Postgame Analysis: Using Video-Based Coaching for Continuous Professional Development

Center for Surgery & Public Health, Brigham & Women's Hospital, Boston, MA, USA.
Journal of the American College of Surgeons (Impact Factor: 4.45). 01/2012; 214(1):115-24. DOI: 10.1016/j.jamcollsurg.2011.10.009
Source: PubMed

ABSTRACT The surgical learning curve persists for years after training, yet existing continuing medical education activities targeting this are limited. We describe a pilot study of a scalable video-based intervention, providing individualized feedback on intraoperative performance.
Four complex operations performed by surgeons of varying experience--a chief resident accompanied by the operating senior surgeon, a surgeon with less than 10 years in practice, another with 20 to 30 years in practice, and a surgeon with more than 30 years of experience--were video recorded. Video playback formed the basis of 1-hour coaching sessions with a peer-judged surgical expert. These sessions were audio recorded, transcribed, and thematically coded.
The sessions focused on operative technique--both technical aspects and decision-making. With increasing seniority, more discussion was devoted to the optimization of teaching and facilitation of the resident's technical performance. Coaching sessions with senior surgeons were peer-to-peer interactions, with each discussing his preferred approach. The coach alternated between directing the session (asking probing questions) and responding to specific questions brought by the surgeons, depending on learning style. At all experience levels, video review proved valuable in identifying episodes of failure to progress and troubleshooting alternative approaches. All agreed this tool is a powerful one. Inclusion of trainees seems most appropriate when coaching senior surgeons; it may restrict the dialogue of more junior attendings.
Video-based coaching is an educational modality that targets intraoperative judgment, technique, and teaching. Surgeons of all levels found it highly instructive. This may provide a practical, much needed approach for continuous professional development.

Download full-text


Available from: Sarah Peyre, Jun 19, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to explore the impact of a professional development program on the teachers' pedagogical beliefs and practices. More specifically, the program endeavoured to design a prototype for teacher professional development in Indonesia that was sustainable and scalable. This one-year program built upon the participating teachers' existing practices, reinforced with the concept of reflection as a tool for ongoing inquiry of their own practices. The three major components of this program were: action research, peer-coaching and leadership support. By using a mixed method of quantitative and qualitative data collection, this study examined the changes in the participating teachers' beliefs and practices, and how these changes may be related to the professional development program. The key findings in this paper have highlighted the importance of (1) the clarity of both the content and the outline of the program, (2) applicable and suitable professional learning methods, (3) modelling, and (4) collaboration among teachers. The findings have also identified teachers' (limited) resources, such as time and access to facilities, to be taken into account when planning for professional development programs. The discussion focuses on the challenge to design professional development programs based on a belief-action relationship.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To investigate health care improvement team coaching activities from the perspectives of coachees, coaches and unit leaders in two national improvement collaboratives. BACKGROUND: Despite numerous methods to improve health care, inconsistencies in success have been attributed to factors that include unengaged staff, absence of supportive improvement resources and organisational inertia. METHODS: Mixed methods sequential exploratory study design, including quantitative and qualitative data from interprofessional improvement teams who received team coaching. The coachees (n = 382), coaches (n = 9) and leaders (n = 30) completed three different data collection tools identifying coaching actions perceived to support improvement activities. RESULTS: Coachees, coaches and unit leaders in both collaboratives reported generally positive perceptions about team coaching. Four categories of coaching actions were perceived to support improvement work: context, relationships, helping and technical support. CONCLUSIONS: All participants agreed that regardless of who the coach is, emphasis should include the four categories of team coaching actions. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should reflect on their efforts to support improvement teams and consider the four categories of team coaching actions. A structured team coaching model that offers needed encouragement to keep the team energized, seems to support health care improvement.
    Journal of Nursing Management 06/2013; 22(4). DOI:10.1111/jonm.12068 · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Evidence suggests that prolonged operative time adversely affects surgical outcomes. However, whether faster surgeons have better outcomes is unclear, as a surgeon's speed could reflect skill and efficiency, but may alternatively reflect haste. Objectives This study evaluates whether median surgeon operative time is associated with adverse surgical outcomes following laparoscopic Roux-en-Y gastric bypass. Methods We performed a retrospective cohort study using statewide clinical registry data from the years 2006 to 2012. Surgeons were ranked by their median operative time and grouped into terciles. Multivariable logistic regression with robust standard errors was used to evaluate the influence of median surgeon operative time on 30-day surgical outcomes, adjusting for patient and surgeon characteristics, trainee involvement, concurrent procedures, and the complex interaction between these variables. Results A total of 16,344 patients underwent surgery during the study period. Compared to surgeons in the fastest tercile, slow surgeons required 53 additional minutes to complete a gastric bypass procedure [median (Interquartile range) 139 (133-150) vs. 86 (69-91), p<0.001]. After adjustment for patient characteristics only, slow surgeons had significantly higher adjusted rates of any complication, prolonged length of stay, ED visits or readmissions, and venous thromboembolism (VTE). After further adjustment for surgeon characteristics, resident involvement, and the interaction between these variables, slow surgeons had higher rates of any complication (10.5% vs. 7.1%, p=0.039), prolonged length of stay (14.0% vs. 4.4%, p=0.002), and VTE (0.39% vs. 0.22%, p<0.001). Conclusions Median surgeon operative duration is independently associated with adjusted rates of certain adverse outcomes following laparoscopic Roux-en-Y gastric bypass. Improving surgeon efficiency while operating may reduce operative time and improve the safety of bariatric surgery.
    Surgery for Obesity and Related Diseases 03/2014; 11(1). DOI:10.1016/j.soard.2014.03.018 · 4.94 Impact Factor