Optimising listening skills: Analysing the effectiveness of a blended model with a top-down approach through cognitive load theory

The ability to listen is critical in the task of language learning. Although listening has the least pedagogical attention, the growing emphasis on communication and language proficiency makes listening skills prominent in the language classroom. This paper aims to analyse the effectiveness of the Blended model to improve teaching listening skills, by instigating a top-down approach through Cognitive Load Theory. The top-down approach aids the students with the background knowledge of the audio with information like context, situation, phrases, etc. The blended model enables the teacher to facilitate students through the technological platform to process their listening input. A questionnaire was adopted for data collection and a semi-structured interview was performed from 60 samples from prefinal year Engineering students selected through purposive sampling techniques and grouped as experimental N = 30 and control N = 30 groups. The experimental group was trained with a top-down approach with the support of LMS. The control group was provided with the same listening material but taught in the conventional method. The purpose of this study is to show the statistically significant impact of employing technology inside the language classroom to teach listening skills. Findings showed that samples in the experimental group could identify the relevant and non-relevant information from the audio, conceptualise the audio content and predict the information beforehand. The difficulties that the students and teachers faced and the remedial measures to overcome them are also discussed. The following objectives were established for the study through mixed methods of enhancing listening skills through Cognitive Load Theory (CLT). •To explore the effect of intervention through a top-down approach with the support of technology (LMS) on enhancing the listening skills of the students.•How the blending of synchronous and asynchronous and a top-down approach develops the predicting skills of the students during the listening comprehension exercises.•To adapt procedures involved in enhancing the self-paced learning efficacy and reducing listening anxiety in ESL learners.

High variability in learning materials benefits children's pattern practice

Concrete materials (e.g., pictures, objects) are believed to be helpful with learning, but not in all circumstances. Variability in these materials (i.e., using different materials vs. the same materials) could be an important factor. We compared how variability in concrete images influenced children's learning about repeating patterns (e.g., ABBABBABB). A total of 87 children aged 4 to 6 years from the United States (75% White; 44% female) completed an experiment via Zoom in which they received brief pattern training. Children were randomly assigned into Low, Medium, and High Variability training conditions, which differed in terms of whether the same materials were used over and over or they varied in their perceptual features. Children in the Low Variability condition performed better at the beginning of training, but this trend ultimately reversed. Children in the High Variability condition performed best by the end of training and on the posttest. Using variable materials may allow children to extract common structures across instances.

Effects of finger and mouse pointing on learning from online split-attention examples

BACKGROUND

Self-management of cognitive load is a recent development in cognitive load theory. Finger pointing has been shown to be a potential self-management strategy to support learning from spatially separated, but mutually referring text and pictures (i.e., split-attention examples).

AIMS

The present study aimed to extend the prior research on the pointing strategy and investigated the effects of finger pointing on learning from online split-attention examples. Moreover, we examined an alternative pointing strategy using the computer mouse, and a combination of finger pointing and computer-mouse pointing.

SAMPLE

One-hundred and forty-five university students participated in the present study.

METHOD

All participants studied an online split-attention example about the human nervous system and were randomly allocated to one of four conditions: (1) pointing with the index finger, (2) pointing with the computer mouse, (3) pointing with the index finger and the computer mouse and (4) no pointing.

RESULTS

Results confirmed our main hypothesis, indicating that finger pointing led to higher retention performance than no pointing. However, the mouse pointing strategy and the combined finger and mouse pointing strategy did not show supportive effects.

CONCLUSIONS

Finger pointing can be used as a simple and convenient self-management strategy in online learning environments. Mouse pointing may not be as effective as finger pointing.

Using cognitive load theory to evaluate and improve preparatory materials and study time for the flipped classroom

BACKGROUND

Preclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as "efficient" if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).

METHODS

We conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017-2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.

RESULTS

The average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.

CONCLUSIONS

Cognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.

