In this episode, Lillian Erdahl, MD, FACS, is joined by Eilidh Gunn, MBChB MRCSEd, from the Surgical Sabermetrics Laboratory at the University of Edinburgh. They discuss Dr Gunn’s recent article, “What About the Coach? Mixed-Methods Study Assessing the Experience of Coaches in a Peer Surgical Coaching Program.” As peer-led surgical coaching becomes an increasingly popular professional development activity, this study explores the impact of participation on surgeons acting as coaches. Using a concurrent, mixed-methods design, results demonstrate that coaches found participation worthwhile and that it affected their own clinical practice.
Learn more about the SCOPE program here.
Disclosure Information: Drs Gunn and Erdahl have nothing to disclose.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Lillian Erdahl,and throughout this series, Dr Tom
Varghese and I will speak with recentlypublished authors about the motivation
behind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Hello,and welcome back to The Operative Word.
I am your co-host, Lillian Erdahl,and I am joined today by Dr
Eilidh Gunn, who was kind enoughto make things work from across the pond,
to tell us about her research,“What about the coach?”,
(00:47):
which is a mixed-methods study
assessing the experience of coachesin a peer surgical coaching program.
So welcome, Dr Gunn.
I thank you so much for inviting meonto The Operative Word.
It's a great privilege to be here.
Well, we're pleased to have you herefrom the University of Edinburgh.
And, also to hear that you completedyour PhD.
(01:10):
You know, partly, this research was duringthe time that you were completing a PhD
and having a surgeonwith a PhD to really delve
into questions aroundhow to teach surgeons.
I think it's important to have somebodywho kind of understands,
the insidetrack of how it is to train in surgery,
(01:31):
and give us feedback abouthow we might improve surgical training.
I also, wanted to just highlightthat this work was done,
in the Sabermetrics lab run by Dr Yule.
And I had to look up what Sabermetrics is.
So surgical Sabermetrics,
according to the website, is the digitizedmeasurement of surgical performance.
(01:56):
So, you know, it's interestingto really break down
surgeryand think about it from that perspective.
Yeah, it's a great aim that’s true.
Yeah, this is a great collaborationbetween the safer
surgery lab, Ariadne Labs, at Harvardand the Surgical Sabermetrics lab
at the University of Edinburgh,with Professor Yule having a history
(02:16):
at Ariadne labsand the safer surgical group.
before coming over to Scotland.
And I was his PhD student.
So surgical Sabermetrics really tries
to utilize license and performanceanalysis and enhancements
that have been learnedthrough professional sports.
And that can have, you know,there's many tears and I have
(02:37):
many colleagues who started their own PhDsin far more kind of digital
and technical fields of analysisthan Than what we discuss here coaching
and but really what that can mean iseither looking at performance enhancement
through behavioral interventionssuch as coaching,
which is what we're going to discusstoday.
And also looking at, digitizing
(02:59):
that performance and looking at metrics.
So that could involve looking at allsorts of different types of data,
whether that's video, whether that's fromsensors placed on the surgeons body,
and whether it's through teamworkanalysis and combining
psychological techniquesto look at performance, such as, MGT
environmentand really is to try and help maximize
(03:21):
surgeon performance as best can to helpan individual achieve their best.
Yeah, well, and and the benefits,
to surgeons of getting feedback,I think are pretty well-established.
But, I appreciate the,the mindful approach to figuring out
the different types of feedbackthat a surgeon needs and how to get data
(03:41):
about the performanceof both the individual and the team
to really use evidence-basedfeedback and, you know,
mentoring and teaching and coachingkind of all,
require us to have a good understandingof what
the individual needs in order to improve.
And so I really appreciatekind of understanding how do you help
an individual improve and having guidance.
(04:04):
And I think that that is
going to come out a little bit as we hearmore about the coaching program.
So I thought we might start by just sortof talking about the SCOPE project.
And, you know, your research looksat the coaches themselves,
but I think
our audience would like to hear probablya little bit about the coaching project,
just to understand
what the coaches were doingand, you know, understand their mindset.
(04:27):
Thank you so much.
So the SCOPE program was createdback in 2018 by Dr Smink,
and Dr Yule, and with,
Dr Pradarelliwho was a research fellow at the time,
and was designed to create a structuredframework to allow,
you know, a attending level surgeonsto coach themselves.
(04:50):
So a peer level coaching program.
And it was thoughtthat this was very powerful
because especially my understandingis in the United States,
you know,attending surgeons practice autonomously.
And so oftentimes
they're running their own surveys for,you know, multiple decades and doing it,
you know, and they're already expertsin their field right?
They’re already doing an incredible job.
And they're, you know, competent.
(05:13):
But I guess the question was more, abouthow do you continue
to maintain that level of excellence,over the course of your career?
And there was quite a well known article,that was published in The New Yorker
by Atul Gawandethat, asked about that, just described
his experience of having a coachand how it enhanced his technical skills.
(05:34):
And so then based off the back of that,
there was a considerationabout how traditional CME
offers the opportunityto go to courses and conferences.
But how could we integratethe concept of coaching done by
either musicians or sports professionalswithin the operative environment?
And how to make that accessible?
And having that opportunity between peersseemed like an ideal chance, you know,
(05:58):
to have two people within the same fieldand to have their own areas of expertise,
a share and exchange practice,but using a structured framework.
And that's really what SCOPE was,key components where,
you know, you'd have your surgeonsand they'd be in pairs.
Allocation was open betweenthe department, how that would come about.
And then you'd have a allocated coachsurgeon and a coachee surgeon.
(06:21):
The description of the coach surgeonbeing the person that would observe
and then provide feedback and do
constructive analysis, with the coacheebeing the surgeon being observed
and with the opportunityfor them to switch roles.
If that was useful, the SCOPE programbeing having a pre-meeting
with your coach,you know what you want them
to improve or what skillsdo you want to look at?
(06:43):
Things that might be interestingbeyond technical skills?
Could be non-technical skills.
So communication, leadership,
teaching and training those kind of thingswhich are hard to elicit.
Even though you,instinctively as a doctor,
In general, as a surgeon
are practicing those skills, maybe tensif not 100 times in the operation.
(07:03):
So you can discuss that and then you'dhave your period of observation.
Then you would do kind of a paired,
analysis and constructivefeedback of that performance.
Following the observationby the coach surgeon.
And usually outsideof the operating theater at a later time
to allow for like kind of decompressand not have, you know,
(07:24):
and trying to get the patient dischargedand seeing the next patient, you know,
so you could have some cognitive distancefrom that.
