Comparing skill transfer and cognitive style effects across three laparoscopic training modalities: a prospective randomized study in medical students

BACKGROUND: Simulation-based training is an important component of modern surgical education. While virtual reality (VR) simulators, box trainers, and serious games are all used in laparoscopic training, comparative data on their effectiveness, transferability, and the role of individual cognitive learning styles remain limited. METHODS: In this prospective, randomized study, 80 medical students without prior laparoscopic experience were assigned to one of four groups: VR simulator, box trainer, serious game, or control. Each group received four one-hour training sessions. Cognitive style was assessed using the Object-Spatial Imagery and Verbal Questionnaire (OSIVQ), and all participants completed standardized pre- and post-tests on a VR simulator. Performance was evaluated using z-scores for efficiency, accuracy, and task completion. RESULTS: All intervention groups demonstrated significant performance improvements. The VR group showed the greatest gains, particularly in complex tasks such as "Fine Dissection" and "Clip Applying". Box trainer training led to marked reductions in error rates. The serious game group primarily improved in basic skills but showed limited transfer to complex tasks. Spatial learners outperformed other cognitive styles across all modalities, whereas verbal learners improved significantly only in the VR group. CONCLUSION: All three simulation modalities support laparoscopic skill acquisition, but their effectiveness varies by task complexity and cognitive profile. VR training appears to be the most inclusive and effective, particularly for learners with non-spatial cognitive styles. These findings support the integration of cognitive profiling and task-specific modality selection into surgical training.