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Post Game Analysis: Using Video-Based Coaching for Continuous Professional Development
Yue-Yung Hu, MD MPH1,2, Sarah E. Peyre, EdD1,3, Alexander F. Arriaga,MD, MPH1,4, Robert T. Osteen, MD, FACS 5, Katherine A. Corso, MPH1, Thomas G. Weiser, MD, MPH5, Richard S. Swanson, MD, FACS 5, Stanley W. Ashley, MD, FACS 1,5, Chandrajit P. Raut, MD, FACS 1,5, Michael J. Zinner, MD, FACS 1,5, Atul A.Gawande, MD, MPH, FACS1,4, Caprice C. Greenberg, MD, MPH, FACS1,6
1Center for Surgery & Public Health, Brigham & Women's Hospital, Boston, MA; 2Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 3STRATUS Center for Medical Simulation, Department of Surgery, Brigham & Women's Hospital, Boston, MA; 4Department of Health Policy & Management, Harvard School of Public Health, Boston, MA; 5Department of Surgery, Brigham & Women's Hospital, Boston, MA; 6 Surgical Outcomes Research, University of Wisconsin Hospitals & Clinics, Madison, WI
Background: The surgical learning curve persists for years after training, yet existing CME efforts targeting this are limited. We describe a pilot study of a scalable video-based intervention, providing individualized feedback on intra-operative performance.
Methods: Four complex operations performed by surgeons of varying experience – a chief resident accompanied by the operating senior surgeon, a surgeon with <10 years in practice, another with 20-30 years, and a surgeon with >30 years of experience – were video-recorded. Video playback formed the basis of 1-hour coaching sessions with a peer-judged surgical expert. These sessions were audio-recorded, transcribed, and thematically coded.
Results: The sessions focused on operative technique, both technical aspects and decision-making. With increasing seniority, more discussion was devoted to the optimization of teaching and facilitation of the resident's technical performance. Coaching sessions with senior surgeons were peer-to-peer interactions, with each discussing his preferred approach. The coach alternated between directing the session (asking probing questions) and responding to specific questions brought by the surgeons, depending on learning style. At all experience levels, video review proved valuable in identifying episodes of failure-to-progress and troubleshooting alternative approaches. All agreed this tool is a powerful one. Inclusion of trainees seems most appropriate when coaching senior surgeons; it may restrict the dialogue of more junior attendings.
Conclusion: Video-based coaching is an educational modality that targets intra-operative judgment, technique, and teaching. Surgeons of all levels found it highly instructive. This may provide a practical, much needed approach for continuous professional development.
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