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Namatovu JF, Mubuuke AG, Buwembo W, Nakigudde J, Kiguli S. Stakeholder views on continuing professional development for doctors working in public primary care facilities in central Uganda: a qualitative study. Pan Afr Med J 2024; 47:97. [PMID: 38799194 PMCID: PMC11126753 DOI: 10.11604/pamj.2024.47.97.417840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction the primary care workforce in the public sector of Uganda is under the district health system. The doctors in this workforce provide leadership and frontline promotive, preventive, curative, rehabilitative, and palliative care. Their numbers are still low and therefore need effective support through continuing professional development (CPD). Part of the support is influenced by stakeholders whose views on CPD in the district health system are important. This study therefore explored the stakeholders' views on the CPD of doctors working in the district health system in central Uganda. Methods a qualitative exploratory study was done, and data was collected using an interview guide through in-depth interviews among ten purposively selected CPD stakeholders influencing different aspects of CPD activities of doctors working in public general hospitals and health center IVs. The interviews were recorded and transcribed verbatim and manually analyzed using deductive thematic analysis. Results five themes were categorized into; CPD practices, facilitators, benefits, challenges, and suggestions. Each of the themes had subthemes; CPD practices; training, mentorship and apprenticeship, support supervision, and quality improvement projects. Facilitators; internet services, grants, health facility managers, facility-based CPD providers, and regional CPD guidelines. Benefits; motivation, knowledge, teamwork, and renewal of practicing licenses. Challenges; workload, allowances, access, documentation, mindset, quality, structure of public health system, and sustainability. Suggestions; training needs analysis, collaboration, monitoring, e-CPD platforms, CPD resource centers, and individual CPD responsibility. Conclusion the stakeholders' views are an indication that effective CPD is a collaborative effort from both the primary care doctors and those in the leadership of the health care system.
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Affiliation(s)
| | | | | | - Janet Nakigudde
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Peadiatrics and Child Health, Makerere University, Kampala, Uganda
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Shafa G, Kiani P, Masino C, Okrainec A, Pasternak JD, Alseidi A, Madani A. Training for excellence: using a multimodal videoconferencing platform to coach surgeons and improve intraoperative performance. Surg Endosc 2023; 37:9406-9413. [PMID: 37670189 DOI: 10.1007/s00464-023-10374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/30/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Continuing Professional Development opportunities for lifelong learning are fundamental to the acquisition of surgical expertise. However, few opportunities exist for longitudinal and structured learning to support the educational needs of surgeons in practice. While peer-to-peer coaching has been proposed as a potential solution, there remains significant logistical constraints and a lack of evidence to support its effectiveness. The purpose of this study is to determine whether the use of remote videoconferencing for video-based coaching improves operative performance. METHODS Early career surgeon mentees participated in a remote coaching intervention with a surgeon coach of their choice and using a virtual telestration platform (Zoom Video Communications, San Jose, CA). Feedback was articulated through annotating videos. The coach evaluated mentee performance using a modified Intraoperative Performance Assessment Tool (IPAT). Participants completed a 5-point Likert scale on the educational value of the coaching program. RESULTS Eight surgeons were enrolled in the study, six of whom completed a total of two coaching sessions (baseline, 6-month). Subspecialties included endocrine, hepatopancreatobiliary, and surgical oncology. Mean age of participants was 39 (SD 3.3), with mean 5 (SD 4.1) years in independent practice. Total IPAT scores increased significantly from the first session (mean 47.0, SD 1.9) to the second session (mean 51.8, SD 2.1), p = 0.03. Sub-category analysis showed a significant improvement in the Advanced Cognitive Skills domain with a mean of 33.2 (SD 2.5) versus a mean of 37.0 (SD 2.4), p < 0.01. There was no improvement in the psychomotor skills category. Participants agreed or strongly agreed that the coaching programs can improve surgical performance and decision-making (coaches 85%; mentees 100%). CONCLUSION Remote surgical coaching is feasible and has educational value using ubiquitous commercially available virtual platforms. Logistical issues with scheduling and finding cases aligned with learning objectives continue to challenge program adoption and widespread dissemination.
