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.
Thanks, Jay, I appreciate your perspective on this. Can’t argue with you that change is slow, particularly when politics are involved. I will admit that I am no better than anyone else at predicting what will come next — I’m just choosing to place my bets that improving helping surgeons (and other healthcare professionals) provide better care will be rewarded on a patient-by-patient level and eventually at a national level.
Jason, here’s another flaw with the concept: WHY do Beyonce and Tom Brady seek coaching? Because their industry rewards merit linearly or exponentially with income. Surgeons participate in an industry where there is no link between merit and income. Great surgeons and bad surgeons make the same. This is the major flaw with all “rent control” policies.
An important point to acknowledge — incentives. Although to some degree you’re right in saying that great surgeons and bad surgeons make the same, this won’t be true in the future. Value-based health care delivery is inevitable. Hospitals and physicians are already seeing penalties for low-value care, such as unnecessary readmissions. The “surgeon scorecard” is an example of outcomes being publicly reported for surgeons. This trend will only grow and will mean that bad surgeons will get penalized financially. As autonomous professionals, we should stay ahead of the game and find ways to improve our own performance — I believe this is the incentive for surgeons in the coming generation of healthcare.
Thanks for the reply, Jason. You seem to be very confident in what the future will bring and the quality measures that will make up the numerator of value measure. 10 years after “Value-based” healthcare seemed like a “lock”, I can show you 10 papers refuting quality improvements for every 1 supporting it. Readmissions lower? Great–mortality is up (because if we readmit the patient we pay a penalty). And the denominator, cost? Way, way up for patients and providers and only way up for payers. Where, oh where is this “value” that seemed just out of our reach 10 years ago and how can doctors still be so confident that it is “inevitable”?
Thanks, Jay, I appreciate your perspective on this. Can’t argue with you that change is slow, particularly when politics are involved. I will admit that I am no better than anyone else at predicting what will come next — I’m just choosing to place my bets that improving helping surgeons (and other healthcare professionals) provide better care will be rewarded on a patient-by-patient level and eventually at a national level.
In his 2007 book ‘Better,’ surgeon Atul Gawanda discussed his experience with using a coach.
https://www.goodreads.com/book/show/213233.Better
makes perfect sense! Only question-and the main one- is who will pay for the coaching time? This has been the eternal barrier to quality improvement efforts in medicine in general.
I was lucky enough to have a great mentor who still works with me.
Makes me keep learning.
This is a great concept. As you point out the long and arduous process of becoming a surgeon is no different than the process many athletes and other high performing professionals go through, yet they have a well established industry at the ready to provide that coaching and the means to hire them. Unfortunately, most surgeons don’t really have enough resources to hire these coaches. Perhaps that responsibility needs to fall on the institutions in which these surgeons work. What about independent, private practice surgeons, over whom the institution has little if any control?
I could envision a small group of elite surgeons from several different institutions getting together and agreeing to take this on and subsequently publicizing the hell out of their experiences. Maybe that would spark a movement.
Thanks for your comment. Great points, as resources are always limited. In the short term, institutions might take on the responsibility for funding coaching programs for their surgeons. As it stands now, surgeons need to leave town for conferences or spend other time completing CME requirements; coaching could be done locally and replace that time/travel cost.
For private practice surgeons, perhaps groups like malpractice insurers could fund coaching sessions — they should be incentivized to help surgeons improve their performance and minimize risk to patients.
Long term, perhaps device manufacturers would also fund coaches for the surgeons they want to use their products — it is only in industry’s best interest for the surgeons using new technologies to adopt them safely and efficiently.
We are currently testing out the idea of developing a network of surgical coaches — hoping to share results and spark that movement over the coming years.
My ever so best wishes for the surgeons which are second in line after God when it comes saving lives!!!
They deserve all the respect and especially emotional support to overcome all the so demanding career and become very high achievers .
Hat off to those that are or decide to become a surgeon and may God protect and guide their hands always !😊❤️😊😊😊❤️❤️❤️