Enhancing surgical training through cognitive load assessment

The cognitive load plays a key role in surgical education, influencing task performance and skill acquisition. This review explores three primary approaches to assessing cognitive load in the surgical context—paper-based measures, physiological measures, and performance-based measures—and highlights their relevance and applications in surgical education. Paper-based tools, such as the NASA Task Load Index and its surgical adaptation, the Surgery Task Load Index, offer simplicity but lack real-time insight. Physiological measures, including heart rate, eye tracking, and electrodermal activity, provide objective and timely data. Neuroimaging techniques, such as electroencephalography and functional near-infrared spectroscopy, provide direct evidence of brain activity but face challenges such as cost and complexity. Performance-based metrics, such as secondary tasks, infer cognitive load from working memory capacity. Accurate assessment of cognitive load can improve training outcomes by adapting demands to cognitive capacity. Future directions include the development of more accurate, multimodal, and user-friendly tools for dynamic, timely assessment, ultimately advancing personalized surgical training and improving patient care.