Visualise for a moment an image of Usain Bolt preparing for the 2016 Rio Olympics under the watchful eye of precisely no one. Out there day and night sprinting on the practice track with a stopwatch in one hand trying to time his runs and simultaneously focus on his stride technique. Or imagine Rafael Nadal training for the US Open by hitting a tennis ball up against a brick wall and pretending there’s a human being hitting the ball back at him. Despite a combination of God-given talent, dedication to their craft and an overwhelming desire to win, there is only so far an elite athlete can go without elite level coaching to guide the way. Coaching is about maximising performance by unlocking an individual’s inherent abilities and in doing so helping them to achieve their own personal and professional goals.
Nadal doesn’t need to be taught how to play tennis any more than a competent attending surgeon needs to be shown how to do a laparotomy. But why is it that elite coaching for elite athletes is seen as a given, yet elite coaching for medical professionals and leaders making daily life-or-death decisions is still something of an abstract concept? If an athlete has a bad day, they may lose a game or a championship title but at least everyone goes home alive, or at least not maimed (combat sports and Mike Tyson notwithstanding).
Coaching has become well established in the business and financial world. The professional goals of team-building, conflict management, organisational effectiveness and strategic thinking are easily transferable to any senior clinician who finds themselves juggling clinical, academic and training commitments whilst trying to maintain a family life of their own. Evidence continues to emerge championing the benefits of coaching in terms of clinical performance and clinician well-being, with an emphasis on reducing burnout.
Coaching is not only for those at the top of the professional tree. Many residents find that the transition from one stage of training to another can unleash all manner of uncertainty and self-doubt which only serves to stifle performance and impede professional growth. Classically, those returning to residency from a prolonged period of absence such as research or maternity leave suffer the most. Increasingly, training boards and organisations are setting aside the resources to address this. For example, trainees in London and many other parts of the UK have free access to professional coaching services through their educational board’s Professional Support Units (PSU). Among many things, recipients are forced to challenge cognitive distortions, understand their core values, pursue 360-degree feedback from peers and clinical supervisors and build towards having the ability to self-coach in a way that sustains them long after the free sessions have ended. And the benefits of coaching need not be confined to trainees who find themselves in difficulty. A randomised study of a group of Canadian residents in 2015 published in the Annals of Surgery showed significantly better procedure-specific skills and fewer technical errors among those subject to comprehensive surgical coaching as opposed to conventional training. A later study from 2018 in the same journal detailed the Wisconsin Surgical Coaching Program in which surgeons of varying levels of experience were coached by senior peers who had been trained in coaching techniques. Videos of surgical procedures were jointly reviewed in sessions focussing on the technical, cognitive and interpersonal skills displayed. The sessions were judged objectively and subjectively to have been effective and spoke to the benefits of flattening hierarchy within the surgical profession.
Now more than ever at a time when the surgical workforce has been pushed to its physical and emotional limits there is a need for more widespread provision and engagement of coaching services. A surgical career is a marathon, but even the greatest distance runners still need someone to help them realise their full potential.
Obi Nnajiuba is a British surgical resident with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
