A coach is a teacher, leader, motivator, and critic, with typically more experience than the learner. Interestingly coaches may not be the most talented performers in their field but compensate for lack of skill with a tireless study of the “game.” The coach helps the athlete/surgeon capitalize on individual strengths and helps the player/surgeon adjust for deficits. The coach typically stays in the background, observes, teaches strategy and technique, and also organizes a team to maximize overall performance (Table 4.2).

In a coaching relationship, both the coach and the athlete are invested. Chemistry does matter, and thus some coach-athlete relationships do not work and this is an important note for the surgeon looking for a coach. The sooner this chemistry is apparent, the better, as both parties can then move forward or reevaluate the relationship. With coaching, both parties share ideas and can benefit and learn from each other. Criticism is always difficult to accept, yet learners, when employing the coaching model, must accept scrutiny to allow the coach to identify not only magnificence but also deficiencies. Similar to chemistry, the sooner this exchange of information is streamlined, the sooner can coaching-type relationships become effective and productive. For surgeons with an independent mind set and confidence, the importance of accepting scrutiny and criticism is a necessary ingredient for success. If the surgeon is not “coachable” then the concept and approach of coaching are not going to be successful. From the start, a coach must express what the learner does not want to see or hear to help maximize performance. Good coaches break performance down into components and critique and enforce deliberate practice. Obstacles to being a good coach include a lack of attention to detail, rigidity, and ego. Clearly the successful coach, especially in medicine, must be facile in communicating, especially with topics that the coached may not want to hear.

Coaching is directly related to the teacher quality. In general, younger teachers are more amenable. Obstacles to being a good coach include fear, unhealthy paranoia, ego, and insecurities. Good coaches break performance down into components and critique and enforce deliberate practice [1].

As noted above, Atul Gawande popularized the concept of coaching in surgery with his essay in the New Yorker [1]. He noted that after 8 years of practice, his skills and complication rate had plateaued. He wanted to continue to improve as a surgeon but found an absence of relevant mentors or coaches. Gawande noted that traditionally, once a surgeon completed residency and fellowship training, no formal method existed for improving one’s skills under the guidance of a “coach.” He found personalized and individualized instruction lacking. He approached a senior surgeon to specifically review his performance and from this improved multiple parts of the procedure.

Gwande cites Jim Knight, Ph.D., Director of the Kansas Coaching Project, to emphasize some key elements that he concluded were important for surgical coaching. These points are as follows: learning may be directly related to the quality of the teacher; coached teachers are more effective than teachers who are not coached; younger teachers are more amenable to being coached; and some concerns that the teachers had about being coached included fear and insecurity.

Furthermore, in surgery, coaching may be seen as a sign of weakness and inadequacy. There is a perception that only incompetent surgeons need coaches. Yet, we know that virtually all successful professional athletes, singers, and Oscar-winning actors have coaches throughout their career, even when at the “top of their game.” Among athletes and performers, society recognizes the difficulty of working without a coach in realizing potential—and the subsequent risk of becoming stagnant. This concept has great value for the medical/surgical world.

Sachdeva et al. further commented that in the world of surgery, having a coach is often perceived as lacking skill, not as an effort toward improving outcomes and efficiency [10]. In Orthopaedics, at The University of New Mexico, the concept of coaching is welcomed and has been accepted and promulgated by senior surgeons and the chair (Fig. 4.1) [11]. Clearly, patients may be suspicious of the concept of the coached surgeon, believing that surgeons who need coaching may not be the most qualified to perform treatment. Additionally, surgical colleagues may also see the presence of a coach as a sign of faltering confidence. This negative connotation of coaching in surgery may stem from the practice of mandated proctoring of young surgeons or those with unacceptable complication rates. It is important to differentiate between the voluntary request for a coach to maximize potential and forced observation of a coach to ensure patient safety (Table 4.3).