Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53

Abstract

Aim: Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear. Method: To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks. Result: Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found distractions and other aspects of workplace environments as contributing to extraneous load. Studies outside the health professions documented similar findings to those within the health professions, supporting relevance of CLT to workplace learning. Conclusion: The authors discuss implications for workplace teaching, curricular design, learning environment, and metacognition. To advance workplace learning, the authors suggest future CLT research should address higher-level questions and integrate other learning frameworks.

Trainee perception of cognitive load during observed faculty staff teaching of procedural skills

“…Very few studies have investigated the three types of cognitive load in procedural settings . Our prior work quantitatively assessed the characteristics of learners, teachers, tasks and settings that were associated with intrinsic, germane and extraneous load amongst colonoscopy learners .…”

“…Although CLT is considered relevant to procedural skills training in HPE, little is known about how teaching affects the levels of intrinsic, germane and extraneous cognitive load experienced by procedural learners. 8 In this study, we characterised teaching activities used during the exemplar setting of colonoscopy, how the activities were enacted, and the degree of impact fellows perceived the teaching activities to have on cognitive load. Although the frequency of use of the teaching activities varied substantially amongst the 10 colonoscopy teachers, their enactments of the activities were quite similar.…”

“…Very few studies have investigated the three types of cognitive load in procedural settings. 8 Our prior work quantitatively assessed the characteristics of learners, teachers, tasks and settings that were associated with intrinsic, germane and extraneous load amongst colonoscopy learners. 15 Naismith et al 21 qualitatively identified characteristics of a simulation perceived by respirology and internal medicine residents as contributing to intrinsic, germane and extraneous load in the context of performing simulated pleural catheter drain placement, thoracentesis and paracentesis (they also compared quantitative cognitive load measures).…”

“…Because germane load is the cognitive load type most directly linked to learning, educators should find it of great interest. However, we know little about the factors or variables that impact germane load in health professions education (HPE) workplace settings, and it remains less studied than intrinsic and extraneous load …”

“…However, we know little about the factors or variables that impact germane load in health professions education (HPE) workplace settings, and it remains less studied than intrinsic and extraneous load. 8 Empirical research confirms the relevance of CLT to procedural training in HPE settings, 8 yet how specific teaching activities may affect learners' intrinsic, germane and extraneous cognitive load levels remains uncertain. Teachers of procedures undoubtedly intend their teaching to promote learning, yet some teaching approaches may have unintended consequences that induce extraneous load or cognitive overload, which interfere with learning.…”