Effects of the Physical Environment on Cognitive Load and Learning: Towards a New Model of Cognitive Load

Effects of Classroom Design on the Memory of University Students: From a Gender Perspective

Classroom design has important effects on the cognitive functions of students. However, this relationship has rarely been analysed in terms of gender. The aim of the present study, therefore, is to analyse the influence of different design variables (classroom geometry, wall colour, and artificial lighting) on university students’ memories from a gender perspective. To do so, 100 university students performed a memory task while visualising different design configurations using a virtual reality setup. Key results show that certain parameters, such as 5.23 m classroom width, 10,500 Kelvin lighting colour temperature, or the blue hue on the walls influence men and women in a similar way, while a purple hue or walls with low colour saturation can generate significantly different behaviour, especially in cognitive processes such as short-term memory. In this study, the use of virtual reality proved to be a useful tool to explore the design effects of virtual learning environments, increasingly present due to training trends and catalysed by the 2020 pandemic. This is a turning point and an international novelty as it will enable the design of classrooms (both physical and virtual) that maximise the cognitive functions of learners, regardless of gender.

Examining the accuracy of residents' self-assessments and faculty assessment behaviours in anesthesiology

BACKGROUND

Residents' accurate self-assessment and clinical judgment are essential for optimizing their clinical skills development. Evidence from the medical literature suggests that residents generally do poorly at self-assessing their performance, often due to factors relating to learners' personal backgrounds, cultures, the specific contexts of the learning environment and rater bias or inaccuracies. We evaluated the accuracy of anesthesiology residents' self-assessed Global Entrustment scores and determined whether differences between faculty and resident scores varied by resident seniority, faculty leniency, and/or year of assessment.

METHODS

We employed variance components modeling techniques and analyzed 329 pairs of faculty and self-assessed entrustment scores among 43 faculty assessors and 15 residents. Using faculty scores as the gold standard, we compared faculty scores with residents' scores (x_i(faculty)-x_i(resident)), and determined residents' accuracy, including over- and under-confidence.

RESULTS

The results indicate that residents were respectively over- and under-confident in 10.9% and 54.4% of the assessments but more consistent in their individual self-assessments (rho = 0.70) than faculty assessors. Faculty scores were significantly higher (α = 0.396; z = 4.39; p < 0.001) than residents' self-assessed scores. Being a lenient/dovish (β = 0.121, z = 3.16, p < 0.01) and a neutral (β = 0.137, z = 3.57, p < 0.001) faculty assessor predicted a higher likelihood of resident under-confidence. Senior residents were significantly less likely to be under-confident compared to junior residents (β = -0.182, z =-2.45, p < 0.05). The accuracy of self-assessments did not significantly vary during the two years of the study period.

CONCLUSIONS

The majority of residents' self-assessments were inaccurate. Our findings may help identify the sources of such inaccuracies.

Which Tools in Multimedia Are Best for Learning Outcomes? A Study Grounded in Cognitive Load Structures

The main objective of this study is to investigate the importance of three compositions in multimedia for learning outcomes (LOs) in relation to individual differences in short-term memory (STM) capacity. The study is based on a survey of 378 individuals at the bachelor level (military officers, teachers, and psychology students). The LOs of three different multimedia compositions (means) were tested. This applied to individuals with low, medium, and high STM capacity. The results show that the successive presentation (Type II) of learning materials through multiple representation forms/channels (speech, pictures, and screen text/labels) provides a better LO than just speech (Type I) and simultaneous presentation (Type III). Overall, visual and verbal channel capacities did not contribute to the LO in any of the three tools tested, but some specific STM capacity types or substructures (visual and verbal progressive capacities) and non-verbal (RAPM) types have significance, particularly in exploiting successive presentation (Type II) for learning. Although the tools used in the multimedia educational material had a low cognitive load, the individuals with low capacity learned relatively less than the individuals with higher capacity. A symbolic form of expression was introduced concerning the relationship between cognitive load structure (CLS) and LOs through various tools in multimedia as an aid in the theoretical and empirical analyses. This is referred to as the CLS-LO formula. The main assumption of this study, based on previous empirical and theoretical ones, is that the relationship between CLS and LO is expressed with the following CLS-LO formula: CLSTypeIII>CLSTypeII>CLSTypeI→LOTypeIII>LOTypeI>LOTypeII. Based on this study, the relationship became: CLSTypeIII>CLSTypeI>CLSTypeII→LOTypeII>LOTypeI=LOTypeIII. This basic research study is primarily a contribution to understanding underlying cognitive processes in STM and their importance for learning in multimodal forms compared with analogue text. The findings will also be relevant as a basis for performance analysis and decision-making under high information pressure, risk, and unpredictable conditions.