And then following that you canthen action plans
to decide,how am I, what am I going to do next?
Or how are we going to do this next.
And you can pick a casethat would reflect those goals again
and then continue that cycle.
Sorry this is quite a long answer.
(07:45):
No, that's a greatthat's a great explanation.
And a lot of thingsthat we put into practice
in early trainingcome to mind when you talk about that.
You know, I think we're buildingon these principles that we use.
But with someone who has already achievedcompetence and,
you know, maybe is looking to achievemastery or determine,
you know, where it is that they need tocontinue to grow and improve.
(08:09):
And for adult
learners, to think about identifyingtheir own learning goals,
but with some, some help and assistancemakes a lot of sense to me.
And of course, you're, you know,all of your work towards your PhD
and thinking about how surgeonslearn and improve,
you know, I think comes into play.
(08:31):
I was also thinking about the,
idea that learning doesn't stop
when you complete residency or fellowship,when you go out on your own,
as you mentioned in the United Stateswe’re very much, sort of
released to be independent surgeonsafter our training.
And I think that there'sbeen a lot of discussion around,
you know, how do you find supportduring that transition time
(08:54):
and how do you find ongoing support?
Because this work is difficultand challenging and,
simply because you understand how to do itand have the technical skills
does not meanthat you stop needing mentorship
and support,or that you stop learning and growing.
Yeah, I think I think that's very true.
And I think that all
training pathways are a little different,or slightly different in the UK.
(09:17):
I think there is the same feeling about
especially early, what we call early yearsconsultants in the UK as well.
That kind of feeling that is lifelong.
And jave, say,you know, Dr Smink himself took part
in the SCOPE programand is really a believer.
And in that kind of lifelonglearning and grow.
But something we discuss in the paper,this concept of growth mindset,
(09:39):
which has been identifiedalso in other kind of
coaching research as well amongstsurgeons, the idea that you can kind
of foster that kind of beliefor that attitude to practice.
Yeah.
And and one of the thingsthat you talked about
is, you know, this is a big timeinvestment for the coaches
and for the hospitals.
mean, you have a, you know, surgeonpeer who's not,
(10:01):
generating clinical work during that time
because they're really focusedon mentoring and training.
And so I think having that that idea
that it's important for our profession,
to continue this
and making that investment,I really appreciate from leaders
like Dr Smink saying, you know,it is important for hospitals to set aside
(10:24):
time for peers to help oneanother continue to grow and improve.
So that the SCOPE program was,
across multiple hospitals and,
you know, over a period of two yearsis kind of the the time period
that you were looking at andyou identified, several potential coaches.
(10:45):
Tell me about the processof kind of identifying the coaches and,
and how you were going to learnabout the coach experience.
Yeah.
So this built upon a workthat had been done by
Dr Pradarelli in his research time and Dr
Trey Sinyard, you knowwas the MPH research fellow
(11:05):
at Ariadne labswho is my co first author on this paper
and really what they had learned is DrPradarelli had managed to expand it
to these eight centerswithin the greater Boston area.
And the
initial feedbackfrom these early iterations of the program
had identified that, you know, maybe both,we initially or most people,
(11:27):
including myself,when I started my own coaching research,
thought that the coachees, you know,would be
the people who would reportthat they benefited from taking part.
Well, that's the hope, isn't it?
You know, that's whythis long coaching program.
But I see
that kind of some of the qualitative datathat have been gathered by Dr Pradarelli
suggest that it was more bidirectionaland actually obviously, incredibly,
(11:50):
they have a massive respectfor Dr Caprice Greenberg,
who is very much like global expertin coaching in surgery, and has published
many wonderful papersand also made done a publication,
that describedthis bi-directional feedback
when they did their ownqualitative analysis of research.
So a lot of coaching work,
(12:12):
and also one of the issues,as you've also described
in your last question,was that some of the feedback
was that the time affordedboth financially and,
you know, with regardsto just physical time, it was quite a lot.
And therefore, recruitment
might be an ongoing challengefor the SCOPE program moving forward.
And also the idea that there wasa potential if the coaches did benefit,
(12:34):
then it would help levelthe playing field, if you will.
You knowthat there was mutual learning for both.
And this was interestingto us in Edinburgh and why we chose to
collaborate together wasI was keen to try and introduce or a trial
doing peer coaching in Edinburghas part of my PhD project,
with a potentialto look at the SCOPE program.
But it was again a question I got askeda lot was that, you know, we'll
(12:57):
surely only half of the, half of the teamis going to benefit from doing this.
So it really went aheadand created some research questions,
which we had a well sharedresearch questions that both Trey and I
had that we’d like to answer.
So my
understanding was that the coaches andpairing was done within the departments
that took part in the program,and that it was done very much, it was a
(13:21):
they were given the autonomy
to be able to decide who is going to coachand who wasn't, though
there is a SCOPE guide that was createdbit try to encourage like,
you know, swapping roles, and also seeingnot always the senior surgeon
being the coach and the junior surgeonbeing the coaches.
They’re, sort of encouraged to like,you know, exchange roles or move against
the more kind of didactic rate...sorry,you can’t see hand movements in a podcast,
(13:46):
but the didactic kind of balancethat you'd expect in senior and junior.
Yeah.
Well, and and again,I think, what I have learned as a teacher
more than anything, a teacher and a mentoris how much I benefit,
personally and how much I learn.
So, so I love the idea of
advancing that culture to say,
(14:08):
you know, it turns outthat, learning is not unidirectional.
It's not top down.
It doesn't follow hierarchiesor anything like that.
But, that actuallyyou can have rich learning that flows,
you know, bidirectional in this casebecause we're talking about a dyad, but,
you know, sort of, up, up and down and,and around a team working together, it's
(14:30):
not always one person teaching anotherby sort of role definition.
That's extremely well put.
And thank you.
Yeah. It's
you know, you can tell why I was excitedto talk to you about this work.
I really enjoyed reading it.
And so once you kind of identifiedyour research question
(14:51):
and then you had to reach out to coaches
and design a way to answer the questions.
So tell me a littlebit about your study design.
Yeah.
So basically we initially decided that,you know, to do this
we would be best placed to try and,you know, reach out
to those surgeonswho had participated as coaches,
(15:13):
in across the multiple centers,in the SCOPE program.
And what we decided to do was,take a mixed methods research approach,
which involvesusing quantitative and qualitative
elements to kind of create,
a kind of a detailed and rich
snapshot of people'sexperiences and opinions.