Pre-clerkship Teaching and Learning in the Virtual Learning Environment: Lessons Learned and Future Directions

In response to the COVID-19 pandemic, we developed and implemented a theory-informed process to adapt a comprehensive pre-clerkship medical school curriculum to run in the virtual learning environment utilizing sociocultural learning theory and cognitive load theory. Of 124 student respondents, 45% rated virtual learning as very or extremely effective, and 49% as moderately effective. Positive aspects of virtual learning included effectiveness of chat moderators, displaying pronouns on Zoom, active learning technology, and captioning and transcription. Negative aspects included access to technology and feeling isolated from community. Overall course ratings, examination performance, and work hours did not differ pre- and post-implementation.

Strategies for facilitating processing of transient information in instructional videos by using learner control mechanisms

Learner control of video presentations by using pause buttons or timeline scrollbars was suggested as helpful for learning from sources of transient information such as dynamic visualizations and spoken words. However, effective learner control could be difficult to attain without sufficient instructional support. This study developed strategies for facilitating processing and integration of transient information based on cognitive load theory by providing learners with explicit guidance in when and how to use pausing and timeline scrollbars while watching instructional videos. A single-factor between-subjects experiment was conducted to examine the effects of the proposed strategies. Ninety undergraduates were randomly assigned to one of three groups - strategy guidance group (learners were provided with guidance in strategies), learner control group (learners were allowed to control the video but without any guidance in strategies), and continuous presentation group (without any learner control mechanism). The results revealed that compared to the learner control group, the strategy guidance group had a greater number of pauses and scrollbacks on the timeline, demonstrated significantly better performance in the immediate comprehension test and higher performance efficiency in the immediate recall and comprehension tests. Compared to the continuous presentation group, the strategy guidance group demonstrated significantly better performance in the immediate recall and comprehension tests and higher performance efficiency in both these tests, as well as better performance in the delayed recall test and higher performance efficiency in the delayed recall test.

Problem representation and diagnostic accuracy during an OSCE

PURPOSE

The National Academy of Medicine has called for "identifying opportunities to improve the diagnostic process". We studied the association between problem representation and diagnostic accuracy during an objective structured clinical exam (OSCE).

MATERIALS AND METHODS

We conducted a non-randomized controlled trial during a ten-case OSCE. We measured whether a summary statement prompt increased the likelihood that the student listed the correct diagnosis and whether better summary statements were correlated with diagnostic accuracy.

RESULTS

114 students provided 1135 responses. The non-prompted control group yielded 631 responses, listing the correct diagnosis first 73% of the time and within the top three slots 85% of the time. The intervention group exposed to the prompt yielded 453 responses listing the correct diagnosis first 72% of the time (P = 0.617) and within the top three slots 84% of the time (P = 0.760). Summary statements were scored on a 0, 0.5, or 1 rubric. When grouped according to summary statement score, students listed the correct diagnosis first 74%, 70%, and 72% of the time respectively (P = 0.666). The correct diagnosis was included within the top three slots 88%, 82%, and 83% of the time (P = 0.238).

CONCLUSIONS

Prompting students to form a summary statement did not improve diagnostic accuracy. Better summary statements were not correlated with diagnostic accuracy.

Can videos affect learning outcomes? Evidence from an actual learning environment

We examine the effect of an innovation in an educational context, a class of 500 + first-year economics students at a well-known Australian university. We study whether introducing content in the form of a multimedia presentation has a detectable effect on specific categories of student knowledge. The multimedia presentation has a narrator presenting concepts with images, words, and worked examples. Our key outcome measure is the probability of answering questions correctly on a mid-term test. A quasi-experimental design is followed to offer a causal interpretation of the results. We find that the multimedia presentation markedly increases students' academic outcomes on the test compared to those that did not view the presentation, especially in regards to procedural and evaluative knowledge. An additional survey reveals gains in students' metacognitive knowledge. These findings suggest that multimedia presentations contribute to improved student learning outcomes and offer valuable options at a time of increased online course delivery. The findings also highlight the relevance of investing in education and resources to develop the necessary design skills among academics and staff.

SUPPLEMENTARY INFORMATION

The online version of this article contains supplementary material available 10.1007/s11423-022-10147-3.

