02.10 The Role of Vulnerability in Surgical Coaching Interventions: A Qualitative Analysis

C. Varlamos1, C. Hibbard1, S. J. Rivard1, A. Duby1, M. Callow1, J. Dimick1, J. Byrn1, M. Byrnes1 1University of Michigan Medicine,Department Of Surgery,Ann Arbor, MI, USA


The role of vulnerability has been widely discussed as a requirement for continuous professional development. Yet, we understand little about this concept in surgeons. Given the nature of surgery, which values confidence, it remains challenging for surgeons to embrace vulnerability. This study explores surgeons’ experiences and views on vulnerability in the context of a group surgical coaching intervention.


Data for this study is part of an ongoing longitudinal qualitative study exploring expert learning among 14 Michigan surgeons participating in a surgical coaching program. For a more diverse perspective, we conducted one-on-one in-depth interviews with an additional 68 colorectal surgeons across the U.S. to gauge attitudes and perceptions around surgical coaching. The 82 interviews were analyzed in a team-based approach and results are reported thematically.


Surgeons reflected on three main themes surrounding vulnerability including technical, social, and the importance in continuous professional development. Participants described coaching as an event that may situate the surgeon as technically vulnerable. Technical vulnerability relates to reluctance to adapt to new surgical techniques, fear of displaying techniques to peers, and knowledge about challenging cases. Surgeons also discussed social vulnerability or threats to a surgeon’s professional identity. Participating surgeons were critical of their mannerisms during coaching sessions and cognizant of the social hierarchy of surgeon “rock stars” in the room. For non-participants, many suggested that social vulnerability may be related to intersectional identities such as race, class, age, geography, or practice setting. For example, being the “old guy in the room”, or as one woman reported, “When you are being put out there…everyone is going to be like this proves that she doesn’t know or she really doesn’t deserve to be here. And I just want to hide.” Lastly, participants and non-participants alike reported that they welcomed opportunities for technical or social vulnerability, stating its importance in the field of medicine. Participants in our study negotiated these vulnerabilities as they described deep-rooted beliefs that vulnerability was essential to the surgeon identity and a mechanism for technical and cultural improvement.


Surgeons discussed technical and social vulnerability as pervasive among surgical coaching interactions. Participants also described the reasons why they believed both vulnerabilities are imperative in order to continue to improve professionally. Our results indicate the necessity of promoting a constructive, collaborative environment so that vulnerability can be nurtured in positive ways. This qualitative analysis illustrates the significance of vulnerability in surgical coaching interventions and continual professional development.