Context
The effective implementation of cognitive load theory (CLT) to optimise the instructional design of simulation‐based training requires sensitive and reliable measures of cognitive load. This ...mixed‐methods study assessed relationships between commonly used measures of total cognitive load and the extent to which these measures reflected participants’ experiences of cognitive load in simulation‐based procedural skills training.
Methods
Two groups of medical residents (n = 38) completed three questionnaires after participating in simulation‐based procedural skills training sessions: the Paas Cognitive Load Scale; the NASA Task Load Index (TLX), and a cognitive load component (CLC) questionnaire we developed to assess total cognitive load as the sum of intrinsic load (how complex the task is), extraneous load (how the task is presented) and germane load (how the learner processes the task for learning). We calculated Pearson's correlation coefficients to assess agreement among these instruments. Group interviews explored residents’ perceptions about how the simulation sessions contributed to their total cognitive load. Interviews were audio‐recorded, transcribed and subjected to qualitative content analysis.
Results
Total cognitive load scores differed significantly according to the instrument used to assess them. In particular, there was poor agreement between the Paas Scale and the TLX. Quantitative and qualitative findings supported intrinsic cognitive load as synonymous with mental effort (Paas Scale), mental demand (TLX) and task difficulty and complexity (CLC questionnaire). Additional qualitative themes relating to extraneous and germane cognitive loads were not reflected in any of the questionnaires.
Conclusions
The Paas Scale, TLX and CLC questionnaire appear to be interchangeable as measures of intrinsic cognitive load, but not of total cognitive load. A more complete understanding of the sources of extraneous and germane cognitive loads in simulation‐based training contexts is necessary to determine how best to measure and assess their effects on learning and performance outcomes.
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Neutral buoyancy facilities are used to prepare astronauts and cosmonauts for extra vehicular activities e.g. on-board of the International Space Station. While previous studies indicated a decrease ...in cognitive performance in an under water setting, they have only provided behavioural data. This study aimed to review whether recording of electro cortical activity by the use of electroencephalography (EEG) is possible in an under water setting and if so, to identify the influence of water immersion at a depth of 4 m on neurocognitive markers. Ten male subjects performed a cognitive choice-reaction times (RT) task that progressed through five levels of increasing difficulty on land and when submerged 4 m under water. N200 latency and amplitude in the occipital and frontal areas were measured, and baseline cortical activity was measured during rest in both conditions. Neither RT nor amplitude or latency of the N200 showed any significant changes between the land and the under water conditions. Also theta, alpha and beta frequencies showed no differences between the two conditions. The data provided in this study demonstrate the possibility of recording EEG even under the extreme conditions of full body water immersion. The lack of cognitive impairment in RT and N200 in the under water condition may be explained by the fact that only experienced divers participated in the study. As a proof of principle, this study generates many new experimental possibilities that will improve our understanding of cognitive processes under water.
Ensuring trainees develop the flexibility with their knowledge to address novel problems, and to efficiently build upon prior knowledge to learn new knowledge is a common goal in health profession ...education. How trainees come to develop this capacity to transfer and transform knowledge across contexts can be described by adaptive expertise, which focuses on the ability of some experts to innovate upon their existing knowledge to develop novel solutions to novel problems. While adaptive expertise is often presented as an alternative framework to more traditional cognitivist and constructivist expertise models, it is unclear whether the
non-routine
and
routine
forms of transfer it describes are distinct from those described by other accounts of transfer. Furthermore, whether
what
(e.g., knowledge) is transferred and
how
(e.g., cognitive processes) differs between these views is still debated. In this review, we describe various theories of transfer and present a synthesis clarifying the relationship between transfer and adaptive expertise. Informed by our analysis, we argue that the mechanisms of transfer in adaptive expertise share important commonalities with traditional accounts of transfer, which when understood, can complement efforts by educators and researchers to foster and study adaptive expertise. We present three instructional principles that may better support transfer and adaptive expertise in trainees: i) identifying and incorporating meaningful variability in practice, ii) integrating conceptual knowledge during practice iii) using assessments of trainees’ transfer. Taken together, we offer an integrative perspective to how educational systems and experiences can be designed to develop and encourage adaptive expertise and transfer.
Context
Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may ...increase task complexity to a point at which novices’ cognitive resources become overloaded.
Objectives
In this experiment, we investigate the effects of variations in task complexity on novices’ cognitive load and learning during simulation‐based procedural skills training.
Methods
Thirty‐eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a ‘very complex’ simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures.
Results
In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29–0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13–2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48–0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78–1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80).
Conclusions
Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation‐based learning outcomes.
