Residents' News

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

There is a recent and needed interest in fostering the maturation of surgical trainees, both in the scientific literature and the lay press. Much of this focus has been on the mentorship and educational development of the surgeon in training. As a point of reference, there were 56 citations in PubMed for the calendar year 2012 (January through September) with mentorship or educator and surgery as keywords. This spans the spectrum from conveying technical skills in the operating room and on the wards, to transferring knowledge, to navigating the intricate dynamics of starting a practice.

While there is a great deal of commonality between a mentor and educator, there are subtle differences. Merriam-Webster has a definition of a mentor as "a trusted counselor or guide." An educator is defined as "one skilled in teaching." As what I believe to be a demonstration of the understanding that there are nuances of becoming a skilled educator, the Joint Council on Thoracic Surgery Education (JCTSE) and The Society of Thoracic Surgeons (STS) jointly sponsor the Educate the Educators (EtE) program. The EtE program’s purpose is to enhance the teaching skills of cardiothoracic surgery faculty.

I recently had the fortunate opportunity to attend and participate in this year’s EtE course held this July 27-29 at The William and Ida Friday Center for Continuing Education at the University of North Carolina, Chapel Hill. This informative course was directed by Dr. Edward Verrier (University of Washington), Dr. Ara Vaporciyan (The University of Texas M.D. Anderson Cancer Center) and Dr. Stephen Yang (The Johns Hopkins University). The EtE program, which had 37 attendees, was run concurrently with this year’s Thoracic Surgery Directors Association 5th Annual Cardiothoracic Surgery Boot Camp.

The course focused on developing a framework for an effective educational environment – one where the trainee is able to learn, retain, and utilize the knowledge or skills. The need to engage learners at all the levels was especially poignant to cardiothoracic surgery education where the team and students span from medical students to general surgery residents to thoracic residents and fellows. Developing a deeper understanding of the level of pre-knowledge will become even more critical as integrated training programs expand.

Understanding the needs of the learner – especially as it relates to the development of curriculum – was a focus of Dr. Vaporciyan’s discussions. The field of curriculum development and assessment is beyond the scope of this article, but hinges on understanding curriculum as a process. The process begins with assessing the needs of the learner. It is followed by a thorough understanding of the goals and objectives of the educational experience. Finally, the materials, methods, and instructors are molded to best utilize their strengths. This approach ultimately makes the learning relevant to the trainee and optimally engages them. The ongoing engagement allows feedback to be best used to measure a trainee’s strengths and weaknesses. The educator then facilitates the process.

A large amount of time was dedicated to understanding the learner of today. This was spearheaded by a luncheon lecture and subsequent direct discussions with Dr. Mark Taylor, M.S.W., Ed.D on the generational changes of learners. What was most interesting, to this attendee, was the influence of intergenerational, cultural, and technological factors on the trainee of today and how those stereotypes (justified and unjustified) are carried through to the current training paradigm. Dr. Taylor’s talks were nicely augmented by those of Dr. Yang on utilizing deliberate teaching. This process focuses on setting objectives for a particular encounter (e.g., surgical case, bedside rounds, lecture) and providing feedback immediately.

The approach to deliberate teaching was especially relevant to today’s thoracic residency paradigm where work-hours are limited. To this end, an approach to maximally optimize learning, placing detailed background preparation with the trainee so that when they participate they are up to speed. That is to say, the majority of the content would be delivered off-line. The trainees are then held responsible for this information so that the learning encounter can be productive and focused on deeper understanding eliminating confusion.

Then the educational encounter would not be a regurgitation of information available elsewhere, but a conversation. This would enable the adult learner of the 21st century to utilize the study method and approach that is most effective for them and their lifestyle.

The commitment of the JTSCE and STS to improving thoracic resident education through the EtE program is outstanding. The EtE program is a very valuable resource for those with an interest in thoracic surgical education to expand their knowledge base.

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: October 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: November 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: November 15, 2012

Thoracic Surgery News is seeking 2 new resident associate medical editors for a 1-year appointment for our publication. To apply, you should be a resident in a field of thoracic surgery and willing to review and potentially comment upon articles for our monthly Residents’ Corner section.

In addition, resident medical editors are expected to work with the other editors to contribute 4 to 6 short articles throughout the appointment year, whether it is case studies by themselves or solicited from other thoracic surgeons, news or opinion pieces on resident issues, or summaries of resident-oriented sessions at meetings they attend.

Please send a CV and cover letter indicating your interest to thoracicsurgerynews@elsevier.com  Deadline: November 15, 2012

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

The researchers pointed out several limitations to their study beyond those intrinsic to surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most involved in training may be the best metric available, they noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," they concluded.

The authors had no disclosures.

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

The researchers pointed out several limitations to their study beyond those intrinsic to surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most involved in training may be the best metric available, they noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," they concluded.

The authors had no disclosures.

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

The researchers pointed out several limitations to their study beyond those intrinsic to surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most involved in training may be the best metric available, they noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," they concluded.

The authors had no disclosures.

Citing a revolution in the way surgeons learn their craft, Dr. Erica L. Mitchell and Dr. Sonal Arora present an analysis of vascular training to identify key learning points and needs as residents move from novice to expert. Their report is in the August issue of the Journal of Vascular Surgery.

A shift toward competency-based training programs is now reflecting a growing emphasis on outcomes-based medical education, according to Dr. Mitchell and Dr. Arora. They discuss how pedagogy and adult learning tools can be applied to vascular training and the development of technical expertise (J Vasc Surg 2012;56:530-7). 

"Surgical educators should use training and assessment methods soundly based in educational principles to develop and deliver curricula that will allow trainees to acquire the skills befitting the modern vascular surgeon," they concluded.

Find the original article by clicking here.

Citing a revolution in the way surgeons learn their craft, Dr. Erica L. Mitchell and Dr. Sonal Arora present an analysis of vascular training to identify key learning points and needs as residents move from novice to expert. Their report is in the August issue of the Journal of Vascular Surgery.

A shift toward competency-based training programs is now reflecting a growing emphasis on outcomes-based medical education, according to Dr. Mitchell and Dr. Arora. They discuss how pedagogy and adult learning tools can be applied to vascular training and the development of technical expertise (J Vasc Surg 2012;56:530-7). 

"Surgical educators should use training and assessment methods soundly based in educational principles to develop and deliver curricula that will allow trainees to acquire the skills befitting the modern vascular surgeon," they concluded.

Find the original article by clicking here.

Citing a revolution in the way surgeons learn their craft, Dr. Erica L. Mitchell and Dr. Sonal Arora present an analysis of vascular training to identify key learning points and needs as residents move from novice to expert. Their report is in the August issue of the Journal of Vascular Surgery.

A shift toward competency-based training programs is now reflecting a growing emphasis on outcomes-based medical education, according to Dr. Mitchell and Dr. Arora. They discuss how pedagogy and adult learning tools can be applied to vascular training and the development of technical expertise (J Vasc Surg 2012;56:530-7). 

