Cognitive Load Measurement Research Articles

Design and validation of an electroencephalogram‐supported approach to tracking real‐time cognitive load variations for adaptive video‐based learning

Cognitive load is a critical internal state associated with learners' learning process and significantly influences learning outcomes. With the worldwide popularity of video‐based learning (VBL), tracking real‐time cognitive load variations becomes more and more important for the timely provision of adaptive learning support during the learning process. This study proposed and validated an electroencephalogram (EEG)‐supported approach to tracking real‐time cognitive load variations during continuous VBL. We recruited 108 healthy adult participants to watch a specially designed video lecture with a sequence of interconnected slides of equal length. EEG signals were continuously recorded throughout the session. The video lecture was designed with varying levels of content difficulty (ie, rated from 1 to 5) across slides and was narrated at three different speeds (ie, slow, normal and fast) to induce cognitive load variations. For each slide, the cognitive load was quantified using both subjective ratings (ie, self‐reported difficulty) and an EEG‐derived measure (ie, alpha power). Through linear mixed model analysis, we demonstrated the feasibility of using alpha power to track real‐time cognitive load variations during the continuous VBL process after controlling the effect of mental fatigue. This study provides a foundation for developing learning enhancement technologies that enable the timely provision of adaptive learning support in VBL. Practitioner notesWhat is already known about this topic Video‐based learning has become a prevailing learning method for the current generation. Tracking the internal learning state of learners is essential for the timely provision of adaptive learning support during the video‐based learning process. Cognitive load is a critical aspect of internal learning state. While EEG has been proven to be valuable in assessing average cognitive load of a task, few studies have investigated the feasibility of utilizing EEG to track real‐time cognitive load variations in a task. What this paper adds An EEG‐supported approach was proposed to track real‐time cognitive load variations in video‐based learning. A high consistency was found between subjective ratings and EEG‐derived measure of cognitive load. The presence of mental fatigue exerted a significant impact on EEG‐derived measure of cognitive load. Implications for practice and/or policy Generative AI can be leveraged to facilitate mass production of lectures required in the approach. Real‐time tracking of cognitive load variations in video‐based learning enables the timely provision of adaptive learning supports. Additional research is warranted to mitigate the effect of mental fatigue on real‐time tracking of cognitive load variations.

Plantar Pressure Variability As A Measure Of Cognitive Load During Gait

Plantar Pressure Variability As A Measure Of Cognitive Load During Gait

(MIS)measuring cognitive load and arousal in deception: A multitrait–multimethod analysis

AbstractPurposeCognitive load and arousal are cornerstones of many deception detection strategies and theories; in turn, their effective measurement is critical. However, fundamental criteria for establishing the quality and accuracy of measures have largely been overlooked. In this study, we examined the reliability and construct validity of common cognitive load and arousal measures.MethodWe obtained three independent secondary datasets in which participants (N = 238) had lied or told the truth about witnessing a suspicious event. Using a multitrait–multimethod analysis, we assessed three measures of their cognitive load and arousal: participants' self‐reports, trained coders' observations, and objective behaviours.ResultsAlthough all measures were reliable, they achieved differing levels of validation. Specifically, measures of cognitive load showed evidence of convergent validity, but not discriminant validity. There was no empirical support for the construct validity of arousal measures.ConclusionsThese findings suggest that inconsistencies in the diagnosticity of cues to deception and theory support may be attributable to the measures employed. Researchers may not be assessing constructs of interest, particularly in the case of arousal.

Watching subtitled videos with the sound off affects viewers' comprehension, cognitive load, immersion, enjoyment, and gaze patterns: A mixed-methods eye-tracking study.

Every day, millions of viewers worldwide engage with subtitled content, and an increasing number choose to watch without sound. In this mixed-methods study, we examine the impact of sound presence or absence on the viewing experience of both first-language (L1) and second-language (L2) viewers when they watch subtitled videos. We explore this novel phenomenon through comprehension and recall post-tests, self-reported cognitive load, immersion, and enjoyment measures, as well as gaze pattern analysis using eye tracking. We also investigate viewers' motivations for opting for audiovisual content without sound and explore how the absence of sound impacts their viewing experience, using in-depth, semi-structured interviews. Our goal is to ascertain whether these effects are consistent among L2 and L1 speakers from different language varieties. To achieve this, we tested L1-British English, L1-Australian English and L2-English (L1-Polish) language speakers (n = 168) while they watched English-language audiovisual material with English subtitles with and without sound. The findings show that when watching videos without sound, viewers experienced increased cognitive load, along with reduced comprehension, immersion and overall enjoyment. Examination of participants' gaze revealed that the absence of sound significantly affected the viewing experience, increasing the need for subtitles and thus increasing the viewers' propensity to process them more thoroughly. The absence of sound emerged as a global constraint that made reading more effortful. Triangulating data from multiple sources made it possible to tap into some of the metacognitive strategies employed by viewers to maintain comprehension in the absence of sound. We discuss the implications within the context of the growing trend of watching subtitled videos without sound, emphasising its potential impact on cognitive processes and the viewing experience.

Mental effort during mindless reading? Pupil fluctuations indicate internal processing during levels of inattention.

