Measuring cognitive load: mixed results from a handover simulation for medical students.

John Q Young,Olle Ten Cate,Patricia S O’Sullivan,Maria-Louise Barilla-Labarca,David M Irby

doi:10.1007/s40037-015-0240-6

John Q Young, Olle Ten Cate + Show 3 more

Open Access

https://doi.org/10.1007/s40037-015-0240-6

Copy DOI

Abstract

IntroductionThe application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. This exploratory study tests a method for measuring cognitive load during handovers.MethodsThe authors developed the Cognitive Load Inventory for Handoffs (CLI4H) with items for intrinsic, extraneous, and germane load. Medical students completed the measure after participating in a simulated handover. Exploratory factor and correlation analyses were performed to collect evidence for validity.ResultsResults yielded a two-factor solution for intrinsic and germane load that explained 50 % of the variance. The extraneous load items performed poorly and were removed from the model. The score for intrinsic load correlated with the Paas Cognitive Load scale (r = 0.31, p = 0.004) and was lower for students with more prior handover training (p = 0.036). Intrinsic load did not, however, correlate with performance. Germane load did not correlate with the Paas Cognitive Load scale but did correlate as expected with performance (r = 0.30, p = 0.005) and was lower for those students with more prior handover training (p = 0.03).ConclusionsThe CLI4H yielded mixed results with some evidence for validity of the score from the intrinsic load items. The extraneous load items performed poorly and the use of only a single item for germane load limits conclusions. The instrument requires further development and testing. Study results and limitations provide guidance to future efforts to measure cognitive load during workplace-based activities, such as handovers.

Highlights

The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types
100 % of second-year (n = 54) and third-year (n = 33) students participated in the objective structured clinical skills examination (OSCE), including the handover station
We found only a small association between the intrinsic load factor and the germane load factor, which supports the relative independence of these two constructs—an issue of some controversy in the cognitive load theory (CLT) literature

Summary

Introduction

The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. The transfer of clinical information and responsibility from one clinician or team to another, occur frequently in health care These transitions in care are vulnerable to communication failures that often lead to medical errors and harm to patients [1]. In response to this hazard, considerable attention has focused on interventions to improve patient safety during handovers [2], many of which were adapted from industries such as nuclear power and space aviation in which transition errors have high consequences [3] These best practices aim to ensure that the necessary information is transmitted via communication protocols that include structured face-to-face and written sign-out, interactive questioning, and distraction-free settings [4]. To further improve patient safety will require a deeper understanding of human cognition in order to identify the challenges trainees face when learning how to give and receive sign-outs and to use this understanding to design an assessment that can help identify novel intervention targets and measure their efficacy

Methods

Results

Discussion

Conclusion