Monthly Archives: April 2015

Cognitive Load and Overload… 4_10_2015


Interesting articles, trying to figure out how all of these ideas  apply to medical simulation

(truth be told we didn’t read all of them – just some…)

1 . Manipulation of cognitive load variables and impact on auscultation test performance Ruth Chen • Lawrence Grierson • Geoffrey Norman Received: 20 January 2014 / Accepted: 20 November 2014

2. 4C/ID in medical education: How to design an educational program based on whole-task learning: AMEE Guide No. 93

3. Mental load: helping clinical learners Geoff White, Clinical Education and Professional Development Unit, School of Primary Health Care, Monash University, Australia

4. Cognitive load theory in health professional education: design principles and strategies. Medical Education 2010: 44: 85–93

5.  Cognitive Load Theory: Implications for medical education: AMEE Guide No. 86 (more overview wtih examples)

Extraneous Load – load not essential to the task
Intrinsic Load – load associated with the task
Germane Load – available working memory to learn and to deal with the extraneous and intrinsic load —  these are elements that allow cognitive resources to be put towards learning/problem solving i.e. assist with information processing.

We should think about each of these as we tailor our learning experiences at different levels of learners.  In health care – as opposed to powerpoint slides – there is always going to be a lot of extraneous load – and we do need to teach learners how to deal with this part of the tax on our working memories.

Nice pictures from article # 4 that show how overloading the intrinsic or extrinsic load can leave not potential germane load left for learners to work with in particular situation

A nice alternate way to think about cog load in reference to slides in powerpoint (but I can abstract this to similar “noise” in a simulation scenario)

Have to vary your learning instructional strategies for novices vs. experts…

Article #2 provides a detailed look at how to provide whole task learning – using cognitive load theory at it’s backbone. This is not just simulation but multiple ways of learning – that take a scaffoldign approach of single or simple task to more complex or multiple task – while at the same time (if I am interpreting this right) allowing for more direct coaching at the beginning and then more hands off coaching at the end – as learners go from novice to expert or at least more advanced. Contained within this schema is continual assessment, feedback and reflection.

Interesting approach – starting with a worked example – “show them what you want them to do” then break this down into sizabel chunks – that progressively get more difficult as the learning continues.

I had to read this article several times. I will probable need to read if a few more times.

Article #4 talks about strategies to minimize extraneous load and minimize intrinsic load for novice learners, and how to increase intrinsic load (and thus germane load) as learner expertise increases.
Minimizing extraneous load for novices:
– starting with goal free strategies (generate a list of as many diagnostic possibilities as you can) and moving to goal directed (what is the most likely diagnosis).
-starting with worked examples (i.e. demonstrations of how to do the task) then moving to completing more and more of a task – I liken this to learning a new computer software by trial and error – clicking button sequences until you finally get it right. It’s inefficient and frustrating. Much better to show the completed task and then let the learner complete a similar one
-Reinforce material by using multimodal presentation
A deconstructed roadmap for moving from unconscious incompetence to unconscious competence