Understanding Cognitive Load in Digital and Online Learning: a New Perspective on Extraneous Cognitive Load

Cognitive load theory has been a major influence for the field of educational psychology. One of the main guidelines of the theory is that extraneous cognitive load should be reduced to leave sufficient cognitive resources for the actual learning to take place. In recent years, research regarding various design factors, in particular from the field of digital and online learning, have challenged this assumption. Interactive learning media, immersion, disfluency, realism, and redundant elements constitute five major challenges, since these design factors have been shown to induce task-irrelevant cognitive load, i.e., extraneous load, while still promoting motivation and learning. However, currently there is no unified approach to integrate such effects into cognitive load theory. By including aspects of constructive alignment, an approach aimed at fostering deep forms of learning in order to achieve specific learning outcomes, we devise a strategy to balance cognitive load in digital learning. Most importantly, we suggest considering both the positive and negative effects on cognitive load that certain design factors of digital learning can cause. In addition, a number of research results highlight that some types of positive effects of digital learning can only be detected using a suitable assessment method. This strategy of aligning cognitive load with desired learning outcomes will be useful for formulating theory-guided and empirically testable hypotheses, but can be particularly helpful for practitioners to embrace emerging technologies while minimizing potential extraneous drawbacks.

Effect of simulation on cognitive load in health care professionals and students: protocol for a systematic review and meta-analysis

OBJECTIVE

The objective of this review is to assess the effect of simulation activities and their design features on cognitive load in health care professionals and students.

INTRODUCTION

Simulation activities are now widely implemented in health care professionals' education. However, the mechanisms by which simulations and their design features lead to health care professionals' and students' learning remains unclear. Still, because of their high interactivity and complexity, simulation activities have the potential to impact the cognitive load of learners. Synthesizing evidence regarding this phenomenon could help simulation educators identify the design features that affect learners' cognitive load, and explain why some simulation activities are more effective than others.

INCLUSION CRITERIA

This review will consider experimental and quasi-experimental studies in which the effect of a simulation activity on cognitive load in health care professionals or students from any discipline or level of practice is evaluated. All academic and health settings will be included.

METHODS

Following the guidelines of the JBI methods for systematic reviews of effectiveness, CINAHL, Embase, ERIC, MEDLINE, PsycINFO, and Web of Science will be searched for studies published in English or French, without a date limit. Retrieved studies will be independently screened for inclusion, then critically appraised for methodological quality by two reviewers using standardized JBI tools. Data extraction will be done independently using adapted tools from JBI. Where possible, data will be pooled using meta-analytical methods.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020187723.

Long-Term BCI Training of a Tetraplegic User: Adaptive Riemannian Classifiers and User Training

While often presented as promising assistive technologies for motor-impaired users, electroencephalography (EEG)-based Brain-Computer Interfaces (BCIs) remain barely used outside laboratories due to low reliability in real-life conditions. There is thus a need to design long-term reliable BCIs that can be used outside-of-the-lab by end-users, e.g., severely motor-impaired ones. Therefore, we propose and evaluate the design of a multi-class Mental Task (MT)-based BCI for longitudinal training (20 sessions over 3 months) of a tetraplegic user for the CYBATHLON BCI series 2019. In this BCI championship, tetraplegic pilots are mentally driving a virtual car in a racing video game. We aimed at combining a progressive user MT-BCI training with a newly designed machine learning pipeline based on adaptive Riemannian classifiers shown to be promising for real-life applications. We followed a two step training process: the first 11 sessions served to train the user to control a 2-class MT-BCI by performing either two cognitive tasks (REST and MENTAL SUBTRACTION) or two motor-imagery tasks (LEFT-HAND and RIGHT-HAND). The second training step (9 remaining sessions) applied an adaptive, session-independent Riemannian classifier that combined all 4 MT classes used before. Moreover, as our Riemannian classifier was incrementally updated in an unsupervised way it would capture both within and between-session non-stationarity. Experimental evidences confirm the effectiveness of this approach. Namely, the classification accuracy improved by about 30% at the end of the training compared to initial sessions. We also studied the neural correlates of this performance improvement. Using a newly proposed BCI user learning metric, we could show our user learned to improve his BCI control by producing EEG signals matching increasingly more the BCI classifier training data distribution, rather than by improving his EEG class discrimination. However, the resulting improvement was effective only on synchronous (cue-based) BCI and it did not translate into improved CYBATHLON BCI game performances. For the sake of overcoming this in the future, we unveil possible reasons for these limited gaming performances and identify a number of promising future research directions. Importantly, we also report on the evolution of the user's neurophysiological patterns and user experience throughout the BCI training and competition.

Exploring a sustainable building's impact on occupant mental health and cognitive function in a virtual environment

Even though people spend the majority of their time indoors, the role of buildings in shaping human experience is still not well understood. The objective of this experimental project is to develop, test, and validate a data-driven neuroscience approach to understand the built environment’s impact on occupant cognitive function and mental health. The present study utilized virtual environments and electroencephalogram (EEG) and event-related potential (ERP) approaches, to provide objective neurophysiological information about how sustainable buildings (SBs) impact people’s affective and cognitive functioning differently compared to conventional building (CBs). The long-term goal is to assess the validity of sustainable building design protocols in promoting and increasing mental health and well-being and the mechanism used to accomplish these increases. The findings showed test subjects demonstrated increased visual system engagement and modulated attentional focus and control processing in the SB compared to the CB environments. The findings can be explained by the cognitive load theory, which is consistent with the interpretation of greater focus on the present environment and reduced internal mental processing (cf. mindfulness), based on the observed increased theta/delta activities and greater engagement of visual systems and corresponding decreases in frontal activity in the SB environment. In addition, the combination of virtual environment (VE) and EEG/ERP has the potential to advance design methods by soliciting occupants’ responses prior to completion of the projects. Building design is more than aesthetics; expanding the horizon for neuroscience would eventually result in a new knowledge base for building design, particularly sustainable building design, since the sustainability of the building often needs to be quantified.