(15:38):
And it can be usedquite a lot across health care.
But we thought this is specific,really useful because we had, unanswered
questionswhere there was a previous set normal or,
you know, research that demonstratedwhat the coaches had experienced.
So we wanted to explore this,and we felt that we wanted to do
(15:59):
get in depth feedback of doing interviewsbecause it was obviously Covid.
It was done via zoom at that time.
But we also wanted to
try and see if we could get some,you know, metrics.
And we used to just sayand we created, a survey,
questionnaire which was anonymized so thatpeople could feel they could be honest.
(16:19):
And we included in thatthat a Net Promoter score,
which is a kind of a usedwithin business and marketing.
And you say on a score 1 to 10,you know, how much are you, like,
how likely are you to recommend,
you know, in this case the SCOPE programto a friend or colleague.
And so we sent that outto all of the eligible
participantswho who had served as coaches.
(16:41):
And we created the interview guideand also the survey guide
that was with myself,Dr Sinyard, Dr Smink, and Dr Yule.
And we also with regards to the methods
got a insight and expertise from DrEmily Cummins
who is an extremely experiencedmixed methods researcher in health care.
(17:06):
And this really was really vital to usto like elevate things
and also because it's not...thekey is you obviously can gather
your two types of your data, but the real,
expertise that is required is
how do you co-analyze those and likehow you use one to reflect the other.
And there's a lots of different,you know, methodologies
(17:27):
as how to do that with the way in whichyou integrate those data together.
And she was really instrumentalin helping us
do that with our data analysisand look at things with regards to the
categories or concepts that we were able
to identify following that process.
I appreciate you kind of explainingthe importance of having an expert.
(17:49):
I do think that sometimes
qualitative data is seen as somethingthat's not gathered scientifically.
You know, it's been hard.
I think as, as we,
bring these types of analysesinto the surgical literature,
particularly in the realm of education,to gain traction.
(18:09):
And as we were discussingbefore we started recording,
you know, the, the mixed methodsand the qualitative analysis
have a long history of study behind them.
These are not really new methods, but,sometimes they're new to surgeons.
Who have looked more at clinical science
and sort of only, quantitative analysis.
(18:30):
And I was wondering, in doing this,who conducted the interviews
and how do you kind of structureso that when you're doing,
semi-structured interviews, you ensure
that you have consistencyin capturing those data?
So it was my coauthor, Dr Sinyardthat, conducted all of the interviews.
He is obviously,based in the Boston area,
(18:54):
was able to conduct those,and we created an interview guide.
He'd also had trainingand semi-structured interview techniques.
And before undertaking the interviews.
And I think that that he saidthat was particularly helpful.
And having done my own, lateron in my own PhD,
I think it is really helpful to havethese kind of signposts to come back to.
(19:16):
Obviously, you don't want to be too rigidbecause you can get these really rich
elements of experience that come through,and that's part of the benefit
of the mixed methods, structure.
You can really get in depth and,you know, insight into the experiences
in that, you know, in that iterationof the coaching program from participants.
But I think that that was really helpful.
(19:37):
And it was also helpfulwhen we created the guide to have input
from multiple team members,you know, to get different perspectives.
And I think also being mindful of timeand just the person,
the individualwho's donating their time to the research
and making surethat you don't rush things along
but you don't, extend things to as wellis quite important.
(19:59):
From my own experience, which is obviouslynot the same as this study.
Yeah.
So we've talked a lot about the backgroundand hopefully our listeners are still
with us,
but I think it's important to understandthat the context and the approach.
So tell me, what everybody really wantsto hear about, which is the results.
What did you find about the experienceof the coaches?
Okay.
(20:20):
So overall,we didn't have any preconceived numbers.
That was something I should have said.
We didn't have like,
when we did the analysis we didn'tuse, like, a set template or a structure.
And that was because what we're doingwas exploratory.
For all we knew when we were analyzing,it could have come back
that nobody had a good time,and then it wasn't worthwhile,
(20:40):
which is obviously kind ofwas not was the null hypothesis.
So when we looked and,what we did was we were able to create,
these kind of conceptual categories,
which is what we did with regardsto the analysis technique that we used.
But basically what we found were overallis that, you know,
when we're looking at it,is that what we identified were...the
(21:03):
coaches...the first was calledaffective attitude towards participation.
So basically the coachesthat were taking part were motivated.
And were, you know,keen to engage with the coaching process.
And they kind of at least stated eithertheir own, you know, desire for their own
practice enhancement or to contributeto the development of others.
(21:24):
And also like reflection onmaybe how their own career progressed
or things that they would want tobenefit from moving forward.
And then when we actually went in,they said, okay, well, were
are there any benefits or Dr Sinyard said,were there any benefits?
You know, they describedthey actually based on observing their
(21:45):
colleagues, how some of them had listedpractice change.
And this was also identified when welooked at their survey results as well.
And also that they feltthey had improved their teaching skills,
but also a senseof professional fulfillment.
You know, when you have
that idea of helping someone whenever,you know, even myself very well, great.
You know, for you, helpingsomeone develop a skill,
(22:06):
it can be rewarding to see thatand then progressing
the way that they want or learn. Yeah, yeah.
I mean,I think that and those things were quite,
you know, we thought that they were,were what we were hoping for that.
And I think that really it was greatto see that coming out of the interviews,
but also coming out in the questionnaireas well, that people really felt
that their performance had improvedas well as that of the coaches.
(22:30):
I love to see thatobserving their peers,
led to improvements in their own practice.
I can remember myself,you know, being in some surgeries
where two surgeons were presenttwo faculty surgeons especially, you know,
complicated, proceduresin, in highly specialized surgeries.
And, it was amazing to see thatboth surgeons
(22:53):
were typically focused on the same sectionof the operative field.
You know,there's a lot of sort of shared knowledge
and experience that comes acrosswhen they're together, working.
And so, you know,I think the observation at that level,
practice is very different than what,you know, a junior trainee
(23:13):
or even a fellow seeswhen they watch another surgeon.
Yeah.
I think it's like, very much like,I don't know,
I think, well, it'svery much like the art of surgery.
You know, that you're describing,like when it goes,
you know, up to the next level of like,okay, someone does something.
And I think that I have to agree.
And it was great to hear people say, well,they thought about how someone had done,
(23:37):
you know, either non-technical skillor had managed, or even,
you know, logistics, that it was helpfulto see how they'd done that.