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Affiliation(s)
- Golsa Shafa
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Parmiss Kiani
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Caterina Masino
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Allan Okrainec
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Amin Madani
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada.
- University Health Network - Toronto Western Hospital, Main Pavilion, 13MP-312B, 399, Bathurst St, Toronto, ON, M5T 2S8, Canada.
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Gwathmey FW, Miller MD. Coaching in Sports Medicine. Clin Sports Med 2023; 42:325-333. [PMID: 36907630 DOI: 10.1016/j.csm.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Similar to elite athletes, surgeons use their skills on a daily basis but coaching for skillset refinement is not common among surgeons. Surgeon coaching has been proposed a method by which surgeons can gain insight into their performance and optimize their practice. However, many barriers exist to surgeon coaching such as logistics, time, cost, and pride. Ultimately, the tangible improvement in surgeon performance, the elevation of surgeon well-being, the optimization of the practice, and better patient outcomes support a wider implementation of surgeon coaching for surgeons at all stages of their career.
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Affiliation(s)
- F Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, University of Virginia Health System, 2280 Ivy Road, Admin South, Charlottesville, VA 22903, USA.
| | - Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, University of Virginia Health System, 2280 Ivy Road, Admin South, Charlottesville, VA 22903, USA
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Parvand M, Salvador R, Westerberg BD, Lea J. Surgical Coaching: Patient Perspectives Regarding Surgeon Coaches in the Operating Room. JOURNAL OF SURGICAL EDUCATION 2023; 80:270-275. [PMID: 36243564 DOI: 10.1016/j.jsurg.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Surgical coaching programs have been introduced as platforms for ongoing professional development amongst independently practicing surgeons. While there is a plethora of evidence regarding the effectiveness of surgical coaching for practicing staff surgeons, patients' opinions regarding surgical coaching are largely unknown. OBJECTIVES To determine patients' baseline attitudes and opinions about the hypothetical situation of their treating surgeon having a surgical coach present during their upcoming operation, and to determine patients' baseline knowledge and prior exposure to surgical coaching. DESIGN AND SETTING This study was conducted at a tertiary hospital in Vancouver, Canada. Patients on the surgical waitlist of 2 independently practicing Otolaryngologists within the subspeciality of Neurotology were invited to participate in the study. Participants engaged in a semi-structured interview to discuss their opinions and knowledge of physician coaches and to learn about surgical coaching. The interview was conducted based on a pre-set script. RESULTS Of the 100 patients approached, 70 consented to participate. Forty-three (61%) participants identified as female, and the mean age was 56±15 years. Initially, 84% of participants (n = 59) consented to the hypothetical presence of a surgical coach. Post-discussion, this number increased to 95.7% (n = 67, p = 0.04). Prior participant exposure to coaching related to employment, education, athletics, or music was high (90%, n = 63). Younger participants between 25 and 45 years of age were more amenable to the presence of a surgical coach compared to participants >66 years of age (p = 0.01). After the interview, 55 (79%) participants were interested in learning more about surgical coaching. CONCLUSION Many patients were unaware of the rationale and importance of surgical coaching programs for practicing staff surgeons. Most patients, especially younger patients, were amenable to the presence of a surgical coach during their surgery, and this number increased in all age categories with patient education about surgical coaching.
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Affiliation(s)
- Mahraz Parvand
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rochelle Salvador
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian David Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Lea
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
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Granchi N, Reid J, Foley K, Couteur AL, Edwards S, Feo R, Trochsler M, Bruening M, Maddern G. Improving surgical excellence: first experience of a video-based intervention in outpatients. ANZ J Surg 2022; 92:2868-2872. [PMID: 36052856 PMCID: PMC9825861 DOI: 10.1111/ans.18012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND There are limited opportunities for surgeons to engage in active learning programs once they achieve Fellowship, especially for non-technical skills such as communication. This study aims to address this gap by evaluating a peer-based coaching program in non-technical skill using video-recorded patient consultations from a routine outpatient clinic. METHODS Standard outpatient consultations between consultant surgeons and patients were video recorded. The surgeon viewed the videos with a peer-coach (senior surgeon) who helped identify areas of strength and areas for improvement. To test the effect of the coaching session, outpatient consultations were recorded roughly 1 month later. Pre and post-coaching videos were assessed using the Maastricht History-Taking and Advice Scoring - Global Rating List (MAAS), a common tool for evaluating non-technical skills in clinicians. RESULTS A total of 12 surgeons consented to participate. Coaching significantly improved MAAS scores (mean difference = -0.61; 95% CI (-0.88, -0.33); P < 0.0001). Surgeons were generally positive about the experience. All found the method of learning suitable, and most thought the process improved their skills. Most thought that coaching would improve patient outcomes and the majority thought they would participate in ongoing coaching as part of their employment. CONCLUSION This supports the concept of surgical coaching as an effective tool to improve communication skills and the quality of surgical consultation. The next step is to expand beyond a voluntary cohort and link surgical coaching to improved patient outcomes.