Learning Echocardiography in the Workplace: A Cognitive Load Perspective

PURPOSE

Although workplace learning environments provide authentic tasks to promote learning, elements of clinical settings may distract trainees and impede learning. The characteristics of workplace learning environments that require optimization are ill-defined. Applying principles of cognitive load theory (CLT) to optimize learning environments by managing intrinsic load (complexity of the task matched to learner knowledge and skill), minimizing extraneous load (any aspect that is not part of task completion), and increasing germane load (processing for storage in long-term memory) could be advantageous. The authors explored trainee perceptions of characteristics that helped or impaired learning from a cognitive load perspective. Echocardiography interpretation was used as a model.

METHOD

The authors conducted semistructured interviews between December 2018 and March 2019 with a purposeful sample of 10 cardiology trainees at the University of California, San Francisco, School of Medicine until thematic sufficiency was achieved. Participants represented a range of training levels (3 fourth-year trainees, 2 fifth-year trainees, 3 sixth-year trainees, and 2 advanced echocardiography fellows) and career aspirations (4 desired careers in imaging). Two independent coders analyzed interview transcripts using template analysis. Codes were mapped to CLT subcomponents.

RESULTS

Trainees selected their own echocardiograms to interpret; if trainees' skill levels and the complexity of the selected echocardiograms were mismatched, excess intrinsic load could result. Needing to look up information essential for task completion, interruptions, reporting software, and time pressures were characteristics that contributed to extraneous load. Characteristics that related to increasing germane load included the shared physical space (facilitating reading echocardiograms with attendings and just-in-time guidance from near peers) and the availability of final reports to obtain feedback independent of teachers.

CONCLUSIONS

As interpreted from a cognitive load perspective, findings highlight characteristics of workplace learning environments that could be optimized to improve learning. The findings have direct application to redesigning these learning environments.

Evidence for validity for the Cognitive Load Inventory for Handoffs

CONTEXT

Patient handovers remain a significant patient safety challenge. Cognitive load theory (CLT) can be used to identify the cognitive mechanisms for handover errors. The ability to measure cognitive load types during handovers could drive the development of more effective curricula and protocols. No such measure currently exists.

METHODS

The authors developed the Cognitive Load Inventory for Handoffs (CLIH) using a multi-step process, including expert interviews to enhance content validity and talk-alouds to optimise response process validity. The final version contained 28 items. From January to March 2019, we administered a cross-sectional survey to 1807 residents and fellows from a large health care system in the USA. Participants completed the CLIH following a handover. Exploratory factor analysis of data from one-third of respondents identified high-performing items; confirmatory factor analysis of data from the remaining sample assessed model fit. Model fit was evaluated using the comparative fit index (CFI) (>0.90), Tucker-Lewis index (TFI) (>0.80), standardised root mean square residual (SRMR) (<0.08) and root mean square of error of approximation (RMSEA) (<0.08).

RESULTS

Participants included 693 trainees (38.4%) (231 in the exploratory study and 462 in the confirmatory study). Eleven items were removed during exploratory factor analysis. Confirmatory factor analysis of the 16 remaining items (five for intrinsic load, seven for extraneous load and four for germane load) supported a three-factor model and met criteria for good model fit: the CFI was 0.95, TFI was 0.93, RMSEA was 0.074 and SRMR was 0.07. The factor structure was comparable for gender and role. Intrinsic, extraneous and germane load scales had high internal consistency. With one exception, scale scores were associated, as hypothesised, with postgraduate level and clinical setting.

CONCLUSIONS

The CLIH measures three types of cognitive load during patient handovers. Evidencefor validity is provided for the CLIH's content, response process, internal structure and association with other variables. This instrument can be used to determine the relative drivers of cognitive load during handovers in order to optimize handover instruction and protocols.

The Physical Learning Environment of Online Distance Learners in Higher Education - A Conceptual Model

Online distance learning is offered not only in post-secondary distance education institutions but in traditional universities as well. With advances in mobile and wireless technologies, completing academic studies anywhere anytime should become feasible. Research in distance education and online learning has focused on computer-mediated communication, instructional design, learner characteristics, educational technology, and learning outcomes. However, little attention has been given to where exactly learners do their learning and studying and how the physical and social aspects of the physical environment within which the online learner is physically embedded (e.g., the home) supports and constrains learning activities. In this paper, the author proposes a conceptual model for understanding the role that the physical environment plays in online distance learning in higher education, drawing on theories and research in environmental psychology, online learning, telework and mobile work, and higher education. Several gaps in research are identified, and suggestions for future research are proposed.

From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine

Cognitive load theory has become a leading model in educational psychology and has started to gain traction in the medical education community over the last decade. The theory is rooted in our current understanding of human cognitive architecture in which an individual's limited working memory and unlimited long-term memory interact during the process of learning. Though initially described as primarily a theory of learning, parallels between cognitive load theory and broader aspects of medical education as well as clinical practice are now becoming clear. These parallels are particularly relevant and evident in complex clinical environments, like resuscitation medicine. The authors have built on these connections to develop a recontextualized version of cognitive load theory that applies to complex professional domains and in which the connections between the theory and clinical practice are made explicit, with resuscitation medicine as a case study. Implications of the new model for medical education are also presented along with suggested applications.

