Laparoscopic surgery can be exhausting and frustrating, and the cognitive load experienced by surgeons may have a major impact on patient safety as well as healthcare economics. As cognitive load decreases with increasing proficiency, its robust assessment through physiological data can help to develop more effective training and certification procedures in this area. We measured data from 31 novices during laparoscopic exercises to extract features based on cardiac and ocular variables. these were compared with traditional behavioural and subjective measures in a dual-task setting. We found significant correlations between the features and the traditional measures. The subjective task difficulty, reaction time, and completion time were well predicted by the physiology features. Reaction times to randomly timed auditory stimuli were correlated with the mean of the heart rate (r = −0.29) and heart rate variability (r = 0.4). completion times were correlated with the physiologically predicted values with a correlation coefficient of 0.84. We found that the multi-modal set of physiology features was a better predictor than any individual feature and artificial neural networks performed better than linear regression. The physiological correlates studied in this paper, translated into technological products, could help develop standardised and more easily regulated frameworks for training and certification. Laparoscopic surgery (LS) offers substantial clinical and economic benefits over open surgery, including decreased postoperative pain and better utilisation of hospital beds and antibiotics 1-3. Consequently, LS is becoming increasingly routine in many surgical conditions. In the United States in 2013, surgeons performed cholecystectomy laparoscopically in 96% of cases 4. The share of laparoscopy procedures within the total number of appendectomy and cholecystectomies in the United Kingdom in 2017 were respectively 74% and 92%, up from 41 and 84% in 2010 5. During LS, surgeons coordinate their hands, eyes, and long-shaft instruments in trocars inserted at narrow incisions, while mentally translating two-dimensional real-time video into the three-dimensional intracorporal setting. They continuously translate hand movements into the inverted movements of tool-tips and receive limited haptic feedback. The additional difficulties of performing LS relative to open surgery are widely acknowledged 6. These highlight further unmet needs in the context of training and assessment, which would be greatly helped by tools that can provide new insights into skill development 7,8. In addition to technical skills based on visual and motor ability, surgeons generally use an array of non-technical skills that include mental readiness, cognitive flexibility, the ability to anticipate problems, team adaptation, safety awareness, situational awareness and communication style 9. Intraoperative decisions are required when, for example, a surgeon faces an anatomic anomaly or patient decompensation. Rapidly making correct decisions and man...