Association between Clinical Simulation Design Features and Novice Healthcare Professionals’ Cognitive Load: A Systematic Review and Meta-Analysis

Abstract

Background Clinical simulations are complex educational interventions characterized by several design features, which have the potential to influence cognitive load, that is, the mental effort required to assimilate new information and learn. This systematic review and meta-analysis explored the associations between simulation design features and cognitive load in novice healthcare professionals. Methods Based on the Joanna Briggs Institute methodology, a search was performed in five databases for quantitative studies in which the cognitive load of novice healthcare professionals was measured during or after a simulation activity. Each clinical simulation was coded to describe its design features. Univariate and multivariate mixed model analyses were performed to explore the associations between simulation design features and cognitive load. Results From 962 unique records, 45 studies were included and 27 provided enough data on subjective cognitive load (i.e., Paas Scale and NASA-Task Load Index scores) to be meta-analyzed. In the multivariate analysis for the NASA-Task Load Index scores, each repetition of a simulation using the same scenario resulted in a linear decrease in cognitive load. In contrast, technology-based instruction before or during a simulation activity was associated with higher cognitive load. In the univariate analyses, other features such as feedback and instructor presence were also statistically associated with cognitive load. Regarding the univariate analyses of the Paas Scale scores, simulator type, briefing, debriefing, and repetitive practice were statistically associated with cognitive load. Conclusion This is the first meta-analysis exploring the relationship between clinical simulation design features and novice healthcare professionals’ cognitive load. Although the findings show that several design features can potentially increase or decrease cognitive load, several gaps and inconsistencies in the current literature make it difficult to appreciate how such reciprocity influences novice healthcare professionals’ learning. These limitations are discussed and avenues for educators and further research are suggested.

Measured task load in directed observers versus active participants undergoing high‐fidelity simulation education in a critical care setting

“…We used the raw (unweighted) total NASA‐TLX score for each participant created by summing the scores on each domain. The NASA‐TLX has been used in human factors research across a wide range of contexts, including looking at the performance of health professionals 17,18 …”

“…The NASA-TLX has been used in human factors research across a wide range of contexts, including looking at the performance of health professionals. 17,18…”

Reality check

“…These may be beneficial in quantifying virtual environments' impact to facilitate critical thinking in the future. Design features to minimise undue cognitive load in simulation include the addition of repetitive practice, as well as instruction before, during, and feedback after simulation (Lapierre et al, 2022).…”

Cognitive load theory in workplace-based learning from the viewpoint of nursing students: application of a path analysis

“…They stated aspects of workplace environments contribute to extraneous load, and adversely impact capacity for engaging in tasks that enhance germane load and learning [ 15 ]. Further studies are recommended to understand the manner and the extent of the impact of cognitive load on different learning outcomes in various learning environments in systems of health professions education [ 1 , 16 , 17 ].…”