The process involves a review of videotaped procedures by both the operating surgeon (or surgical resident) and the coach to recognize points at which performance was subpar and to have a discussion about steps needed for improvement. Through further reviews of videotapes of subsequent procedures, the surgeon or resident learns to internalize the techniques of performance improvement.
While ideal in a perfect world, such a schema is far from universally feasible in our current surgical culture. Although master classes and coaching are accepted as the norm in other fields that also require technical excellence, such as classical music and athletics, our surgical culture does not readily accept that our surgical technique might be less than perfect. We tend to downplay the notion that we (and our patients) might benefit from improving our surgical skills beyond mere competence to the point of mastery. A culture change in this regard will not occur overnight and most likely must begin by making coaching a standard and accepted part of surgical training programs, both for the residents and for the teachers themselves.
We make the tacit assumption that attending surgeons are teachers, but we rarely teach them how to teach. The fact that many attendings don’t know how to give effective feedback to residents may be a reason that they fail to give specific coaching on how their learners might improve and why these attendings take over an increasing portion of the procedures themselves. In order for faculty to improve the quality of their teaching, they need training of their own. The training should be a mandatory, “protected” part of their day or it will not occur, and the “teaching the teachers” must be done by master teachers who are respected for their skill not only as a surgeons but also as a surgical educators. This role is an appropriate one for Associate Members of the new ACS Academy of Master Surgeon Educators to assume (see https://www.facs.org/education/academy/membership).
Coaching by master surgeons should become a professional norm. It is only after surgical education and coaching are incorporated all along the training continuum – from novice to competent to master during residency training – that surgeons already in practice will accept it as a regular part of their work. Refinements in procedures and new procedures would be met by continued professional improvement that would be enhanced by master surgeon coaching. We owe it to ourselves and our patients to achieve excellence, not mere competence. “Okay” is not good enough.
Dr. Deveney is a professor of surgery and the vice chair of education in the department of surgery at Oregon Health & Science University, Portland. She is the coeditor of ACS Surgery News.