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Affiliation(s)
- Nelson Granchi
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Jessica Reid
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Katarina Foley
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Amanda Le Couteur
- School of PsychologyThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suzanne Edwards
- Adelaide Health Technology Assessment, School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rebecca Feo
- College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Markus Trochsler
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Martin Bruening
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
| | - Guy Maddern
- Discipline of SurgeryThe University of Adelaide, The Queen Elizabeth HospitalWoodville SouthSouth AustraliaAustralia
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Shafa G, Masino C, Madani A, Okrainec A. Perceptions of the multidisciplinary operative team on intraoperative telecoaching among surgeons. Surg Open Sci 2022; 10:145-147. [PMID: 36193260 PMCID: PMC9526219 DOI: 10.1016/j.sopen.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/25/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Telecoaching, intraoperative coaching through videoconference, has been suggested as a tool to overcome logistical barriers with in-person coaching. However, little is known about the operative team's perception of telecoaching and its unique set of challenges. This qualitative study explores the perceptions of the multidisciplinary operative team on surgical telecoaching. A telecoaching program between peer surgeons was implemented using the Karl Storz Visitor1 remote presence system (Karl Storz, Germany). Semistructured interviews were conducted with the 12 operative team members present during 2 telecoaching sessions completed during the study period. Twelve participants were interviewed. The 4 central themes that emerged from the data were effective communication and collaboration, improving performance, operating room workflow, and culture and optics. Participating surgeon mentees reported that the session met expectations and learning goals and revealed concerns about negative perception of their autonomy and expertise by colleagues and patients. Conversely, team members unanimously reported a positive impression of surgeon mentees for taking additional measures to improve their performance and for patient outcomes. The operative team members reported that telecoaching was conducive to their own learning and relevant for complex cases. Considerations for future implementation of telecoaching include robust privacy standards for patients and staff, strong internet connectivity, coordinating with the operative team, and space constraints. Operative team participants viewed the intervention favorably and identified practical considerations for its continued use in an operating room environment. However, more work is needed on surgical culture as a contributor to low adoption and its impact on coaching programming activity.
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Coaching for Surgeons: A Scoping Review of the Quantitative Evidence. ANNALS OF SURGERY OPEN 2022; 3:e179. [PMID: 36199481 PMCID: PMC9508984 DOI: 10.1097/as9.0000000000000179] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/04/2022] [Indexed: 11/25/2022] Open
Abstract
To characterize quantitative studies on coaching interventions for professional surgeons to understand how surgical coaching is defined; examine how different coaching programs are designed, implemented, and evaluated; and identify any relevant research gaps. Mini Abstract: This scoping review revealed that very few studies have quantitatively assessed coaching programs for surgeons focus on technical and nontechnical skills. Studies demonstrate that coaching is well accepted by surgeons. However, effects on technical/nontechnical skills are inconsistent and no evidence confirms that coaching improves patient outcomes. Additional randomized control trials are needed to evaluate the effects of surgical coaching on surgeons’ performance, patient safety, and surgeons’ wellness.
