Surgery Attendings' Autonomy-Supportive and Controlling Coaching in the Operating Room

The aims of the study are to identify themes that differentiate autonomy-supportive from controlling surgical coaching through case observation and compare differences in attending and resident perceptions of attending coaching.

Reflexive thematic analysis was used to analyze audio transcripts of attending-resident interactions in this descriptive, exploratory case series of 18 operating room procedures. Deductive and inductive coding were used to generate themes. Postoperative survey responses of perceived frequency of the attending's autonomy-supportive behaviors were analyzed quantitatively.

This study was conducted at a tertiary referral center affiliated with the academic institution.

Nine attending surgeons and 13 general surgery residents were observed across 18 elective general surgery cases. Participants were selected through purposive sampling for variation in cases and participants.

Coaching behaviors varied throughout each case. Three themes influenced how these behaviors were classified: (1) fostering the surgeon identity, which provided a baseline for interpreting coaching interactions; (2) dynamic evolution of intraoperative goals, which could lead to divergent expectations; and (3) influence of word choice, which modulated perceptions of control. Autonomy-supportive coaching could still occur even in high-stakes or restrictive operative contexts by maintaining cognitive engagement and providing appropriate scaffolding. There was no significant difference in perceived frequency of attendings' autonomy-supportive behavior in all categories.

This exploratory study identifies that attending faculty exhibit both autonomy supportive and controlling coaching in the operating room. Future directions can identify best coaching and recommend strategies for use.