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Professional Coaching in Surgery: An Effort to Improve Practice and Patient Care
Vol. 225, No. 4S1, October 2017
Scientific Forum Abstracts
RESULTS: Male sex, more comorbidities, higher BMI, previous open abdominal surgery, and a higher white cell count (WBC) independently predict longer operative times. Conversely, presence of nausea (but not vomiting or fever) is protective. Male sex, older age, and higher WBC are associated with complicated cholecystectomies. Surgeon or resident seniority have no effect on either outcome, and neither does time from symptoms to surgery, or presence of choledocholithiasis. Model prediction was very good, with area under the curve (AUC) ¼ 0.80. Our findings are summarized in the Table.
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respondents “agreed” or “slightly agreed” that intraoperative coaching would improve specific surgical outcomes such as morbidity and mortality, and 63.5% of respondents were interested in being coached, with an additional 21.2% “maybe” interested. There were 75.3% of respondents who expressed interest in providing coaching services to others.
Table. Variable Operative duration Male sex Charlson Comorbidity Index BMI Prior open surgery Preoperative nausea WBC Additional procedure Complicated cholecystectomy Male sex Age WBC Additional procedure
Effect size (95% CI)
p Value
17.4 (6.18e28.71) 4.6 (2.46e6.82) 1.1 (0.44e1.72) 12 (1.04e22.93) 22.7 (35.23 to 10.09) 2.2 (0.98e3.38) 55.2 (27e83.49) Odds Ratio (95% CI) 3 (1.48e6.12) 1.1 (1.02e1.2) 1.1 (1.03e1.2) 8.8 (2.22e35)
0.003 <0.001 0.001 0.032 <0.001 <0.001 <0.001 0.002 <0.001 0.007 0.002
CONCLUSIONS: Knowledge of the above factors may alert surgeons to the possibility of a challenging cholecystectomy preoperatively.
CONCLUSIONS: Surgeons from all age groups, practice types, and experience levels had a positive outlook on voluntary intraoperative coaching. Future directions include developing a curriculum and providing coaching to surgeons. The survey will also be sent to surgeons around the country to assess geographic differences and obtain more statistical power.
Professional Coaching in Surgery: An Effort to Improve Practice and Patient Care Nitin Chopra, MBA, Dominic A Nistal, Jonathan A Cabin, MD, I Michael Leitman, Susan Lerner, MD Icahn School of Medicine at Mount Sinai, New York, NY; The Center for Advanced Facial Plastic Surgery, Los Angeles, CA
Rescue of Del1 Knock Out Phenotype in Bone Fracture Healing in Mice Tatiana V Boyko, MD, Owen Marecic, Michael Lopez, Elly Seo, MA, Xinming Tong, PhD, Charles Chan, PhD, Michael T Longaker, MD, MBA, FACS, George P Yang, MD, FACS Stanford University, Stanford, CA
INTRODUCTION: Surgical practice requires expert technical skills that are developed during years of formal training. After residency and fellowship, however, opportunities for feedback are rare. The purpose of this study was to assess the perceived benefit of and interest in a voluntary, intraoperative coaching program for surgeons who have completed their training. METHODS: An electronic survey was distributed to 528 faculty surgeons within an academic medical center during February 2017. The survey primarily assessed the perceived benefit of coaching as a tool to improve surgical practice. Secondary outcomes included interest in receiving coaching, interest in participating as a coach, and the perceived benefit of coaching on operating room time, anesthesia time, morbidity, and mortality. RESULTS: There were 85.9% of respondents who “agreed” or “slightly agreed” that intraoperative coaching would improve surgical practice (Figure). There was no significant difference in response to the primary outcome between age groups (p ¼ 0.19), gender (p ¼ 0.38), or years in surgical practice (p ¼ 0.68). 77.7% of
INTRODUCTION: The bone cartilage stroma progenitor cell (BCSP) skeletal progenitor has been shown to be the primary cell responding to fracture. We have shown that knocking out extracellular matrix protein Del1 (KO) results in decreased amounts of BCSPs and in their increased apoptosis. We hypothesized that adding exogenous Del1 protein would rescue the deleterious effects of the KO phenotype. METHODS: Femurs of 8 week-old wild type (WT) and KO male mice were fractured. The BCSPs were isolated on postoperative day 7 via fluorescence-activated cell sorting after mechanical and enzymatic digestion of the fracture callus and staining for previously identified signature cell surface markers. Knock out and WT BCSPs were plated in vitro with or without Del1 protein. In vivo, hydrogels with slow release of Del1 protein were placed at the fracture site. At 4 weeks, microCT scans and mechanical strength testing (MST) were performed to assess fracture callus size and strength. RESULTS: In vitro, exogenous Del1 normalized apoptosis and proliferation rates of KO BCSPs. In vivo, implantation of
Scientific Forum Abstracts
RESULTS: Male sex, more comorbidities, higher BMI, previous open abdominal surgery, and a higher white cell count (WBC) independently predict longer operative times. Conversely, presence of nausea (but not vomiting or fever) is protective. Male sex, older age, and higher WBC are associated with complicated cholecystectomies. Surgeon or resident seniority have no effect on either outcome, and neither does time from symptoms to surgery, or presence of choledocholithiasis. Model prediction was very good, with area under the curve (AUC) ¼ 0.80. Our findings are summarized in the Table.