"Surgical educators should use training and assessment methods soundly based in educational principles to develop and deliver curricula that will allow trainees to acquire the skills befitting the modern vascular surgeon," they concluded.

Find the original article by clicking here.

SAN FRANCISCO – Resident involvement in surgical procedures does not clinically affect surgical outcomes, according to a retrospective study of more than 60,000 cases from the National Surgical Quality Improvement Program database.

"There is a small – although questionable as clinically relevant – overall increase in mild and surgical complications. This is mostly caused by superficial wound infections when residents participate in surgical procedures," said Dr. P. Ravi Kiran, staff surgeon and head of the research section in the department of colorectal surgery at the Cleveland Clinic.

Using data from the National Surgical Quality Improvement Program database from 2005 to 2007, Dr. Kiran and his colleagues compared outcomes for patients who underwent surgery with and without resident participation.

The database, which includes data from pre-, intra-, and postoperative phases, uses clearly defined parameters and specialist nurse reviewers. It also includes resident participation and a morbidity probability, which offers an opportunity to use preoperative factors to stratify risk within subgroups, Dr. Kiran said at the annual meeting of the American Surgical Association.

Resident cases were matched with nonresident cases on the basis of age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors. Primary outcomes included 30-day mortality and postoperative complications (mild vs. severe, and surgical vs. medical). Secondary outcomes included the duration of surgery and length of hospital stay.

Mild complications included superficial surgical site infections (SSIs), peripheral nerve injury, urinary tract infection, deep venous thrombosis, and thrombophlebitis. Severe complications included deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, reoperation, pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, and sepsis.

Surgical complications included superficial SSI, deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, peripheral nerve injury, and reoperation. Medical complications included pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, sepsis, urinary tract infection, deep vein thrombosis, and thrombophlebitis.

For cases with resident vs. nonresident participation, the surgical complication rates were 7% and 6.2%, respectively – a significant difference – and mild complications rates were 4.4% and 3.5%, respectively. In addition, the mean operative time was significantly greater for cases involving residents – 122 vs. 97 minutes. The length of postoperative hospital stay was not significantly longer in the resident group.

The researchers identified 40,474 patients in the resident group and 20,237 patients in the nonresident group. The two groups were similar in terms of median age (50 years), sex (67% female), mean morbidity probability (0.09), American Society of Anesthesiologists classification, and presence of diabetes (6.4%) and hypertension (35%).

The groups were also similar in terms of presence of chronic obstructive pulmonary disease (0.27%), congestive heart failure or myocardial infarction in the past 6 months (0%), dialysis (0.044%), and preoperative sepsis (0.035%). Surgeons’ speciality areas were likewise similar for the two groups (general, 93%; vascular, 6%; and other, 1.36%).

Postgraduate year (PGY) 1-2 residents participated in 31% of operations, PGY 3-5 residents participated in 56%, and residents in PGY 6 or higher participated in 13% of cases.

The 10 most common surgical procedures were laparoscopic appendectomy, laparoscopic gastric bypass, laparoscopic cholecystectomy with and without operative cholangiogram, open appendectomy (nonruptured), thromboendarterectomy, colectomy (partial with anastomosis), laparoscopic colectomy (partial with anastomosis), ventral hernia repair, and placement of gastric band. These procedures were similar in terms of the percentages of resident and nonresident participation.

"We found that there was no difference in the [overall] 30-day mortality between the groups – 0.18% in the resident group and 0.20% in the no-resident group," said Dr. Kiran. However, any 30-day complications were 7.5% in the resident group and 6.7% in the nonresident group, a significant difference.

"When we further looked at the surgical complications, we noted that the cause of the difference in surgical complications between the two groups was the higher rate of SSIs in the resident group, when compared with the no-resident group ... the other surgical complications were similar," he said. The SSI rate was 3.0% for the resident group, compared with 2.2% for the nonresident group.

Interestingly, the researchers also found that overall 30-day complication rates increased with PGY – the rates were 6% for PGY 1-2, 8% for PGY 3-5, and 9% for PGY of 6 or more.

When they examined specific outcomes and complications between different PGY groups and matched cases without the involvement of residents, they found a similar pattern for the overall cohort.

"The reason for the difference in 30-day complications in the groups was because of differences in complications that were classified as mild, and primarily because the superficial surgical site infections were higher in the PGY 1-2 years, with an increased operative time," they said. The same was true for PGY 3-5 and PGY 6 and greater.

Also, as PGY increased, so did operative time – in both resident and nonresident groups. "This suggests that the reason for the increasing complications with increasing PGY years may have been related to increasing complexity of surgery," said Dr. Kiran.

"One overarching issue seems to be how we might achieve high-quality patient care and delivery of the clinical outcomes in the context of training," said Dr. Clifford Ko, a discussant.

However, he also acknowledged that teaching residents takes time. Dr. Ko, a colorectal surgeon and the director of the Center for Surgical Outcomes and Quality at the University of California, Los Angeles, questioned whether the longer operating time associated with resident involvement should be reduced.

"Although we would not perhaps be able to minimize time differences, I think that we have already achieved some mark of control by the gradation of responsibility over time, as residents continue with their training," Dr. Kiran said.

Although the surgical and mild complication rates were slightly greater, it’s unclear whether these differences are clinically relevant.

"The reasons for [these differences] are likely multifactorial and may be related to prolonged operative time. Considering that more complex cases may be performed in teaching hospitals and require resident participation, ‘resident’ could be a surrogate of severity of disease and intensity of operation – factors that may not be clearly discernible in a retrospective study – and this may explain the differences seen.

"Also, quality measures currently underway to reduce surgical site infections across the board may further minimize any of these differences that may exist," Dr. Kiran concluded.

The authors reported that they had no relevant disclosures.

SAN FRANCISCO – Resident involvement in surgical procedures does not clinically affect surgical outcomes, according to a retrospective study of more than 60,000 cases from the National Surgical Quality Improvement Program database.

"There is a small – although questionable as clinically relevant – overall increase in mild and surgical complications. This is mostly caused by superficial wound infections when residents participate in surgical procedures," said Dr. P. Ravi Kiran, staff surgeon and head of the research section in the department of colorectal surgery at the Cleveland Clinic.

Using data from the National Surgical Quality Improvement Program database from 2005 to 2007, Dr. Kiran and his colleagues compared outcomes for patients who underwent surgery with and without resident participation.

The database, which includes data from pre-, intra-, and postoperative phases, uses clearly defined parameters and specialist nurse reviewers. It also includes resident participation and a morbidity probability, which offers an opportunity to use preoperative factors to stratify risk within subgroups, Dr. Kiran said at the annual meeting of the American Surgical Association.

Resident cases were matched with nonresident cases on the basis of age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors. Primary outcomes included 30-day mortality and postoperative complications (mild vs. severe, and surgical vs. medical). Secondary outcomes included the duration of surgery and length of hospital stay.

