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theory [ 16 ]. Learning is not necessarily development. For example, a student might
learn a piece of knowledge, a skill, and even demonstrate he/she has learned it;
however, he/she may not have developed proficiency or enhanced his/her skills as a
result of that learning. To explore the separate but interdependent nature of learning
and development, let’s return to the resident who recognized a need to improve his
communication skills.
Given the dynamics of the work environment, learning new concepts or trying to
address competency gaps outside the application environment is not necessarily suf-
ficient for improving performance. To learn and develop, individual engagement in
the workplace setting must be part of the learning process. Billett [ 7 ] reviewed five
different workplaces focusing on individual engagement at work. He found guided
learning strategies including modeling, mentoring, coaching, questioning, analo-
gies, and diagrams enhance learning and workplace performance.
If we accept guided learning strategies are important to improving performance,
then better integrating them within surgical education is important. Coaches and
mentors would play an important role in offering modeling, questioning, sharing
analogies, and helping learners to diagram their progress. In the surgical workplace
learning environment, residency program directors, attending surgeons, residents,
students, nurses, and other key members of surgical teams are able to serve as
coaches and mentors but would also receive benefits of being coached and men-
tored. To help medical learners with continuous learning and performance, an
important step is to recognize and adopt guided learning strategies. Creating a cul-
ture of coaching and mentoring within surgical workplace learning environments
embeds guided learning strategies in the natural flow of the workplace. When these
professional learning relationships are closely connected to the needs of the learner
(to grow, improve, address a shortcoming) and the emphasis is on continuous
growth, problem solving, and ongoing development, an action learning environment
is created [ 17 ]. Changing the learning cultural to actively include coaches and men-
tors may be difficult. Prior to moving forward, it is useful to define coaches and
mentors and explore whether or not coaching and mentoring positively impacts
performance.
A Modern Tale of Surgical Mentoring and Coaching (Cont.)
Through the ongoing performance review process, the resident found out his
communication skills were an area of concern. Recognizing communication
was an issue, he began to read articles and books about effective communica-
tion. When meeting with him, he demonstrated he knew the elements of effec-
tive communication. He explained that in the few weeks prior to reaching out,
he tried implementing the strategies. With frustration, he shared he was con-
tinuing to struggle in the surgical setting and, in particular, when attending
physicians were present. Learning about communication skills had provided
knowledge; however, defining the skills was not sufficient for developing com-
munication skills within the context of the surgical workplace.J.L. Koehler and E. Sturm