Inside the Black Box of Deliberate Practice: How do Coaches Coach to Improve Trauma Triage

Deepika Mohan; Robert M Arnold; Baruch Fischhoff; Jonathan Elmer; Raquel M Forsythe; Kimberly J Rak; Jacqueline L Barnes; Douglas B White

doi:10.1016/j.jss.2024.07.114

Inside the Black Box of Deliberate Practice: How do Coaches Coach to Improve Trauma Triage

J Surg Res. 2024 Aug 28:302:669-678. doi: 10.1016/j.jss.2024.07.114. Online ahead of print.

Authors

Deepika Mohan¹, Robert M Arnold², Baruch Fischhoff³, Jonathan Elmer⁴, Raquel M Forsythe⁵, Kimberly J Rak⁶, Jacqueline L Barnes⁶, Douglas B White⁶

Affiliations

¹ Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: mohand@upmc.edu.
² Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York City, New York.
³ Department of Engineering and Environmental Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania.
⁴ Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁵ Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁶ Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

PMID: 39208492
DOI: 10.1016/j.jss.2024.07.114

Abstract

Introduction: Deliberate practice, goal-oriented training with feedback from a coach, is a common tool for improving physicians' performance. However, little is known about how coaches foster performance improvement.

Methods: A content analysis of video-recorded training sessions was performed to analyze the coaches' behaviors during a pilot randomized trial of deliberate practice in trauma triage. The intervention consisted of three video-conference sessions during which trial physicians, under the supervision of a coach, played a customized video game designed to review trauma triage principles. A multidisciplinary team specified tasks (e.g., create collaborative learning environment) that coaches should complete, and suggested 19 coaching strategies (e.g., encourage culture of error) to allow execution of these tasks. Two independent raters translated those strategies into a coding framework and applied it deductively to the recorded sessions. The frequencies of the coaching strategies were summarized, and tested for variation across coaches and time.

Results: Thirty physicians received the intervention across two 1-mo blocks. Most (28 [93%]) completed three sessions, each covering two (interquartile range 1-2) triage principles. Coaches used coaching strategies 18 (interquartile range 14.5-22) times per triage principle, using some often (2-3 times/principle) and others infrequently (<1 time/principle). The three coaches used similar numbers (20 versus 16 versus 18.5, P = 0.07) and types of strategies. However, use increased over time (16.8 [Block 1] versus 20 [Block 2] P = 0.018).

Conclusions: Coaches used 19 coaching strategies to deliver this deliberate practice intervention, with behavior that evolved over time. Future trials should isolate the most potent strategies and should assess the best method of standardizing coaching.

Keywords: Behavioral intervention development; Deliberate practice; Healthcare professional education; Heuristics; Trauma triage.