Abstract
Cognitive Load Theory (CLT) has started to find more applications in medical education research. Unfortunately, misconceptions such as lower cognitive load always being beneficial to learning and the continued use of dated concepts and methods can result in improper applications of CLT principles in medical education design and research. This review outlines how CLT has evolved and presents a synthesis of current-day CLT principles in a holistic model for medical education design. This model distinguishes three dimensions: task fidelity: from literature (lowest) through simulated patients to real patients (highest); task complexity: the number of information elements; and instructional support: from worked examples (highest) through completion tasks to autonomous task performance (lowest). These three dimensions together constitute three steps to proficient learning: (I) start with high support on low-fidelity low-complexity tasks and gradually fade that support as learners become more proficient; (II) repeat I for low-fidelity but higher-complexity tasks; and (III) repeat I and II in that order at subsequent levels of fidelity. The numbers of fidelity levels and complexity levels within fidelity levels needed depend on the aims of the course, curriculum or individual learning trajectory. This paper concludes with suggestions for future research based on this model.
Highlights
The medical domain is a complex knowledge domain
Cognitive Load Theory (CLT) has started to find more applications in medical education research. Misconceptions such as lower cognitive load always being beneficial to learning and the continued use of dated concepts and methods may result in improper applications of CLT principles in medical education design and research
Empirical findings supporting CLT principles come from four types of measures: (1) indirect measures of cognitive load through task performance accuracy [9,10,11] or time needed for task performance [12, 13]; (2) dual-task performance measures [14, 15]; (3) bio-measures such as functional magnetic resonance imaging [16] or specific electroencephalographic (EEG) [17, 18] or eye-tracking variables [19]; and (4) subjective rating scales [4, 20, 21]
Summary
The making of a diagnosis requires medical practitioners to process and integrate information that is retrieved from multiple sources, such as the patient him or herself, fellow practitioners who have seen the patient before, the patient’s medical records, and similar patient cases This is precisely what Cognitive Load Theory (CLT) is about: the process called learning whereby new information is digested and related to knowledge already stored and organized in longterm memory, the result of which is a more elaborate and extensive knowledge base [1]. This review outlines how CLT has evolved and presents a synthesis of current-day CLT principles in a holistic model for medical education design This model distinguishes three dimensions, which together constitute three steps to proficient learning. After outlining these dimensions and steps, this paper concludes with suggestions for future research based on this model
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