title: Systematic review of coaching to enhance surgeons' operative performance.
abstract: BACKGROUND
  There is increasing attention on the coaching of surgeons and trainees to improve performance but no comprehensive review on this topic. The purpose of this review is to summarize the quantity and the quality of studies involving surgical coaching methods and their effectiveness.
  
  
  METHODS
  We performed a systematic literature search through PubMed and PsychINFO by using predefined inclusion criteria. Evidence for main outcome categories was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and the Medical Education Research Study Quality Instrument (MERSQI).
  
  
  RESULTS
  Of a total 3,063 articles, 23 met our inclusion criteria; 4 randomized controlled trials and 19 observational studies. We categorized the articles into 4 groups on the basis of the outcome studied: perception, attitude and opinion; technical skills; nontechnical skills; and performance measures. Overall strength of evidence for each outcome groups was as follows: Perception, attitude, and opinion (Grading of Recommendations Assessment, Development, and Evaluation: Very Low, Medical Education Research Study Quality Instrument [MERSQI]: 10); technical skills (randomized controlled trials: High, 13.1; Observation studies: Very Low, 11.5); nontechnical skills (Very Low, 12.4) and performance measures (Very Low, 13.6). Simulation was the most used setting for coaching; more than half of the studies deployed an experienced surgeon as a coach and showed that coaching was effective.
  
  
  CONCLUSIONS
  Surgical coaching interventions have a positive impact on learners' perception and attitudes, their technical and nontechnical skills, and performance measures. Evidence of impact on patient outcomes was limited, and the quality of research studies was variable. Despite this, our systematic review of different coaching interventions will benefit future coaching strategies and implementation to enhance operative performance.
authors.affiliation: Department of Surgery, University of Washington Medicine, Seattle, WA.
authors.forename: Hyeyoun
authors.initials: H
authors.lastname: Min
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA.
authors.forename: Dianali Rivera
authors.initials: DR
authors.lastname: Morales
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Orgill
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Smink
authors.affiliation: Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA. Electronic address: syule@partners.org.
authors.forename: Steven
authors.initials: S
authors.lastname: Yule
mesh_terms: D002983:Clinical Competence; D000068156:Formative Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D013663:Teaching