Challenges in learning aerobic and anaerobic concepts: an interpretative understanding from the cognitive load theory perspective

PURPOSE

It has been acknowledged in physical education (PE) that knowledge empowers learners to develop a physically active lifestyle In this study, we consider Cognitive Load Theory (CLT) as a valuable extension of the constructivist learning theory to help articulate the role of three pivotal instructional factors, content knowledge, learners, and instructional process, in learning fitness knowledge in PE. Guided by CLT, this study was intended to identify middle school students' cognitive architecture about aerobic and anaerobic concepts and pedagogical factors that might enhance or limit scientific conceptualization.

METHODS

We employed a mixed-methods approach. A total of 291 students randomly drawn from the 24 schools provided data on conceptual knowledge levels via standardized test and conceptual structures of understanding via semi-structured interviews about the aerobic/anaerobic concepts.

RESULTS

Results from integrated quantitative and qualitative analyses reveal the role of task element interactivity as a function of conceptualization in the students' cognitive architecture. The students lack the understanding that aerobic and anaerobic concepts are associated with the concepts of complex metabolic systems that dictate the energy pathways experienced in physical activity. Their understandings are characterized by a tendency of overly simplifying the complex conceptions for convenient schema activation. The simplified conception is likely to prohibit their understanding from becoming consistent with the science. The findings suggest that teachers should anticipate lack of understanding of knowledge connectivity when teaching fitness concepts and establish the task element interactivity with enhanced clarity to facilitate knowledge learning.

CONCLUSION

Consistent with the constructivist learning theory, the findings inform us that teaching complex fitness concepts require the teacher to connect prior knowledge as a prerequisite to activate relevant cognitive architecture and actively build connections between the prior knowledge and the to-be learned concepts. PE curriculum designers and teachers should anticipate the complex challenges in teaching the aerobic and anaerobic concepts because of their connections to other concepts associated with human energy systems such as intensity and oxygen supply.

The influence of classroom seating arrangement on children's cognitive processes in primary school: the role of individual variables

To date, despite the great debate regarding the best seating arrangement for learning in classrooms, no empirical studies have examined the direct effects of different seating arrangements on children’s cognitive processes. This is particularly important nowadays that the COVID-19 measures include maintaining distance in the classroom. Aim of this study was experimentally investigating the effect of changing the seating arrangement (clusters vs. single desks), on logical reasoning, creativity and theory of mind, in children attending primary school. Furthermore, some individual characteristics (e.g., gender, loneliness, popularity) were analysed as potential moderators. Results on 77 participants showed that, when children were seated in single desks, their score in logical reasoning was globally higher. Furthermore, when seated in single desks, girls showed a better performance in the theory of mind, and lonelier children performed better in theory of mind and creativity. This on field experimental study suggests the importance of considering both the nature of the task and children’s individual characteristics when deciding on a seating arrangement in the classroom.

Predicting Cognitive Load and Operational Performance in a Simulated Marksmanship Task

Modern operational environments can place significant demands on a service member's cognitive resources, increasing the risk of errors or mishaps due to overburden. The ability to monitor cognitive burden and associated performance within operational environments is critical to improving mission readiness. As a key step toward a field-ready system, we developed a simulated marksmanship scenario with an embedded working memory task in an immersive virtual reality environment. As participants performed the marksmanship task, they were instructed to remember numbered targets and recall the sequence of those targets at the end of the trial. Low and high cognitive load conditions were defined as the recall of three- and six-digit strings, respectively. Physiological and behavioral signals recorded included speech, heart rate, breathing rate, and body movement. These features were input into a random forest classifier that significantly discriminated between the low- and high-cognitive load conditions (AUC = 0.94). Behavioral features of gait were the most informative, followed by features of speech. We also showed the capability to predict performance on the digit recall (AUC = 0.71) and marksmanship (AUC = 0.58) tasks. The experimental framework can be leveraged in future studies to quantify the interaction of other types of stressors and their impact on operational cognitive and physical performance.

Cognitive-Load Theory: Methods to Manage Working Memory Load in the Learning of Complex Tasks

Cognitive-load researchers attempt to engineer the instructional control of cognitive load by designing methods that substitute productive for unproductive cognitive load. This article highlights proven and new methods to achieve this instructional control by focusing on the cognitive architecture used by cognitive-load theory and aspects of the learning task, the learner, and the learning environment.

The Effects of Different Types of Environmental Noise on Academic Performance and Perceived Task Difficulty in Adolescents With ADHD

Objective: To examine the effects of environmental noises (speech and white noise) relative to a no noise control condition on the performance and difficulty ratings of youth with ADHD (N = 52) on academic tasks. Method: Reading performance was measured by an oral retell (reading accuracy) and the time spent reading. Writing performance was measured through the proportion of correct writing sequences (writing accuracy) and the total words written on an essay. Results: Participants in the white noise condition took less time to read the passage and wrote more words on the essay compared with participants in the other conditions, though white noise did not improve academic accuracy. The participants in the babble condition rated the tasks as most difficult. Conclusion: Although white noise appears to improve reading time and writing fluency, the findings suggest that white noise does not improve performance accuracy. Educational implications are discussed.