And I think that that does showit's those kind of moments
and things that you identify, you know,they're very hard to capture, like,
outside of doing some like coachingor giving or just even by giving someone
(23:57):
the opportunity with a very simple setstructure to get that observation
opportunity as well, whether it's in videoor whether it's in person.
Yeah.
And, you know, I think that
that thinking about all the different waysthat we have continuing learning,
in our careers led you to talk about,
(24:18):
CME, sort of comparing their experiencewith coaching to CME.
What did you find?
So, I mean, obviously we can
you know, discussabout the fact that there is,
you know, potential biasand the responding,
you know, cohort of peoplewho wanted to do interviews with us.
But most people feltthat the when compared
to existing, CME activities that they,
(24:41):
it was they preferredor it was beneficial comparatively.
You know, we feltthis might be because of the fact,
like based on some of their interviewcontent, that,
you know, the acquisition of the knowledgewas immediate or directly
applicable, sorry, applicable to their,their own, operative environment.
There's active
participation,you know, as opposed to passive learning.
(25:04):
You know,you have to be engaged to be a coach
and you have to be engaged as wellto be a coachee equally.
And but then also when that was exploredagain, there were some upsides
and downsides to people saying, well,if you made this official for CME,
then it becomes your more like hurdlebased or objective based.
And is that a benefit or not?
(25:25):
That's maybe for future research.
But yeah, I think it just yeah,I think it's environmental especially,
but also the kind of the focusof coaching itself
might be making it more appealingto some people.
And, and part of what you were looking for
was, you know, is this a valuableuse of the coach's time.
So I thinkwhether it gives you CME credits or not,
(25:48):
having it be valuable learningtime for the coach seems to support it.
That that it's worthcontinuing these programs, which again
I think is is part of the questionor part of the driving,
need to do this research to understandwhether it's really worth
taking so much time to do an activitylike peer coaching.
Well, it's reassuring that,you know, the majority of respondents
(26:12):
did feel like that.
You know, it was worthwhile use of time.
You know, a 15 out of the 19 thought so,
and the net promoter scorealso is reflective of that.
But I think that this leads us very nicelybecause I'm aware of time,
just on the fact that, you know,navigating the logistics of coaching was a
(26:33):
one of the main findings in regardsto barriers, if you will, to participating
in the future.
And, people
often find that, you know, schedulingand time were
a, a big challengeto actually taking part in the sessions.
And some coaches did mention,
you know, financial cost,but felt that the benefit outweighed that.
(26:56):
But I think that, you know, it's somethingthat definitely needs to be considered
for future research as to how to overcomethose barriers to like.
As many people as possible,the opportunity to take part.
Yeah.
Well, and I want to be, careful,how I talk about the effects
on surgical culture because it'sfrom the perspective of the coaches.
(27:17):
And, but I was, thinkingalso about the investment
of the organization in that timeand potentially the cost of it.
And, and the coaches, talkedabout the flattening of the hierarchy
and perhaps increasing the psychologicalsafety for junior team members.
And I wondered if you could divea little bit more into how they thought
(27:37):
this experience achieved that or,you know, led to that culture change.
The I think this was, for me personally,a surprising finding in a way.
Because we had obviously had discussionsand there is some really
there's a great paperthat was written about,
challenging surgical culture by
Burns et al, which is part with CapriceGreenberg as well, looking
(28:02):
at the wider effectof coaching programs on surgical culture,
but basically what we foundis that when we discussed it with them,
they talked about the fact that, you know,everyone could benefit from a coach.
And, you know, one of the participantssaid, you know, they're
everyone is kind of put on an equal basisif they're taking part
(28:22):
in a coaching program and it's,
you know,you're able to give each other feedback.
But also, I think that the other thing isthat, you know, it was kind of
other things that we discussedis also things
that might be challengingthat you are able discuss
with your colleagues with regards to likelogistics or shared experiences or,
(28:45):
maybe more challenging aspectsof the procedure that have been done.
And then with that, you,this may be me just, you know, suggesting,
like talking about, you know, how
they've overcome, you know, operativeor technical challenges and,
and maybe allowsfor that kind of camaraderie that you
might not have another opportunityto get necessarily in another way.
(29:07):
And, you know,
with that kind of structure, although I'msure many people have their colleagues,
maybe they have mentors within their
departments that they can meet withand have, like casual,
you know, coffee or watercoolerkind of conversations in their own time.
But I think that that's maybe
what coaching allows foris that kind of dedicated time.
(29:28):
To work with someonewho has the same challenges
or in the same environment that you areand the coaches have then been able
to identify that as being constructive
and even people whose experiences
weren't ideal in the program still feltit was of value.
As like, I think it was describedas a master class learning experience.
(29:49):
So that was great.
When I read that in the transcript. And
so the master
class, I may be rambling a bit,so please forgive me.
No, I think that there's the workis very rich.
And again, I think that'swhat I appreciate about particularly
the qualitative,
portion of the mixed methods.
And if you'll bear with me,I'm going to read a quote from that
(30:13):
that was in the paper.
One of the surgeons said, “We
have a good culture in our group,but coaching adds to that.
That adds to the fact that I'm therefor you and you're there for me.
And I think it is a big thingthat goes beyond the nuts and bolts
of throwing a suture betteror something like that.
It's just adding to the
culture of support amongst the faculty,which I think is really key.” And,
(30:34):
and I think if we can leave our audiencewith anything, it's the idea
that nobody should do this jobalone, regardless of how much mastery
they have of the technicaland performance aspects of surgery.
And so that that, more than anything, wasthe message that came out of this for me.
We're all lifelong learners.
(30:56):
And, the benefits of having peerswho can help you
continue to grow and learnreally came through in this paper.
I think that, that's a great summary.
And it's, I'm really gratefulthat that’s the message that we were able
to convey as a research team,when we were putting together, this work.
Well, thank you, Dr Gunn.
(31:16):
I hope that our listeners will considercoaching.
That was again a message from the paper.
Many of the coaches wished that they hadhad that experience early in their career.
And, so as we continue to look
at the SCOPE projector other opportunities for coaching,
I, you know,I hope that people will consider it.
Yeah, it's great.
(31:37):
And, you know, you can still sign up,you know, get access to the materials
if anyone is interested.
And I can forward a link onif people would like to learn more
about the SCOPE program.
And I’d also like to thank Dr Erdahland JACS
for having me todayand for accepting our research paper.
