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Bridging GAPS in Perioperative Education: Implementation of the Goals, Autonomy, Preparation, and Strategy Framework
Joel Norton1, Tabitha Thornton-Swan2, Lachlan Dick3
1Surgical Sabermetrics Laboratory, Usher Institute, University of Edinburgh, Edinburgh, UK; Clinical Surgery, University of Edinburgh, Edinburgh, UK; Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Journal of Surgical Education
|August 4, 2026
Summary
The Goals, Autonomy, Preparation and Strategy (GAPS) framework improved surgical education quality and frequency. This perioperative education enhancement did not significantly affect surgeons' intraoperative cognitive load.
Area of Science:
- Surgical Education
- Medical Simulation
- Cognitive Load Theory
Background:
- Preoperative educational briefings are crucial for surgical training but often lack consistency.
- Disparities exist between surgical trainers and trainees regarding the frequency and quality of educational discussions.
- The Goals, Autonomy, Preparation and Strategy (GAPS) framework offers a structured approach to perioperative education.
Purpose of the Study:
- To evaluate surgeon and trainee perceptions of current preoperative educational briefing practices.
- To assess the impact of implementing the GAPS framework on perioperative education.
- To determine the effect of the GAPS framework on intraoperative cognitive load.
Main Methods:
- A mixed-methods study involving a Phase 1 survey of surgical trainers and trainees.
- Phase 2 involved implementing the GAPS framework in vascular surgery for pre- and post-implementation data collection.
- Intraoperative cognitive load was measured using the Subjective Underwater Reading Task (SURG-TLX).
Main Results:
- Surveys revealed significant disparities in perceived briefing frequency and discussion of educational goals and strategy.
- GAPS implementation led to significant improvements in briefing frequency, learning objective discussion, autonomy, and teaching quality.
- Surgeon satisfaction with briefing structure, quality, and frequency significantly increased post-GAPS implementation.
Conclusions:
- A consistent lack of alignment persists between surgical trainers and residents regarding educational briefing.
- The GAPS framework is feasible for integration into routine surgical practice, enhancing perioperative education.
- GAPS implementation improved educational outcomes without significantly increasing intraoperative cognitive load.
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