Cognitive-Motor Dual Task Interference Effects on Declarative Memory: A Theory-Based Review

Bouts of exercise performed either prior to or immediately following study periods enhance encoding and learning. Empirical evidence supporting the benefits of interventions that simultaneously pair physical activity with material to be learned is not conclusive, however. A narrative, theory-based review of dual-task experiments evaluated studies in terms of arousal theories, attention theories, cognitive-energetic theories, and entrainment theories. The pattern of the results of these studies suggests that cognitive-motor interference can either impair or enhance memory of semantic information and the manner in which physical activity impacts working memory within executive processing appears to explain disparate outcomes. The integration and timing of physical movements in concert with the type of information to be encoded and remembered appears to be a critical requirement for learning. These observations have implications for the role of physical activity in education, rehabilitation, and gerontological settings.

Neuroscience in service research: an overview and discussion of its possibilities

Purpose

The purpose of this paper is to discuss recent developments in neuroscientific methods and demonstrate its potential for the service field. This work is a call to action for more service researchers to adopt promising and increasingly accessible neuro-tools that allow the service field to benefit from neuroscience theories and insights.

Design/methodology/approach

The paper synthesizes key literature from a variety of domains (e.g. neuroscience, consumer neuroscience and organizational neuroscience) to provide an in-depth background to start applying neuro-tools. Specifically, this paper outlines the most important neuro-tools today and discusses their theoretical and empirical value.

Findings

To date, the use of neuro-tools in the service field is limited. This is surprising given the great potential they hold to advance service research. To stimulate the use of neuro-tools in the service area, the authors provide a roadmap to enable neuroscientific service studies and conclude with a discussion on promising areas (e.g. service experience and servicescape) ripe for neuroscientific input.

Originality/value

The paper offers service researchers a starting point to understand the potential benefits of adopting the neuroscientific method and shows their complementarity with traditional service research methods like surveys, experiments and qualitative research. In addition, this paper may also help reviewers and editors to better assess the quality of neuro-studies in service.

Heart Rate and Heart Rate Variability Correlate with Clinical Reasoning Performance and Self-Reported Measures of Cognitive Load

Cognitive load is a key mediator of cognitive processing that may impact clinical reasoning performance. The purpose of this study was to gather biologic validity evidence for correlates of different types of self-reported cognitive load, and to explore the association of self-reported cognitive load and physiologic measures with clinical reasoning performance. We hypothesized that increased cognitive load would manifest evidence of elevated sympathetic tone and would be associated with lower clinical reasoning performance scores. Fifteen medical students wore Holter monitors and watched three videos depicting medical encounters before completing a post-encounter form and standard measures of cognitive load. Correlation analysis was used to investigate the relationship between cardiac measures (mean heart rate, heart rate variability and QT interval variability) and self-reported measures of cognitive load, and their association with clinical reasoning performance scores. Despite the low number of participants, strong positive correlations were found between measures of intrinsic cognitive load and heart rate variability. Performance was negatively correlated with mean heart rate, as well as single-item cognitive load measures. Our data signify a possible role for using physiologic monitoring for identifying individuals experiencing high cognitive load and those at risk for performing poorly during clinical reasoning tasks.

Comparing cognitive load levels among family members of the critically ill exposed to electronic decision aids

Cognitive load predicts one's ability to process information and learn from decision support interventions. The present study compared intrinsic and extraneous cognitive load levels resulting from exposure to two different electronic decision aids. A convenience sample of ninety-seven surrogate decision makers for critically ill patients were randomly assigned to receive either a single dose of a video-based or avatar-based decision aid. Intrinsic and extraneous cognitive load levels among recipients of the video-based decision support resource were lower than recipients of the avatar-based decision support resource. After controlling for age, the observed differences in intrinsic cognitive load were not significantly different, whereas the observed differences in extraneous cognitive load remained. Extraneous cognitive load is a modifiable factor to consider for future developers of decision support interventions that may determine the efficacy of efforts to support patients and family members with decision making.

The role of cognitive load in university students' comprehension of multiple documents

Abstract. The study investigates the cognitive load of students working on tasks that require the comprehension of multiple documents (Multiple Document Comprehension, MDC). In a sample of 310 students, perceived task difficulty (PD) and mental effort (ME) were examined in terms of task characteristics, individual characteristics, and students' processing behavior. Moreover, it was investigated if PD and ME can still contribute to MDC while controlling for these variables. The perceived difficulty of the task was shown to be related to the number of documents, text length, study level, and sourcing. Mental effort was predicted by text length, study level, and processing time. When including these variables as covariates, cognitive load was incrementally predictive of MDC. The results are discussed in terms of how working memory resources can shape the process of comprehending multiple documents.

Cognitive load and performance in immersive virtual reality versus conventional virtual reality simulation training of laparoscopic surgery: a randomized trial

BACKGROUND

Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training.

METHODS

A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance.

RESULTS

Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics.

CONCLUSION

Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.

