Workload-adapted versus uniform-difficulty simulation-based laparoscopic training

Background: Implementing an effective training protocol is essential for a successful simulation-based program, and modifying task difficulty may improve training outcome even if it may temporarily hinder performance during training compared with uniform difficulty. We sought to compare workload-adapted (increasing task difficulty) versus uniform training protocols to evaluate their effects on in-training performance and post-training skill transfer. Methods: We assigned trainees into either an experimental group, which practised tasks of increasing difficulty in target size and platform stability, or a control group, which practised tasks of constant, moderate difficulty. Both groups completed 6 sessions of laparoscopic suturing over 3 days. We assessed performance using suture time and total number of successful sutures. We evaluated post-training skill transfer at 2 time points using the same anastomosis task. Results: We included 22 trainees. Baseline skills were comparable between groups. The control group demonstrated significantly faster improvement in average suture times during training than the experimental group (p < 0.001). Both groups improved successful suture numbers during training, with no significant between-group difference in improvement rates. However, in post-training transfer tests, the experimental group exhibited significantly shorter suture times (p = 0.03) and more successful sutures (p = 0.046). Conclusion: Despite slower in-training improvement, workload-adapted training significantly enhanced post-training skill transfers compared with uniform task practice. These findings support the argument that aligning task demands with trainees’ cognitive capacity can optimize post-training skill acquisition and transfer.