Surgical Coaching for Advancement of Global Surgical Skills and Capacity: A Systematic Review

Background: Surgical coaching is an emerging concept of education and collaboration to improve surgical performance. Surgical education in low-resource settings remains a challenge because of confounding barriers of access, resources, and sustainability. No formal assessments of coaching as a means to improve surgical quality in low- or middle-income countries (LMICs) exist. The purpose of this review is to explore if surgical coaching could serve as an effective method of fostering continued education and advancement of surgical skills in low-resource settings. Methods: We conducted a systematic literature search in July 2018. Included studies were peer-reviewed and met preestablished study criteria. Studies must have assessed surgical coaching, specifically defined as a means to establish continuous professional growth of trainees and practicing surgeons. Results: Of 2189 articles, 175 were selected for full-text analysis, 23 met inclusion criteria for analysis, 13 of these 23 articles evaluated coaching of trainees, 10 articles assessed coaching surgeons in established careers. 18 of the 23 articles discussed skill acquisition, 4 of which assessed nontechnical skills alone, and 14 assessed technical skills or both technical and nontechnical skills. Remote or cross-institutional coaching was explored in 8 of the 23 studies. None of the studies discussed or evaluated coaching in LMICs. Conclusions: Coaching is a method of teaching surgeons at multiple stages of a career. The explored advantages of surgical coaching may be applied to continuous performance improvement and collaboration with surgeons in LMICs. Furthermore, coaching may aid in advancement of the well-established Lancet Global Surgery Indicators, improving surgical capacity and quality in LMICs.