Surgical coaching to achieve the ABMS vision for the future of continuing board certification.

In February 2019, the American Board of Medical Specialties (ABMS) released the final report of the Continuing Board Certification: Vision for the Future initiative, issuing strong recommendations to replace ineffective, traditional mechanisms for physicians' maintenance of certification with meaningful strategies that strengthen professional self-regulation and simultaneously engender public trust. The Vision report charges ABMS Member Boards, including the American Board of Surgery (ABS), to develop and implement a more formative, less summative approach to continuing certification. To realize the ABMS's Vision in surgery, new programs must support the assessment of surgeons' performance in practice, identification of individualized performance gaps, tailored goals to address those gaps, and execution of personalized action plans with accountability and longitudinal support. Peer surgical coaching, especially when paired with video-based assessment, provides a structured approach that can meet this need. Surgical coaching was one of the approaches to continuing professional development that was discussed at an ABS-sponsored retreat in January 2020; this commentary review provides an overview of that discussion. The professional surgical societies, in partnership with the ABS, are uniquely positioned to implement surgical coaching programs to support the continuing certification of their membership. In this article, we provide historical context for board certification in surgery, interpret how the ABMS's Vision applies to surgical performance, and highlight recent developments in video-based assessment and peer surgical coaching. We propose surgical coaching as a foundational strategy for accomplishing the ABMS's Vision for continuing board certification in surgery.

Development and Assessment of the Wisconsin Surgical Coaching Rubric.

Importance: Surgical coaching continues to gain momentum as an innovative method for continuous professional development. A tool to measure the performance of a surgical coach is needed to provide formative feedback to coaches for continued skill development and to assess the fidelity of a coaching intervention for future research and dissemination. Objective: To evaluate the validity of the Wisconsin Surgical Coaching Rubric (WiSCoR), a novel tool to assess the performance of a peer surgical coach. Design, Setting, and Participants: Surgical coaching sessions from November 2014 through February 2018 conducted by 2 statewide peer surgical coaching programs were audio recorded and transcribed. Twelve raters used WiSCoR to rate the performance of the surgical coach for each session. The study included peer surgical coaches in the Wisconsin Surgical Coaching Program (n = 8) and the Michigan Bariatric Surgery Collaborative coaching program (n = 15). The data were analyzed in 2019. Interventions or Exposures: Use of WiSCoR to rate peer surgical coaching sessions. Main Outcomes and Measures: There were 282 WiSCoR ratings from the 106 coaching sessions included in the study. WiSCoR was evaluated using a framework, including inter-rater reliability assessed with Gwet weighted agreement coefficent. Descriptive statistics of WiSCoR were calculated. Results: Eight coaches (35%) and 11 coachees (29%) were from the Wisconsin Surgical Program and 15 coaches (65%) and 27 coachees (71%) were from the Michigan Bariatric Surgery Collaborative. The validity of WiSCoR is supported by high interrater reliability (Gwet weighted agreement coefficient, 0.87) as well as a weakly positive correlation of WiSCoR to coachee ratings of coaches (r = 0.22; P = .04), rigorous content development, consistent rater training, and the association of WiSCoR with coach and coaching program development. The mean (SD) overall coach performance rating using WiSCoR was 3.23 (0.82; range, 1-5). Conclusions and Relevance: WiSCoR is a reliable measure that can assess the performance of a surgical coach, inform fidelity to coaching principles, and provide formative feedback to surgical coaches. While coachee ratings may reflect coachee satisfaction, they are not able to determine the quality of a coach.

Association of Personality and Thinking Style With Effective Surgical Coaching.

Importance: While interest in surgical coaching programs is rising, there is no objective method for selecting effective surgical coaches. Objective: To identify a quantitative measure to determine who will be an effective surgical coach. Design, Setting, and Participants: This prospective cohort study included coaches and coachees from 2 statewide peer surgical coaching programs: the Wisconsin Surgical Coaching Program and the Michigan Bariatric Surgical Collaborative coaching program. Data were collected from April 2014 to February 2018, and analysis began August 2018. Interventions: The Myers-Briggs Type Indicator was administered to coaches and coachees, and the Life Styles Inventory was administered to surgical coaches before their first coaching session. Main Outcomes and Measures: Coach performance in the first coaching session and all coaching sessions using the Wisconsin Surgical Coaching Rubric. Results: Twenty-three surgical coaches and 38 coachees combined for a total of 65 unique pairs and 106 coaching sessions. Overall, 22 of 23 coaches (96%) and 32 of 38 coachees (84%) were men. An increase in a coach's Life Styles Inventory constructive style score correlated with an increase in overall coach performance for the first coaching session (r = 0.70; P = .002). Similarity in the coaching pair's Myers-Briggs Type Indicator judging/perceiving dichotomy was also associated with an increase in overall coach performance for their first coaching session (ß = 0.38; P = .02). When all sessions were included in the analysis, these objective measures were no longer associated with coach performance. Conclusions and Relevance: Surgeons of all personalities and thinking styles can become an effective coach with appropriate training and experience. Coach training can be tailored to support diverse behavioral styles and preferences to maximize coach effectiveness.

A Statewide Surgical Coaching Program Provides Opportunity for Continuous Professional Development.

OBJECTIVE: We sought to develop and evaluate a video-based coaching program for board-eligible/certified surgeons. SUMMARY BACKGROUND DATA: Multiple disciplines utilize coaching for continuous professional development; however, coaching is not routinely employed for practicing surgeons. METHODS: Peer-nominated surgeons were trained as coaches then paired with participant surgeons. After setting goals, each coaching pair reviewed video-recorded operations performed by the participating surgeon. Coaching sessions were audio-recorded, transcribed, and coded to identify topics discussed. The effectiveness with which our coaches were able to utilize the core principles and activities of coaching was evaluated using 3 different approaches: self-evaluation; evaluation by the participants; and assessment by the study team. Surveys of participating surgeons and coach-targeted interviews provided general feedback on the program. All measures utilized a 5-point Likert scale format ranging from 1 (low) to 5 (high). RESULTS: Coach-participant surgeon pairs targeted technical, cognitive, and interpersonal aspects of performance. Other topics included managing intraoperative stress. Mean objective ratings of coach effectiveness was 3.1 ±â€Š0.7, ranging from 2.0 to 5.0 on specific activities of coaching. Subjective ratings by coaches and participants were consistently higher. Coaches reported that the training provided effectively prepared them to facilitate coaching sessions. Participants were similarly positive about interactions with their coaches. Identified barriers were related to audio-video technology and scheduling of sessions. Overall, participants were satisfied with their experience (mean 4.4 ±â€Š0.7) and found the coaching program valuable (mean 4.7 ±â€Š0.7). CONCLUSIONS: This is the first report of cross-institutional surgical coaching for the continuous professional development of practicing surgeons, demonstrating perceived value among participants, as well as logistical challenges for implementing this evidence-based program. Future research is necessary to evaluate the impact of coaching on practice change and patient outcomes.