Presentation
Dyadic Video-Reflective Coaching to Enhance Surgeons’ Non-Technical Skills in Robotic-Assisted Surgeries
DescriptionIntroduction
Non-technical skills (NTS) are crucial for ensuring safety, effective communication, and teamwork in the operating room (OR). In robotic-assisted surgeries (RAS), the physical distance between surgeons and their teams complicates interactions, making NTS even more important. Despite their significance, surgical education often focuses more on technical proficiency, leading to gaps in NTS training. Research has shown that these skills can decay over time, even as technical expertise improves. This study explores the effectiveness of a personalized coaching approach for enhancing surgeons’ NTS in the OR, focusing on four primary NTS constructs: situation awareness, decision-making, communication and teamwork, and leadership, as defined by the Non-Technical Skills for Surgeons (NOTSS) framework.
Methods
We implemented a dyadic, video-reflection coaching method to provide personalized feedback to surgeons regarding their NTS performance. Nine surgeons from three hospitals within a university health system participated. Each surgeon’s NTS was observed across three procedures. During these surgeries, we collected video footage, audio, and eye-tracking data to analyze NTS performance. Expert raters independently assessed surgeons’ NTS using the NOTSS tool. Surgeons then participated in personalized coaching sessions where they reviewed video clips of their performance, followed by reflective discussions facilitated by a trained coach. The surgeons received two coaching sessions between the three observations. To evaluate the effectiveness of the intervention, we used Cliff’s Delta effect sizes to quantify improvements in NTS. Additionally, qualitative thematic analysis was performed on coaching transcripts to identify successful coaching techniques and understand surgeons’ responses to the intervention.
Results
Our quantitative analysis showed that personalized coaching significantly improved surgeons’ NTS in two key areas: situation awareness and leadership. Large effect sizes were observed for both constructs, with situation awareness improving from the first to the third observation (δ = 0.70, 95% CI: 0.22, 0.91) and leadership showing a similar trend (δ = 0.81, 95% CI: 0.14, 0.97). Overall NTS improved moderately (δ = 0.49, 95% CI: 0.25, 0.67). However, decision-making and communication and teamwork demonstrated smaller improvements.
Thematic analysis identified several coaching techniques that contributed to these results. Open-ended probing questions encouraged surgeons to reflect on their actions and critically assess their performance. Positive reinforcement and re-emphasizing effective behaviors helped reinforce exemplary NTS practices. Redirecting reflections allowed surgeons to recognize areas for improvement while offering alternative strategies for addressing NTS challenges in the OR. Surgeons engaged actively in the process, frequently asking questions, acknowledging feedback, and envisioning changes. Emotion-driven behaviors like enthusiasm and self-criticism emerged as key indicators of surgeons’ openness to improvement.
Discussion and conclusion
Our findings indicate that dyadic, video-reflection coaching can enhance key NTS in RAS, particularly in the areas of situation awareness and leadership. The use of personalized video feedback allows surgeons to directly observe their behavior and reflect on their performance in a structured, supportive environment. This method mirrors the successful practice of using recorded procedures to improve technical skills, extending its application to NTS. The structured feedback, tailored to each surgeon’s unique behaviors, was key to facilitating meaningful behavior change in the OR. This study suggests that personalized NTS coaching can have a lasting impact on surgical education and highlights the importance of integrating NTS training into routine practice.
Non-technical skills (NTS) are crucial for ensuring safety, effective communication, and teamwork in the operating room (OR). In robotic-assisted surgeries (RAS), the physical distance between surgeons and their teams complicates interactions, making NTS even more important. Despite their significance, surgical education often focuses more on technical proficiency, leading to gaps in NTS training. Research has shown that these skills can decay over time, even as technical expertise improves. This study explores the effectiveness of a personalized coaching approach for enhancing surgeons’ NTS in the OR, focusing on four primary NTS constructs: situation awareness, decision-making, communication and teamwork, and leadership, as defined by the Non-Technical Skills for Surgeons (NOTSS) framework.
Methods
We implemented a dyadic, video-reflection coaching method to provide personalized feedback to surgeons regarding their NTS performance. Nine surgeons from three hospitals within a university health system participated. Each surgeon’s NTS was observed across three procedures. During these surgeries, we collected video footage, audio, and eye-tracking data to analyze NTS performance. Expert raters independently assessed surgeons’ NTS using the NOTSS tool. Surgeons then participated in personalized coaching sessions where they reviewed video clips of their performance, followed by reflective discussions facilitated by a trained coach. The surgeons received two coaching sessions between the three observations. To evaluate the effectiveness of the intervention, we used Cliff’s Delta effect sizes to quantify improvements in NTS. Additionally, qualitative thematic analysis was performed on coaching transcripts to identify successful coaching techniques and understand surgeons’ responses to the intervention.
Results
Our quantitative analysis showed that personalized coaching significantly improved surgeons’ NTS in two key areas: situation awareness and leadership. Large effect sizes were observed for both constructs, with situation awareness improving from the first to the third observation (δ = 0.70, 95% CI: 0.22, 0.91) and leadership showing a similar trend (δ = 0.81, 95% CI: 0.14, 0.97). Overall NTS improved moderately (δ = 0.49, 95% CI: 0.25, 0.67). However, decision-making and communication and teamwork demonstrated smaller improvements.
Thematic analysis identified several coaching techniques that contributed to these results. Open-ended probing questions encouraged surgeons to reflect on their actions and critically assess their performance. Positive reinforcement and re-emphasizing effective behaviors helped reinforce exemplary NTS practices. Redirecting reflections allowed surgeons to recognize areas for improvement while offering alternative strategies for addressing NTS challenges in the OR. Surgeons engaged actively in the process, frequently asking questions, acknowledging feedback, and envisioning changes. Emotion-driven behaviors like enthusiasm and self-criticism emerged as key indicators of surgeons’ openness to improvement.
Discussion and conclusion
Our findings indicate that dyadic, video-reflection coaching can enhance key NTS in RAS, particularly in the areas of situation awareness and leadership. The use of personalized video feedback allows surgeons to directly observe their behavior and reflect on their performance in a structured, supportive environment. This method mirrors the successful practice of using recorded procedures to improve technical skills, extending its application to NTS. The structured feedback, tailored to each surgeon’s unique behaviors, was key to facilitating meaningful behavior change in the OR. This study suggests that personalized NTS coaching can have a lasting impact on surgical education and highlights the importance of integrating NTS training into routine practice.
Event Type
Oral Presentations
TimeMonday, March 3111:37am - 12:00pm EDT
LocationPier 9
Simulation and Education (SE)