According to cognitive load theory, instructions can impose three types of cognitive load on the learner: intrinsic load, extraneous load, and germane load. Proper measurement of the different types of cognitive load can help us understand why the effectiveness and efficiency of learning environments may differ as a function of instructional formats and learner characteristics. In this article, we present a ten-item instrument for the measurement of the three types of cognitive load. Principal component analysis on data from a lecture in statistics for PhD students (n = 56) in psychology and health sciences revealed a threecomponent solution, consistent with the types of load that the different items were intended to measure. This solution was confirmed by a confirmatory factor analysis of data from three lectures in statistics for different cohorts of bachelor students in the social and health sciences (ns = 171, 136, and 148), and received further support from a randomized experiment with university freshmen in the health sciences (n = 58).

In two studies, we investigated whether a recently developed psychometric instrument can differentiate intrinsic, extraneous, and germane cognitive load. Study I revealed a similar three-factor solution for language learning (n ¼ 108) and a statistics lecture (n ¼ 174), and statistics exam scores correlated negatively with the factors assumed to represent intrinsic and extraneous cognitive load during the lecture. In Study II, university freshmen who studied applications of Bayes' theorem in exampleeexample (n ¼ 18) or exampleeproblem (n ¼ 18) condition demonstrated better posttest performance than their peers who studied the applications in problemeexample (n ¼ 18) or problemeproblem (n ¼ 20) condition, and a slightly modified version of the aforementioned psychometric instrument could help researchers to differentiate intrinsic and extraneous cognitive load. The findings provide support for a recent reconceptualization of germane cognitive load as referring to the actual working memory resources devoted to dealing with intrinsic cognitive load.

Cognitive Load Theory (CLT) has started to find more applications in medical education research. Unfortunately, misconceptions such as lower cognitive load always being beneficial to learning and the continued use of dated concepts and methods can result in improper applications of CLT principles in medical education design and research. This review outlines how CLT has evolved and presents a synthesis of current-day CLT principles in a holistic model for medical education design. This model distinguishes three dimensions: task fidelity: from literature (lowest) through simulated patients to real patients (highest); task complexity: the number of information elements; and instructional support: from worked examples (highest) through completion tasks to autonomous task performance (lowest). These three dimensions together constitute three steps to proficient learning: (I) start with high support on low-fidelity low-complexity tasks and gradually fade that support as learners become more proficient; (II) repeat I for low-fidelity but higher-complexity tasks; and (III) repeat I and II in that order at subsequent levels of fidelity. The numbers of fidelity levels and complexity levels within fidelity levels needed depend on the aims of the course, curriculum or individual learning trajectory. This paper concludes with suggestions for future research based on this model.

Blended learning, defined as a combination of face-to-face and online learning, is expected to lead to improved education. Besides, practical reasons, like increased access to education and resource management, are mentioned for its implementation. To examine whether the expectation of improved education is met, meta-analyses were conducted.They revealed that, on average, blended learning is somewhat more effective than more traditional learning. Additionally, students evaluated it as equally attractive, but seemed to perceive it as more demanding. In sum, blended learning is equal, or maybe even better, than more traditional learning. However, the effects on effectiveness, attractiveness and perceived demands differed much between studies. Moderator analyses found that quizzes positively affect the effectiveness and attractiveness of blended learning. Concluding, blended learning has potential to improve education, when thoughtfully designed, for example by the inclusion of frequent quizzes.

Recent research has shown that dissociative symptoms are related to self-reports of deviant sleep experiences. The present study is the 1st to explore whether sleep loss can fuel dissociative symptoms. Twenty-five healthy volunteers were deprived of sleep for 1 night. Sleepiness and dissociative symptoms were assessed every 6 hr. The authors measured both spontaneous dissociative symptoms and dissociative symptoms induced by dot-staring during sensory deprivation. Sleepiness as well as spontaneous and induced dissociative symptoms were stable throughout the day but increased during the night. These findings provide further evidence for a robust relationship between disruptions in sleep patterns and dissociative symptoms.

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In comparison with 'traditional' part-task OSCEs, whole-task OSCEs like the HDPE increase students' use of diagnostic reasoning during study time.

During their course, medical students have to become proficient in a variety of competencies. For each of these competencies, educational design can use cognitive load theory to consider three dimensions: task fidelity: from literature (lowest) through simulated patients (medium) to real patients (highest); task complexity: the number of information elements in a learning task; and instructional support: from worked examples (highest) through completion tasks (medium) to autonomous task performance (lowest). One should integrate any competency into a medical curriculum such that training in that competency facilitates the students' journey that starts from high instructional support on low-complexity low-fidelity learning tasks all the way to high-complexity tasks in high-fidelity environments carried out autonomously. This article presents twelve tips on using cognitive load theory or, more specifically, a set of four tips for each of task fidelity, task complexity, and instructional support, to achieve that aim.