Surgical Coaching for Performance Optimization: Perceptual-Cognitive Expertise Displayed During Surgical Peer...

Surgeons rely heavily on perceptual-cognitive skills-such as pattern recognition, anticipatory reasoning, and real-time decision-making-to navigate complex intraoperative environments. While these skills are honed during training, few structured opportunities exist for continued development once in independent practice. Surgical peer coaching has emerged as a promising model for fostering professional growth, but its potential to support cognitive skill refinement remains underexplored.

Thirteen practicing surgeons participated in a longitudinal, video-based group peer coaching program embedded within a statewide surgical quality collaborative. Across nine recorded sessions held over four years, participants reviewed operative videos, offered structured peer feedback, and engaged in facilitated group discussion. Transcripts were analyzed using interaction analysis, an approach focused on understanding complex tasks in social contexts. The analysis aimed to identify how perceptual-cognitive skills were surfaced, shared, and practiced during feedback interactions.

Three key perceptual-cognitive skills were practiced consistently throughout the sessions: (1) pattern recognition-such as identifying distorted anatomy or procedural flow; (2) situational probability assessment-anticipating likely intraoperative events or complications; and (3) cue identification-detecting real-time signals to guide decisions. Participants verbalized their own reasoning and used shared video review to compare mental models, assess alternative approaches, and reflect on judgment under uncertainty. These exchanges made expert thinking visible and teachable, demonstrating that cognitive skills can be collaboratively refined through structured discussion.

Video-based peer coaching offers a feasible and scalable model for promoting deliberate practice among experienced surgeons. By enabling reflective discussion and shared reasoning, this format supports the development of perceptual cognitive expertise, skills which are critical for surgical safety and performance. These findings underscore the value of integrating cognitive coaching into continuing surgical education and broader quality improvement efforts.