Mild complications included superficial surgical site infections (SSIs), peripheral nerve injury, urinary tract infection, deep venous thrombosis, and thrombophlebitis. Severe complications included deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, reoperation, pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, and sepsis.

Surgical complications included superficial SSI, deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, peripheral nerve injury, and reoperation. Medical complications included pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, sepsis, urinary tract infection, deep vein thrombosis, and thrombophlebitis.

For cases with resident vs. nonresident participation, the surgical complication rates were 7% and 6.2%, respectively – a significant difference – and mild complications rates were 4.4% and 3.5%, respectively. In addition, the mean operative time was significantly greater for cases involving residents – 122 vs. 97 minutes. The length of postoperative hospital stay was not significantly longer in the resident group.

The researchers identified 40,474 patients in the resident group and 20,237 patients in the nonresident group. The two groups were similar in terms of median age (50 years), sex (67% female), mean morbidity probability (0.09), American Society of Anesthesiologists classification, and presence of diabetes (6.4%) and hypertension (35%).

The groups were also similar in terms of presence of chronic obstructive pulmonary disease (0.27%), congestive heart failure or myocardial infarction in the past 6 months (0%), dialysis (0.044%), and preoperative sepsis (0.035%). Surgeons’ speciality areas were likewise similar for the two groups (general, 93%; vascular, 6%; and other, 1.36%).

Postgraduate year (PGY) 1-2 residents participated in 31% of operations, PGY 3-5 residents participated in 56%, and residents in PGY 6 or higher participated in 13% of cases.

The 10 most common surgical procedures were laparoscopic appendectomy, laparoscopic gastric bypass, laparoscopic cholecystectomy with and without operative cholangiogram, open appendectomy (nonruptured), thromboendarterectomy, colectomy (partial with anastomosis), laparoscopic colectomy (partial with anastomosis), ventral hernia repair, and placement of gastric band. These procedures were similar in terms of the percentages of resident and nonresident participation.

"We found that there was no difference in the [overall] 30-day mortality between the groups – 0.18% in the resident group and 0.20% in the no-resident group," said Dr. Kiran. However, any 30-day complications were 7.5% in the resident group and 6.7% in the nonresident group, a significant difference.

"When we further looked at the surgical complications, we noted that the cause of the difference in surgical complications between the two groups was the higher rate of SSIs in the resident group, when compared with the no-resident group ... the other surgical complications were similar," he said. The SSI rate was 3.0% for the resident group, compared with 2.2% for the nonresident group.

Interestingly, the researchers also found that overall 30-day complication rates increased with PGY – the rates were 6% for PGY 1-2, 8% for PGY 3-5, and 9% for PGY of 6 or more.

When they examined specific outcomes and complications between different PGY groups and matched cases without the involvement of residents, they found a similar pattern for the overall cohort.

"The reason for the difference in 30-day complications in the groups was because of differences in complications that were classified as mild, and primarily because the superficial surgical site infections were higher in the PGY 1-2 years, with an increased operative time," they said. The same was true for PGY 3-5 and PGY 6 and greater.

Also, as PGY increased, so did operative time – in both resident and nonresident groups. "This suggests that the reason for the increasing complications with increasing PGY years may have been related to increasing complexity of surgery," said Dr. Kiran.

"One overarching issue seems to be how we might achieve high-quality patient care and delivery of the clinical outcomes in the context of training," said Dr. Clifford Ko, a discussant.

However, he also acknowledged that teaching residents takes time. Dr. Ko, a colorectal surgeon and the director of the Center for Surgical Outcomes and Quality at the University of California, Los Angeles, questioned whether the longer operating time associated with resident involvement should be reduced.

"Although we would not perhaps be able to minimize time differences, I think that we have already achieved some mark of control by the gradation of responsibility over time, as residents continue with their training," Dr. Kiran said.

Although the surgical and mild complication rates were slightly greater, it’s unclear whether these differences are clinically relevant.

"The reasons for [these differences] are likely multifactorial and may be related to prolonged operative time. Considering that more complex cases may be performed in teaching hospitals and require resident participation, ‘resident’ could be a surrogate of severity of disease and intensity of operation – factors that may not be clearly discernible in a retrospective study – and this may explain the differences seen.

"Also, quality measures currently underway to reduce surgical site infections across the board may further minimize any of these differences that may exist," Dr. Kiran concluded.

The authors reported that they had no relevant disclosures.

SAN FRANCISCO – Resident involvement in surgical procedures does not clinically affect surgical outcomes, according to a retrospective study of more than 60,000 cases from the National Surgical Quality Improvement Program database.

"There is a small – although questionable as clinically relevant – overall increase in mild and surgical complications. This is mostly caused by superficial wound infections when residents participate in surgical procedures," said Dr. P. Ravi Kiran, staff surgeon and head of the research section in the department of colorectal surgery at the Cleveland Clinic.

Using data from the National Surgical Quality Improvement Program database from 2005 to 2007, Dr. Kiran and his colleagues compared outcomes for patients who underwent surgery with and without resident participation.

The database, which includes data from pre-, intra-, and postoperative phases, uses clearly defined parameters and specialist nurse reviewers. It also includes resident participation and a morbidity probability, which offers an opportunity to use preoperative factors to stratify risk within subgroups, Dr. Kiran said at the annual meeting of the American Surgical Association.

Resident cases were matched with nonresident cases on the basis of age, sex, specialty, surgical procedure, morbidity probability, and important comorbidities and risk factors. Primary outcomes included 30-day mortality and postoperative complications (mild vs. severe, and surgical vs. medical). Secondary outcomes included the duration of surgery and length of hospital stay.

Mild complications included superficial surgical site infections (SSIs), peripheral nerve injury, urinary tract infection, deep venous thrombosis, and thrombophlebitis. Severe complications included deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, reoperation, pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, and sepsis.

Surgical complications included superficial SSI, deep (organ) SSI, wound disruption, bleeding requiring transfusion, failure of graft or prosthesis, peripheral nerve injury, and reoperation. Medical complications included pneumonia, pulmonary embolism, acute renal failure, stroke, myocardial infarction, sepsis, urinary tract infection, deep vein thrombosis, and thrombophlebitis.

For cases with resident vs. nonresident participation, the surgical complication rates were 7% and 6.2%, respectively – a significant difference – and mild complications rates were 4.4% and 3.5%, respectively. In addition, the mean operative time was significantly greater for cases involving residents – 122 vs. 97 minutes. The length of postoperative hospital stay was not significantly longer in the resident group.

The researchers identified 40,474 patients in the resident group and 20,237 patients in the nonresident group. The two groups were similar in terms of median age (50 years), sex (67% female), mean morbidity probability (0.09), American Society of Anesthesiologists classification, and presence of diabetes (6.4%) and hypertension (35%).

The groups were also similar in terms of presence of chronic obstructive pulmonary disease (0.27%), congestive heart failure or myocardial infarction in the past 6 months (0%), dialysis (0.044%), and preoperative sepsis (0.035%). Surgeons’ speciality areas were likewise similar for the two groups (general, 93%; vascular, 6%; and other, 1.36%).

