Coaching: the new CME?

I just finished "Personal Best," Atul Gawande's latest New Yorker article, in which he explores the idea of improving performance in the operating room (and throughout the healthcare system) not by holding more traditional continuing medical education activities, but by providing personal coaching. The coach would observe the healthcare practitioner in practice, and suggest ways to improve outcomes for the patients, along with efficiencies for the team, and reduce errors and costs.

This is such a great idea, even better than academic detailing, which is pretty great in itself. Gawande called on a retired general surgeon he knew from his resident days to act as his personal coach. The doc sat in the corner of the OR and observed, then gave Gawande his observations. He's been working on implementing his suggestions, and it appears to be working: His complication rate is heading downward after a long period of stagnation.

The idea isn't without its challenges, he admits. You have to trust that the coach's advice will be good, and you have to be able to find people who are willing and qualified to do it. But the biggest sticking point may be this: "The greatest difficulty, though, may simply be a profession’s willingness to accept the will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?"

And this part made me smile, in a sad way: "I have spoken to other surgeons about the idea. 'Oh, I can think of a few people who could use some coaching' has been a common reaction. Not many say, 'Man, could I use a coach!'”

I'm lucky that I had the huge good fortune to have a fantastic coach in my early years with Medical Meetings, my former editor Tamar Hosansky. I wish everyone could have that level of personal, supportive backup throughout their careers. We would all be doing a better job, whatever our jobs may be.

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