Overview

The Rural Surgical Networks of Alberta (RSONA) Coaching Stream Summary Report (Phase 1) details the evaluation and pilot execution of an automated coaching preparedness program designed for rural surgeons in Alberta. Operating in collaboration with the Office of Global Surgery (OGS), RSONA established this coaching initiative as one of six streams intended to better equip rural physicians for expanded obstetric and surgical responsibilities. Prepared by Paul Bellows on behalf of a project team sponsored by Dr. Abdullah Saleh and owned by Glen Vanstone, Phase 1 focused on defining coach competency criteria and testing the Virti VR virtual reality platform as an onboarding and evaluation tool.

The Phase 1 pilot successfully created a competency-based curriculum, an automated four-step assessment workflow (incorporating the GROW coaching model), and an end-to-end coach journey map. To train and test AI-driven virtual avatars within Virti, the team created four realistic, rural-context personas—Dr. Jasmine, Dr. Jameson, Dr. Maurice, and Dr. Kerry—based on user research with active rural physicians. Beta testing with senior surgeons yielded strong qualitative endorsements and demonstrated measurable knowledge gains (e.g., a 123.8% score increase on repeat testing for one persona). While participation numbers fell below initial expectations, the project team concluded that Virti is an effective platform and recommended moving forward into Phase 2 to build a full operational deployment program.

The Systemic Problem

Alberta’s rural surgical network faces severe systemic challenges that impact healthcare delivery and physician retention:

• Physician Isolation and Turnover: Rural surgeons frequently leave their positions prematurely due to professional isolation, extreme stress, high emotional load, and a lack of connection to both their geographic communities and broader surgical peer networks.
• Resource Constraints and Service Gaps: Rural healthcare facilities suffer from chronic staffing shortages—particularly among nurses and anesthetists—forced facility closures, and limited surgical equipment. Consequently, rural patients are often forced to endure long, costly, and stressful travel to urban centers for routine or emergency procedures.
• Imposter Syndrome and Anxiety: Surgeons who are new to Canada, transitioning between communities, or attempting to expand their scope of practice often face high anxiety, lack of confidence when adopting new techniques, and fear of judgment. Standard urban coaching models frequently fail because they ignore these unique rural pressures, resource limits, and interpersonal dynamics.

Outcomes

Through the Phase 1 pilot, the RSONA Coaching Stream achieved several key technical, clinical, and evaluative outcomes:

• Framework & Competency Curriculum: Developed a 10-competency evaluation framework tailored to rural coaching (e.g., Establishing Trust & Psychological Safety, Contextual Awareness, Managing Surgical Anxiety) and integrated the 4-step GROW model (Goals, Reality, Options, Will).
• Automated Preparedness Pathway: Designed a functional 4-gate workflow inside Virti (C1: Interactive GROW Module, C2: Simulation Round 1 Baseline, C3: Mandatory Reflection, C4: Simulation Round 2 Applied Learning) that captures an observable improvement (“delta”) signal in coaching performance.
• Production-Ready Persona Library: Built and trained four AI avatars in Virti reflecting authentic rural scenarios—ranging from managing severe burnout (Dr. Jasmine) and navigating surgical anxiety (Dr. Jameson) to licensing hurdles (Dr. Maurice) and systemic resource exhaustion (Dr. Kerry).
• Validated AI Feedback & Beta Endorsement: Beta testing confirmed that Virti’s dynamic AI feedback was highly accurate and meaningful. Participating senior surgeons, such as cardiac surgeon Dr. William Kidd, strongly endorsed the technology as lifelike and effective for evaluating coaching readiness.
• Clear Operational Roadmap: Established privacy boundaries, defined baseline safety rules, and outlined the necessary Phase 2 next steps, including coach/coachee matching logic, contracting pathways, and live-use governance.