Phase I Evaluation of Adaptive Learning as a Cognitive Readiness Component in a Proficiency-Based Simulator Curriculum for Laparoscopic Cholecystectomy

Background Proficiency-based surgical training increasingly combines cognitive preparation with simulator-based technical assessment. Adaptive learning platforms offer individualized knowledge reinforcement, but their added value within structured simulator curricula remains unclear. Aims The aim of this study was to evaluate whether adaptive learning improves knowledge acquisition and cognitive readiness within a proficiency-based simulator curriculum prior to technical assessment using the Global Operative Assessment of Laparoscopic Skills (GOALS). Methods This Phase I evaluation compared adaptive learning–supported instruction with standard instructional methods embedded in a proficiency-based simulator curriculum. Outcomes included overall knowledge acquisition and performance in higher-order cognitive domains, particularly clinical reasoning and guideline-based decision-making, which are considered prerequisites for safe progression to simulator-based technical assessment. Results Adaptive learning did not lead to a significant increase in overall knowledge acquisition compared with standard instruction. However, learners exposed to adaptive learning demonstrated superior performance in higher-order cognitive tasks, specifically clinical reasoning and guideline-concordant decision-making. These domains reflect essential cognitive competencies required before advancing to technical skills assessment using GOALS. Conclusion While adaptive learning does not replace standard instruction for broad knowledge acquisition, it selectively enhances higher-order cognitive competencies relevant to surgical safety and decision-making. Integrating adaptive learning as a cognitive readiness and safety-focused component within proficiency-based surgical curricula appears justified. Adaptive learning should complement—rather than replace—intensive simulator-based technical training to optimize structured progression toward operative competence.