Although CME/CPD activities provide excellent educational opportunities for physicians, barriers remain for Family Physicians with Enhanced Surgical Skills (FP ESS) and their surgical teams to access and engage with context-specific, team-based learning. FP ESS, FPAs (Family Practice Anesthetists), and nurses living in remote communities most often practice independently with minimal support. Many FP ESS have been trained outside of British Columbia, and have no real connection to specialist advice or support within their region. This lack of a collaborative relationship means that regional specialists also rarely have an opportunity to learn about the type of care that is provided in rural hospitals, or the skills of local providers.
The rural surgical team requires better relationships and support from regional colleagues in order to continually develop their skill sets. Although many specialists have expressed interest and willingness to become involved in a working relationship with their counterparts in rural communities, currently this type of collegial relationship is almost non-existent. If rural surgical programs are to be adequately supported, it is necessary to develop a strategy to assess and respond to individual and community development needs, to enhance quality improvement of the surgical team, and to improve communication and engagement within the provincial network of regional and rural physicians.
Introduction of a New Clinical Coaching Program
The Clinical Coaching for Excellence program was created by UBC CPD and RCCbc to bring both educational and quality improvement opportunities to rural family physicians and nurses who provide anesthesia, operative delivery, and surgical services in small volume rural surgical programs. Recognizing that surgical excellence belongs to the team – surgeons, anesthesiologists, and nurses – coachees are paired with coaches from within their own discipline. Coaching for each discipline might happen independently, in parallel, or even collectively as a team when appropriate. Regional coaches offer their advanced training, expertise, and experience to encourage and support the professional development of their rural surgical team, while rural practitioners enrich coaches’ appreciation of the complexities of rural surgical care with a rich knowledge of local resource limitations and travel and transport constraints of the rural community.
The stimulus for these coaching programs has been the consensus, recently published in the Joint Position Paper on Rural Surgery and Operative Delivery, that rural surgery teams are more sustainable when nested within a larger surgical care network. At its core, this Clinical Coaching program is directed not only at improving surgical care locally, but towards building the positive relationships that are foundational to effective network models of surgical care. This Clinical Coaching program is included as a strategic pillar in a new proposal under consideration BC to provide resources to support formal rural surgical and obstetrical networks.
Goals of Clinical Coaching
- Support the best surgical and operative delivery care in our smaller rural programs;
- Support specialist and nursing outreach services;
- Introduce an innovative CPD opportunity for the FP ESS, family practice anesthetists, and nurses providing surgical care in smaller programs;
- Build a new platform for Continuous Quality Improvement (CQI) for rural surgical care; and
- Enhance and support high quality rural surgical teams of care interconnected with regional centre surgical teams.
Current Coaching Program
The program is currently being piloted in two rural surgery communities. To date, the coaching program has been built to support general surgical teams, but future iterations of the program will provide opportunities for coaching in obstetrics and gynecology as well.
This program encourages most of the coaching activity to occur either in the rural community hospital or remotely through new remote presence technology. Support is provided for travel expenses and for sessional fees. In addition, there will be opportunities for practitioners to travel to the regional centres, supported by REAP, for coaching experiences in these larger surgical programs.
Participants will complete a formal self-evaluation and set individual goals at the start of their local program. The programs are accredited CPD experiences both with the CFPC for family physicians and with the RCPSC for specialists. The UBC Coaching program is based on research of best practices, and involves education and training of the participants as well as ongoing program evaluation. The Clinical Coaching program has partnered with UBC’s Centre for Health Education Scholarship (CHES) to conduct in-depth research on the quality of the educational experience and the effect of the program on professional relationships.
Our overarching takeaway from the two communities currently engaged, before any formal evaluation, is the unanimous enthusiasm for clinical coaching. We might have anticipated this appetite for coaching amongst the rural surgical team; however, we could not anticipate the uptake and support from the regional centres, including and especially general surgeons.
To achieve the goal of a province-wide coaching program we must:
- Build on initial learning in the two pilot communities to iteratively improve the program;
- Maintain the flexibility to construct the local coaching program to meet local needs while adhering to the principles that assure the integrity of the overall program; and
- Appreciate that some coaching might occur specialist to specialistin those communities that have one or more specialist surgeons on staff locally.
Our ambition for the Clinical Coaching program is to grow a high functioning rural surgery network in which strong professional relationships based on trust, respect, and collaboration are foundational. Separated by geography and culture, trained in very different programs, belonging to communities of practice which have not been collegial historically, these relationships will need opportunities to flourish. We hope that a strong coaching program, linking rural practitioners with coaches in the regional referral centres, will act as the scaffolding on which new relationships can be built.