A new application of the temporal contiguity effect in designing narrated slideshows

We investigated whether the temporal contiguity effect, which holds that information sources, such as visual information and narration need to be temporally coordinated for learning to be effective, can also be found in narrated slideshows. A concurrent presentation-key point format (CPK), in which visual information sequentially appeared as key points on the slide with corresponding narration, was compared to a concurrent presentation-whole format (CPW), in which visual information was shown all at once on the slide with corresponding narration, and a sequential presentation format (SP), in which the narration was played first before all the corresponding visual information was presented at once. Ninety-nine undergraduates were randomly divided across the CPK, CPW and SP conditions. Results revealed that participants in the CPK group had higher post-test performance and learning efficiency than participants in the CPW and SP conditions. Performance in the CPW condition was higher than in the SP conditions, but only in terms of learning efficiency. The results suggested that the occurrence of the temporal contiguity effect not only depends on whether the presentation of narration and visual information in narrated slideshows is concurrent or not, but also on how concurrent it is.

Is the Global Pandemic Driving Me Crazy? The Relationship Between Personality Traits, Fear of Missing Out, and Social Media Fatigue During the COVID-19 Pandemic in Nigeria

Individ    uals' psychological behaviors and fear of missing out are affected by the global pandemic. This study investigates how individual "Big Five" personality traits influence fear of missing out leading to social media fatigue, the impact of social media fatigue on social media fatigue behavior during the COVID-19 lockdown. As a result, this study proposes and develops a model using the structural equation modelling for data obtained from young adults in the South-Western region of Nigeria. Results show the impact of openness, conscientiousness, and extraversion emotional instability was positively significant towards fear of missing out over the use of social media during COVID-19, whereas the effect of agreeableness and emotional stability were insignificant towards fear of missing out over the use of social media during COVID-19. In addition, the impact of the fear of missing out on social media fatigue influences social media fatigue behavior. Theoretical and managerial implications for "Big Five" personality traits, fear of missing out, social media fatigue, and social media behaviors are provided.

Teaching the technical performance of bronchoscopy to residents in a step-wise simulated approach: factors supporting learning and impacts on clinical work - a qualitative analysis

BACKGROUND

The ability to perform a bronchoscopy is a valuable clinical skill for many medical specialities. Learning this skill is demanding for residents, due to the high cognitive load. Lessons learned from cognitive load theory might provide a way to facilitate this learning. The aim of this study was to investigate residents' perception of factors that support and hinder learning, as well as outcome and acceptance of a workshop on flexible bronchoscopy.

METHODS

Three half-day workshops were designed to teach 12 residents the basics of handling a flexible bronchoscope. They consisted of four phases that alternated between short theoretical aspects and longer practical situations. The practical phases focussed initially on manoeuvring a bronchoscope through holes in panels inside a box, and then on examination and practice using a three-dimensional printed model of the bronchial tree. Afterwards, three audio- and video-recorded focus groups were conducted, transcribed and coded, and underwent reflexive thematic analysis.

RESULTS

Analysis of the focus groups defined two themes: (1) factors that supported a safe and positive learning environment were optimised for intrinsic load, simulated setting, absence of pressure, dyad practice (working in pairs), small group sizes and playful learning; and (2) impacts on clinical work were perceived as high levels of learning and improved patient safety. The residents did not report factors that hindered their learning. Some suggestions were made to improve the set-up of the wooden box.

CONCLUSIONS

The half-day workshop was designed according to several factors, including cognitive load theory in a simulated setting, and creation of a safe and positive learning environment. The residents perceived this as supporting learning and patient safety. Further studies can be designed to confirm these results in a quantitative setting.

TRIAL REGISTRATION

This study was not interventional, therefore was not registered.

Exploring the relationship between emotion and cognitive load types during patient handovers

Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.

Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation

BACKGROUND

Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training.

METHODS

30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes.

RESULTS

Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'.

CONCLUSIONS

The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.

