Applying Elite Sports Coaching Routines to Enhance Cognitive Load Management and Skill Development in Trainee Surgeons: A Pilot Study

• This pilot study applied elite sports coaching through the PERFORM model to surgical training. • The PERFORM model utilises performance-enhancing routines intended to reduce stress and improve technical skills. • Surgeons using PERFORM reported lower situational stress SURG-TLX scores. • The PERFORM model intervention showed positive trends in improving laparoscopic performance in trainee surgeons. To evaluate whether a metacognitive mental skills training intervention, the PERFORM model, improves technical performance and reduces cognitive load in resident surgeons. An experimental study using partial randomization was conducted as a pilot and proof-of-concept. Baseline and postintervention assessments were conducted for technical performance (GOALS), subjective workload (SURG-TLX), and physiological stress response (Electrodermal Activity). Assessment of technical performance was carried out retrospectively by blinded, expert raters through video-recordings utilizing the GOALS framework. The intervention group received training on the PERFORM model. The study was conducted over two days at a UK institute utilizing high-fidelity laparoscopic simulators. Resident surgical trainees were recruited via convenience sampling. Eligibility criteria also included postgraduate doctors with an interest in surgery but not yet accepted into a Higher Surgical Training Programme. Thirty-two participants were recruited, with 29 completing the study (n = 14 control, n = 15 intervention). The PERFORM group demonstrated small to moderate improvements in laparoscopic performance (GOALS score Δ = +2.0, d = 0.38), and reductions in perceived workload (SURG-TLX total Δ = -4.7), particularly in situational stress (d = 0.60). This pilot and proof-of-concept study demonstrates that metacognitive training in surgery, via the PERFORM model, may enhance technical performance and reduce the experience of stress in resident surgeons. These findings warrant further evaluation to assess long-term and physiological outcomes in a wider cohort. Integrating PERFORM into surgical curricula may offer a scalable tool to promote cognitive resilience and enhance performance.