2026 Proffered Presentations
S168: EVALUATING THE IMPACT OF THE SURGICAL COACHING PROGRAM ON JUNIOR NEUROSURGICAL RESIDENT AUTONOMY AND CONFIDENCE
Alankrita Raghavan, MD; Kennedy Carpenter; Pakawat Chongsathidkiet, MD, PhD; Ellen O'Callaghan, BA; Seeley Yoo, BA; Steven Cook, MD; C R Goodwin, MD, PhD; Katherine McDaniel, PhD; Michael Haglund, MD, PhD; Duke University
Early neurosurgical training faces multiple challenges, including work-hour restrictions, scrutiny of operating room (OR) utilization, and increased emphasis on patient outcomes, rightly highlighting the need for structured education outside the clinical environment. To address this, we established the Surgical Coaching Program (SCP) to provide one-on-one, procedure-specific training for junior residents. This data focuses on the results from the first two years of the program’s PGY-2 participants and integrates data from pre- and post-intervention rubric surveys as well as pre- and post-program confidence surveys.
PGY-2 residents at our institution (n=6, over 2 years) participated in five targeted sessions covering pinning and positioning, hemicraniectomy, suboccipital craniotomy, posterior cervical decompression and fusion (PCDF), and basics of fluoroscopy with percutaneous pedicle screw placement. Each session utilized cadaveric dissection, spine models, or OR-based simulation, with faculty coaches providing one-on-one structured technical instruction. Resident performance in the hemicraniectomy, suboccipital craniotomy, and PCDF sessions was assessed using standardized rubrics based on the Zwisch scale of autonomy (Figure 1), which evaluates progressive stages of independence across procedural steps. In addition, residents completed confidence surveys at the start and conclusion of the program, rating their comfort with anatomical orientation, technical execution, and overall procedural readiness.
Both rubric and confidence data demonstrated meaningful improvements across all domains. Rubric scores reflected measurable gains in technical execution and procedural readiness, with residents showing clear progression through critical steps of each operation following the intervention (Figure 2). Confidence survey results paralleled these findings, with residents consistently reporting higher self-assessed preparedness, anatomical understanding, and comfort with technical maneuvers across all five procedures (Figures 3 and 4). The most pronounced increases were observed in fluoroscopy and percutaneous pedicle screw placement, where residents reported substantial improvements in image interpretation, C-arm manipulation, and trajectory planning. Similarly, hemicraniectomy and posterior cervical decompression sessions were associated with marked gains in confidence for exposure, bone work, and handling of dural and neural elements. Gains in the pinning and positioning session and the suboccipital craniotomy session were also reported, underscoring the program’s broad educational value.
While the small sample size limits the generalizability of results, the consistency across rubric and confidence measures reinforces the utility of structured, individualized coaching for early residents. This data demonstrates that a dedicated one-on-one surgical coaching curriculum can strengthen technical competency and enhance resident confidence across a range of foundational neurosurgical procedures. By integrating objective rubrics with resident-reported confidence measures, this analysis highlights the dual benefit of structured coaching in both observed performance and self-perceived readiness. Based on these results, we expanded the program to include PGY-3 residents (pterional craniotomy, retrosigmoid craniotomy, endoscopic endonasal approaches to the sella, and anterior neck dissections), and data collection for these sessions is ongoing. These findings support the feasibility and educational impact of early coaching and warrant further multi-institutional evaluation to determine long-term effects on operative autonomy and patient care.
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