Teaching as Coaching


Variable

Mentor

Coacha

Age

Often older than student

Any age

Life skills

Yes

Often no

Knowledge and education

Yes

No

Team skills

No

Yes

Task

Yes

Yes

Involved in a sport

Often no

Yes


aCoaches can be mentors: fairness, integrity, motivation



Coach: The word “coach” stems from the Hungarian word kocsi, meaning to transport people from where they are to where they want to be [2]. In today’s world, a coach is usually defined as someone who teaches and trains an athlete or a performer. It is a private instructor who has expertise in a particular subject. The first known use of the word “coach” as an instructor or teacher dates back to 1830 at Oxford, when the coach would “carry” the student through the examination [3]. In sports, the first known use of the word was in Europe in the 1860s, in which the word was used to describe the instructor of the 1859 English Cricket Team [3, 4]. Today, almost all professional athletes and performers have at least one coach. A modern coach may be a teacher, leader, motivator, and critic. However, the use of coaches is rare within medical professions [5].

Mentor: Similar to a coach, a mentor is someone who teaches, helps, or advises a less experienced, often younger individual. A mentor is a trusted counselor and guide, who can also be a tutor but most importantly is a role model. Learners tend to hold their mentors in high regard and attempt to emulate their skills and persona. This concept of mentorship stems back to ancient Greece [6]. Mentor was the son of Heracles and also a friend of Odysseus, and Odysseus entrusted Mentor with the education of his son Telemachus. The first modern known usage of “mentor” was in 1699 in Les Aventures de Télémaque by François Fénelon [7]. Mentor was the main character in this book that remained popular until the eighteenth century. Mentor denounced war and imperialism while promoting a federation of nations to work together, and altruism. The character enforced the continued use of the noun mentor who wisely advised and taught.

Although mentors and coaches both aim to assist learners, the method of guidance is different. Simply put, mentors are role models, whereas coaches are critics. Other distinctions include long-term or short-term instruction and general or specific goals, respectively [8]. The coach aims to help address immediate problems for the learner, with the goal being improvement of a particular performance feature.



So What Is a Coach?


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).


Table 4.2
Surgical techniques



















Technique

Definitiona

Competency

An ability or skill

Proficiency

Advancement in knowledge or skill; the quality or state of being proficient

Mastery

Knowledge or skill that makes one master of a subject; command


aMerriam Webster Dictionary. Competency, proficiency, mastery (2017). ​www.​merriam-webster.​com/​. Accessed 10 Jan 2017 [9]

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 in Teaching


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].


Coaching in Surgery


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).

A421300_1_En_4_Fig1_HTML.gif


Figure 4.1
Coaching requires introducing the coach and obtaining permission from the patient. We routinely request permission in clinic during our standard preoperative visit and then introduce the patient the day of surgery



Table 4.3
Tasks for the surgical coach and the surgeon being coached

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Mar 10, 2018 | Posted by in ORTHOPEDIC | Comments Off on Teaching as Coaching
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