Bridging GAPS in Perioperative Education: Implementation of the Goals, Autonomy, Preparation, and Strategy Framework

To collate perspectives on preoperative educational briefing practices, and assess the impact of the Goals, Autonomy, Preparation and Strategy (GAPS) framework on perioperative education and intraoperative cognitive load.

Phase 1 of this mixed-methods study was a survey to ascertain perceptions of perioperative education from surgical trainers and trainees. Phase 2 was the introduction of the GAPS framework into routine surgical practice, with quantitative and qualitative data collected pre- and postimplementation. Intraoperative subjective cognitive load was self-reported (SURG-TLX) and assessed with a linear mixed-effects model.

The Phase 1 survey was disseminated to attendees at surgical education workshops and operating surgeons at the Royal Infirmary of Edinburgh (RIE). Phase 2 took place within the Department of Vascular Surgery, RIE.

Phase 1 included 46 faculty surgeons and 46 surgical trainees from an international cohort. Phase 2 included 7 faculty vascular surgeons and 8 residents/fellows.

Ninety-two surgeons completed the Phase 1 survey, demonstrating trainee vs. faculty surgeon disparity in the perceived frequency (p = 0.05) of educational briefings, and discussion surrounding trainee educational goals (p = 0.05) and operative strategy (p = 0.04). Fifteen surgeons participated in 95 (51 pre-, 44 postimplementation) procedures in Phase 2. Following GAPS implementation, significant improvements were reported in briefing frequency (p = 0.008), discussion around resident learning objectives (p = 0.004) and autonomy (p = 0.02), and intraoperative teaching quality (p = 0.01). Higher rates of satisfaction were reported with briefing structure (p = 0.02), quality (p = 0.04) and frequency (p = 0.02). Similar improvements were observed in debriefing satisfaction and content. GAPS implementation did not significantly impact SURG-TLX score (+2.66 points; 95% CI -0.62 to 5.94; p = 0.10).

There is a persistent lack of alignment between trainers and residents as to the quality and frequency of educational briefing. Implementation of the GAPS framework into daily surgical practice was feasible, and resulted in measurable improvement in perioperative education, with no significant impact on cognitive load.