Postgraduate year (PGY) 1-2 residents participated in 31% of operations, PGY 3-5 residents participated in 56%, and residents in PGY 6 or higher participated in 13% of cases.

The 10 most common surgical procedures were laparoscopic appendectomy, laparoscopic gastric bypass, laparoscopic cholecystectomy with and without operative cholangiogram, open appendectomy (nonruptured), thromboendarterectomy, colectomy (partial with anastomosis), laparoscopic colectomy (partial with anastomosis), ventral hernia repair, and placement of gastric band. These procedures were similar in terms of the percentages of resident and nonresident participation.

"We found that there was no difference in the [overall] 30-day mortality between the groups – 0.18% in the resident group and 0.20% in the no-resident group," said Dr. Kiran. However, any 30-day complications were 7.5% in the resident group and 6.7% in the nonresident group, a significant difference.

"When we further looked at the surgical complications, we noted that the cause of the difference in surgical complications between the two groups was the higher rate of SSIs in the resident group, when compared with the no-resident group ... the other surgical complications were similar," he said. The SSI rate was 3.0% for the resident group, compared with 2.2% for the nonresident group.

Interestingly, the researchers also found that overall 30-day complication rates increased with PGY – the rates were 6% for PGY 1-2, 8% for PGY 3-5, and 9% for PGY of 6 or more.

When they examined specific outcomes and complications between different PGY groups and matched cases without the involvement of residents, they found a similar pattern for the overall cohort.

"The reason for the difference in 30-day complications in the groups was because of differences in complications that were classified as mild, and primarily because the superficial surgical site infections were higher in the PGY 1-2 years, with an increased operative time," they said. The same was true for PGY 3-5 and PGY 6 and greater.

Also, as PGY increased, so did operative time – in both resident and nonresident groups. "This suggests that the reason for the increasing complications with increasing PGY years may have been related to increasing complexity of surgery," said Dr. Kiran.

"One overarching issue seems to be how we might achieve high-quality patient care and delivery of the clinical outcomes in the context of training," said Dr. Clifford Ko, a discussant.

However, he also acknowledged that teaching residents takes time. Dr. Ko, a colorectal surgeon and the director of the Center for Surgical Outcomes and Quality at the University of California, Los Angeles, questioned whether the longer operating time associated with resident involvement should be reduced.

"Although we would not perhaps be able to minimize time differences, I think that we have already achieved some mark of control by the gradation of responsibility over time, as residents continue with their training," Dr. Kiran said.

Although the surgical and mild complication rates were slightly greater, it’s unclear whether these differences are clinically relevant.

"The reasons for [these differences] are likely multifactorial and may be related to prolonged operative time. Considering that more complex cases may be performed in teaching hospitals and require resident participation, ‘resident’ could be a surrogate of severity of disease and intensity of operation – factors that may not be clearly discernible in a retrospective study – and this may explain the differences seen.

"Also, quality measures currently underway to reduce surgical site infections across the board may further minimize any of these differences that may exist," Dr. Kiran concluded.

The authors reported that they had no relevant disclosures.

This year’s 92nd Annual Meeting of The American Association for Thoracic Surgery (AATS) reemphasized a bright horizon for thoracic surgery trainees. The consensus amongst trainees is that there is a markedly improved job market and that the professions commitment toward innovation, cutting edge technology, and excellence has rejuvenated spirits.

The AATS annual meeting highlighted this drive toward technologic innovation with minimally invasive cardiac and thoracic surgery, transcatheter aortic valve, endovascular thoracic aortic stenting, and mechanical circulatory support for heart and lung being emphasized.

The Thoracic Surgery Resident’s Association (TSRA), which represents thoracic surgery residents across the nation, presented Dr. Hiroo Takayama from Columbia University with the 2012 Dwight C. McGoon Award. The McGoon award recognizes a distinguished young faculty member in cardiothoracic surgery with an outstanding commitment to resident education and mentorship.

The outgoing leadership of the TSRA, Dr. Jason Williams (President) from Duke University, Dr. Stephen McKellar (Vice President) from Mayo Clinic in Rochester, Minn., and Dr. Tom Nguyen from Columbia University are to be commended for their hard work and enthusiasm in promoting trainee issues, stimulating trainee recruitment, and interest in thoracic surgery.

At this year’s AATS meeting, the TSRA organized and hosted the first annual Spouse Support Network Mixer. Approximately 25-30 residents and spouses attended the successful event, and the Thoracic Surgery Directors Association has agreed to support future resident and spouse events.

The TSRA/AATS Residents’ Luncheon featured a keynote address by Dr. John Calhoon, Professor and Chairman of the Department of Cardiothoracic Surgery at the University of Texas Health Sciences Center in San Antonio. Dr. Calhoon commented on the importance of being prepared for the written and oral board exams.

In addition, Dr. Calhoon focused his talk on the complex nuances and need to create a balance of professional and personal development as trainees transition into their practice as cardiothoracic surgeons.

Over 3,200 copies of the TSRA Review of Cardiothoracic Surgery have been distributed internationally.

This useful book is a vademicum of cardiothoracic surgery knowledge.

The next educational project that the TSRA will undertake is a Primer of Cardiothoracic Surgery. The primer project, headed by Dr. Sam Youssef, will be a complementary book to augment the TSDA Boot Camp intended to ease the transition into thoracic residency.

There has been unprecedented interest in thoracic surgery resident leadership with 32 applicants for vacant positions on the TSRA Executive Committee.

The TSRA is committed to integrating newer training pathway residents. An ongoing dialogue of the role of faculty, traditional residents, and integrated residents as I-6 programs progress will be emphasized as general surgery residents and medical students are introduced to the field of cardiothoracic surgery.

Dr. Bryan A. Whitson is a resident editor of Thoracic Surgery News and a Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota.

This year’s 92nd Annual Meeting of The American Association for Thoracic Surgery (AATS) reemphasized a bright horizon for thoracic surgery trainees. The consensus amongst trainees is that there is a markedly improved job market and that the professions commitment toward innovation, cutting edge technology, and excellence has rejuvenated spirits.

The AATS annual meeting highlighted this drive toward technologic innovation with minimally invasive cardiac and thoracic surgery, transcatheter aortic valve, endovascular thoracic aortic stenting, and mechanical circulatory support for heart and lung being emphasized.

The Thoracic Surgery Resident’s Association (TSRA), which represents thoracic surgery residents across the nation, presented Dr. Hiroo Takayama from Columbia University with the 2012 Dwight C. McGoon Award. The McGoon award recognizes a distinguished young faculty member in cardiothoracic surgery with an outstanding commitment to resident education and mentorship.

The outgoing leadership of the TSRA, Dr. Jason Williams (President) from Duke University, Dr. Stephen McKellar (Vice President) from Mayo Clinic in Rochester, Minn., and Dr. Tom Nguyen from Columbia University are to be commended for their hard work and enthusiasm in promoting trainee issues, stimulating trainee recruitment, and interest in thoracic surgery.

