Training with cognitive load improves performance under similar conditions in a real surgical task

Ganesh Sankaranarayanan, Coleman A. Odlozil, Katerina O. Wells, Steven G. Leeds, Sanket Chauhan, James W. Fleshman, Daniel B. Jones, Suvranu De

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Enhancing cognitive load while performing a bimanual surgical task affects performance. Whether repeated training under this condition could benefit performance in an operating room was tested using a virtual reality simulator with cognitive load applied through two-digit math multiplication questions. Method: 11 subjects were randomized to Control, VR and VR + CL groups. After a pre-test, VR and VR + CL groups repeated the peg transfer task 150 times over 15 sessions with cognitive load applied only for the last 100 trials. After training, all groups took a post-test and two weeks later the retention test with and without cognitive load and the transfer task on a pig intestine of 150 cm long under cognitive load. Results and conclusion: Mixed ANOVA analysis showed significant differences between the control and VR and VR + CL groups (p = 0.013, p = 0.009) but no differences between the VR + CL and the VR groups (p = 1.0). GOALS bimanual dexterity score on transfer test show that VR + CL group outperformed both Control and VR groups (p = 0.016, p = 0.03). Training under cognitive load benefitted performance on an actual surgical task under similar conditions.

Original languageEnglish (US)
Pages (from-to)620-629
Number of pages10
JournalAmerican journal of surgery
Issue number3
StatePublished - Sep 2020
Externally publishedYes


  • Cognitive load
  • Laparoscopy
  • Surgical education
  • Virtual reality simulation

ASJC Scopus subject areas

  • Surgery


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