Cognitive load predicts point-of-care ultrasound simulator performance

Abstract

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. Keywords What this paper addsHigh cognitive load during simulation training is associated with impaired learning and incomplete skill transfer to clinical practice. Measuring cognitive load can thus help to identify individuals whose skills are not fully consolidated. Using cognitive load measures in this way requires a higher standard of validity evidence than currently exists in the literature. Using point-of-care ultrasonography as a model, this study provides a proof-of-principle for how multiple cognitive load measures can be incorporated to strengthen validity claims. Across the expertise continuum, ultrasound simulator performance was most sensitively predicted by a combination of prior ultrasound training and cognitive load.

The effect of autostereoscopic holograms on anatomical knowledge: a randomised trial

“…It has been utilised to generate instructional principles for designing anatomical multimedia and generalisable design guidelines for medical education . Further, CLT has served as a useful lens when analysing medical training methods …”

“…14 Further, CLT has served as a useful lens when analysing medical training methods. [15][16][17][18][19] Technological solutions have also been suggested as a tool for improving anatomical education, including mobile technology 20 or three-dimensional (3-D) display technology. 21 This article focuses on 3-D display technology, using a categorisation suggested by Geng.…”

Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL)

“…Regarding the test–retest reliability, the extraneous CL was the least stable factor among the three identified factors in the Chinese version MDT‐CL. The possible reason might include the following: (a) there are only three items included in the extraneous CL and Leppink et al (Leppink et al, ) indicated that the stability of a scale or subscale can be affected when there are only few items within a scale or subscale and (b) extraneous CL may vary when the participant's emotions (Pawar et al, ) or the physical environment (Aldekhyl, Cavalcanti, & Naismith, ) is subject to change. Future studies are needed to conduct equivalence reliability for testing the stability of the extraneous CL (Park et al, ).…”

“…However, the correlation between extraneous CL and germane CL (r = 0.003) in our study is different than the original study (r = −0.19). If a nursing care activity is presented to a nurse in a simple or familiar way, and there is a lower extraneous CL, it seems that the nurse may devote more cog- (Pawar et al, 2018) or the physical environment (Aldekhyl, Cavalcanti, & Naismith, 2018) is subject to change.…”

Measuring cognitive load

“…The paper ‘Cognitive load predicts point-of-care ultrasound simulator performance’ by Aldekhyl, Cavalcanti, and Naismith, in this issue of Perspectives on Medical Education [ 1 ], is an important paper that adds to work on cognitive load theory and medical education [ 2 – 4 ]. The implications of the findings of this paper extend substantially beyond the confines of medical practice that is the focus of the work.…”