Thank you for listening
(31:58):
to the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
by using the hashtag #JACSOperativeWord.
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at facs.org/podcast.
You are listening to The Operative Word,
a podcast brought to you by the Journalof the American College of Surgeons.
I'm Dr Lillian Erdahl,and throughout this series, Dr Tom
Varghese and I will speak with recentlypublished authors about the motivation
behind their latest research
and the clinical implicationsit has for the practicing surgeon.
The opinions expressed in this podcastare those of the participants,
(00:26):
and not necessarilythat of the American College of Surgeons.
Hello,and welcome back to The Operative Word.
I am your co-host, Lillian Erdahl,and I am joined today by Dr
Eilidh Gunn, who was kind enoughto make things work from across the pond,
to tell us about her research,“What about the coach?”,
(00:47):
which is a mixed-methods study
assessing the experience of coachesin a peer surgical coaching program.
So welcome, Dr Gunn.
I thank you so much for inviting meonto The Operative Word.
It's a great privilege to be here.
Well, we're pleased to have you herefrom the University of Edinburgh.
And, also to hear that you completedyour PhD.
(01:10):
You know, partly, this research was duringthe time that you were completing a PhD
and having a surgeonwith a PhD to really delve
into questions aroundhow to teach surgeons.
I think it's important to have somebodywho kind of understands,
the insidetrack of how it is to train in surgery,
(01:31):
and give us feedback abouthow we might improve surgical training.
I also, wanted to just highlightthat this work was done,
in the Sabermetrics lab run by Dr Yule.
And I had to look up what Sabermetrics is.
So surgical Sabermetrics,
according to the website, is the digitizedmeasurement of surgical performance.
(01:56):
So, you know, it's interestingto really break down
surgeryand think about it from that perspective.
Yeah, it's a great aim that’s true.
Yeah, this is a great collaborationbetween the safer
surgery lab, Ariadne Labs, at Harvardand the Surgical Sabermetrics lab
at the University of Edinburgh,with Professor Yule having a history
(02:16):
at Ariadne labsand the safer surgical group.
before coming over to Scotland.
And I was his PhD student.
So surgical Sabermetrics really tries
to utilize license and performanceanalysis and enhancements
that have been learnedthrough professional sports.
And that can have, you know,there's many tears and I have
(02:37):
many colleagues who started their own PhDsin far more kind of digital
and technical fields of analysisthan Than what we discuss here coaching
and but really what that can mean iseither looking at performance enhancement
through behavioral interventionssuch as coaching,
which is what we're going to discusstoday.
And also looking at, digitizing
(02:59):
that performance and looking at metrics.
So that could involve looking at allsorts of different types of data,
whether that's video, whether that's fromsensors placed on the surgeons body,
and whether it's through teamworkanalysis and combining
psychological techniquesto look at performance, such as, MGT
environmentand really is to try and help maximize
(03:21):
surgeon performance as best can to helpan individual achieve their best.
Yeah, well, and and the benefits,
to surgeons of getting feedback,I think are pretty well-established.
But, I appreciate the,the mindful approach to figuring out
the different types of feedbackthat a surgeon needs and how to get data
(03:41):
about the performanceof both the individual and the team
to really use evidence-basedfeedback and, you know,
mentoring and teaching and coachingkind of all,
require us to have a good understandingof what
the individual needs in order to improve.
And so I really appreciatekind of understanding how do you help
an individual improve and having guidance.
(04:04):
And I think that that is
going to come out a little bit as we hearmore about the coaching program.
So I thought we might start by just sortof talking about the SCOPE project.
And, you know, your research looksat the coaches themselves,
but I think
our audience would like to hear probablya little bit about the coaching project,
just to understand
what the coaches were doingand, you know, understand their mindset.
(04:27):
Thank you so much.
So the SCOPE program was createdback in 2018 by Dr Smink,
and Dr Yule, and with,
Dr Pradarelliwho was a research fellow at the time,
and was designed to create a structuredframework to allow,
you know, a attending level surgeonsto coach themselves.
(04:50):
So a peer level coaching program.
And it was thoughtthat this was very powerful
because especially my understandingis in the United States,
you know,attending surgeons practice autonomously.
And so oftentimes
they're running their own surveys for,you know, multiple decades and doing it,
you know, and they're already expertsin their field right?
They’re already doing an incredible job.
And they're, you know, competent.
(05:13):
But I guess the question was more, abouthow do you continue
to maintain that level of excellence,over the course of your career?
And there was quite a well known article,that was published in The New Yorker
by Atul Gawandethat, asked about that, just described
his experience of having a coachand how it enhanced his technical skills.
(05:34):
And so then based off the back of that,
there was a considerationabout how traditional CME
offers the opportunityto go to courses and conferences.
But how could we integratethe concept of coaching done by
either musicians or sports professionalswithin the operative environment?
And how to make that accessible?
And having that opportunity between peersseemed like an ideal chance, you know,
(05:58):
to have two people within the same fieldand to have their own areas of expertise,
a share and exchange practice,but using a structured framework.
And that's really what SCOPE was,key components where,
you know, you'd have your surgeonsand they'd be in pairs.
Allocation was open betweenthe department, how that would come about.
And then you'd have a allocated coachsurgeon and a coachee surgeon.
(06:21):
The description of the coach surgeonbeing the person that would observe
and then provide feedback and do
constructive analysis, with the coacheebeing the surgeon being observed
and with the opportunityfor them to switch roles.
If that was useful, the SCOPE programbeing having a pre-meeting
with your coach,you know what you want them
to improve or what skillsdo you want to look at?
(06:43):
Things that might be interestingbeyond technical skills?
Could be non-technical skills.
So communication, leadership,
teaching and training those kind of thingswhich are hard to elicit.
Even though you,instinctively as a doctor,
In general, as a surgeon
are practicing those skills, maybe tensif not 100 times in the operation.
(07:03):
So you can discuss that and then you'dhave your period of observation.
Then you would do kind of a paired,
analysis and constructivefeedback of that performance.
Following the observationby the coach surgeon.
And usually outsideof the operating theater at a later time
to allow for like kind of decompressand not have, you know,
(07:24):
and trying to get the patient dischargedand seeing the next patient, you know,
so you could have some cognitive distancefrom that.
And then following that you canthen action plans
to decide,how am I, what am I going to do next?
Or how are we going to do this next.
And you can pick a casethat would reflect those goals again
and then continue that cycle.
Sorry this is quite a long answer.