Characteristics of Cognitive in Children with Learning Difficulties

In order to explore the relationship between cognitive function in children with learning difficulties and social environment, this study uses the Wechsler Intelligence Scale and the self-made general environment questionnaire to investigate 185 children with learning difficulties and compares them with 185 normal children, and gives attention test to 50 children with learning difficulties. The results show that family environment has a certain influence on the children with learning difficulties, they have a significantly lower verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ) and full scale intelligence quotient (FIQ), and the separation of VIQ and P IQ is common among them. As the children with learning difficulties grow older, their ability for abstract generalization tends to decline, which may be a characteristic of their intelligence development. This study aims to compare the functional differences in cortical regions between children with learning difficulties and children without from the perspective of cognitive neuropsychology, so as to provide effective assistance for children with learning difficulties.

Simulation-based education for novices: complex learning tasks promote reflective practice

CONTEXT

Simulated clinical immersion (SCI), in which clinical situations are simulated in a realistic environment, safely and gradually exposes novices to complex problems. Given their limited experience, undergraduate students can potentially be quite overwhelmed by SCI learning tasks, which may result in misleading learning outcomes. Although task complexity should be adapted to the learner's level of expertise, many factors, both intrinsic and extraneous to the learning task, can influence perceived task complexity and its impact on cognitive processes.

OBJECTIVES

The purpose of this mixed-methods study was to understand the effects of task complexity on undergraduate pharmacy students' cognitive load, task performance and perception of learning in SCI.

METHODS

A total of 167 second-year pharmacy students were randomly assigned to undertake one simple and one complex learning task in SCI consecutively. Participants' cognitive load was measured after each task and debriefing. Task performance and time on task were also assessed. As part of a sequential explanatory design, semi-structured interviews were conducted with students showing maximal variations in intrinsic cognitive load to elucidate their perceptions of learning when dealing with complexity.

RESULTS

Although the complex task generated significantly higher cognitive load and time on task than the simple task, performance was high for both tasks. Qualitative results revealed that a lack of clinical experience, an unfamiliar resource in the environment and the constraints inherent to SCI, such as time limitations, hindered the clinical reasoning process and led to poorer self-evaluation of performance. Simple tasks helped students gain more self-confidence, whereas complex tasks further encouraged reflective practice during debriefings.

CONCLUSIONS

Although complex tasks in SCI were more cognitively demanding and took longer to execute, students indicated that they learned more from them than they did from simple tasks. Complex tasks constitute an additional challenge in terms of clinical reasoning and thus provide a more valuable learning experience from the student's perspective.

Impact of Indoor Physical Environment on Learning Efficiency in Different Types of Tasks: A 3 × 4 × 3 Full Factorial Design Analysis

Indoor physical environments appear to influence learning efficiency nowadays. For improvement in learning efficiency, environmental scenarios need to be designed when occupants engage in different learning tasks. However, how learning efficiency is affected by indoor physical environment based on task types are still not well understood. The present study aims to explore the impacts of three physical environmental factors (i.e., temperature, noise, and illuminance) on learning efficiency according to different types of tasks, including perception, memory, problem-solving, and attention-oriented tasks. A 3 × 4 × 3 full factorial design experiment was employed in a university classroom with 10 subjects recruited. Environmental scenarios were generated based on different levels of temperature (17 °C, 22 °C, and 27 °C), noise (40 dB(A), 50 dB(A), 60 dB(A), and 70 dB(A)) and illuminance (60 lx, 300 lx, and 2200 lx). Accuracy rate (AC), reaction time (RT), and the final performance indicator (PI) were used to quantify learning efficiency. The results showed ambient temperature, noise, and illuminance exerted significant main effect on learning efficiency based on four task types. Significant concurrent effects of the three factors on final learning efficiency was found in all tasks except problem-solving-oriented task. The optimal environmental scenarios for top learning efficiency were further identified under different environmental interactions. The highest learning efficiency came in thermoneutral, relatively quiet, and bright conditions in perception-oriented task. Subjects performed best under warm, relatively quiet, and moderately light exposure when recalling images in the memory-oriented task. Learning efficiency peaked to maxima in thermoneutral, fairly quiet, and moderately light environment in problem-solving process while in cool, fairly quiet and bright environment with regard to attention-oriented task. The study provides guidance for building users to conduct effective environmental intervention with simultaneous controls of ambient temperature, noise, and illuminance. It contributes to creating the most suitable indoor physical environment for improving occupants learning efficiency according to different task types. The findings could further supplement the present indoor environment-related standards or norms with providing empirical reference on environmental interactions.

Embodied learning: introducing a taxonomy based on bodily engagement and task integration

Research on learning and education is increasingly influenced by theories of embodied cognition. Several embodiment-based interventions have been empirically investigated, including gesturing, interactive digital media, and bodily activity in general. This review aims to present the most important theoretical foundations of embodied cognition and their application to educational research. Furthermore, we critically review recent research concerning the effectiveness of embodiment interventions and develop a taxonomy to more properly characterize research on embodied cognition. The main dimensions of this taxonomy are bodily engagement (i.e. how much bodily activity is involved) and task integration (i.e. whether bodily activities are related to a learning task in a meaningful way or not). By locating studies on the 2 × 2 grid resulting from this taxonomy and assessing the corresponding learning outcomes, we identify opportunities, problems, and challenges of research on embodied learning.

