Cognitive overload in novice surgeons significantly impacts performance during surgical tasks.

• Subjective cognitive load rose sharply with task complexity (p<0.00001), while performance dropped (p<0.00001).
• Neural activation increased in key brain areas as cognitive load escalated, indicating differing responses for those who maintained performance versus those who declined.

Awareness of these dynamics can guide training approaches to enhance patient safety and surgical proficiency.

• “Maintainers” showed increased activation in the dorsolateral prefrontal cortex, while “decliners” exhibited greater frontal deactivation.