Coaching for Surgeons: A Scoping Review of the Quantitative Evidence

Abstract

To characterize quantitative studies on coaching interventions for professional surgeons to understand how surgical coaching is defined; examine how different coaching programs are designed, implemented, and evaluated; and identify any relevant research gaps.

Background: Surgical coaching is gaining attention as an approach that could help surgeons optimize performance and improve overall wellbeing. However, surgical coaching programs and definitions of coaching vary widely between studies.

Methods: A systematic literature search of PubMed, Scopus, Web of Science, CENTRAL, clinicaltrials.gov, and WHO ICTRP was conducted according to the PRISMA-ScR framework to identify studies and registered clinical trials written in English. Original quantitative studies on coaching interventions for professional surgeons were included. Characteristics of the coachees, coaching programs, study designs, outcomes, and findings were charted and analyzed.

Results: From 2589 references, 8 studies (6 published; 2 registered trials) met inclusion criteria. Published studies targeted technical or nontechnical skills, included 2-26 surgeons as coachees, and used coaches who were surgeons. Two studies demonstrated that surgeons react positively to coaching. Studies showed inconsistent effects on technical/nontechnical skills. Only two studies measured patient adverse events and reported no significant positive impacts. The registered randomized trials targeted surgeons' physiological parameters or wellbeing and used professional coaches. These trials measure surgeon and patient outcomes.

Conclusions: There is an emerging interest in coaching programs to improve surgeons' performance by targeting their professional skills and personal factors. However, more randomized trials are needed to evaluate the impact of coaching interventions on patient outcomes and surgeon wellness.

Keywords: coaching; nontechnical skills; performance; technical skills; wellbeing.

FIGURE 1.

Visualization of the coaching goals and settings of the interventions.

FIGURE 2.

Research gaps diagram classifying studies by coaching goal, outcome, design GRADE, and findings. Study findings are represented by colors. Green represents positive findings, yellow mixed findings, and red negative findings. Dark gray represents outcomes of trials that have not been published yet. Light gray represents outcomes that were not evaluated by any of the studies included in the review. We used an adapted Kirkpatrick model to categorize the studies’ outcomes. Outcomes related to surgeons’ reactions to the coaching intervention or coaching in general were classified as Kirkpatrick level 1. Outcomes measuring technical or nontechnical skills, knowledge, or attitudes in a simulated environment were considered Kirkpatrick level 2. Outcomes measuring technical or nontechnical skill or changes in behavior measured in the operating room or in real life were classified as Kirkpatrick level 3. Patient outcomes or surgeon-centered outcomes were classified as Kirkpatrick level 4. We used an approach inspired by the GRADE system to to classify evidence levels based on intervention study designs. Randomized trials were considered “high,” quasi-experimental studies with contemporaneous controls were categorized as “moderate” and without controls as “low.”