Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep;164(3):561-565.
doi: 10.1016/j.surg.2018.04.033. Epub 2018 Jun 11.

Justifying our decisions about surgical technique: Evidence from coaching conversations

Arielle E Kanters  1 , Sarah P Shubeck  2 , Gurjit Sandhu  3 , Caprice C Greenberg  4 , Justin B Dimick  3
Affiliations

Justifying our decisions about surgical technique: Evidence from coaching conversations

Arielle E Kanters et al. Surgery. 2018 Sep.

Abstract

Background: The quality of an operation depends on operative technique. There is very little evidence, however, regarding how surgeons arrive at their intraoperative decisions. The objective of this study was to determine the extent to which practicing surgeons participating in a coaching program justify their technical decisions based on their experience or based on evidence.

Methods: This qualitative study evaluated 10 pairs of surgeons participating in a video review coaching program in October 2015. Using thematic analysis, the conversations were coded in an iterative process with comparative analysis to identify emerging themes.

Results: Three major themes emerged during analysis: (1) Individuals often reported modifications in surgical technique after a negative postoperative complication; (2) participants were noted to defend the use of certain techniques or surgical decisions based on the perceived expert opinion of others; and (3) surgeons rarely referred to evidence in surgical literature as a motivation for changing surgical technique.

Conclusions: In this qualitative analysis of coaching conversations we found that practicing surgeons often justify their surgical decisions with anecdotal evidence and "lessons learned," rather than deferring to surgical literature. This either represents a lack of evidence or poor uptake of existing data.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: Dr. Dimick is a CoFounder of ArborMetrix, a company that makes software for profiling hospital quality and efficiency. For the remaining authors none were declared.

References

    1. Kitto S, Petrovic A, Gruen RL, et al. Evidence-based medicine training and implementation in surgery: the role of surgical cultures. Journal of Evaluation in Clinical Practice. 2011;17(4):819–826. - PubMed
    1. Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, et al. Surgical coaching for individual performance improvement. Ann Surg. 2015;261(1):32–34. - PubMed
    1. Greenberg CC, Klingensmith ME. The Continuum of Coaching: Opportunities for Surgical Improvement at all Levels. Annals of surgery. 2015;262(2):217–219. - PMC - PubMed
    1. Birkmeyer JD, Finks JF, O’Reilly A, et al. Surgical skill and complication rates after bariatric surgery. The New England journal of medicine. 2013;369(15):1434–1442. - PubMed
    1. Beasley HL, Ghousseini HN, Wiegmann DA, et al. Strategies for building peer surgical coaching relationships. JAMA surgery. 2017;152(4):e165540. - PubMed

Publication types