At this year’s AATS meeting, the TSRA organized and hosted the first annual Spouse Support Network Mixer. Approximately 25-30 residents and spouses attended the successful event, and the Thoracic Surgery Directors Association has agreed to support future resident and spouse events.

The TSRA/AATS Residents’ Luncheon featured a keynote address by Dr. John Calhoon, Professor and Chairman of the Department of Cardiothoracic Surgery at the University of Texas Health Sciences Center in San Antonio. Dr. Calhoon commented on the importance of being prepared for the written and oral board exams.

In addition, Dr. Calhoon focused his talk on the complex nuances and need to create a balance of professional and personal development as trainees transition into their practice as cardiothoracic surgeons.

Over 3,200 copies of the TSRA Review of Cardiothoracic Surgery have been distributed internationally.

This useful book is a vademicum of cardiothoracic surgery knowledge.

The next educational project that the TSRA will undertake is a Primer of Cardiothoracic Surgery. The primer project, headed by Dr. Sam Youssef, will be a complementary book to augment the TSDA Boot Camp intended to ease the transition into thoracic residency.

There has been unprecedented interest in thoracic surgery resident leadership with 32 applicants for vacant positions on the TSRA Executive Committee.

The TSRA is committed to integrating newer training pathway residents. An ongoing dialogue of the role of faculty, traditional residents, and integrated residents as I-6 programs progress will be emphasized as general surgery residents and medical students are introduced to the field of cardiothoracic surgery.

Dr. Bryan A. Whitson is a resident editor of Thoracic Surgery News and a Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota.

This year’s 92nd Annual Meeting of The American Association for Thoracic Surgery (AATS) reemphasized a bright horizon for thoracic surgery trainees. The consensus amongst trainees is that there is a markedly improved job market and that the professions commitment toward innovation, cutting edge technology, and excellence has rejuvenated spirits.

The AATS annual meeting highlighted this drive toward technologic innovation with minimally invasive cardiac and thoracic surgery, transcatheter aortic valve, endovascular thoracic aortic stenting, and mechanical circulatory support for heart and lung being emphasized.

The Thoracic Surgery Resident’s Association (TSRA), which represents thoracic surgery residents across the nation, presented Dr. Hiroo Takayama from Columbia University with the 2012 Dwight C. McGoon Award. The McGoon award recognizes a distinguished young faculty member in cardiothoracic surgery with an outstanding commitment to resident education and mentorship.

The outgoing leadership of the TSRA, Dr. Jason Williams (President) from Duke University, Dr. Stephen McKellar (Vice President) from Mayo Clinic in Rochester, Minn., and Dr. Tom Nguyen from Columbia University are to be commended for their hard work and enthusiasm in promoting trainee issues, stimulating trainee recruitment, and interest in thoracic surgery.

At this year’s AATS meeting, the TSRA organized and hosted the first annual Spouse Support Network Mixer. Approximately 25-30 residents and spouses attended the successful event, and the Thoracic Surgery Directors Association has agreed to support future resident and spouse events.

The TSRA/AATS Residents’ Luncheon featured a keynote address by Dr. John Calhoon, Professor and Chairman of the Department of Cardiothoracic Surgery at the University of Texas Health Sciences Center in San Antonio. Dr. Calhoon commented on the importance of being prepared for the written and oral board exams.

In addition, Dr. Calhoon focused his talk on the complex nuances and need to create a balance of professional and personal development as trainees transition into their practice as cardiothoracic surgeons.

Over 3,200 copies of the TSRA Review of Cardiothoracic Surgery have been distributed internationally.

This useful book is a vademicum of cardiothoracic surgery knowledge.

The next educational project that the TSRA will undertake is a Primer of Cardiothoracic Surgery. The primer project, headed by Dr. Sam Youssef, will be a complementary book to augment the TSDA Boot Camp intended to ease the transition into thoracic residency.

There has been unprecedented interest in thoracic surgery resident leadership with 32 applicants for vacant positions on the TSRA Executive Committee.

The TSRA is committed to integrating newer training pathway residents. An ongoing dialogue of the role of faculty, traditional residents, and integrated residents as I-6 programs progress will be emphasized as general surgery residents and medical students are introduced to the field of cardiothoracic surgery.

Dr. Bryan A. Whitson is a resident editor of Thoracic Surgery News and a Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota.

The role of a coach is to provide objective and constructive feedback on what he or she observes, helping the practitioner to recognize what is successful and what can be improved. Coaches do not judge or instruct; instead, they guide and facilitate. They act as collaborators and partners to assist in developing a better understanding of their own performance, and they help them to use their experience, knowledge, and abilities to provide the best care possible (Nursing Standard 2009;23:48-55). The focus should always be on the surgeon and not what the coach would do in a similar situation.

Coaching can be valuable for surgeons at all stages of their career (J. Am. Coll. Surg. 2012;214:115-24). It is easy to imagine the role of a coach in smoothing the increasingly jarring transition from training to independent practice. But experience in other areas suggests that established practitioners can also benefit.

As one develops expertise, actions become more automated and more experienced practitioners spend less time examining their approaches and actions (Fitts, P.M.; Posner, M.I.; Human Performance. Brooks/Cole Publishing Co.: Belmont, Calif., 1967; Work 2006;26:93-6). A coach can serve as a catalyst to jump-start introspection and further practice improvement.

The Importance of Adult Learning Theory

Until recently, medical education has not encompassed the proven principles by which adults learn. In 2007, Boonyasai and colleagues developed a list of adult learning principles based on major educational theories that could be applied in medicine (JAMA 2007;298:1023-37):

• Enabling adult learners to be active participants.
• Providing content relating to the learner’s current experiences.
• Assessing learners’ needs and tailoring teaching to their past experience.
• Allowing learners to identify and pursue their own learning goals.
• Allowing learners to practice their learning.
• Supporting learners during self-directed learning.
• Providing feedback to learners.
• Facilitating learner self-reflection.
• Role-modeling behaviors.

A coaching program would almost by definition include at least the first eight principles, so this list is likely to be an effective approach for improving performance.

What Makes a Good Coach?

The best athletic coaches were not always the standout athletes. They did, however, almost always participate in the sport they coach at a very high level. This is because the characteristics of a good athletic coach to do not necessarily parallel the characteristics of a good athlete, but an intimate knowledge of the skill set is critical.

Similarly, the most experienced and skilled surgeons will not necessarily make the best coaches, but a surgical coach by definition must be a surgeon. A surgical coach must develop an easy rapport and a trusting relationship with each surgeon. The coach must be empathetic and tactful, but also flexible – able to ask probing questions and make constructive comments (Consult. Psychol. J. Pract. Res.;2001;53:240-50). The best surgical coaches are likely to be experienced, thoughtful, inquisitive, nonjudgmental, and well respected by their colleagues.