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Louridas M, Sachdeva AK, Yuen A, Blair P, MacRae H. Coaching in Surgical Education: A Systematic Review. Ann Surg 2022; 275:80-84. [PMID: 33856384 DOI: 10.1097/sla.0000000000004910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objectives of this study were to review the coaching literature to (1) characterize the criteria integral to the coaching process, specifically in surgery, and (2) describe how these criteria have been variably implemented in published studies. BACKGROUND Coaching is a distinct educational intervention, but within surgery the term is frequently used interchangeably with other more established terms such as teaching and mentoring. METHODS A systematic search was performed of the MEDLINE and Cochrane databases to identify studies that used coach/coaching as an intervention for surgeons for either technical or nontechnical skills. Study quality was evaluated using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 2280 articles were identified and after screening by title, abstract and full text, 35 remained. Thirteen coaching criteria (a-m) were identified in 4 general categories: 1. overarching goal (a. refine performance of an existing skill set), 2. the coach (b. trusting partnership, c. avoids assessment, d. 2-way communication), the coachee (e. voluntary participation, f. self-reflection, g. goal setting, h. action plan, i. outcome evaluation), and the coach-coachee rapport (j. coaching training, k. structured coaching model, l. non-directive, m. open ended questions). Adherence to these criteria ranged from as high of 73% of studies (voluntary participation of coach and coachee) to as low as 7% (use of open-ended questions). CONCLUSIONS Coaching is being used inconsistently within the surgical education literature. Our hope is that with establishing criteria for coaching, future studies will implement this intervention more consistently and allow for better comparison and generalization of results.
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Affiliation(s)
- Marisa Louridas
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Ajit K Sachdeva
- Division of Education, American College of Surgeons, Chicago, Illinois
| | - Andrew Yuen
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Patrice Blair
- Division of Education, American College of Surgeons, Chicago, Illinois
| | - Helen MacRae
- Department of Surgery, University of Toronto, Toronto, Ontario
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Zahid A, Miskovic D. Proctorship in Minimally Invasive Colorectal Surgery. Clin Colon Rectal Surg 2021; 34:186-193. [PMID: 33815001 DOI: 10.1055/s-0040-1722765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Teaching an established surgeon in a novel technique by a colleague who has acquired a level of expertise is often referred to as "proctoring" or "precepting." Surgical preceptorships can be defined as supervised teaching programs, whereby individual or groups of surgeons (proctors) experienced in a certain technique support a colleague who wants to adopt this technique (sometimes referred to as "delegates" or "preceptees"). Preceptorship programs really focus on a specific technique, technology, or skill which is required to broaden, complement, or transform an established surgeon's practice. Within colorectal surgery, in the past 30 years, there is been an evolution of interventional options including open, laparoscopic, robotic, and endoscopic procedures. With each new emerging technology and technique, safe and effective uptake by established surgeons is best been attained by a period of proctorship by an experienced colleague. Formalizing this has been facilitated largely through industry support. There, however, remains a considerable chasm when it comes to standardization, quality control, and jurisprudence. This article aims to describe the requirements for a contemporary proctorship program, to examine instruments of quality control, and how to improve effectiveness.
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Affiliation(s)
- Assad Zahid
- St Mark's Hospital, London, United Kingdom.,University of Sydney, Australia
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Foley K, Granchi N, Reid J, Leopardi L, Maddern G. Peer Coaching as a Form of Performance Improvement: What Surgeons Really Think. JOURNAL OF SURGICAL EDUCATION 2021; 78:525-532. [PMID: 32839147 DOI: 10.1016/j.jsurg.2020.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/26/2020] [Accepted: 08/01/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Coaching has been proposed as a potential form of continuing professional development (CPD) for surgeons. Our study aimed to elicit qualified surgeons' perceptions of peer coaching as a form of CPD and to determine the effect of demographic factors on surgeons' views. METHODS A cross-sectional paper survey was conducted across 2 South Australian metropolitan hospitals from November 2018 to January 2019. This comprised 5 demographic questions and 6 Likert items eliciting views on peer-based coaching and was distributed at departmental unit meetings to surgical consultants and fellows. Participation was voluntary and a definition of "peer-based coaching" was provided. RESULTS Hundred and eighteen surgeons of a possible 125 (94.4% response rate) from 8 surgical specialties completed the survey with 45.4% (n = 54) having received coaching since obtaining their fellowship. The majority of participants (72.9%, n = 86) reported consultant surgeons would benefit from peer coaching and that one-on-one coaching in an individual setting would be a useful CPD activity (73.7%, n = 87). Just over half the participants (53.4%, n = 63) felt that coaching by a nonsurgeon such as a psychologist would benefit their nonoperative skills. Many participants (61.8%, n = 73) felt more inclined to participate if CPD points were awarded. Despite the support in favor of coaching, a significant percentage of participants (45.8%, n = 54) wanted further evidence of its efficacy. CONCLUSIONS There is support amongst surgeons for peer coaching and its inclusion as a form of CPD, however, many require more evidence of its benefits, thus highlighting the need for ongoing research studies, consultation and pilot coaching programs.
