Surgical coaching applied to laparoscopic TME for continuous professional development in rectal surgery: proof of concept

Characteristics of Surgical Coaching Interventions: A Systematic Review

OBJECTIVE

Coaching is increasingly utilized as an educational intervention for performance improvement in surgeons and surgical trainees. Surgical coaching has been utilized across a broad range of specialties, experience levels and outcomes with generally positive results. Coaching interventions are often developed by individual institutions for their own context which has resulted in a heterogenous group of interventions. This review aims to investigate surgical coaching interventions to identify common characteristics that comprise an effective coaching intervention.

METHODS

A systematic review was conducted to identify studies investigating surgical coaching interventions up to July 2024. Studies were limited to English language peer-reviewed studies that adequately described the characteristics and outcomes of the surgical coaching intervention. Data on the primary and secondary outcomes, study objective and participants' demographics were also recorded.

RESULTS

The search across 4 electronic databases generated 9538 citations. Following screening and review of full text articles 28 studies were included in the review. Surgical coaching interventions were carried out in 8 separate countries with the majority (22/28) in North America. Studies involved between 3 and 107 participants. Coaching interventions were markedly heterogenous, and specific details of the methods used were inconsistently documented. Study length ranged from 1 (9/28) to 14 (1/28) sessions and duration from less than 15 minutes (1/29) to greater than 3 hours (3/28). The most common themes were goal setting (10/28), feedback (7/28) and reflection (7/28). Outcomes were generally positive with 47 of 55 identified outcomes demonstrating benefit from surgical coaching. There were 3 key domains and 13 sub-domains that comprised the majority of coaching interventions.

CONCLUSIONS

Surgical coaching has been shown to be a promising intervention that requires more rigorous research to develop the field. We have identified 3 key domains which can be utilized to analyses and develop coaching interventions in the future.

Laparoscopic approach for rectal cancer surgery: triumph of reason or necessity of evolution?

The role of laparoscopy in rectal cancer surgery has evolved considerably since the early 2000s. Initial randomized trials, such as COLOR II and COREAN, indicated that laparoscopic approaches offered similar pathological outcomes with better postoperative recovery than open surgery. In contrast, trials like ACOSOG Z6051 and ALaCaRT suggested noninferiority could not be established. Variability in trial outcomes, focusing on either disease-free survival or pathological measures, initially hindered consensus. Long-term analyses have shown no significant difference in disease-free survival between laparoscopic and open approaches. Meta-analyses have reinforced the benefits of laparoscopic surgery, with reduced mortality and similar oncologic effectiveness to open surgery. However, new techniques like transanal TME (TaTME) and robotic approaches have introduced alternatives, though each presents unique challenges, from recurrence rates in TaTME to costs in robotics. While laparoscopy remains the preferred method due to accessibility and outcomes, robotic surgery is expected to gain traction in high-volume centers.

Residents as Medical Coaches

OBJECTIVES

With the recent implementation of Competency-based Medical Education (CBME) and emphasis on direct observation of learners, there is an increased interest in the concept of clinical coaching. While there is considerable literature on the role of attending physicians as coaches, little data is available on the role of residents as coaches, and residents' perceptions about effective coaching. We aimed to identify distinct characteristics of residents' coaching, to examine residents' perceptions on what they valued most in clinical coaches, and to explore trainees' ideas about how to optimize this role.

DESIGN

We performed an exploratory qualitative study, using 45 minutes semi-structured interviews. We did a thematic analysis of the interview transcripts using both inductive and deductive coding.

PARTICIPANTS

We invited and interviewed 5 surgical and 5 nonsurgical residents, and 3 surgical and 3 nonsurgical attending staff. Residents were recruited from all post graduate levels and from a variety of programs.

SETTING

Our study was done in a large tertiary teaching hospital.

RESULTS

Residents perceived that they have a significant role as coaches for junior learners, different from the attending's role. The proximity between the coach and the coaches leads to a different supervisor-learner rapport. This was of benefit as learners described feeling more comfortable making mistakes and seeking feedback, which potentiates effective coaching. Residents reported feeling that it was easier to coach their recently-acquired skills as the subtleties of the tasks and the troubleshooting were fresher in memory. Residents expressed appreciating a coach who values autonomy and does not intervene except when patient safety is at risk. Strategies identified to further optimize residents' role as coaches include placing coaching as a priority, ensuring dedicated time, and offering teaching sessions on coaching.

CONCLUSIONS

Residents have distinct roles as coaches, driven by their recent experience being coached and as near peers. More research is needed to evaluate concrete measures to optimize residents' role as coaches and to improve their coaching skills.