# Cognitive learning versus practical “hands-on” training for acquisition of laparoscopic surgical skills: an optimal combination study

## TL;DR

This study compares different training methods for laparoscopic surgery and finds that a balanced mix of hands-on practice and cognitive learning works best for beginners.

## Contribution

The study identifies an optimal balanced combination of practical training and cognitive learning for improving laparoscopic surgical skills in novices.

## Key findings

- A 50% practical training and 50% cognitive learning group showed the most improvement in all four performance assessments.
- Groups with imbalanced training (75% PT or 75% CL) improved fewer assessments compared to the balanced group.
- All three training modes improved MIS skills in novices, but the balanced approach was most effective.

## Abstract

Most minimally invasive surgery (MIS) training curricula involve practical training (PT) and cognitive learning (CL) to different extents. It has been proven that acquiring and training specific skills through CL can improve MIS skills. This study aimed to discover the most efficient combination of these two approaches and examine their effects on acquiring MIS skills in novices.

Sixty medical students without MIS experience participated in this randomized controlled study and were divided into three groups. The first group received the same amount of PT (50%) as CL (50%). The second group focused on PT (75%) compared to the CL (25%). The third group focused more on CL (75%), with less PT implemented (25%). Before and after training, participants performed an ex vivo laparoscopic cholecystectomy (LCHE). Objective Structured Assessment of Technical Skills (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS) scores were used for MIS skill evaluation.

Group 1 improved all four performance assessments (global GOALS 14.3 vs. 18.0, p < 0.001, LCHE-specific GOALS 5.9 vs. 6.9, p = 0.016, global OSATS 19.4 vs. 26.4, p < 0.001, LCHE-specific OSATS 37.9 vs. 46.5, p = 0.004). Group 2 and Group 3 improved three of four performance scores (Group 2: global GOALS 15.0 vs. 18.4, p < 0.001, LCHE-specific GOALS 7.0 vs. 7.7, p = 0.115, global OSATS 19.6 vs. 25.8, p < 0.001, LCHE-specific OSATS 41.3 vs. 50.7, p = 0.001; Group 3: global GOALS 13.8 vs. 17.9, p < 0.001, LCHE-specific GOALS 5.8 vs. 6.6, p = 0.148, global OSATS 18.9 vs. 25.5, p < 0.001, LCHE-specific OSATS 36.8 vs. 43.5, p = 0.034).

A balanced combination of PT and CL seems to offer the most effective training compared to predominantly PT or CL training. All three training modes improved MIS skills in novices.

The online version contains supplementary material available at 10.1007/s00464-025-11673-w.