Varying levels of fidelity on psychomotor skill attainment: a CORTRAK product assessment

Background

A task trainer is defined as a model that represents a part or region of the human body such as an arm and an abdomen… generally used to support procedural skills training. Concepts for consideration when selecting a task trainer include fidelity and cognitive load. Insertion of small - bore FTs in acutely ill patients continues to be a high - risk skill. The most frequent complication is insertion of the F T into the pulmonary system, which can lead to pneumothorax, pneumonitis and death. Training consists of placing the FT under electromagnetic visual assistance in a task trainer.

Objective

This study describes assessment of two task trainers that are used to simulate assisted feeding tube (FT) insertion. Simulation is an excellent approach to close the learning gap and ensure competency. Study selection: This study used a prospective observational design. Participants (n=20) were registered nurses considered to be superusers. They were randomly assigned to order of the task trainer.

Findings and conclusions

The findings suggest the learners preferred the low-fidelity task trainer. The clear Anatomical Box scored higher overall (18.35/21) when compared with the human-like task trainer (16.5/21). A higher fidelity task trainer may seem attractive; however, with a lens to cognitive load theory, it may hinder the early learning process. Fidelity requirements vary depending on the training task. Recommendations from this study include: initial instruction should focus on the psychomotor steps for the FT insertion process. The high-fidelity human torso is recommended for performance, final competency and ongoing competency maintenance.

Cognitive load predicts point-of-care ultrasound simulator performance

INTRODUCTION

The ability to maintain good performance with low cognitive load is an important marker of expertise. Incorporating cognitive load measurements in the context of simulation training may help to inform judgements of competence. This exploratory study investigated relationships between demographic markers of expertise, cognitive load measures, and simulator performance in the context of point-of-care ultrasonography.

METHODS

Twenty-nine medical trainees and clinicians at the University of Toronto with a range of clinical ultrasound experience were recruited. Participants answered a demographic questionnaire then used an ultrasound simulator to perform targeted scanning tasks based on clinical vignettes. Participants were scored on their ability to both acquire and interpret ultrasound images. Cognitive load measures included participant self-report, eye-based physiological indices, and behavioural measures. Data were analyzed using a multilevel linear modelling approach, wherein observations were clustered by participants.

RESULTS

Experienced participants outperformed novice participants on ultrasound image acquisition. Ultrasound image interpretation was comparable between the two groups. Ultrasound image acquisition performance was predicted by level of training, prior ultrasound training, and cognitive load. There was significant convergence between cognitive load measurement techniques. A marginal model of ultrasound image acquisition performance including prior ultrasound training and cognitive load as fixed effects provided the best overall fit for the observed data.

DISCUSSION

In this proof-of-principle study, the combination of demographic and cognitive load measures provided more sensitive metrics to predict ultrasound simulator performance. Performance assessments which include cognitive load can help differentiate between levels of expertise in simulation environments, and may serve as better predictors of skill transfer to clinical practice.

A preliminary psychometric evaluation of the eight-item cognitive load scale

AIM

The aim of this article is to report the psychometric properties of the eight-item cognitive load scale.

BACKGROUND

According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions. To date, no psychometric analyses of instruments evaluating cognitive load have been reported within healthcare settings.

METHODS

A convenience sample of 62 surrogate decision makers for critically ill patients were exposed to one of two healthcare decision support interventions were recruited from four intensive care units at a tertiary medical center in Northeast Ohio. Participants were administered a battery of psychosocial instruments and the eight-item cognitive load scale (CLS).

RESULTS

The CLS demonstrated a bidimensional factor structure with acceptable discriminant validity and internal consistency reliability (Cronbach's α = 0.75 and 0.89).

CONCLUSIONS

The CLS is a psychometrically sound instrument that may be used in the evaluation of decision support among surrogate decision makers of the critically ill. The authors recommend application of the cognitive load scale in the evaluation and development of healthcare education and interventions.

The effectiveness of sequencing virtual patients with lectures in a deductive or inductive learning approach

BACKGROUND

Virtual patients (VPs) can be sequenced with other instructional methods in different ways.

AIM

To investigate the effect of sequencing VPs with lectures in a deductive approach, in comparison with an inductive approach, on students' knowledge acquisition, retention, and transfer.

METHODS

For two different topics, 84 out of 87 students have participated in the lecture and VP sessions. Students from female and male campuses have been randomly assigned to one of the two learning approaches (deductive and inductive), yielding four experimental groups. Each group received a lecture session and an independent VP learning activity, which either followed the lecture session in the deductive group or preceded it in the inductive group. Students were administrated knowledge acquisition and retention written tests as well as transfer tests using two new VPs.

RESULTS

There was no significant effect for the learning approach on knowledge acquisition or retention, while for knowledge transfer, males have benefited from the inductive approach in topic 1 while in the more complex topic 2, they have benefited from the deductive approach. On the other hand, females seem to be largely unaffected by learning approach.

CONCLUSIONS

Sequencing VPs in inductive and deductive learning approaches leads to no significant differences on students' performance when full guidance is offered in the inductive approach.

