The More the Merrier? Appropriateness of Massed Simulation Training in Surgical Residency.

Background: Surgical postgraduate training is often debated in an economically squeezed health care system, particularly regarding the effectiveness of massed training, when considering the impact on Cognitive Load (CL). However, the relationship between CL and massed training in surgical education has not been extensively studied. Objective: This study aimed to explore how a five-day simulation-based orthopedic course affected cognitive load among orthopedic residents. Methods: Surgical residents (N = 40) in their final phase of medical specialization were enrolled in a surgical skill simulations course from spring 2022 till fall 2023. Questionnaires were administered to course participants to measure CL using NASA-TLX. Fluctuations in CL during the five-day course were analyzed using ANCOVA and Spearman correlation. Results: Forty out of the 41 course participants agreed to participate. The findings revealed fluctuations in CL among orthopedic residents during the five-day course. NASA-TLX scores increased significantly after day 1 ( Conclusion: The findings revealed variations in perceived workload over the five days, with no single factor identified as the primary driver of changes in CL. While the study did not find a detrimental impact from massed training, further research is needed to understand the connection between training approaches and their impact on CL and learning outcomes.