tumors, debride infections, and attend to other life-altering conditions from head to toe.
Those training to be specialists, such as cardiac or orthopedic surgeons, treat hundreds of additional patients with heart disease or joint disorders. By the time they finish residency or fellowships, surgeons have spent most of the preceding decade learning their technical trade under the graduated supervision of experienced surgeons.
What happens after completing this formal training is far less rigorous. For the majority of their careers, surgeons are on their own for maintaining and improving their skills. As two colleagues and I drew attention to in the Journal of the American Medical Association, current strategies for professional development for surgeons are suboptimal. Surgeons might operate with an assistant, discuss difficult cases with colleagues, or attend conferences, but they rarely operate with a peer surgeon and receive direct feedback on how they perform. Without the opportunity for targeted, longitudinal learning from other talented colleagues, surgeons risk plateauing as their careers progress.
Today’s surgeons are under enormous systematic and cultural pressures to see more patients, juggle electronic medical records, and ensure good online ratings. It is a daunting challenge for them to provide optimal care under these circumstances. So how can they not only maintain their skills but actually improve them while staying up-to-date with constantly evolving surgical knowledge and technology?
Coaching is one promising approach to help them do this. It has proven to be an effective strategy for improving individual performance in other high-performing professions such as athletics, music, business, and education, and should work for surgery as well.
A surgical coach is a peer or expert surgeon who uses effective communication skills to guide another surgeon to improve a specific skill. Coaching can be used to improve surgeons’ technical skills, such as how to stitch together two blood vessels or two organs, or non-technical skills such as leadership techniques or teamwork behaviors in the operating room.
Evidence to support the effectiveness of coaching for surgeons is in its early stages but is growing quickly. Small-scale studies have shown that coaching can apply to surgeons at various stages in their careers, from trainees in the last year of residency to surgeons with more than 30 years in practice. Over the past few years, formal surgical coaching programs have developed around academic medical centers in Wisconsin, Michigan, and Illinois. Last year, surgeons at four of Harvard Medical School’s teaching hospitals began participating in a new surgical coaching program in Boston. Alongside a surgeon champion at each institution, the research group at Ariadne Labs that I am part of is coordinating this program and studying its impact on surgical skill and surgeon-surgeon coaching interactions.
Will busy surgeons want to participate in coaching? Early reviews of these programs have shown that many of them actually enjoy the coaching interactions. What we don’t yet know is whether surgeons who work with a coach improve their patients’ outcomes.
Coaching has great potential to become a standard component of surgical practice. Instead of allowing skills and techniques to plateau after surgical training, surgeons can turn to coaching to continue honing their skills so they are at their peak for every operation throughout their careers. If elite performers in sports, music, and business rely on coaches to maintain and improve their performance, why wouldn’t surgeons do the same when the health and lives of their patients are at stake?
Jason Pradarelli, M.D., is a general surgery resident at Brigham and Women’s Hospital in Boston and a safe surgery fellow at Ariadne Labs.