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Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
尽管最近医学教育发生了变化，外科培训仍主要基于学徒模式。然而,完成培训后，外科医生在实践中很少有结构化的学习机会来提高他们的技能或获得新技能。带有反馈的个性化观察很少是传统继续医学教育学习的特征。最近提出了教练作为一种方式来弥补这些教育差距；然而，数据有限，目前很少有教练项目。这项研究的目的是总结在实践中外科医生的教练计划的特点，包括参与者满意度，方案成果,以及实施的障碍，在已出版的文献中。
根据PRISMA指南进行了一项混合研究系统综述，以确定描述或调查截至2019年6月6日执业外科医生指导的所有原始研究。定量分析用于总结数值数据，使用描述性数据的扎根理论方法进行定性分析，将结果汇总为研究主题。
物品识别后，27个被包括在最终的合成中。26篇文章描述了教练计划的执行。课程差异很大，18/26侧重于教授新技能，其余的关于技能的改进。主题分析确定了指导更深入分析的两个主要数据类别：教练的结果和障碍。在报告教练结果的16个(62%)项目中，42％至100％的参与者报告了与指导直接相关的临床实践变化。82％至100％的参与者报告了完成计划后的积极满意度。据报道，参加教练计划的障碍出现在3个主要主题上：后勤限制，外科文化,和感知的缺乏需要。
在实践中指导外科医生受到参与者的高度评价，并经常导致临床实践的变化，而文化和后勤问题被认为是实施的障碍。需要更好地了解这些因素，以指导教练计划的开发和实施。
根据PRISMA指南进行了一项混合研究系统综述，以确定描述或调查截至2019年6月6日执业外科医生指导的所有原始研究。定量分析用于总结数值数据，使用描述性数据的扎根理论方法进行定性分析，将结果汇总为研究主题。
物品识别后，27个被包括在最终的合成中。26篇文章描述了教练计划的执行。课程差异很大，18/26侧重于教授新技能，其余的关于技能的改进。主题分析确定了指导更深入分析的两个主要数据类别：教练的结果和障碍。在报告教练结果的16个(62%)项目中，42％至100％的参与者报告了与指导直接相关的临床实践变化。82％至100％的参与者报告了完成计划后的积极满意度。据报道，参加教练计划的障碍出现在3个主要主题上：后勤限制，外科文化,和感知的缺乏需要。
在实践中指导外科医生受到参与者的高度评价，并经常导致临床实践的变化，而文化和后勤问题被认为是实施的障碍。需要更好地了解这些因素，以指导教练计划的开发和实施。
