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Published on: August 12, 2019
The Impact of Escalating Cognitive Workload on Novice Surgeon's Brain Activation
Jessica Caterson1, Mary S L Goble1, Virginia Caddick1
1Hamlyn Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Annals of Surgery
|August 6, 2026
Summary
Cognitive overload in novice surgeons impairs suturing performance. Neural activation in the dorsolateral prefrontal cortex (DLPFC) increased in those maintaining performance but decreased in those whose performance declined, offering insights into surgical training.
Area of Science:
- Neurosurgery
- Cognitive Neuroscience
- Medical Education
Background:
- Cognitive load significantly impacts surgical performance and patient safety.
- Understanding neurocognitive responses to cognitive overload in novice surgeons is critical for effective training.
- Previous studies indicate prefrontal cortex deactivation in senior residents under overload, but novice responses are less understood.
Purpose of the Study:
- To characterize neural activation patterns in novice surgical residents during a suturing task with increasing cognitive load.
- To investigate the association between neural activation, cognitive load, and surgical performance in novice surgeons.
- To explore individual differences in cognitive overload resilience among novice surgical residents.
Main Methods:
- Twenty novice surgeons completed a suturing task under self-paced, time-pressured, and time-and-cognitive-stress conditions.
- Functional near-infrared spectroscopy (fNIRS) measured neural activation in the prefrontal and premotor cortices.
- Suturing performance, subjective cognitive load (SURG-TLX), and heart rate variability (HRV) were assessed.
Main Results:
- Subjective cognitive load and task complexity increased significantly, while suturing performance declined.
- Neural activation increased in the dorsolateral prefrontal cortex (DLPFC), premotor cortex (PMC), and supplementary motor area (SMA) with escalating cognitive load.
- Novice surgeons who maintained performance showed increased left DLPFC activation, whereas those with performance decline exhibited attenuated DLPFC activation and greater frontal PFC deactivation.
Conclusions:
- The DLPFC is crucial for planning and attention, the frontal PFC for multitasking, and the PMC/SMA for motor preparation during surgical tasks.
- Findings reveal distinct neurocognitive responses to cognitive overload in novice surgeons, differentiating between performance maintainers and decliners.
- This research provides a foundation for developing targeted interventions to enhance cognitive resilience and improve surgical training safety.
