Surgical coaching has had a decade-long presence in the field of Surgery, and at Penn Obstetrics and Gynecology, is the particular interest of a working group led by Stefan Gysler, MD, and Catherine Salva, MD, MSEd. Dr. Gysler is a member of the faculty of the Division of Gynecologic Oncology; Dr. Salva is the Director of the Residency Program and of Gynecologic Services at the Hospital of the University of Pennsylvania. Both Drs. Salva and Gysler are members of the Academy for Surgical Coaching (ASC), a multi-national and multi-institutional organization that provides surgical coaching services to professional societies, healthcare systems, and individual surgeons.
See One - Do One - Teach One in the 21st Century
The training curriculum for young surgeons in the United States hearkens back to Dr. William Stewart Halsted, who established the first formal surgical residency training program at the Johns Hopkins School of Medicine in the 1890s. The Halsted Model, as it came to be known, involved hands-on, hospital-based training for residents, often involving a mentor and the guidance of skilled surgeons. Through a several-year period of increasing responsibility, the trainee then acquired patient management and surgical skills until the eventual achievement of near-total independence and autonomy. Halsted's Model is also known as the apprentice model or "the see one — do one — teach one" approach, and it continues to be a foundation for training, with strong advocates in surgical education.
However, the Halsted Model has been challenged recently by technology growth, new guidelines for resident duty hours, a national focus on patient safety and quality improvement, the needs of continuous professional development, and a deeper understanding of how residents learn and retain information.
The timeframes implicit in the various fields of surgery are another concern. General surgical residents can expect to receive up to 60 months of surgical training. Obstetrics and gynecology residents, on the other hand, will spend between 18 to 24 months within a 4-year residency program rotating through gynecologic surgical specialties. In a recent report, the founders of the Academy for Surgical Coaching note that despite this marked variability in surgical volume and experience, all residency graduates regardless of specialty are expected to be similarly prepared for independent practice. In the same report, the authors underline the critical need for innovation in obstetrics and gynecology residency surgical training in particular, a need identified in the American Board of Medical Specialties (ABMS) Vision for the Future Commission final report in 2019.
Among the many findings of the Future Commission report was recognition of the value of surgical coaching at the local level.
Surgical Coaching Defined
According to the ASC, surgical coaching is an evidence-based strategy for achieving lifelong learning and practice improvement, with the general intent of assisting trainees as they make the transition from residency to independent practice and self-autonomy.
As envisioned by the ACS, there is a clear distinction between surgical coaching and other forms of education. Thus, surgical coaching is not mentoring, or continuing education. Nor is it based upon the traditional apprentice model. Furthermore, surgical coaching may, or may not involve the real-time interaction common in other types of coaching (e.g., athletics, music). One approach to surgical coaching described by Drs. Gysler and Salva, for example, combines video with self-assessment.
The Elements of Video-Based Surgical Coaching
Video-based coaching (VBC) has been found to offer substantial improvement in skills versus standard surgical training in randomized trials involving general surgery residents, and has a natural place in surgical coaching, according to Dr. Gysler.
"The fact is, most procedures today are videotaped," Dr. Gysler explains. "So, the concept is to have residents review their videos and meet with a surgical coach who can, based on the trainees' own objectives and self-assessment, work with that individual on improving those trainee-driven goals.' Dr. Gysler explains.
As surgical coaches, Drs. Gysler and Salva are familiar with recent advances in learning theory, and what drives skill acquisition and retention. Further, as surgeons, they are aware both of the value of self-reflection and the nuances of schedule in practice.
"This is the main difference between coaching and traditional education," says Dr. Salva. "You're not teaching a technique or step-by-step procedure. You're coaching a trainee to seek out self-improvement — which is a core principle of how adults learn best."
The benefit of video coaching, according to Drs. Salva and Gysler, is that video can be used to extend the individual's learning experience in an offline setting, and open the door for things like self-reflection, self-assessment and individual learning and progress in an environment conducive to learning and the successful advance of knowledge and skill.
Community-Building, Culture Change and the Paradigm of Surgical Coaching
Outside of the advantages of video coaching, Dr. Salva adds, is the general benefit to community-building inherent in surgical coaching, and its contribution to the future of surgical education.
"It really is community building," she explains. "We love talking to anyone who might be interested in innovative approaches to surgical training. We're collaborating with people in undergraduate and graduate medical education, for example, and in residency programs in general surgery, urology and other specialties."
Both Drs. Gysler and Salva recognize that surgical coaching involves a new and elemental shift in thinking about surgical training, however, and the challenges therein.
"Investing in surgical coaching involves a lot of culture change and paradigm change," Dr. Gysler concludes. "It means thinking about the ways that we've always done things, realizing that there are new educational approaches to apply and use that are really exciting. We're trying to start the wave in our own department but we're also having a lot of discussions with people in general surgery and others — there are a lot of like-minded people out there."
For more information about surgical coaching at Penn Obstetrics and Gynecology, contact Catherine.Salva@pennmedicine.upenn.edu or Stefan.Gysler@pennmedicine.upenn.edu.