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Affiliation(s)
- Katarina Foley
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Nelson Granchi
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Jessica Reid
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Lisa Leopardi
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | - Guy Maddern
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
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Valanci-Aroesty S, Alhassan N, Feldman LS, Landry T, Mastropietro V, Fiore J, Lee L, Fried GM, Mueller CL. Implementation and Effectiveness of Coaching for Surgeons in Practice - A Mixed Studies Systematic Review. JOURNAL OF SURGICAL EDUCATION 2020; 77:837-853. [PMID: 32057740 DOI: 10.1016/j.jsurg.2020.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/02/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Despite recent changes to medical education, surgical training remains largely based on the apprenticeship model. However, after completing training, there are few structured learning opportunities available for surgeons in practice to refine their skills or acquire new skills. Personalized observation with feedback is rarely a feature of traditional continuing medical education learning. Coaching has recently been proposed as a modality to meet these educational gaps; however, data are limited, and few coaching programs presently exist. The purpose of this study is to summarize the characteristics of coaching programs for surgeons in practice including participant satisfaction, program outcomes, and barriers to implementation, in the published literature. METHODS A mixed studies systematic review was conducted according to PRISMA guidelines to identify all original studies describing or investigating coaching for practicing surgeons up to 06/2019. Quantitative analysis was used to summarize numerical data, and qualitative analysis using grounded theory methodology for descriptive data was used to summarize the results into themes across studies. RESULTS After identification of articles, 27 were included in the final synthesis. Twenty-six articles described execution of a coaching program. Programs varied widely with 18/26 focusing on teaching new skills, and the remainder on refinement of skills. Thematic analysis identified 2 major data categories that guided deeper analysis: outcomes of and barriers to coaching. Of the 16 (62%) programs that reported outcomes of coaching, 42% to 100% of participants reported changes in clinical practice directly associated with coaching. Positive satisfaction after completion of a program was reported by 82% to 100% of participants. Reported barriers to participating in a coaching program emerged along 3 main themes: logistical constraints, surgical culture, and perceived lack of need. CONCLUSIONS Coaching for surgeons in practice is highly rated by participants and often results in clinical practice changes, while cultural and logistical issues were identified as barriers to implementation. A better understanding of these factors is required to guide coaching program development and implementation.
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Affiliation(s)
- Sofia Valanci-Aroesty
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Noura Alhassan
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Tara Landry
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Victoria Mastropietro
- McGill University Health Centre, Montreal General Hospital, Library, Montreal, Quebec, Canada
| | - Julio Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Carmen L Mueller
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Department of Surgery, McGill University, Montreal, Quebec, Canada.