(07:45):
No, that's a greatthat's a great explanation.
And a lot of thingsthat we put into practice
in early trainingcome to mind when you talk about that.
You know, I think we're buildingon these principles that we use.
But with someone who has already achievedcompetence and,
you know, maybe is looking to achievemastery or determine,
you know, where it is that they need tocontinue to grow and improve.
(08:09):
And for adult
learners, to think about identifyingtheir own learning goals,
but with some, some help and assistancemakes a lot of sense to me.
And of course, you're, you know,all of your work towards your PhD
and thinking about how surgeonslearn and improve,
you know, I think comes into play.
(08:31):
I was also thinking about the,
idea that learning doesn't stop
when you complete residency or fellowship,when you go out on your own,
as you mentioned in the United Stateswe’re very much, sort of
released to be independent surgeonsafter our training.
And I think that there'sbeen a lot of discussion around,
you know, how do you find supportduring that transition time
(08:54):
and how do you find ongoing support?
Because this work is difficultand challenging and,
simply because you understand how to do itand have the technical skills
does not meanthat you stop needing mentorship
and support,or that you stop learning and growing.
Yeah, I think I think that's very true.
And I think that all
training pathways are a little different,or slightly different in the UK.
(09:17):
I think there is the same feeling about
especially early, what we call early yearsconsultants in the UK as well.
That kind of feeling that is lifelong.
And jave, say,you know, Dr Smink himself took part
in the SCOPE programand is really a believer.
And in that kind of lifelonglearning and grow.
But something we discuss in the paper,this concept of growth mindset,
(09:39):
which has been identifiedalso in other kind of
coaching research as well amongstsurgeons, the idea that you can kind
of foster that kind of beliefor that attitude to practice.
Yeah.
And and one of the thingsthat you talked about
is, you know, this is a big timeinvestment for the coaches
and for the hospitals.
mean, you have a, you know, surgeonpeer who's not,
(10:01):
generating clinical work during that time
because they're really focusedon mentoring and training.
And so I think having that that idea
that it's important for our profession,
to continue this
and making that investment,I really appreciate from leaders
like Dr Smink saying, you know,it is important for hospitals to set aside
(10:24):
time for peers to help oneanother continue to grow and improve.
So that the SCOPE program was,
across multiple hospitals and,
you know, over a period of two yearsis kind of the the time period
that you were looking at andyou identified, several potential coaches.
(10:45):
Tell me about the processof kind of identifying the coaches and,
and how you were going to learnabout the coach experience.
Yeah.
So this built upon a workthat had been done by
Dr Pradarelli in his research time and Dr
Trey Sinyard, you knowwas the MPH research fellow
(11:05):
at Ariadne labswho is my co first author on this paper
and really what they had learned is DrPradarelli had managed to expand it
to these eight centerswithin the greater Boston area.
And the
initial feedbackfrom these early iterations of the program
had identified that, you know, maybe both,we initially or most people,
(11:27):
including myself,when I started my own coaching research,
thought that the coachees, you know,would be
the people who would reportthat they benefited from taking part.
Well, that's the hope, isn't it?
You know, that's whythis long coaching program.
But I see
that kind of some of the qualitative datathat have been gathered by Dr Pradarelli
suggest that it was more bidirectionaland actually obviously, incredibly,
(11:50):
they have a massive respectfor Dr Caprice Greenberg,
who is very much like global expertin coaching in surgery, and has published
many wonderful papersand also made done a publication,
that describedthis bi-directional feedback
when they did their ownqualitative analysis of research.
So a lot of coaching work,
(12:12):
and also one of the issues,as you've also described
in your last question,was that some of the feedback
was that the time affordedboth financially and,
you know, with regardsto just physical time, it was quite a lot.
And therefore, recruitment
might be an ongoing challengefor the SCOPE program moving forward.
And also the idea that there wasa potential if the coaches did benefit,
(12:34):
then it would help levelthe playing field, if you will.
You knowthat there was mutual learning for both.
And this was interestingto us in Edinburgh and why we chose to
collaborate together wasI was keen to try and introduce or a trial
doing peer coaching in Edinburghas part of my PhD project,
with a potentialto look at the SCOPE program.
But it was again a question I got askeda lot was that, you know, we'll
(12:57):
surely only half of the, half of the teamis going to benefit from doing this.
So it really went aheadand created some research questions,
which we had a well sharedresearch questions that both Trey and I
had that we’d like to answer.
So my
understanding was that the coaches andpairing was done within the departments
that took part in the program,and that it was done very much, it was a
(13:21):
they were given the autonomy
to be able to decide who is going to coachand who wasn't, though
there is a SCOPE guide that was createdbit try to encourage like,
you know, swapping roles, and also seeingnot always the senior surgeon
being the coach and the junior surgeonbeing the coaches.
They’re, sort of encouraged to like,you know, exchange roles or move against
the more kind of didactic rate...sorry,you can’t see hand movements in a podcast,
(13:46):
but the didactic kind of balancethat you'd expect in senior and junior.
Yeah.
Well, and and again,I think, what I have learned as a teacher
more than anything, a teacher and a mentoris how much I benefit,
personally and how much I learn.
So, so I love the idea of
advancing that culture to say,
(14:08):
you know, it turns outthat, learning is not unidirectional.
It's not top down.
It doesn't follow hierarchiesor anything like that.
But, that actuallyyou can have rich learning that flows,
you know, bidirectional in this casebecause we're talking about a dyad, but,
you know, sort of, up, up and down and,and around a team working together, it's
(14:30):
not always one person teaching anotherby sort of role definition.
That's extremely well put.
And thank you.
Yeah. It's
you know, you can tell why I was excitedto talk to you about this work.
I really enjoyed reading it.
And so once you kind of identifiedyour research question
(14:51):
and then you had to reach out to coaches
and design a way to answer the questions.
So tell me a littlebit about your study design.
Yeah.
So basically we initially decided that,you know, to do this
we would be best placed to try and,you know, reach out
to those surgeonswho had participated as coaches,
(15:13):
in across the multiple centers,in the SCOPE program.
And what we decided to do was,take a mixed methods research approach,
which involvesusing quantitative and qualitative
elements to kind of create,
a kind of a detailed and rich
snapshot of people'sexperiences and opinions.
(15:38):
And it can be usedquite a lot across health care.
But we thought this is specific,really useful because we had, unanswered
questionswhere there was a previous set normal or,
you know, research that demonstratedwhat the coaches had experienced.