The coach described by Atul Gawande in "Personal Best," his article on surgical coaching, embodied all of those qualities and excelled as a surgical coach (Gawande A. Personal Best. Top Athletes and Singers Have Coaches. Should You? New Yorker Oct. 3, 2011). When we questioned him about his deftness in this new role, he credited the light hand (socially) that he developed from years of intraoperative consults.

Coaches need time and flexibility in their schedule. For this reason, surgeons who are nearing retirement or who are newly retired may be good candidates to serve as coaches. Many of these surgeons are likely to have the experience and respect required for surgical coaching. The key is to ensure that they also have the flexibility, openness, and lack of judgment.

Another potential pool of coaches may be surgeons interested in a more flexible lifestyle for personal reasons, such as childrearing or caregiving for an ill or elderly family member. Surgical coaching can provide a way to remain engaged in surgery and continue to contribute to the field without the same demands as a busy surgical practice.

Some Basic Principles

Jim Knight has developed a paradigm that he terms "partnership learning" to coach teachers (Knight, J. Instructional Coaching: A Partnership Approach to Improving Instruction. Corwin Press: Thousand Oaks, Calif., 2007). He contrasts this with the "dominator approach" upon which most traditional professional development is based – for example, the situation in which a person gives a PowerPoint presentation to convey an "expert opinion" to a roomful of people. Sound familiar?

Instead, Mr. Knight advocates the use of core principles that will foster a partnership, the cornerstone of coaching (Knight, J. Partnership Learning. University of Kansas Center for Research on Learning: Lawrence, Kan., 2002). Here are some ways they could apply to surgical coaching:

1. Equality – The opinions and approaches of the surgeon and the surgical coach are equally valuable.
2. Choice – At a minimum, the surgeon should be allowed to choose the specific case and setting for each coaching session.
3. Voice and dialogue – The surgeon should feel free to speak openly. Coaches should listen more than they talk. The coach should not control or dominate the interaction, but rather engage in a dialogue.
4. Reflection – "Reflection on action" after an operation is likely to be more effective than "reflection in action" in the operating room so that the surgeon can concentrate fully on dissecting his or her own performance. In addition, coaching sessions can take place in a private, confidential setting away from patients and other providers. The use of video as a "thinking device" to prompt open dialogue holds significant promise.
5. Praxis – Surgeons should be encouraged to explicitly think about how they will apply insights from the coaching session to their clinical practice.

Three other points deserve mention. Confidentiality and trust are critical, especially as surgeons acclimate to the idea of working with a coach. Additionally, the coaching style should be individualized and adapted to each surgeon throughout a coaching session. Such adaptability is an important characteristic of a successful coach. Finally, coaches should not have administrative oversight for the surgeon they are coaching. This is to ensure that the content of coaching sessions remain focused on performance improvement and not on performance evaluations or career development.

Will It Work?

There are very little empirical data on coaching in any discipline. What does exist tends to be exploratory and qualitative. However, Cornett and Knight describe several randomized trials, and a review in the field of education suggests that coaching will be successful (Cornett, J.; Knight, J. Research on Coaching:Approaches and Perspectives, 2009;192-216).

Researchers found that only 10% of teachers used a new skill in the classroom when they were provided with a verbal description. After modeling, practice, and feedback were added, the rate of adoption increased to 19%. It was only with the addition of peer coaching that an astounding 95% of teachers utilized the new skill. (Bush, R. N. Effective Staff Development in Making Our Schools More Effective: Proceedings of Three State Conferences. Far West Laboratories: San Francisco, 1984).

Other studies demonstrated that coaching increased skill transfer from 15% to 75%, compared with traditional approaches to professional development. Even more striking was the fact that these skills were still being used 6 months later. If we are even half as successful with coaching in surgery, results will be orders of magnitude better than any previous attempts at intraoperative performance improvement.

How Do We Move Forward?

The American College of Surgeons Division of Education – with its dedication to improving quality, safety, and education – is in a particularly strong position to develop surgical coaching and is exploring potential programs with us in Wisconsin and with others. Other surgical societies, including local and regional organizations, offer another opportunity to develop coaching programs. The state chapters of the American Academy of Pediatrics instituted a quality improvement initiative that included team coaching, and found several advantages to this approach over a national one (J. Contin. Educ. Health Profess. 2008;28:131-9).

Trust in, familiarity with, and participation in local/regional societies or state chapters is likely to increase acceptance and participation by practicing surgeons. The infrastructure of a regional society allows for participation across all practice settings – not just in large hospitals where a coach may be locally available – yet it is small enough to afford some level of familiarity, trust, and respect for the coach.

This type of cross-institutional collaboration may seem counterintuitive in light of the traditional competitive relationships of neighboring institutions; however, the success of programs such as the Surgical Care and Outcomes Assessment Program (SCOAP) in Washington State and the Michigan Surgical Collaboratives (MSQC and MSBC) suggests that as a discipline we are ready to work together to improve the quality and safety of surgical care.

Given the current paucity of data, we must continue to study any new programs or interventions, but surgical coaching seems like an idea whose time has come.

Acknowledgments

I would like to thank Atul Gawande, Yue-Yung Hu, Robert Osteen, and Michael Zinner for conversations and research that helped me formulate these ideas.☐

Dr. Greenberg is an associate professor of surgery, and director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

The role of a coach is to provide objective and constructive feedback on what he or she observes, helping the practitioner to recognize what is successful and what can be improved. Coaches do not judge or instruct; instead, they guide and facilitate. They act as collaborators and partners to assist in developing a better understanding of their own performance, and they help them to use their experience, knowledge, and abilities to provide the best care possible (Nursing Standard 2009;23:48-55). The focus should always be on the surgeon and not what the coach would do in a similar situation.

Coaching can be valuable for surgeons at all stages of their career (J. Am. Coll. Surg. 2012;214:115-24). It is easy to imagine the role of a coach in smoothing the increasingly jarring transition from training to independent practice. But experience in other areas suggests that established practitioners can also benefit.

As one develops expertise, actions become more automated and more experienced practitioners spend less time examining their approaches and actions (Fitts, P.M.; Posner, M.I.; Human Performance. Brooks/Cole Publishing Co.: Belmont, Calif., 1967; Work 2006;26:93-6). A coach can serve as a catalyst to jump-start introspection and further practice improvement.

The Importance of Adult Learning Theory

Until recently, medical education has not encompassed the proven principles by which adults learn. In 2007, Boonyasai and colleagues developed a list of adult learning principles based on major educational theories that could be applied in medicine (JAMA 2007;298:1023-37):

• Enabling adult learners to be active participants.
• Providing content relating to the learner’s current experiences.
• Assessing learners’ needs and tailoring teaching to their past experience.
• Allowing learners to identify and pursue their own learning goals.
• Allowing learners to practice their learning.
• Supporting learners during self-directed learning.
• Providing feedback to learners.
• Facilitating learner self-reflection.
• Role-modeling behaviors.