Five Strategies for Optimizing Instructional Materials: Instructor- and Learner-Managed Cognitive Load

Researchers of cognitive load theory and the cognitive theory of multimedia learning have identified several strategies to optimize instructional materials. In this review article we focus on five of these strategies or solutions to problematic instructional designs in multimedia learning: (a) the multimedia principle (use visualizations and drawings to complement texts); (b) the split-attention effect or spatial contiguity principle (show texts contiguously or integrated with visualizations); (c) the redundancy effect, alike the coherence principle (remove nonessential learning information); (d) the signaling principle (cue or signal essential learning information); and (e) the transient information effect or segmenting principle (segment or control the pace of animations and videos). Usually, both cognitive theories have investigated solutions that instructors, teachers, and designers should pursue to optimize students’ learning. Here, in a novel approach, we show that these strategies can also be used by learners who want to self-manage their cognitive load and learning process. We provide several examples of both instructor- and learner-managed solutions aligned with these strategies. When assessing which agent, either the instructor or the learner, was most effective, we observed mixed results in the literature. However, the expertise reversal effect may help predict the direction of these effects: novice students may learn better under instructor-managed conditions, whereas more expert students may learn more under learner-managed conditions.

The micro revolution: effect of Bite-Sized Teaching (BST) on learner engagement and learning in postgraduate medical education

CONTEXT

Bite-sized learning is an instructional method that utilizes brief, focused learning units. This approach may be beneficial in medical education given demands on learner time and cognitive load. This study aims to assess the impact of this approach on knowledge acquisition and learner attitudes in postgraduate medical education.

METHODS

An instructional method, termed Bite-Sized Teaching (BST), was implemented within the curriculum at a US Internal Medicine postgraduate training program. In BST, content is distilled into manageable units focused on relevant schemas and delivered via brief peer teaching. A two-fold assessment of BST was performed that included cross sectional survey to assess learner attitudes and experiences and a controlled study to assess knowledge acquisition with BST and case-based teaching control.

RESULTS

One hundred and six of 171 residents (62% response rate) completed the survey. Most residents (79.8%) reported BST was among the best conference types in the curriculum. Important components of BST cited by residents include the distilled content, multiple short talk format and peer teaching. Residents report incorporating what they learned via BST into their teaching (76.1%) and clinical practice (74.1%). Resident who had participated as speaker were significantly more likely to report incorporating learning from BST into their teaching (87.2% vs 63.0%, p < 0.01, Cramer's V effect size = 0.37) and clinical practice (89.7% vs 65.3%, p = 0.02, Cramer's V effect size 0.28). Fifty-one residents participated in the knowledge assessment. Residents taught via BST scored significantly higher on immediate post-test compared to case-based teaching (score [SE] 62.5% [1.9] vs 55.2% [2.4], p = 0.03, Hedges g effect size 0.66). While both groups improved over pretest, there was no significant difference in scores between BST and case-based teaching at two (score [SE] 57.1 [2.1] vs 54.8 [2.5], p = 0.54) and six weeks (score [SD] 55.9 [2.1] vs 53.0 [2.9], p = 0.43).

CONCLUSIONS

Teaching via brief, focused learning units delivered by peers is well received by learners and appears to have a significantly greater impact on immediate knowledge recall than case-based teaching. Further study on long term knowledge retention and behaviors is needed. Bite-Sized Teaching may be a promising instructional approach in medical education.

Memory-related cognitive load effects in an interrupted learning task: A model-based explanation

BACKGROUND

The Cognitive Load Theory provides a well-established framework for investigating aspects of learning situations that demand learners' working memory resources. However, the interplay of these aspects at the cognitive and neural level is still not fully understood.

METHOD

We developed four computational models in the cognitive architecture ACT-R to clarify underlying memory-related strategies and mechanisms. Our models account for human data of an experiment that required participants to perform a symbol sequence learning task with embedded interruptions. We explored the inclusion of subsymbolic mechanisms to explain these data and used our final model to generate fMRI predictions.

RESULTS

The final model indicates a reasonable fit for reaction times and accuracy and links the fMRI predictions to the Cognitive Load Theory.

CONCLUSIONS

Our work emphasizes the influence of task characteristics and supports a process-related view on cognitive load in instructional scenarios. It further contributes to the discussion of underlying mechanisms at a neural level.