So we wanted to explore this,and we felt that we wanted to do
(15:59):
get in depth feedback of doing interviewsbecause it was obviously Covid.
It was done via zoom at that time.
But we also wanted to
try and see if we could get some,you know, metrics.
And we used to just sayand we created, a survey,
questionnaire which was anonymized so thatpeople could feel they could be honest.
(16:19):
And we included in thatthat a Net Promoter score,
which is a kind of a usedwithin business and marketing.
And you say on a score 1 to 10,you know, how much are you, like,
how likely are you to recommend,
you know, in this case the SCOPE programto a friend or colleague.
And so we sent that outto all of the eligible
participantswho who had served as coaches.
(16:41):
And we created the interview guideand also the survey guide
that was with myself,Dr Sinyard, Dr Smink, and Dr Yule.
And we also with regards to the methods
got a insight and expertise from DrEmily Cummins
who is an extremely experiencedmixed methods researcher in health care.
(17:06):
And this really was really vital to usto like elevate things
and also because it's not...thekey is you obviously can gather
your two types of your data, but the real,
expertise that is required is
how do you co-analyze those and likehow you use one to reflect the other.
And there's a lots of different,you know, methodologies
(17:27):
as how to do that with the way in whichyou integrate those data together.
And she was really instrumentalin helping us
do that with our data analysisand look at things with regards to the
categories or concepts that we were able
to identify following that process.
I appreciate you kind of explainingthe importance of having an expert.
(17:49):
I do think that sometimes
qualitative data is seen as somethingthat's not gathered scientifically.
You know, it's been hard.
I think as, as we,
bring these types of analysesinto the surgical literature,
particularly in the realm of education,to gain traction.
(18:09):
And as we were discussingbefore we started recording,
you know, the, the mixed methodsand the qualitative analysis
have a long history of study behind them.
These are not really new methods, but,sometimes they're new to surgeons.
Who have looked more at clinical science
and sort of only, quantitative analysis.
(18:30):
And I was wondering, in doing this,who conducted the interviews
and how do you kind of structureso that when you're doing,
semi-structured interviews, you ensure
that you have consistencyin capturing those data?
So it was my coauthor, Dr Sinyardthat, conducted all of the interviews.
He is obviously,based in the Boston area,
(18:54):
was able to conduct those,and we created an interview guide.
He'd also had trainingand semi-structured interview techniques.
And before undertaking the interviews.
And I think that that he saidthat was particularly helpful.
And having done my own, lateron in my own PhD,
I think it is really helpful to havethese kind of signposts to come back to.
(19:16):
Obviously, you don't want to be too rigidbecause you can get these really rich
elements of experience that come through,and that's part of the benefit
of the mixed methods, structure.
You can really get in depth and,you know, insight into the experiences
in that, you know, in that iterationof the coaching program from participants.
But I think that that was really helpful.
(19:37):
And it was also helpfulwhen we created the guide to have input
from multiple team members,you know, to get different perspectives.
And I think also being mindful of timeand just the person,
the individualwho's donating their time to the research
and making surethat you don't rush things along
but you don't, extend things to as wellis quite important.
(19:59):
From my own experience, which is obviouslynot the same as this study.
Yeah.
So we've talked a lot about the backgroundand hopefully our listeners are still
with us,
but I think it's important to understandthat the context and the approach.
So tell me, what everybody really wantsto hear about, which is the results.
What did you find about the experienceof the coaches?
Okay.
(20:20):
So overall,we didn't have any preconceived numbers.
That was something I should have said.
We didn't have like,
when we did the analysis we didn'tuse, like, a set template or a structure.
And that was because what we're doingwas exploratory.
For all we knew when we were analyzing,it could have come back
that nobody had a good time,and then it wasn't worthwhile,
(20:40):
which is obviously kind ofwas not was the null hypothesis.
So when we looked and,what we did was we were able to create,
these kind of conceptual categories,
which is what we did with regardsto the analysis technique that we used.
But basically what we found were overallis that, you know,
when we're looking at it,is that what we identified were...the
(21:03):
coaches...the first was calledaffective attitude towards participation.
So basically the coachesthat were taking part were motivated.
And were, you know,keen to engage with the coaching process.
And they kind of at least stated eithertheir own, you know, desire for their own
practice enhancement or to contributeto the development of others.
(21:24):
And also like reflection onmaybe how their own career progressed
or things that they would want tobenefit from moving forward.
And then when we actually went in,they said, okay, well, were
are there any benefits or Dr Sinyard said,were there any benefits?
You know, they describedthey actually based on observing their
(21:45):
colleagues, how some of them had listedpractice change.
And this was also identified when welooked at their survey results as well.
And also that they feltthey had improved their teaching skills,
but also a senseof professional fulfillment.
You know, when you have
that idea of helping someone whenever,you know, even myself very well, great.
You know, for you, helpingsomeone develop a skill,
(22:06):
it can be rewarding to see thatand then progressing
the way that they want or learn. Yeah, yeah.
I mean,I think that and those things were quite,
you know, we thought that they were,were what we were hoping for that.
And I think that really it was greatto see that coming out of the interviews,
but also coming out in the questionnaireas well, that people really felt
that their performance had improvedas well as that of the coaches.
(22:30):
I love to see thatobserving their peers,
led to improvements in their own practice.
I can remember myself,you know, being in some surgeries
where two surgeons were presenttwo faculty surgeons especially, you know,
complicated, proceduresin, in highly specialized surgeries.
And, it was amazing to see thatboth surgeons
(22:53):
were typically focused on the same sectionof the operative field.
You know,there's a lot of sort of shared knowledge
and experience that comes acrosswhen they're together, working.
And so, you know,I think the observation at that level,
practice is very different than what,you know, a junior trainee
(23:13):
or even a fellow seeswhen they watch another surgeon.
Yeah.
I think it's like, very much like,I don't know,
I think, well, it'svery much like the art of surgery.
You know, that you're describing,like when it goes,
you know, up to the next level of like,okay, someone does something.
And I think that I have to agree.
And it was great to hear people say, well,they thought about how someone had done,
(23:37):
you know, either non-technical skillor had managed, or even,
you know, logistics, that it was helpfulto see how they'd done that.
And I think that that does showit's those kind of moments
and things that you identify, you know,they're very hard to capture, like,
outside of doing some like coachingor giving or just even by giving someone
(23:57):
the opportunity with a very simple setstructure to get that observation
opportunity as well, whether it's in videoor whether it's in person.
Yeah.
