Building a Coaching Framework for Surgeons

Cleveland Clinic surgeon Cara King, DO, MS, is leading a program to train a team of colleagues to be surgical coaches and match them with others who want to level up their performance.

The program represents a new avenue of professional support at the health system, where, since 2009, Cleveland Clinic’s Center for Excellence in Coaching & Mentoring has offered board-certified executive coaching to physicians and other healthcare professionals.

With support from an education grant, Dr. King, Section Head of Minimally Invasive Gynecologic Surgery and Medical Gynecology, has so far trained 10 Cleveland Clinic surgeons to be coaches, from the Digestive Disease Institute and the Obstetrics and Gynecology Institute. The half-day training incorporates a presentation about coaching followed by coaching sessions and a simulation. Ultimately, the coaches will be matched with 20 coachees to support them in identifying goals and associated actions. Eventually, says Dr. King, the hope is that the framework can be expanded throughout the health system.

The effort is a passion project for Dr. King, who has been a part of the non-profit Academy for Surgical Coaching with Caprice Greenberg, MD, Chair of Surgery at the University of North Carolina–Chapel Hill, since its inception in 2019.

“The concept of surgical coaching is something I think everyone can jump on board with, but the challenge is how to operationalize it,” says Dr. King, who is now the organization’s president. “The goals of the academy are to train surgeons on how to be coaches and do faculty development for surgeons who want to be coachees. We've trained almost 400 coaches on an international scale so far.”

In this Q&A with Consult QD, Dr. King describes the coaching dynamic and how participants benefit by the flattening of traditional learning hierarchies.

Q&A

What distinguishes coaching from traditional training methods?

Dr. King: Teaching is really where our mindset goes in regard to medical school, residency, fellowship and even attendinghood. Teachers tend to have hierarchy over their learners. They're either dispelling information, giving information or asking very specific questions and looking for very deliberate answers.

Coaching has a flattened hierarchy. The coach is meeting the coachee where they are and learning what the coachee sees as their ideal state. The coach then guides them through very specific action items to close that delta. A coaching relationship feels different because the coach is asking a lot of questions and empowering the coachee to understand that they have the knowledge and the skill in them to reach their goals.

Coaching is more longitudinal as well. Often we do three-, six- or 12-month coaching relationships. And there's a lot more accountability on the part of the coachee.

What kinds of people tend to want to be coachees?

Dr. King: There are natural times in people's careers that coaching is very helpful. But in my opinion, every coach should have a coach and every surgeon should have a coach. I'm a coach and I'm a coachee.

A sweet spot for receiving coaching is when you transition into practice. We're doing a lot of interesting projects at the national level for integrating this in a 12-month way: six months before somebody graduates and six months into the first part of their practice.

I think coaching also is great for when you've been out for a while and there's a change in technology, a change in approach or a change in equipment. As a surgeon, you can become used to ingrained ways of doing things. It's nice to have a coach to give you a new viewpoint and to take you to the next level.

What's the formal way that coaches and coachees come together?

People can go straight to the Academy for Surgical Coaching and request a coach. There’s a questionnaire for the individual, and we use it to match that person with five or six of the coaches we think could be a good fit. Then we do a “speed dating” kind of interaction with the individual and those people so they can find someone who us a great fit.

So you can go through the academy. A lot of national (medical) societies are actually integrating us as well. So you can go through a national society.

And then many large academic institutions are also starting to integrate coaching models. So here at Cleveland Clinic, obviously we have the Center for Excellence in Coaching & Mentoring. And then within the Obstetrics and Gynecology Institute and the Digestive Disease Institute, we have this new platform for performance coaching too.

And what forms does the coaching take?

Within the academy, we talk a lot about video coaching, which means coachees bring de-identified surgical videos to their coaches and they review them together. With that being said, you can use all different types of media or even no media at all.

The performance domains are technical skills, communication skills, stress management skills, and leadership skills — all these different areas of performance can be coached in.

Someone who wants to be coached in communications with a scrub tech or learner may bring an audio voice note of their procedure, as long as they have everyone's permission.

Or someone might want to be coached on ergonomics. And I'll have them come in with random pictures taken during their surgeries. We compare how their ergonomics change depending on what's going on in the case. And some things that come up around stress management just involve talking.

Is the coaching relationship established for a specific time period?

You can get a ton out of a one-off coaching session, but the ideal relationship usually lasts three, six or 12 months. And your coach may switch depending on your goals. I may be the best coach for one type of performance metric, but maybe now you need help specifically in bariatric surgery and that’s not me. Longevity is helpful, but switching, if needed, might also be critical.

What skills do the coaches learn?

There is a skillset that they learn and also a mindset shift.

We teach them the scaffolding of a coaching session. That goes from goal setting to something called guided inquiry, where they're asking questions, and then it moves into action items. Each coaching session is 45 to 60 minutes, and the sessions take place about every four to six weeks. We teach them how to hold this scaffolding for each session.

But the mindset shift, in my opinion, is the hardest part because our entire lives we have been used to teaching; coaching is not where our brains go. We have to get used to asking the right questions. How do we go through goal setting without telling coachees what we think the goals should be? How do we give feedback without making people defensive? How do we lead with curious for guided inquiry? How do we tailor our techniques to our coachees? The coachee also may be trying to push us teach because that’s what they're used to.

It sounds like the coachee also has to learn how to be coached. Is that addressed?

Dr. King: Yes. We use either a webinar or videos as orientation so they know this is going to feel a little bit different than what they've experienced in the past.

Should organizations be pressing surgeons to participate in coaching?

Dr. King: For the first five years of our coaching journey through the academy, we have emphasized that coaching is for all surgeons, both high and low performers. You have to want to be coached for this to be as fruitful as possible. And people have just gravitated to us because they want to be a part of it.

More recently, we have been getting inquiries about coaching surgeons who are having sub-optimal outcomes or performance issues. This has prompted big discussions within the academy. We never want coaching to be punitive. We never want people to conclude that if someone is being coached, they must be having issues. And so we're addressing this very delicately.

When we first launch a program at an institution, we always ask, “Who is the best surgeon in your group?” That person should be a coachee. Because if you flip everything on its head like that, then people realize the goal isn't what they thought. It isn't that they’re being told they need help.

Changing the culture is hardest thing to do, but the most important. But you get going and you have your department chair being coached, then people really understand that this is for everybody.

Have you had experiences outside of medicine that made you a strong believer in the coaching dynamic?

Dr. King: I’ve used coaching throughout my entire life. I always have a growth mindset. I have space to learn everywhere. I had a podcast coach when I launched my podcast. I have a parent coach to help me be the best parent I can with my kids.

My mom is a high-end athletic coach for people who are competing in ironmen and marathons. She's incredible. And she's been coaching me virtually for 10-plus years. I am a long-distance runner. I do marathons, triathlons, all of that.

I would go for a run. I have my Garmin. It would break down all my numbers, but then I'd be like, what do I do with this? So I see that my pace increased maybe at mile 17, but why? As soon as I had a two-way conversation around those numbers, everything changed. And that was really the inspiration for me to move into this space.