Cognitive capacity in self-directed learning: Evidence of middle school students' executive attention to resist distraction

Self-directed learning (SDL) is a rapidly developing trend in schools, although its prerequisites, such as children's skills and abilities to plan and monitor their own learning, have not been investigated in detail. Due to additional cognitive load it induces, SDL has been in some cases found to be detrimental for learning, especially for students with a lower cognitive capacity. With this study, we explored some of the causes for the variability in learning gains. We examined 111 middle school students' self-directed category learning using an exploratory web-task for autonomous learning, focusing on their information search (browsing a taxonomy of unknown dinosaurs) and their memorization of respective category labels. We were interested to detect whether students' performance in a complex span task (Ospan) was also reflected in their search and learning behavior. Results revealed different learning gain trajectories in the latter task, where higher WMC students were more confident about their learning. Also, the students with lower WMC were found to search the taxonomy by repeatedly searching the same (basic type of) dinosaur exemplar. In line with prior findings about human mental capacity restrictions and cognitive load theory, the present work evidenced the important role of students' resistance to distraction, and its relation to differences in self-directed search and memorizing. The results imply the need to teach metacognitive skills and offer supportive scaffolding in order to avoid cognitive overload in SDL.

A systematized review of cognitive load theory in health sciences education and a perspective from cognitive neuroscience

INTRODUCTION

To design instructions in health sciences education, it is highly relevant to heed the working memory and the approaches for managing cognitive load. In this article, we tried to mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health sciences education and discussing cognitive load from the perspective of cognitive neurosciences as brain-aware medical education.

MATERIALS AND METHODS

We searched databases of Pubmed, Proquest, SCOPUS, and ISI Web of Science for relevant literature in September 1, 2018.

RESULTS

The 27 articles out of a total of 46 records, along with 23 papers from snowballing and hand searching were included in this study. Main items encompassed; "Various types of cognitive loads," "Aim of cognitive load theory," "Strategies to managing Cognitive Load," "Cognitive Load Theory in novice and experienced learners and "expertise reversal effect," Medical and Health Sciences Curriculums and Cognitive Load Theory," "Challenges of Cognitive Load Theory."

CONCLUSIONS

We discussed six important themes for CLT in health sciences education according to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane load was suggested, as it processes further gain access to neural circuits that are engaged in sensory, motor, executive, and decision-making pathways in the brain.

Evaluation of a medication calculation mobile app using a cognitive load instructional design

OBJECTIVE

For students attending healthcare courses, such as nursing and paramedicine, the ability to calculate medication dosages accurately is an essential but often a complex cognitive skill to be learned. This study aimed to determine whether a 'mastering medication calculation' mobile app, developed using an instructional design based on cognitive load theory, could improve students' medication calculation ability and self-efficacy. Additional objectives were: (1) To examine the correlations between students' medication calculation ability, self-efficacy and their numerical ability; (2) To explore how well medication calculation ability can be predicted by students' numerical ability and their medication calculation self-efficacy; (3) To obtain students' opinions regarding the mobile app's usefulness and usability.

METHOD

A quasi-experimental study was carried out with a convenience sample of 60 second year UK university healthcare students who used the app for 8 weeks while in clinical practice. Students were given medication calculation ability and self-efficacy tests pre- and post-intervention. In addition, they were asked pre-intervention to complete a numeracy test and to complete a post-intervention survey to obtain their opinions on the usefulness of the app.

RESULTS

Following the use of the app students were significantly more able (p = 0.004) and more confident (p < 0.001) in performing medication calculations. There were significant positive correlations found between students' numerical ability and medication calculation ability (p < 0.001) and between students' medication calculation ability and self-efficacy (p < 0.001). Hierarchical multiple regression analysis indicated numerical ability (β = 0.46, p < 0.001) and medication calculation self-efficacy (β = 0.46, p < 0.001) to be the strongest predictors of medication calculation ability, with age and gender being non-significant. All students indicated the app to be an excellent method to support them in learning how to perform medication calculations.

