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Surgical digest

Is there a role for coaching in surgical training and beyond?

Rebecca Winterborn

MB, ChB, MD, FRCS, PGCert US, PGCert Med Ed.
Consultant Vascular Surgeon
North Bristol NHS Trust
United Kingdom

I have often wondered why as Consultant Surgeons we do not have coaches. Professional sportspeople, singers and even high-end executives receive coaching throughout their careers.

Why is it that we think as surgeons we magically become competent and stay competent? Why do we still follow a model of pedagogy, where there is a presumption that, following a period of teaching, after a certain point, instruction is no longer needed. ‘You’re cooked’ and you can go the rest of the way yourself, with a reliance on continuing personal development.

Back in 2011, Atul Gawande authored an article in The New Yorker entitled Personal Best1. He noted that within 10 years of completing his surgical training he had reached a plateau. His rate of complications steadily lowered to better than average and there they stayed. It felt to him like the only direction they could go, was backwards. He reflected that his outcomes were not necessarily about his evolving practical skills but more about familiarity and judgment. Would coaching help to maintain his outcomes, in the same way that coaching helps to maintain Rafa Nadal’s outcomes playing tennis. He enlisted the support of a retired colleague who observed him in theatre and offered advice and coaching. He noted that his complication rates started to reduce again as he applied the insights.

Are we doing our patients a dis-service by not having coaching throughout our careers? In addition, whereas coaching might be useful in the operating room, it could be even more useful outside the operating room.

The International Coaching Federation defines coaching as ‘partnering with clients in a thought-provoking and creative process that inspires them to maximise their personal and professional potential’2.

Having just been involved in an Annual Review of Competency Progression (ARCP) meeting, I am struck by the number of trainees who are having challenges around confidence: a lack of trust in their own skills rather than a lack of surgical or decision-making skill.

Why is this? Some would say it is because they have not developed resilience, from the Latin ‘resilientem’ – inclined to leap or spring back – or as ‘the capacity to recover quickly from difficulties, toughness.’ – but I believe there is much more to it than that.

It needs to be recognised that many trainees were exposed to significant disruption due to Covid-19, and much like the disease itself there is an element of long Covid affecting trainees. Much was talked about the effects of Covid on training during the pandemic, but my impression is that there is a much longer tail on this than was initially anticipated.

Support and Wellbeing services offer an excellent resource to trainees but a suggestion to refer oneself is often based on a less than satisfactory ARCP. This may lead to feelings of failure, judgement, and further reduction in confidence rather than the positive support it is intended to be.

How would it be to receive regular coaching? Would it be helpful for all educational supervisors to be trained as coaches? I think it would be great to be proactive rather than reactive when it comes to supporting surgeons both in training and beyond. Why do we wait for people to be on the road to burn-out before offering them support? The science of medicine is the easy part. I believe it is the art of medicine that requires regular nurturing.

There have been very few studies exploring the role of coaching in surgery, and all that I have found, are from the United States. Sharon Stein and colleagues from University Hospitals Cleveland, Ohio, and the Association of Women Surgeons undertook a study on the implementation of a virtual coaching programme3. They trained 75 surgeons as coaches who delivered virtual coaching on strength recognition, personal and professional fulfilment, and work life integration to 121 surgical residents. Coaches noted improvement in their goal setting, self-confidence, and working relationships. They also noted improvement in their communication skills both during and outside of the coaching experience. Eighty-six percent of coaches recommended implementing a coaching programme at their home hospital.

Professor Dyrbye from the Mayo clinic conducted a randomized control trial (RCT) of monthly coaching sessions for 6 months versus no coaching and demonstrated a significant reduction in burn-out and improved resilience scores, although these waned with time from completion of the coaching4. A second RCT authored by Tyra Fainstad and colleagues randomized 101 female residents to either a web-based group-coaching programme lasting 6 months or a control group5. Professional coaching reduced emotional exhaustion and impostor syndrome scores and increased self-compassion scores.

I can honestly say that my personal experience of coaching has changed my life. Those of you who read my article ‘A night on call that changed my life…..’ will know that I suffered with Post traumatic stress disorder (PTSD) and unfortunately, I have suffered with my very own ‘long covid’ having experienced another episode of PTSD, at the start of the pandemic, after a traumatic maternity case.

Following support from my local hospital psychology team and Practitioner Health6 I was directed to a fantastic service called Joyful Doctor7. I undertook a programme of coaching which gave me the opportunity to explore my needs, emotions, behaviours, values and talents. I now live the most fruitful and joyful life, ever.

Every cloud has a silver lining, but I do wonder whether if I had experienced regular coaching throughout my training and Consultant career, I may not have had to endure the feelings of despair, shame and judgement that came with PTSD and burnout. The experience was so transformational that I have now become a certified coach and am able to offer a similar coaching programme to that which I received.

So in answer to the question, I posed in the title, my response is YES!!


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