Checklist-Based Instruction Improves Learning Efficiency and Reduces Cognitive Load During Basic Surgical Skills...

Mastering basic surgical skills is essential for medical students transitioning from theoretical learning to clinical practice. However, novice learners often require repeated practice to achieve consistent procedural performance. Guided by Cognitive Load Theory (CLT), this study aimed to evaluate the effects of a standardized checklist-based instructional model on learning efficiency, procedural performance, and cognitive load during wound dressing and suture removal training.

In this prospective randomized controlled trial, 70 fifth-year undergraduate clinical medical students undergoing their initial clinical internship training were enrolled to either the Checklist Group (n = 35) or the Control Group (n = 35). Both groups received standardized instructional videos before practice. The Checklist Group used a structured four-dimension checklist covering pre-procedural preparation, aseptic technique, procedural steps, and post-procedural care, whereas the Control Group followed traditional textbook-based instructions. The primary outcome was learning efficiency, defined as the number of practice attempts required to achieve proficiency, which was defined as three consecutive successful performances with a modified Global Rating Scale (GRS) ≥ 18/30 and no major aseptic technique violations. Secondary outcomes included immediate and two-week delayed procedural performance assessed using the GRS, and cognitive load measured using the modified NASA Task Load Index (NASA-TLX).

The Checklist Group required significantly fewer practice attempts to reach the predefined proficiency criterion compared with the Control Group (wound dressing: median [IQR], 4 [3.5-5] vs. 6 [5-7.5], p < 0.001; suture removal: 5 [4-6] vs. 8 [7-9], p < 0.001). The Checklist Group also achieved higher GRS scores in both immediate and two-week delayed assessments (all p < 0.001). In addition, NASA-TLX scores demonstrated significantly lower total cognitive load in the Checklist Group for both wound dressing and suture removal tasks (p = 0.0027 and p < 0.001, respectively).

Checklist-based instruction was associated with fewer practice attempts required to reach the predefined proficiency criterion, improved procedural performance, and reduced cognitive load during basic surgical skills training. The maintained performance observed in the two-week delayed assessment suggests that checklist-based instruction may support sustained procedural performance at two weeks after training. These findings support the potential value of checklist-based approaches as a structured instructional strategy for basic clinical skills education.