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Cognitive Load Effect on Intraoperative Learning - A Randomized Trial in Simulation-Based Settings.

Mohammed F Shaheen¹, Abdulrahman Alhabeeb², Fareeda Mukhtar³

¹College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Hepatobiliary Sciences Department and Organ Transplant Center, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia.

Journal of Surgical Education

|October 17, 2025

Summary

This summary is machine-generated.

Simulating a noisy operating room (OR) increased cognitive load (CL) and impaired surgical trainees' knowledge acquisition during chest tube insertion training. Managing CL is crucial for effective surgical education.

Keywords:

cognitive load education intraoperative teaching learning surgery

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Area of Science:

Medical Education
Surgical Training
Cognitive Psychology

Background:

Operating room (OR) distractions increase cognitive load (CL) in surgical trainees, potentially hindering learning.
The impact of intraoperative teaching within a high-stress OR environment on CL and knowledge acquisition is not well understood.

Purpose of the Study:

To investigate the effect of a noisy OR simulation on cognitive load and knowledge acquisition in surgical trainees during a chest tube insertion procedure.
To compare learning outcomes between trainees in a low-stress versus a noisy OR simulation environment.

Main Methods:

A randomized controlled trial involved 61 medical students, divided into a control group (low-stress simulation) and an experimental group (noisy OR simulation).
Cognitive load was measured using subjective scales (m-MCLS) and objective methods (heart rate, tactile response task).
Knowledge acquisition was assessed via post-simulation quiz scores.

Main Results:

The noisy OR simulation group (EG) experienced significantly higher extraneous cognitive load (p < 0.001).
Objective measures showed more attentional lapses in the EG (skipped TRT responses: 19% vs. 5.3%, p < 0.001).
Knowledge acquisition was impaired in the EG, with lower quiz scores (57.4% vs. 67.5%, p = 0.02).

Conclusions:

A realistic, noisy OR simulation intensifies cognitive load and negatively impacts surgical trainees' knowledge acquisition.
Integrating cognitive load management strategies into surgical training curricula is recommended to improve performance.
Further research is needed to determine optimal simulation realism and interventions for mitigating negative learning impacts.