Cognitive load theory: Practical implications and an important challenge

The field of medical education has adopted a wide variety of theories from other fields. A fairly recent example is cognitive load theory, which originated in educational psychology. Several empirical studies inspired by cognitive load theory and reviews of practical implications of cognitive load theory have contributed to guidelines for the design of medical education. Simultaneously, several research groups have developed instruments for the measurement of cognitive load in a medical education context. These developments notwithstanding, obtaining evidence for different types of cognitive load remains an important challenge. Therefore, the aim of this article is twofold: to provide medical educators with three key guidelines for the design of instruction and assessment and to discuss several fundamental issues in the remaining challenges presented by different types of cognitive load. The guidelines revolve around minimizing cognitive activity that does not contribute to learning, working with specific learning goals in mind, and appreciating the multifaceted relation between learning and assessment. Key issues around the types of cognitive load include the context in which learning occurs, the continued use of single-item mental effort ratings, and the timing of cognitive load and learning outcome measurements.

Information overload in consumers of health-related information: a scoping review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this scoping review is to examine and map the breadth of evidence on information overload in lay adult and adolescent consumers of health-related information.

Measuring Cognitive Load in Embodied Learning Settings

In recent years, research on embodied cognition has inspired a number of studies on multimedia learning and instructional psychology. However, in contrast to traditional research on education and multimedia learning, studies on embodied learning (i.e., focusing on bodily action and perception in the context of education) in some cases pose new problems for the measurement of cognitive load. This review provides an overview over recent studies on embodied learning in which cognitive load was measured using surveys, behavioral data, or physiological measures. The different methods are assessed in terms of their success in finding differences of cognitive load in embodied learning scenarios. At the same time, we highlight the most important challenges for researchers aiming to include these measures into their study designs. The main issues we identified are: (1) Subjective measures must be appropriately phrased to be useful for embodied learning; (2) recent findings indicate potentials as well as problematic aspects of dual-task measures; (3) the use of physiological measures offers great potential, but may require mobile equipment in the context of embodied scenarios; (4) meta-cognitive measures can be useful extensions of cognitive load measurement for embodied learning.

The simulated clinical environment: Cognitive and emotional impact among undergraduates

CONTEXT

Simulated clinical immersion (SCI) is used in undergraduate healthcare programs to expose the learner to real-life situations in authentic simulated clinical environments. For novices, the environment in which the simulation occurs can be distracting and stressful, hence potentially compromising learning.

OBJECTIVES

This study aims to determine whether SCI (with environment) imposes greater extraneous cognitive load and stress on undergraduate pharmacy students than simulated patients (SP) (without environment). It also aims to explore how features of the simulated environment influence students' perception of learning.

METHODS

In this mixed-methods study, 143 undergraduate pharmacy students experienced both SCI and SP in a crossover design. After the simulations, participants rated their cognitive load and emotions. Thirty-five students met in focus groups to explore their perception of learning in simulation.

RESULTS

Intrinsic and extraneous cognitive load and stress scores in SCI were significantly but modestly higher compared to SP. Qualitative findings reveal that the physical environment in SCI generated more stress and affected students? focus. In SP, students concentrated on clinical reasoning. SCI stimulated a focus on data collection but impeded in-depth problem solving processes.

CONCLUSION

The physical environment in simulation influences what and how students learn. SCI was reported as more cognitively demanding than SP. Our findings emphasize the need for the development of adapted instructional design guidelines in simulation for novices.

Performance of a cognitive load inventory during simulated handoffs: Evidence for validity

BACKGROUND

Advancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types.

OBJECTIVE

To develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff.

METHODS

Based on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas' Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity.

RESULTS

Confirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson's r = 0.83, p < 0.001), case complexity (beta = 0.74, p < 0.001), level of experience (beta = -0.96, p < 0.001), and handoff accuracy (r = -0.34, p < 0.001).

CONCLUSION

These results offer encouragement that intrinsic load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load.

Disruptive Effects of Colorful vs. Non-colorful Play Area on Structured Play-A Pilot Study with Preschoolers

To contribute to young children's development, sensory enrichment is often provided via colorful play areas. However, little is known about the effects of colorful environments on children while they engage in age-appropriate tasks and games. Studies in adults suggest that aspects of color can distract attention and impair performance, and children are known to have less developed attentional and executive abilities than adults. Preliminary studies conducted in children aged 5-8 suggest that the colorfulness of both distal (e.g., wall decorations) and proximal (e.g., the surface of the desktop) environments can have a disruptive effect on children's performance. The present research seeks to extend the previous studies to an even younger age group and focus on proximal colorfulness. With a sample of 15 pre-schoolers (3-4 years old) we examined whether a colorful play surface compared to a non-colorful (white) play surface would affect engagement in developmentally appropriate structured play. Our pilot findings suggest that a colorful play surface interfered with preschoolers' structured play, inducing more behaviors indicating disruption in task execution compared with a non-colorful play surface. The implications of the current study for practice and further research are discussed.

Thrive or overload? The effect of task complexity on novices' simulation-based learning

CONTEXT

Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded.

OBJECTIVES

In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training.

METHODS

Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures.

RESULTS

In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80).

CONCLUSIONS

Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.