Country surgeons have been brushing up on their ‘soft skills’ in an innovative Rural Health research project.

The Asynchronous Video-Coaching in Rural Settings project captured footage of surgeons in different professional settings and provided them with virtual coaching to improve their skills.

Go-Pro recording devices were used for participating surgeons in Port Lincoln, Mount Gambier, Whyalla in South Australia and Wagga Wagga in New South Wales. 

The surgeons videoed their consultations, ward rounds and operations. Selected surgeons and psychologists used the footage to coach them on their situational awareness, teamwork, leadership and decision-making skills.

Project Lead University of Adelaide Professor Guy Maddern says the feedback from surgeons involved in the study was largely positive, with improvements in non-technical skills reported in 76 per cent of participants.

“This study has demonstrated the feasibility of the program, its acceptance by doctors, patients and staff, and that valuable information can be gathered and fed back to the surgeon being assessed.

“The response we received from surgeons was the feedback was really valuable and useful.”

Elements the coaches assessed included the surgeons’ engagement with assistants and nursing teams, response to patients, and collaboration with support staff. Their assessments informed the support and advice given to surgeons. 

In 90 per cent of feedback communication was the primary area for improvement. Issues included not engaging with surgical teams during procedures, speaking to medical professionals and ignoring patients during ward rounds, and avoiding eye contact with patients during consultation. “We saw the same issues reappearing, and  a common practice was a surgeon looking at a computer when they should be looking at the patient.

“While the communication skills of some surgeons are exemplary, many aren’t aware that’s what they’re doing, and this kind of practice can have an impact on the patient.”

The coaching aims to standardise behaviours in the operating theatre, consulting suite and wards, which are hugely variable.

Support staff, including nurses, were particularly positive in their response to the program, observing improvements in communication skills among participating surgeons.

The initiative was developed in response to research that suggests the ‘soft skills’ of surgeons tended to decline over time.

“Generally speaking, once surgeons are qualified, there is no review of their non-technical skills, and evidence shows that these skills tend to deteriorate over time,” Professor Maddern says.

“This is a result of surgeons largely working in isolation particularly in rural areas. With a small surgical team, they don’t often have the opportunity to receive feedback from their colleagues.

“In these areas, the confidentiality element was very important to surgeons, and they valued the coaching they received from the psychologists.”

The initiative aimed to fill the gap in the development of these skills between Traineeships, when extensive education was provided, and as a surgical career progress.

The intrusiveness of the Go-Pro when conducting rounds, consultations and surgeries was initially an obstacle for some surgeons. But almost all agreed, the feedback was worth the temporary inconvenience once they saw how they would be supported—rather than attacked—in their coaching sessions.

Over the course of the study 153 video sessions were completed by 17 surgeons that Professor Maddern hopes will be adopted widely in the surgical profession and by medical practitioners more broadly.

“We now have enough data, although not sufficient to be statistically significant—to say that it’s not just a nice idea, but it can support surgeons in rural areas.

“We think if we can get this program working effectively and efficiently this is something other groups would like to take on. We have no doubt in our minds that it can be adopted more widely.

“We are now heartened to go forward and set up the program to make it available to surgeons.”

The next step for the program will be to potentially secure funding for the cost of psychologist coaching and technology, and administration of sending devices across the country.

Professor Maddern believes the program will have most success if it was adopted by the Royal Australasian College of Surgeons as part of its Professional Development program. 

He says the benefits of improved communication, collaboration and decision-making will be felt by surgeons and the wider public.

“Surgeons could be protected from medico-legal problems that tend to arise from communication issues, but most importantly, patients would get a better experience.

“In the ward, mistakes are being made due to/ because of confusion when what consultants think is being done, is not done, because of problems with communication. 

“By improving communication, we can lower cost associated with additional surgery or longer hospital stays, improve safety, and provide a better outcome for patients.”

The project aligns with the RACS Rural Health Equity Strategic Action Plan’s aim to improve the outcomes of people living in rural areas of Australia and Aotearoa New Zealand.