CONCLUSION

This study indicated that the app's instructional design, based on cognitive load theory, significantly improved students' medication calculation ability and self-efficacy. Although the app's usability was highly rated by the students, further research is needed to determine if the app's instructional design can be used by learners of different levels of expertise and whether the design can be adopted for the learning of other complex cognitive skills. As numerical ability is essential for medication calculation ability, early identification and rectification of any numerical deficits is recommended.

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.

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.

Helping medical students in their study of statistics: A flexible approach

In the course of their curriculum, medical students must acquire knowledge and skills in a variety of domains. Teachers and educational designers need to integrate each of these topics into the curriculum and decide what to cover during which period and with which learning materials and activities. Since medical experts are expected to have at least basic skills with numerical information that can inform decision-making in their daily work, statistics is an indispensable component of the medical curriculum. Statistics is a complex topic that is characterized by hierarchically organized and counterintuitive concepts. To help medical students develop a conceptual understanding of statistics that enables them to understand and communicate statistical information regarding patients or from empirical research, teachers and educational designers should organize their students' study of statistics such that they are guided into the topic systematically and gradually. This article outlines the evolution of statistics education and research in this area, how it applies to medical education, and how a flexible approach can help teachers and educational designers create a learning environment in which students can develop the knowledge and skills they will need during their internships and jobs.

Stroop-like effects in a new-code learning task: A cognitive load theory perspective

To determine whether and how learning is biased by competing task-irrelevant information that creates extraneous cognitive load, we assessed the efficiency of university students with a learning paradigm in two experiments. The paradigm asked participants to learn associations between eight words and eight digits. We manipulated congruity of the digits' ink colour with the words' semantics. In Experiment 1 word stimuli were colour words (e.g., blue, yellow) and in Experiment 2 colour-related word concepts (e.g., sky, banana). Marked benefits and costs on learning due to variation in extraneous cognitive load originating from processing task-irrelevant information were evident. Implications for cognitive load theory and schooling are discussed.

The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial

Background

Cognitive overload can inhibit learning, and cognitive load theory-based instructional design principles can be used to optimize learning situations. This study aims to investigate the effect of implementing cognitive load theory-based design principles in virtual reality simulation training of mastoidectomy.

Methods

Eighteen novice medical students received 1 h of self-directed virtual reality simulation training of the mastoidectomy procedure randomized for standard instructions (control) or cognitive load theory-based instructions with a worked example followed by a problem completion exercise (intervention). Participants then completed two post-training virtual procedures for assessment and comparison. Cognitive load during the post-training procedures was estimated by reaction time testing on an integrated secondary task. Final-product analysis by two blinded expert raters was used to assess the virtual mastoidectomy performances.

Results

Participants in the intervention group had a significantly increased cognitive load during the post-training procedures compared with the control group (52 vs. 41 %, p = 0.02). This was also reflected in the final-product performance: the intervention group had a significantly lower final-product score than the control group (13.0 vs. 15.4, p < 0.005).

Conclusions

Initial instruction using worked examples followed by a problem completion exercise did not reduce the cognitive load or improve the performance of the following procedures in novices. Increased cognitive load when part tasks needed to be integrated in the post-training procedures could be a possible explanation for this. Other instructional designs and methods are needed to lower the cognitive load and improve the performance in virtual reality surgical simulation training of novices.

Practising what we preach: using cognitive load theory for workshop design and evaluation

Theory-based instructional design is a top priority in medical education. The goal of this Show and Tell article is to present our theory-driven approach to the design of instruction for clinical educators. We adopted cognitive load theory as a framework to design and evaluate a series of professional development workshops that were delivered at local, national and international academic conferences in 2014. We used two rating scales to measure participants' cognitive load. Participants also provided narrative comments as to how the workshops could be improved. Cognitive load ratings from 59 participants suggested that the workshop design optimized learning by managing complexity for different levels of learners (intrinsic load), stimulating cognitive processing for long-term memory storage (germane load), and minimizing irrelevant distracters (extraneous load). Narrative comments could also be classified as representing intrinsic, extraneous, or germane load, which provided specific directions for ongoing quality improvement. These results demonstrate that a cognitive load theory approach to workshop design and evaluation is feasible and useful in the context of medical education.

