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Comprehensive Surgical Coaching Enhances Surgical Skill in the Operating Room: A Randomized Controlled Trial

Bonrath, Esther M. MD; Dedy, Nicolas J. MD; Gordon, Lauren E. MSc; Grantcharov, Teodor P. MD, PhD

doi: 10.1097/SLA.0000000000001214

Objectives: The aim of the study was to determine whether individualized coaching improved surgical technical skill in the operating room to a higher degree than current residency training.

Background: Clinical training in the operating room is a valuable opportunity for surgeons to acquire skill and knowledge; however, it often remains underutilized. Coaching has been successfully used in various industries to enhance performance, but its role in surgery has been insufficiently investigated.

Methods: This randomized controlled trial was conducted at one surgical training program. Trainees undergoing a minimally invasive surgery rotation were randomized to either conventional training (CT) or comprehensive surgical coaching (CSC). CT included ward and operating room duties, and regular departmental teaching sessions. CSC comprised performance analysis, debriefing, feedback, and behavior modeling. Primary outcome measures were technical performance as measured on global and procedure-specific rating scales, and surgical safety parameters, measured by error count. Operative performance was assessed by blinded video analysis of the first and last cases recorded by the participants during their rotation.

Results: Twenty residents were randomized and 18 completed the study. At posttraining the CSC group (n = 9) scored significantly higher on a procedure-specific skill scale compared with the CT group (n = 9) [median, 3.90 (interquartile range, 3.68–4.30) vs 3.60 (2.98–3.70), P = 0.017], and made fewer technical errors [10 (7–13) vs 18 (13–21), P = 0.003]. Significant within-group improvements for all skill metrics were only noted in the CSC group.

Conclusions: Comprehensive surgical coaching enhances surgical training and results in skill acquisition superior to conventional training.

Supplemental Digital Content is Available in the Text.This randomized controlled trial examined the effectiveness of comprehensive coaching as an approach to enhance operative performance in surgical postgraduate training. Coaching involved structured performance analysis, video debriefing, feedback, and behavior modeling. After 2 months, coaching led to superior surgical skills as measured by performance and error metrics compared with conventional residency.

Department of Surgery, University of Toronto, St. Michael's Hospital, Toronto, Canada.

Reprints: Esther M. Bonrath, MD, 30 Bond St, Toronto, ON M5B1W8, Canada. E-mail:

Disclosure: Supported by the Ontario Research Fund (Grant No. RE05-049). The authors declare no conflicts of interest.

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