S89
respondents “agreed” or “slightly agreed” that intraoperative coaching would improve specific surgical outcomes such as morbidity and mortality, and 63.5% of respondents were interested in being coached, with an additional 21.2% “maybe” interested. There were 75.3% of respondents who expressed interest in providing coaching services to others.
Table. Variable Operative duration Male sex Charlson Comorbidity Index BMI Prior open surgery Preoperative nausea WBC Additional procedure Complicated cholecystectomy Male sex Age WBC Additional procedure
Effect size (95% CI)
p Value
17.4 (6.18e28.71) 4.6 (2.46e6.82) 1.1 (0.44e1.72) 12 (1.04e22.93) 22.7 (35.23 to 10.09) 2.2 (0.98e3.38) 55.2 (27e83.49) Odds Ratio (95% CI) 3 (1.48e6.12) 1.1 (1.02e1.2) 1.1 (1.03e1.2) 8.8 (2.22e35)
0.003 <0.001 0.001 0.032 <0.001 <0.001 <0.001 0.002 <0.001 0.007 0.002
CONCLUSIONS: Knowledge of the above factors may alert surgeons to the possibility of a challenging cholecystectomy preoperatively.
CONCLUSIONS: Surgeons from all age groups, practice types, and experience levels had a positive outlook on voluntary intraoperative coaching. Future directions include developing a curriculum and providing coaching to surgeons. The survey will also be sent to surgeons around the country to assess geographic differences and obtain more statistical power.
Professional Coaching in Surgery: An Effort to Improve Practice and Patient Care Nitin Chopra, MBA, Dominic A Nistal, Jonathan A Cabin, MD, I Michael Leitman, Susan Lerner, MD Icahn School of Medicine at Mount Sinai, New York, NY; The Center for Advanced Facial Plastic Surgery, Los Angeles, CA
Rescue of Del1 Knock Out Phenotype in Bone Fracture Healing in Mice Tatiana V Boyko, MD, Owen Marecic, Michael Lopez, Elly Seo, MA, Xinming Tong, PhD, Charles Chan, PhD, Michael T Longaker, MD, MBA, FACS, George P Yang, MD, FACS Stanford University, Stanford, CA
INTRODUCTION: Surgical practice requires expert technical skills that are developed during years of formal training. After residency and fellowship, however, opportunities for feedback are rare. The purpose of this study was to assess the perceived benefit of and interest in a voluntary, intraoperative coaching program for surgeons who have completed their training. METHODS: An electronic survey was distributed to 528 faculty surgeons within an academic medical center during February 2017. The survey primarily assessed the perceived benefit of coaching as a tool to improve surgical practice. Secondary outcomes included interest in receiving coaching, interest in participating as a coach, and the perceived benefit of coaching on operating room time, anesthesia time, morbidity, and mortality. RESULTS: There were 85.9% of respondents who “agreed” or “slightly agreed” that intraoperative coaching would improve surgical practice (Figure). There was no significant difference in response to the primary outcome between age groups (p ¼ 0.19), gender (p ¼ 0.38), or years in surgical practice (p ¼ 0.68). 77.7% of
INTRODUCTION: The bone cartilage stroma progenitor cell (BCSP) skeletal progenitor has been shown to be the primary cell responding to fracture. We have shown that knocking out extracellular matrix protein Del1 (KO) results in decreased amounts of BCSPs and in their increased apoptosis. We hypothesized that adding exogenous Del1 protein would rescue the deleterious effects of the KO phenotype. METHODS: Femurs of 8 week-old wild type (WT) and KO male mice were fractured. The BCSPs were isolated on postoperative day 7 via fluorescence-activated cell sorting after mechanical and enzymatic digestion of the fracture callus and staining for previously identified signature cell surface markers. Knock out and WT BCSPs were plated in vitro with or without Del1 protein. In vivo, hydrogels with slow release of Del1 protein were placed at the fracture site. At 4 weeks, microCT scans and mechanical strength testing (MST) were performed to assess fracture callus size and strength. RESULTS: In vitro, exogenous Del1 normalized apoptosis and proliferation rates of KO BCSPs. In vivo, implantation of