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Background Many coaching methods have been well studied and formalized, but the approach most commonly used in the continuing education of surgeons is peer coaching. Through a qualitative thematic analysis, we sought to determine if surgeons can comfortably and effectively transition to a co-learner dynamic for effective peer coaching. Methods This qualitative study evaluated 20 surgeons participating in a video review coaching exercise in October 2015. Each conversation was coded by 2 authors focusing on the dynamics of the coach and coachee relationship. Once coded, thematic analysis was performed. Results Two themes emerged in our analysis: (1) Participants often alternated between the roles of coach and coachee, even though they received assigned roles prior to the start of the session. For example, a coach would defer to the coachee, suggesting they felt unqualified to teach a particular technique or procedure. (2) The interactions demonstrated bidirectional exchange of ideas with both participants offering expertise when appropriate. For example, the coach and coachee frequently engaged in back-and-forth discussion about techniques, instrument selection, and intraoperative decision-making. Conclusion Our qualitative analysis demonstrates that surgeons naturally and effectively assume co-learner roles when participating in an early surgical coaching experience.

Background The quality of an operation depends on operative technique. There is very little evidence, however, regarding how surgeons arrive at their intraoperative decisions. The objective of this study was to determine the extent to which practicing surgeons participating in a coaching program justify their technical decisions based on their experience or based on evidence. Methods This qualitative study evaluated 10 pairs of surgeons participating in a video review coaching program in October 2015. Using thematic analysis, the conversations were coded in an iterative process with comparative analysis to identify emerging themes. Results Three major themes emerged during analysis: (1) Individuals often reported modifications in surgical technique after a negative postoperative complication; (2) participants were noted to defend the use of certain techniques or surgical decisions based on the perceived expert opinion of others; and (3) surgeons rarely referred to evidence in surgical literature as a motivation for changing surgical technique. Conclusions In this qualitative analysis of coaching conversations we found that practicing surgeons often justify their surgical decisions with anecdotal evidence and “lessons learned,” rather than deferring to surgical literature. This either represents a lack of evidence or poor uptake of existing data.