A coaching program would almost by definition include at least the first eight principles, so this list is likely to be an effective approach for improving performance.

What Makes a Good Coach?

The best athletic coaches were not always the standout athletes. They did, however, almost always participate in the sport they coach at a very high level. This is because the characteristics of a good athletic coach to do not necessarily parallel the characteristics of a good athlete, but an intimate knowledge of the skill set is critical.

Similarly, the most experienced and skilled surgeons will not necessarily make the best coaches, but a surgical coach by definition must be a surgeon. A surgical coach must develop an easy rapport and a trusting relationship with each surgeon. The coach must be empathetic and tactful, but also flexible – able to ask probing questions and make constructive comments (Consult. Psychol. J. Pract. Res.;2001;53:240-50). The best surgical coaches are likely to be experienced, thoughtful, inquisitive, nonjudgmental, and well respected by their colleagues.

The coach described by Atul Gawande in "Personal Best," his article on surgical coaching, embodied all of those qualities and excelled as a surgical coach (Gawande A. Personal Best. Top Athletes and Singers Have Coaches. Should You? New Yorker Oct. 3, 2011). When we questioned him about his deftness in this new role, he credited the light hand (socially) that he developed from years of intraoperative consults.

Coaches need time and flexibility in their schedule. For this reason, surgeons who are nearing retirement or who are newly retired may be good candidates to serve as coaches. Many of these surgeons are likely to have the experience and respect required for surgical coaching. The key is to ensure that they also have the flexibility, openness, and lack of judgment.

Another potential pool of coaches may be surgeons interested in a more flexible lifestyle for personal reasons, such as childrearing or caregiving for an ill or elderly family member. Surgical coaching can provide a way to remain engaged in surgery and continue to contribute to the field without the same demands as a busy surgical practice.

Some Basic Principles

Jim Knight has developed a paradigm that he terms "partnership learning" to coach teachers (Knight, J. Instructional Coaching: A Partnership Approach to Improving Instruction. Corwin Press: Thousand Oaks, Calif., 2007). He contrasts this with the "dominator approach" upon which most traditional professional development is based – for example, the situation in which a person gives a PowerPoint presentation to convey an "expert opinion" to a roomful of people. Sound familiar?

Instead, Mr. Knight advocates the use of core principles that will foster a partnership, the cornerstone of coaching (Knight, J. Partnership Learning. University of Kansas Center for Research on Learning: Lawrence, Kan., 2002). Here are some ways they could apply to surgical coaching:

1. Equality – The opinions and approaches of the surgeon and the surgical coach are equally valuable.
2. Choice – At a minimum, the surgeon should be allowed to choose the specific case and setting for each coaching session.
3. Voice and dialogue – The surgeon should feel free to speak openly. Coaches should listen more than they talk. The coach should not control or dominate the interaction, but rather engage in a dialogue.
4. Reflection – "Reflection on action" after an operation is likely to be more effective than "reflection in action" in the operating room so that the surgeon can concentrate fully on dissecting his or her own performance. In addition, coaching sessions can take place in a private, confidential setting away from patients and other providers. The use of video as a "thinking device" to prompt open dialogue holds significant promise.
5. Praxis – Surgeons should be encouraged to explicitly think about how they will apply insights from the coaching session to their clinical practice.

Three other points deserve mention. Confidentiality and trust are critical, especially as surgeons acclimate to the idea of working with a coach. Additionally, the coaching style should be individualized and adapted to each surgeon throughout a coaching session. Such adaptability is an important characteristic of a successful coach. Finally, coaches should not have administrative oversight for the surgeon they are coaching. This is to ensure that the content of coaching sessions remain focused on performance improvement and not on performance evaluations or career development.

Will It Work?

There are very little empirical data on coaching in any discipline. What does exist tends to be exploratory and qualitative. However, Cornett and Knight describe several randomized trials, and a review in the field of education suggests that coaching will be successful (Cornett, J.; Knight, J. Research on Coaching:Approaches and Perspectives, 2009;192-216).

Researchers found that only 10% of teachers used a new skill in the classroom when they were provided with a verbal description. After modeling, practice, and feedback were added, the rate of adoption increased to 19%. It was only with the addition of peer coaching that an astounding 95% of teachers utilized the new skill. (Bush, R. N. Effective Staff Development in Making Our Schools More Effective: Proceedings of Three State Conferences. Far West Laboratories: San Francisco, 1984).

Other studies demonstrated that coaching increased skill transfer from 15% to 75%, compared with traditional approaches to professional development. Even more striking was the fact that these skills were still being used 6 months later. If we are even half as successful with coaching in surgery, results will be orders of magnitude better than any previous attempts at intraoperative performance improvement.

How Do We Move Forward?

The American College of Surgeons Division of Education – with its dedication to improving quality, safety, and education – is in a particularly strong position to develop surgical coaching and is exploring potential programs with us in Wisconsin and with others. Other surgical societies, including local and regional organizations, offer another opportunity to develop coaching programs. The state chapters of the American Academy of Pediatrics instituted a quality improvement initiative that included team coaching, and found several advantages to this approach over a national one (J. Contin. Educ. Health Profess. 2008;28:131-9).

Trust in, familiarity with, and participation in local/regional societies or state chapters is likely to increase acceptance and participation by practicing surgeons. The infrastructure of a regional society allows for participation across all practice settings – not just in large hospitals where a coach may be locally available – yet it is small enough to afford some level of familiarity, trust, and respect for the coach.

This type of cross-institutional collaboration may seem counterintuitive in light of the traditional competitive relationships of neighboring institutions; however, the success of programs such as the Surgical Care and Outcomes Assessment Program (SCOAP) in Washington State and the Michigan Surgical Collaboratives (MSQC and MSBC) suggests that as a discipline we are ready to work together to improve the quality and safety of surgical care.

Given the current paucity of data, we must continue to study any new programs or interventions, but surgical coaching seems like an idea whose time has come.

Acknowledgments

I would like to thank Atul Gawande, Yue-Yung Hu, Robert Osteen, and Michael Zinner for conversations and research that helped me formulate these ideas.☐

Dr. Greenberg is an associate professor of surgery, and director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

The role of a coach is to provide objective and constructive feedback on what he or she observes, helping the practitioner to recognize what is successful and what can be improved. Coaches do not judge or instruct; instead, they guide and facilitate. They act as collaborators and partners to assist in developing a better understanding of their own performance, and they help them to use their experience, knowledge, and abilities to provide the best care possible (Nursing Standard 2009;23:48-55). The focus should always be on the surgeon and not what the coach would do in a similar situation.

Coaching can be valuable for surgeons at all stages of their career (J. Am. Coll. Surg. 2012;214:115-24). It is easy to imagine the role of a coach in smoothing the increasingly jarring transition from training to independent practice. But experience in other areas suggests that established practitioners can also benefit.