And, you know, I think that
that thinking about all the different waysthat we have continuing learning,
in our careers led you to talk about,
(24:18):
CME, sort of comparing their experiencewith coaching to CME.
What did you find?
So, I mean, obviously we can
you know, discussabout the fact that there is,
you know, potential biasand the responding,
you know, cohort of peoplewho wanted to do interviews with us.
But most people feltthat the when compared
to existing, CME activities that they,
(24:41):
it was they preferredor it was beneficial comparatively.
You know, we feltthis might be because of the fact,
like based on some of their interviewcontent, that,
you know, the acquisition of the knowledgewas immediate or directly
applicable, sorry, applicable to their,their own, operative environment.
There's active
participation,you know, as opposed to passive learning.
(25:04):
You know,you have to be engaged to be a coach
and you have to be engaged as wellto be a coachee equally.
And but then also when that was exploredagain, there were some upsides
and downsides to people saying, well,if you made this official for CME,
then it becomes your more like hurdlebased or objective based.
And is that a benefit or not?
(25:25):
That's maybe for future research.
But yeah, I think it just yeah,I think it's environmental especially,
but also the kind of the focusof coaching itself
might be making it more appealingto some people.
And, and part of what you were looking for
was, you know, is this a valuableuse of the coach's time.
So I thinkwhether it gives you CME credits or not,
(25:48):
having it be valuable learningtime for the coach seems to support it.
That that it's worthcontinuing these programs, which again
I think is is part of the questionor part of the driving,
need to do this research to understandwhether it's really worth
taking so much time to do an activitylike peer coaching.
Well, it's reassuring that,you know, the majority of respondents
(26:12):
did feel like that.
You know, it was worthwhile use of time.
You know, a 15 out of the 19 thought so,
and the net promoter scorealso is reflective of that.
But I think that this leads us very nicelybecause I'm aware of time,
just on the fact that, you know,navigating the logistics of coaching was a
(26:33):
one of the main findings in regardsto barriers, if you will, to participating
in the future.
And, people
often find that, you know, schedulingand time were
a, a big challengeto actually taking part in the sessions.
And some coaches did mention,
you know, financial cost,but felt that the benefit outweighed that.
(26:56):
But I think that, you know, it's somethingthat definitely needs to be considered
for future research as to how to overcomethose barriers to like.
As many people as possible,the opportunity to take part.
Yeah.
Well, and I want to be, careful,how I talk about the effects
on surgical culture because it'sfrom the perspective of the coaches.
(27:17):
And, but I was, thinkingalso about the investment
of the organization in that timeand potentially the cost of it.
And, and the coaches, talkedabout the flattening of the hierarchy
and perhaps increasing the psychologicalsafety for junior team members.
And I wondered if you could divea little bit more into how they thought
(27:37):
this experience achieved that or,you know, led to that culture change.
The I think this was, for me personally,a surprising finding in a way.
Because we had obviously had discussionsand there is some really
there's a great paperthat was written about,
challenging surgical culture by
Burns et al, which is part with CapriceGreenberg as well, looking
(28:02):
at the wider effectof coaching programs on surgical culture,
but basically what we foundis that when we discussed it with them,
they talked about the fact that, you know,everyone could benefit from a coach.
And, you know, one of the participantssaid, you know, they're
everyone is kind of put on an equal basisif they're taking part
(28:22):
in a coaching program and it's,
you know,you're able to give each other feedback.
But also, I think that the other thing isthat, you know, it was kind of
other things that we discussedis also things
that might be challengingthat you are able discuss
with your colleagues with regards to likelogistics or shared experiences or,
(28:45):
maybe more challenging aspectsof the procedure that have been done.
And then with that, you,this may be me just, you know, suggesting,
like talking about, you know, how
they've overcome, you know, operativeor technical challenges and,
and maybe allowsfor that kind of camaraderie that you
might not have another opportunityto get necessarily in another way.
(29:07):
And, you know,
with that kind of structure, although I'msure many people have their colleagues,
maybe they have mentors within their
departments that they can meet withand have, like casual,
you know, coffee or watercoolerkind of conversations in their own time.
But I think that that's maybe
what coaching allows foris that kind of dedicated time.
(29:28):
To work with someonewho has the same challenges
or in the same environment that you areand the coaches have then been able
to identify that as being constructive
and even people whose experiences
weren't ideal in the program still feltit was of value.
As like, I think it was describedas a master class learning experience.
(29:49):
So that was great.
When I read that in the transcript. And
so the master
class, I may be rambling a bit,so please forgive me.
No, I think that there's the workis very rich.
And again, I think that'swhat I appreciate about particularly
the qualitative,
portion of the mixed methods.
And if you'll bear with me,I'm going to read a quote from that
(30:13):
that was in the paper.
One of the surgeons said, “We
have a good culture in our group,but coaching adds to that.
That adds to the fact that I'm therefor you and you're there for me.
And I think it is a big thingthat goes beyond the nuts and bolts
of throwing a suture betteror something like that.
It's just adding to the
culture of support amongst the faculty,which I think is really key.” And,
(30:34):
and I think if we can leave our audiencewith anything, it's the idea
that nobody should do this jobalone, regardless of how much mastery
they have of the technicaland performance aspects of surgery.
And so that that, more than anything, wasthe message that came out of this for me.
We're all lifelong learners.
(30:56):
And, the benefits of having peerswho can help you
continue to grow and learnreally came through in this paper.
I think that, that's a great summary.
And it's, I'm really gratefulthat that’s the message that we were able
to convey as a research team,when we were putting together, this work.
Well, thank you, Dr Gunn.
(31:16):
I hope that our listeners will considercoaching.
That was again a message from the paper.
Many of the coaches wished that they hadhad that experience early in their career.
And, so as we continue to look
at the SCOPE projector other opportunities for coaching,
I, you know,I hope that people will consider it.
Yeah, it's great.
(31:37):
And, you know, you can still sign up,you know, get access to the materials
if anyone is interested.
And I can forward a link onif people would like to learn more
about the SCOPE program.
And I’d also like to thank Dr Erdahland JACS
for having me todayand for accepting our research paper.
Thank you for listening
(31:58):
to the Journal of the American Collegeof Surgeons Operative Word Podcast.
If you enjoyed today's episode,spread the word on social media
by using the hashtag #JACSOperativeWord.
Subscribe to The Operative Wordwherever podcasts are available,
or listen on the American Collegeof Surgeons website at facs.org/podcast.
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