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MacKenzie C, Chan TM, Mondoux S. Clinical Improvement Interventions for Residents and Practicing Physicians: A Scoping Review of Coaching and Mentoring for Practice Improvement. AEM EDUCATION AND TRAINING 2019; 3:353-364. [PMID: 31637353 PMCID: PMC6795351 DOI: 10.1002/aet2.10345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Graduate medical education (GME) bodies are beginning to mandate coaching as an integral part of the learning process, in addition to current requirements for mentorship. Once an emergency medicine physician transitions beyond graduate training, there is no requirement and little focus on coaching as a method of improving or maintaining clinical practice. Our objective was to understand and describe the current state of the published literature with regard to the use of coaching and mentorship for both GME and practicing physicians. METHODS We conducted a structured review of the literature through PubMed and Google Scholar and included all articles applying coaching or mentorship modalities to GME trainees or practicing physicians. A Google Form was used for standardized data abstraction. Data were collected pertaining to the settings of intervention, the nature of the intervention, its effect, and its resource requirements. RESULTS A total of 3,546 papers were isolated during the literature review. After exclusion, 186 underwent full-text review by the authors of which 126 articles were included in the final data analysis. Eighty-two articles (65%) pertained to mentorship and 14 (11%) to coaching; the remainder of the articles discussed a combination or variation of these two concepts. Fifty-three (42%) articles were descriptive studies and 35 (28%) were narrative reviews or commentaries. Forty-seven (37%) articles originated from within surgical specialties and coaching was most commonly applied to procedural or manual skills with 22 (17%) instances among all studies. CONCLUSIONS Most literature on coaching and mentorship is descriptive or narrative, and few papers are in the specialty of emergency medicine. Most interventions are limited to single instances of coaching or mentorship without longitudinal application of the intervention. There is an important need to study and publish further evidence on coaching interventions.
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Affiliation(s)
- Casey MacKenzie
- Michael G. DeGroote School of MedicineDepartment of MedicineMcMaster UniversityHamiltonOntario
| | - Teresa M. Chan
- Division of Emergency MedicineDepartment of MedicineMcMaster UniversityHamiltonOntario
- McMaster program for Education Research, Innovation, and Theory (MERIT)HamiltonOntario
| | - Shawn Mondoux
- Institute of Health Policy, Management and Evaluation (IHPME)University of TorontoTorontoOntarioCanada
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Hathaway H, Heinsohn T. On the Merits of Surgical Coaching in Continuous Professional Development: Comments on “Coaching Experts: Applications to Surgeons and Continuing Professional Development”. Surg Innov 2019; 26:265-266. [DOI: 10.1177/1553350618819518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hugh Hathaway
- University of Oxford Medical Sciences Division, Oxford, UK
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14
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Papadakis S, Cole AG, Reid RD, Assi R, Gharib M, Tulloch HE, Mullen KA, Wells G, Pipe AL. From Good to Great: The Role of Performance Coaching in Enhancing Tobacco-Dependence Treatment Rates. Ann Fam Med 2018; 16:498-506. [PMID: 30420364 PMCID: PMC6231943 DOI: 10.1370/afm.2312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/20/2018] [Accepted: 09/01/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the incremental effect of performance coaching, delivered as part of a multicomponent intervention (Ottawa Model for Smoking Cessation [OMSC]), in increasing rates of tobacco-dependence treatment by primary care clinicians. METHODS In a cluster-randomized controlled trial, 15 primary care practices were randomly assigned to 1 of the following active-treatment conditions: OMSC or OMSC plus performance coaching (OMSC+). All practices received support to implement the OMSC. In addition, clinicians in the OMSC+ group participated in a 1.5-hour skills-based coaching session and received an individualized performance report. All clinicians and a cross-sectional sample of their patients were surveyed before and 4 months after introduction of the interventions. The primary outcome measure was rates of tobacco-dependence treatment strategy (Ask, Advise, Assist, Arrange) delivery. Secondary outcomes were patient quit attempts and smoking abstinence measured at 6 months' follow-up. RESULTS Primary care clinicians (166) and patients (1,990) were enrolled in the trial. Clinicians in the OMSC+ group had statistically greater rates of delivery for Ask (adjusted odds ratio [AOR] = 1.69; 95% CI, 1.05-2.72), Assist (AOR = 1.64; 95% CI, 1.08-2.49), and Arrange (AOR = 2.01; 95% CI, 1.22-3.31). Sensitivity analysis found that the rate of delivery for Advise was greater only among those clinicians who attended the coaching session (AOR = 1.65; 95% CI, 1.10-2.49; P = .02). No differences were documented between groups for cessation outcomes. CONCLUSIONS Performance coaching significantly increased rates of tobacco-dependence treatment by primary care clinicians when delivered as part of a multicomponent intervention.
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Affiliation(s)
- Sophia Papadakis
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada .,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinic of Social and Family Medicine, University of Crete, Rethymnon, Crete, Greece
| | - Adam G Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Robert D Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Roxane Assi
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marie Gharib
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather E Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George Wells
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew L Pipe
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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