As one develops expertise, actions become more automated and more experienced practitioners spend less time examining their approaches and actions (Fitts, P.M.; Posner, M.I.; Human Performance. Brooks/Cole Publishing Co.: Belmont, Calif., 1967; Work 2006;26:93-6). A coach can serve as a catalyst to jump-start introspection and further practice improvement.

The Importance of Adult Learning Theory

Until recently, medical education has not encompassed the proven principles by which adults learn. In 2007, Boonyasai and colleagues developed a list of adult learning principles based on major educational theories that could be applied in medicine (JAMA 2007;298:1023-37):

• Enabling adult learners to be active participants.
• Providing content relating to the learner’s current experiences.
• Assessing learners’ needs and tailoring teaching to their past experience.
• Allowing learners to identify and pursue their own learning goals.
• Allowing learners to practice their learning.
• Supporting learners during self-directed learning.
• Providing feedback to learners.
• Facilitating learner self-reflection.
• Role-modeling behaviors.

A coaching program would almost by definition include at least the first eight principles, so this list is likely to be an effective approach for improving performance.

What Makes a Good Coach?

The best athletic coaches were not always the standout athletes. They did, however, almost always participate in the sport they coach at a very high level. This is because the characteristics of a good athletic coach to do not necessarily parallel the characteristics of a good athlete, but an intimate knowledge of the skill set is critical.

Similarly, the most experienced and skilled surgeons will not necessarily make the best coaches, but a surgical coach by definition must be a surgeon. A surgical coach must develop an easy rapport and a trusting relationship with each surgeon. The coach must be empathetic and tactful, but also flexible – able to ask probing questions and make constructive comments (Consult. Psychol. J. Pract. Res.;2001;53:240-50). The best surgical coaches are likely to be experienced, thoughtful, inquisitive, nonjudgmental, and well respected by their colleagues.

The coach described by Atul Gawande in "Personal Best," his article on surgical coaching, embodied all of those qualities and excelled as a surgical coach (Gawande A. Personal Best. Top Athletes and Singers Have Coaches. Should You? New Yorker Oct. 3, 2011). When we questioned him about his deftness in this new role, he credited the light hand (socially) that he developed from years of intraoperative consults.

Coaches need time and flexibility in their schedule. For this reason, surgeons who are nearing retirement or who are newly retired may be good candidates to serve as coaches. Many of these surgeons are likely to have the experience and respect required for surgical coaching. The key is to ensure that they also have the flexibility, openness, and lack of judgment.

Another potential pool of coaches may be surgeons interested in a more flexible lifestyle for personal reasons, such as childrearing or caregiving for an ill or elderly family member. Surgical coaching can provide a way to remain engaged in surgery and continue to contribute to the field without the same demands as a busy surgical practice.

Some Basic Principles

Jim Knight has developed a paradigm that he terms "partnership learning" to coach teachers (Knight, J. Instructional Coaching: A Partnership Approach to Improving Instruction. Corwin Press: Thousand Oaks, Calif., 2007). He contrasts this with the "dominator approach" upon which most traditional professional development is based – for example, the situation in which a person gives a PowerPoint presentation to convey an "expert opinion" to a roomful of people. Sound familiar?

Instead, Mr. Knight advocates the use of core principles that will foster a partnership, the cornerstone of coaching (Knight, J. Partnership Learning. University of Kansas Center for Research on Learning: Lawrence, Kan., 2002). Here are some ways they could apply to surgical coaching:

1. Equality – The opinions and approaches of the surgeon and the surgical coach are equally valuable.
2. Choice – At a minimum, the surgeon should be allowed to choose the specific case and setting for each coaching session.
3. Voice and dialogue – The surgeon should feel free to speak openly. Coaches should listen more than they talk. The coach should not control or dominate the interaction, but rather engage in a dialogue.
4. Reflection – "Reflection on action" after an operation is likely to be more effective than "reflection in action" in the operating room so that the surgeon can concentrate fully on dissecting his or her own performance. In addition, coaching sessions can take place in a private, confidential setting away from patients and other providers. The use of video as a "thinking device" to prompt open dialogue holds significant promise.
5. Praxis – Surgeons should be encouraged to explicitly think about how they will apply insights from the coaching session to their clinical practice.

Three other points deserve mention. Confidentiality and trust are critical, especially as surgeons acclimate to the idea of working with a coach. Additionally, the coaching style should be individualized and adapted to each surgeon throughout a coaching session. Such adaptability is an important characteristic of a successful coach. Finally, coaches should not have administrative oversight for the surgeon they are coaching. This is to ensure that the content of coaching sessions remain focused on performance improvement and not on performance evaluations or career development.

Will It Work?

There are very little empirical data on coaching in any discipline. What does exist tends to be exploratory and qualitative. However, Cornett and Knight describe several randomized trials, and a review in the field of education suggests that coaching will be successful (Cornett, J.; Knight, J. Research on Coaching:Approaches and Perspectives, 2009;192-216).

Researchers found that only 10% of teachers used a new skill in the classroom when they were provided with a verbal description. After modeling, practice, and feedback were added, the rate of adoption increased to 19%. It was only with the addition of peer coaching that an astounding 95% of teachers utilized the new skill. (Bush, R. N. Effective Staff Development in Making Our Schools More Effective: Proceedings of Three State Conferences. Far West Laboratories: San Francisco, 1984).

Other studies demonstrated that coaching increased skill transfer from 15% to 75%, compared with traditional approaches to professional development. Even more striking was the fact that these skills were still being used 6 months later. If we are even half as successful with coaching in surgery, results will be orders of magnitude better than any previous attempts at intraoperative performance improvement.

How Do We Move Forward?

The American College of Surgeons Division of Education – with its dedication to improving quality, safety, and education – is in a particularly strong position to develop surgical coaching and is exploring potential programs with us in Wisconsin and with others. Other surgical societies, including local and regional organizations, offer another opportunity to develop coaching programs. The state chapters of the American Academy of Pediatrics instituted a quality improvement initiative that included team coaching, and found several advantages to this approach over a national one (J. Contin. Educ. Health Profess. 2008;28:131-9).

Trust in, familiarity with, and participation in local/regional societies or state chapters is likely to increase acceptance and participation by practicing surgeons. The infrastructure of a regional society allows for participation across all practice settings – not just in large hospitals where a coach may be locally available – yet it is small enough to afford some level of familiarity, trust, and respect for the coach.

This type of cross-institutional collaboration may seem counterintuitive in light of the traditional competitive relationships of neighboring institutions; however, the success of programs such as the Surgical Care and Outcomes Assessment Program (SCOAP) in Washington State and the Michigan Surgical Collaboratives (MSQC and MSBC) suggests that as a discipline we are ready to work together to improve the quality and safety of surgical care.

Given the current paucity of data, we must continue to study any new programs or interventions, but surgical coaching seems like an idea whose time has come.

Acknowledgments

I would like to thank Atul Gawande, Yue-Yung Hu, Robert Osteen, and Michael Zinner for conversations and research that helped me formulate these ideas.☐

Dr. Greenberg is an associate professor of surgery, and director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org