Challenges of getting to B (Briefing / Preoperative goal setting) in the BID model

Purpose: Implementing effective operative teaching models such as Briefing, Intra-operative teaching, and De- briefing (BID model) begins with establishing pre-operative teaching goals. However, the practice of setting pre-operative teaching goals is not widespread. This study aims to investigate the benefits, barriers, and facilitators of pre-operative goal setting as perceived by faculty surgeons. Methods: This qualitative study involved interviews with faculty members from our general surgery residency program, utilizing a standardized questionnaire. The interviews were recorded and transcribed. Qualitative analysis software (ATLAS.ti.9) was used to analyze the transcripts. We report the themes and relational networks. Results: All eight participants agreed that preoperative goal setting enhances teaching and improves resident satisfaction. However, individual and systemic barriers prevent this from being routinely practiced. These barriers include a belief that non-deliberate teaching is effective, administrative burdens that lead to organizational challenges and faculty burnout, workflow designs that hinder the alignment of faculty and residents for operative teaching, and a lack of clear expectations. Facilitators of incorporating preoperative goal setting into routine teaching practice include educating both faculty and residents, establishing realistic expectations, and aligning educational goals in the operating room. Faculty should be able to express their preferences for how and when to set preoperative goals. Cultivating a culture that considers preoperative goal setting as integral to operative teaching is essential for sustaining this practice. Conclusions: Despite recognizing its benefits, preoperative goal setting is not consistently practiced. This study identifies both individual and systemic barriers, as well as facilitators, that can guide efforts to promote and enhance the practice of preoperative goal setting.