Simulation‐based education for novices: complex learning tasks promote reflective practice

Abstract

Context Simulated clinical immersion (SCI), in which clinical situations are simulated in a realistic environment, safely and gradually exposes novices to complex problems. Given their limited experience, undergraduate students can potentially be quite overwhelmed by SCI learning tasks, which may result in misleading learning outcomes. Although task complexity should be adapted to the learner's level of expertise, many factors, both intrinsic and extraneous to the learning task, can influence perceived task complexity and its impact on cognitive processes. Objectives The purpose of this mixed‐methods study was to understand the effects of task complexity on undergraduate pharmacy students’ cognitive load, task performance and perception of learning in SCI. Methods A total of 167 second‐year pharmacy students were randomly assigned to undertake one simple and one complex learning task in SCI consecutively. Participants’ cognitive load was measured after each task and debriefing. Task performance and time on task were also assessed. As part of a sequential explanatory design, semi‐structured interviews were conducted with students showing maximal variations in intrinsic cognitive load to elucidate their perceptions of learning when dealing with complexity. Results Although the complex task generated significantly higher cognitive load and time on task than the simple task, performance was high for both tasks. Qualitative results revealed that a lack of clinical experience, an unfamiliar resource in the environment and the constraints inherent to SCI, such as time limitations, hindered the clinical reasoning process and led to poorer self‐evaluation of performance. Simple tasks helped students gain more self‐confidence, whereas complex tasks further encouraged reflective practice during debriefings. Conclusions Although complex tasks in SCI were more cognitively demanding and took longer to execute, students indicated that they learned more from them than they did from simple tasks. Complex tasks constitute an additional challenge in terms of clinical reasoning and thus provide a more valuable learning experience from the student's perspective.

Medical education, simulation and uncertainty

“…Cognitive load refers to the volume of working memory involved in processing information. 12 If cognitive load exceeds working memory capacity, learning may be impaired. Novel tasks with multiple interacting elements, such as the 'uncertainty simulation', have been associated with self-reports of increased cognitive load and poorer performance.…”

“…Novel tasks with multiple interacting elements, such as the 'uncertainty simulation', have been associated with self-reports of increased cognitive load and poorer performance. 12,13 Despite this, recent work suggests that increasing the cognitive load within simulation does not result in poorer objective performance, and may be more useful in encouraging reflection, when compared with simpler tasks. 12 The literature exploring 'uncertainty' in clinical practice suggests that it can provoke detrimental feelings of shame and anxiety.…”

“…12,13 Despite this, recent work suggests that increasing the cognitive load within simulation does not result in poorer objective performance, and may be more useful in encouraging reflection, when compared with simpler tasks. 12 The literature exploring 'uncertainty' in clinical practice suggests that it can provoke detrimental feelings of shame and anxiety. 14,15 Therefore, it is understandable that our students often interpreted uncertainty as a personal failure, even when they met faculty member expectations.…”

“…14 Simulation, debriefing and deliberate practice may provide a method to deliver this learning. 12 A limitation of our work relates to the analysis process. Although there was a review of coding structures by a second researcher, this person was part of the research team.…”

Engagement in cloud-supported collaborative learning and student knowledge construction: a modeling study

“…Numerous studies have pointed out that reflection plays an important role in the knowledge construction process (Renner et al 2020;Tremblay et al 2019). Reflective thinking refers to purposeful thought in which learners engage in active, persistent, and careful consideration of ideas for deeper understanding (Wilson and Murdoch 2013).…”