The cognitive load of inpatient consults: A convergent parallel mixed methods study using the consult cognitive load instrument.

Abstract

11027 Background: Consultation is crucial for inpatient care and a primary responsibility of fellows. Understanding the cognitive load associated with the complex skill of consultation would enhance fellow learning. The authors aimed to determine themes describing the fellow experience during consults, align these themes with Consult Cognitive Load (CCL) scores, and identify strategies to manage cognitive load. Methods: The authors studied 16 fellows using mixed methods. Fellows who accepted an invitation completed a consult followed by the CCL, a measure of cognitive load during consults, and an interview. Three authors conducted a thematic analysis. Member checks and triangulation with fellows supported theme trustworthiness. Subsequently, three authors rated the extent and cognitive demand of each theme expressed in each transcript. The authors measured interrater reliability and used Spearman correlation to describe the association of these ratings with CCL scores. The authors examined themes to identify strategies that educators might use. Results: Analysis revealed four themes: “nature and scope,” which conceptually aligned with intrinsic cognitive load (IL); “leveraging resources,” which had elements of both IL and extraneous cognitive load (EL); “extraneous factors,” which aligned with EL; and “drivers,” which aligned with germane cognitive load (GL). Interrater reliability for extent and demand ratings ranged from 0.57 to 0.79. The correlation between “nature and scope” and IL was 0.37, “extraneous factors” and EL 0.71, and “drivers” and GL 0.32. “Leveraging resources” did not correlate with IL (0.06) or EL (-0.09). Potential strategies based on themes included offering level-appropriate assistance to match IL, focusing the fellow’s attention to reduce EL, and providing succinct teaching to promote GL. Conclusions: This study provided deep insight into the fellow consult experience and suggested trustworthy strategies that educators can use to design and guide consult learning. The theme “leveraging resources” merits further exploration.