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Transfer is a desired outcome of simulation-based training, yet evidence for how instructional design features promote transfer is lacking. In clinical reasoning, transfer is improved when trainees ...experience instruction integrating basic science explanations with clinical signs and symptoms. To test whether integrated instruction has similar effects in procedural skills (i.e., psychomotor skills) training, we studied the impact of instruction that integrates conceptual (
why)
and procedural (
how)
knowledge on the retention and transfer of simulation-based lumbar puncture (LP) skill. Medical students (
N
= 30) were randomized into two groups that accessed different instructional videos during a 60-min self-regulated training session. An unintegrated video provided procedural
How
instruction via step-by-step demonstrations of LP, and an integrated video provided the same
How
instruction with integrated conceptual
Why
explanations (e.g., anatomy) for key steps. Two blinded raters scored post-test, retention, and transfer performances using a global rating scale. Participants also completed written procedural and conceptual knowledge tests. We used simple mediation regression analyses to assess the total and indirect effects (mediated by conceptual knowledge) of integrated instruction on retention and transfer. Integrated instruction was associated with improved conceptual (
p
< .001) but not procedural knowledge test scores (
p
= .11). We found no total effect of group (
p
> .05). We did find a positive indirect group effect on skill retention (
B
ab
= .93,
p
< .05) and transfer (
B
ab
= .59,
p
< .05), mediated through participants improved conceptual knowledge. Integrated instruction may improve trainees’ skill retention and transfer through gains in conceptual knowledge. Such integrated instruction may be an instructional design feature for simulation-based training aimed at improving transfer outcomes.
Background:
Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills ...in a safe environment.
Purpose:
The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
A total of 47 participants including orthopaedic surgery residents (n = 37), sports medicine fellows (n = 5), and staff surgeons (n = 5) performed arthroscopic hip labral repair on a dry model. Prior arthroscopic experience was noted. Participants were evaluated by 2 orthopaedic surgeons using a task-specific checklist, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task completion time, and a final global rating scale. All procedures were video-recorded and scored by an orthopaedic fellow blinded to the level of training of each participant.
Results:
The internal consistency/reliability (Cronbach alpha) using the total ASSET score for the procedure was high (intraclass correlation coefficient > 0.9). One-way analysis of variance for the total ASSET score demonstrated a difference between participants based on the level of training (F3,43 = 27.8, P < .001). A good correlation was seen between the ASSET score and previous exposure to arthroscopic procedures (r = 0.52-0.73, P < .001). The interrater reliability for the ASSET score was excellent (>0.9).
Conclusion:
The results of this study demonstrate that the use of dry models to assess the performance of arthroscopic hip labral repair by trainees is both valid and reliable. Further research will be required to demonstrate a correlation with performance on cadaveric specimens or in the operating room.
To conduct a pilot investigation about the alignment between didactic multimedia materials utilized by pharmacy faculty, with Mayer's Principles for Multimedia Learning and faculty characteristics ...associated with greater alignment.
An investigatory systematic process was used which included a modified Learning Object Review Instrument (LORI) to evaluate the faculty video-recorded lectures for alignment with Mayer’s Principles of Multimedia Learning, hence capturing the number and type of misalignments. Correlations were performed to evaluate the association between faculty characteristics; and ratings and proportions of misalignments.
Five hundred fifty-five PowerPoint slides of 13 lectures from 13 faculty members were reviewed. The average (SD) LORI score per slide was 4.44 (0.84) out of 5 with an average score per lecture ranging from 3.83 (0.96) to 4.95 (0.53). Across all lecture slides, misalignments with multimedia principles were captured in 20.2% of slides. For each lecture, the average percentage of misalignments was 27.6% ranging from 0% to 49%. Principal misalignments included violation of the principles of coherence (66.1%), signaling (15.2%), and segmenting (8%). No faculty characteristics were significantly associated with LORI ratings or proportion of misalignments within lectures.
Faculty had high LORI ratings for their multimedia material but these varied significantly between lectures. Misalignments with multimedia principles were identified and were related primarily to extraneous processing. These misalignments, when addressed, have the potential to improve learning, thus suggesting an opportunity for the faculty to develop ways to optimize multimedia educational delivery. Future investigation is needed to clarify how clinical pharmacy faculty can develop multimedia material and the impact of faculty development on the application of multimedia principles and learning outcomes.
Following completion of structured training in residency or fellowship programs, surgeons need to acquire new skills throughout their careers to address changes in their surgical practices, and to ...perform new procedures and use new technologies as these are developed. The opportunities available to surgeons to acquire the new skills, safely introduce these skills into surgical practice, and then maintain the skills, vary greatly and may not fully support a surgeon's needs. The article shares background information relating to the vexing problems, and describes established educational theories and frameworks as well as specific frameworks relating to surgical skills training and verification that may be used in designing and implementing comprehensive and impactful surgical skills training programs aimed at practicing surgeons. A number of practical strategies based on these theories and frameworks are highlighted. National professional organizations and academic medical centers need to play a critical role in pursuing such efforts, which will remain pivotal in supporting the professional work of surgeons and in providing optimal surgical care well into the future.
A scoping review was performed to assess published evidence regarding how best to teach ultrasound-guided regional anesthesia (UGRA). The literature search yielded 205 articles, of which 35 met the ...inclusion criteria. Current literature on the topic can be divided into 3 main themes: the development of motor skills, learning and teaching sonoanatomy, and understanding of the requirements for establishing a UGRA education program and evaluation. We discuss the current status and future direction of research on UGRA training.