Do research findings on schema-based instruction translate to the classroom?

INTRODUCTION

Schema-based instruction has been shown to improve diagnostic performance and reduce cognitive load. However, to date, this has only been studied in controlled research settings. More distractions in classrooms may limit generalizability to real-world settings. We evaluated whether schema-based instruction would maintain its effects on cognitive load optimization and performance in a classroom.

METHODS

Focused on the approach of interpreting cardiac auscultation findings, 101 first-year medical students at Western University were randomized to receive a traditional (n = 48) or a schema-based lecture (n = 53). Students completed four written questions to test diagnostic performance and a cognitive load assessment at the end of the lecture. Diagnostic performance and cognitive load were compared with independent t-tests.

RESULTS

Schema-based instruction was associated with increased diagnostic performance on written questions (64 ± 22 % vs 44 ± 25 % p < 0.001) and reduced intrinsic cognitive load (mean difference = 15 %, standard error 3 %, p < 0.001). There was no significant difference in reported extraneous (p = 0.36) or germane (p = 0.42) cognitive load.

CONCLUSIONS

Our results demonstrate that schema-based instruction can be used to reduce intrinsic load and improve diagnostic performance in a real-world classroom setting. The results would be strengthened by replication across other locations and topics.

Manipulation of cognitive load variables and impact on auscultation test performance

Health profession educators have identified auscultation skill as a learning need for health professional students. This article explores the application of cognitive load theory (CLT) to designing cardiac and respiratory auscultation skill instruction for senior-level undergraduate nursing students. Three experiments assessed student auscultation performance following instructional manipulations of the three primary components of cognitive load: intrinsic, extraneous, and germane load. Study 1 evaluated the impact of intrinsic cognitive load by varying the number of diagnoses learned in one instruction session; Study 2 evaluated the impact of extraneous cognitive load by providing students with single or multiple examples of diagnoses during instruction; and Study 3 evaluated the impact of germane cognitive load by employing mixed or blocked sequences of diagnostic examples to students. Each of the three studies presents results that support CLT as explaining the influence of different types of cognitive processing on auscultation skill acquisition. We conclude with a discussion regarding CLT's usefulness as a framework for education and education research in the health professions.

ECG rhythm analysis with expert and learner-generated schemas in novice learners

Although instruction using expert-generated schemas is associated with higher diagnostic performance, implementation is resource intensive. Learner-generated schemas are an alternative, but may be limited by increases in cognitive load. We compared expert- and learner-generated schemas for learning ECG rhythm interpretation on diagnostic accuracy, cognitive load and knowledge acquisition. Fifty-seven medical students were randomized to two experiments. Experiment 1 (n = 29) compared use of traditional teaching frameworks to expert generated schemas. Participants randomly received either a traditional framework or an expert-generated schema to practice each of two content areas in a crossed design. Learning accuracy and cognitive load were measured during the training phase. Discriminating knowledge and diagnostic accuracy were tested immediately after the training phase and 1-2 weeks after. Using the same methodology, experiment 2 (n = 28) compared use of learner-generated versus expert-generated schemas. In experiment 1, learning from expert-generated schemas was associated with lower cognitive load (13 vs 16, p < 0.001), higher diagnostic accuracy on immediate testing (40 vs 29 %, p = 0.018), and higher discriminating knowledge (81 vs 71 %, p < 0.001). Both groups performed similarly on delayed testing (14 vs 8 %, p = 0.6). In experiment 2, use of learner-generated schemas reduced diagnostic accuracy during the training phase (55 vs 77 %, p < 0.001), with similar performance on the immediate (30 vs 33 %, p = 0.89) and delayed (7 vs 5 %, p = 0.79) testing phases.. Learner-generated schema generation was associated with increased cognitive load (17.1 vs 13.5, p < 0.001). When compared to traditional frameworks, use of an expert-generated schema improved learning of ECG rhythm interpretation. Participants generating their own schemas perform similarly to those using expert-generated schemas despite reporting higher cognitive load.