Abstract：
Evidence for surgical coaching has yet to demonstrate an impact on surgeons\' practice. We evaluated a surgical coaching program by analyzing quantitative and qualitative data on surgeons\' intraoperative performance.
In the 2018-2019 Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 practicing surgeons in multiple specialties at four academic medical centers were recruited to complete three peer coaching sessions, each comprising preoperative goal-setting, intraoperative observation, and postoperative debriefing. Coach and coachee rated the coachee\'s performance using modified Objective Structured Assessment of Technical Skills (OSATS, range 1-5) and Non-Technical Skills for Surgeons (NOTSS, range 4-16). We used generalized estimating equations to evaluate trends in skill ratings over time, adjusting for case difficulty, clinical experience, and coaching role. Upon program completion, we analyzed semi-structured interviews with individual participants regarding the perceived impact of coaching on their practice.
Eleven of 23 coachees (48%) completed three coaching sessions, three (13%) completed two sessions, and six (26%) completed one session. Adjusted mean OSATS ratings did not vary over three coaching sessions (4.39 vs 4.52 vs 4.44, respectively; P = 0.655). Adjusted mean total NOTSS ratings also did not vary over three coaching sessions (15.05 vs 15.50 vs 15.08, respectively; P = 0.529). Regarding patient care, participants self-reported improved teamwork skills, communication skills, and awareness in and outside the operating room. Participants acknowledged the potential for coaching to improve burnout due to reduced intraoperative stress and enhanced peer support but also the potential to worsen burnout by adding to chronic work overload.
Surgeons reported high perceived impact of peer coaching on patient care and surgeon well-being, although changes in coachees\' technical and non-technical skills were not detected over three coaching sessions. While quantitative skill measurement warrants further study, longitudinal peer surgical coaching should be considered a meaningful strategy for surgeons\' professional development.
In the 2018-2019 Surgical Coaching for Operative Performance Enhancement (SCOPE) program, 46 practicing surgeons in multiple specialties at four academic medical centers were recruited to complete three peer coaching sessions, each comprising preoperative goal-setting, intraoperative observation, and postoperative debriefing. Coach and coachee rated the coachee\'s performance using modified Objective Structured Assessment of Technical Skills (OSATS, range 1-5) and Non-Technical Skills for Surgeons (NOTSS, range 4-16). We used generalized estimating equations to evaluate trends in skill ratings over time, adjusting for case difficulty, clinical experience, and coaching role. Upon program completion, we analyzed semi-structured interviews with individual participants regarding the perceived impact of coaching on their practice.
Eleven of 23 coachees (48%) completed three coaching sessions, three (13%) completed two sessions, and six (26%) completed one session. Adjusted mean OSATS ratings did not vary over three coaching sessions (4.39 vs 4.52 vs 4.44, respectively; P = 0.655). Adjusted mean total NOTSS ratings also did not vary over three coaching sessions (15.05 vs 15.50 vs 15.08, respectively; P = 0.529). Regarding patient care, participants self-reported improved teamwork skills, communication skills, and awareness in and outside the operating room. Participants acknowledged the potential for coaching to improve burnout due to reduced intraoperative stress and enhanced peer support but also the potential to worsen burnout by adding to chronic work overload.
Surgeons reported high perceived impact of peer coaching on patient care and surgeon well-being, although changes in coachees\' technical and non-technical skills were not detected over three coaching sessions. While quantitative skill measurement warrants further study, longitudinal peer surgical coaching should be considered a meaningful strategy for surgeons\' professional development.
摘要：
手术指导的证据尚未证明对外科医生的实践有影响。我们通过分析外科医生术中表现的定量和定性数据来评估手术指导计划。
在2018-2019年手术性能增强（SCOPE）计划中，在四个学术医疗中心招募了46名多个专业的执业外科医生，以完成三个同伴辅导课程，每个都包括术前目标设定，术中观察,和术后汇报。教练和教练使用修改后的客观结构化技术技能评估(OSATS，范围1-5)和外科医生非技术技能(NOTSS，范围4-16）。我们使用广义估计方程来评估技能评级随时间变化的趋势，调整案例难度，临床经验,和教练角色。程序完成后，我们分析了对个别参与者进行的半结构化访谈,以了解教练对他们的实践的影响.
23名教练中有11名(48%)完成了三次教练课程，三次(13%)完成了两次会议，六人(26%)完成了一次会议。调整后的平均OSATS评分在三个教练课程中没有变化（分别为4.39vs4.52vs4.44；P=0.655）。调整后的平均NOTSS总评分在三个教练课程中也没有变化（分别为15.05vs15.50vs15.08；P=0.529）。关于病人护理，参与者自我报告团队合作技能得到提高，沟通技巧,以及手术室内外的意识。参与者承认，由于减少术中压力和增强同伴支持，教练有可能改善倦怠，但也有可能通过增加慢性工作超负荷来恶化倦怠。
外科医生报告说，同伴辅导对患者护理和外科医生福祉的影响很高，尽管在三个教练课程中没有检测到技术和非技术技能的变化。虽然定量技能测量需要进一步研究，纵向同伴手术指导应被视为外科医生职业发展的有意义的策略。
在2018-2019年手术性能增强（SCOPE）计划中，在四个学术医疗中心招募了46名多个专业的执业外科医生，以完成三个同伴辅导课程，每个都包括术前目标设定，术中观察,和术后汇报。教练和教练使用修改后的客观结构化技术技能评估(OSATS，范围1-5)和外科医生非技术技能(NOTSS，范围4-16）。我们使用广义估计方程来评估技能评级随时间变化的趋势，调整案例难度，临床经验,和教练角色。程序完成后，我们分析了对个别参与者进行的半结构化访谈,以了解教练对他们的实践的影响.
23名教练中有11名(48%)完成了三次教练课程，三次(13%)完成了两次会议，六人(26%)完成了一次会议。调整后的平均OSATS评分在三个教练课程中没有变化（分别为4.39vs4.52vs4.44；P=0.655）。调整后的平均NOTSS总评分在三个教练课程中也没有变化（分别为15.05vs15.50vs15.08；P=0.529）。关于病人护理，参与者自我报告团队合作技能得到提高，沟通技巧,以及手术室内外的意识。参与者承认，由于减少术中压力和增强同伴支持，教练有可能改善倦怠，但也有可能通过增加慢性工作超负荷来恶化倦怠。
外科医生报告说，同伴辅导对患者护理和外科医生福祉的影响很高，尽管在三个教练课程中没有检测到技术和非技术技能的变化。虽然定量技能测量需要进一步研究，纵向同伴手术指导应被视为外科医生职业发展的有意义的策略。