Mind wandering, an experience characterized by a reduced external focus of attention and an increased internal focus, has seen significant theoretical advancement in understanding its underlying cognitive processes. The levels-of-inattention hypothesis posits that in mind wandering, external attention is reduced in a graded fashion, reflecting different levels of weak versus deep attentional decoupling. However, it has remained unclear whether internal processing during mind wandering, and mindless reading in particular, requires effort and, if so, whether it is graded or distinct. To address this, we analyzed pupil size as a measure of cognitive load in the sustained-attention-to-stimulus task during text reading. We examined whether decoupled external attention is linked to an overall reduction in workload and whether internal focus of attention is graded or represents a distinct cognitive process. Overall, overlooking errors in the text was associated with a small pupil size, indicating reduced effortful processing. However, this effect varied with error type: overlooking high- or medium-level errors (weak decoupling) resulted in reduced pupil size, while overlooking low-level errors (deep decoupling) had no effect on pupil size. Moreover, detecting an error (at any processing level) elicited a task-evoked pupillary response, which was absent when it was overlooked. These findings suggest that weak decoupling reduces internal resource-demanding processing and are in line with the hypothesis that large pupils during deep decoupling may be associated with distinct states of effortful internal processing. They further support both the levels-of-inattention hypothesis and the notion that internal focus is a distinct mode of deeply decoupled processing. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Which ERP components are effective in measuring cognitive load in multimedia learning? A meta-analysis based on relevant studies.

The open and generative nature of multimedia learning environments tends to cause cognitive overload in learners, and cognitive load is difficult for researchers to observe objectively because of its implicit and complex nature. Event-related potentials (ERP), a method of studying potential changes associated with specific events or stimuli by recording the electroencephalogram (EEG), has become an important method of measuring cognitive load in cognitive psychology. Although many studies have relied on ERP output measurements to compare different levels of cognitive load in multimedia learning, the results of the effect of cognitive load on ERP have been inconsistent. In this study, we used a meta-analysis of evidence-based research to quantitatively analyze 17 experimental studies to quantitatively evaluate which ERP component (amplitude) is most sensitive to cognitive load. Forty five effect sizes from 26 studies involving 360 participants were calculated. (1) The results of the studies analyzed in subgroups indicated high level effect sizes for P300 and P200 (2) Analyses of moderating variables for signal acquisition did not find that different methods of signal acquisition had a significant effect on the measurement of cognitive load (3) Analyses of moderating variables for task design found that a task system with feedback was more convenient for the measurement of cognitive load, and that designing for 3 levels of cognitive load was more convenient for the measurement of cognitive load than for 2 levels of cognitive load. (4) Analyses of continuous moderating variables for subject characteristics did not find significant effects of age, gender, or sample size on the results.

Unobtrusive measurement of cognitive load and physiological signals in uncontrolled environments

While individuals fail to assess their mental health subjectively in their day-to-day activities, the recent development of consumer-grade wearable devices has enormous potential to monitor daily workload objectively by acquiring physiological signals. Therefore, this work collected consumer-grade physiological signals from twenty-four participants, following a four-hour cognitive load elicitation paradigm with self-chosen tasks in uncontrolled environments and a four-hour mental workload elicitation paradigm in a controlled environment. The recorded dataset of approximately 315 hours consists of electroencephalography, acceleration, electrodermal activity, and photoplethysmogram data balanced across low and high load levels. Participants performed office-like tasks in the controlled environment (mental arithmetic, Stroop, N-Back, and Sudoku) with two defined difficulty levels and in the uncontrolled environments (mainly researching, programming, and writing emails). Each task label was provided by participants using two 5-point Likert scales of mental workload and stress and the pairwise NASA-TLX questionnaire. This data is suitable for developing real-time mental health assessment methods, conducting research on signal processing techniques for challenging environments, and developing personal cognitive load assistants.

Using SIM-TLX to investigate the potential impacts on cognitive load while undertaking tasks in a virtual workplace

PurposeThe ability to measure cognitive load in the workplace provides several opportunities to improve workplace learning. In recent years, virtual reality (VR) has seen an increase in use for training and learning applications due to improvements in technology and reduced costs. This study aims to focus on the use of simulation task load index (SIM-TLX), a recently developed self-reported measure of cognitive load for virtual environments to measure cognitive load while undertaking tasks in different environments.Design/methodology/approachThe authors conducted a within-subject design experiment involving 14 participants engaged in digit-recall n-back tasks (1-back and 2-back) in two VR environments: a neutral grey environment and a realistic industrial ozone facility. Cognitive load was then assessed using the SIM-TLX.FindingsThe findings revealed higher task difficulty for the 2-back task due to higher mental demand. Furthermore, a notable interaction emerged between cognitive load and different virtual environments.Research limitations/implicationsThis study relied solely on an n-back task and SIM-TLX self-report measure to assess cognitive load. Future studies should consider including ecologically valid tasks and physiological measurement tools such as eye-tracking to measure cognitive load.Practical implicationsIdentifying cognitive workload sources during VR tasks, especially in complex work environments, is considered beneficial to the application of VR training aimed at improving workplace learning.Originality/valueThis study provides unique insights into measuring cognitive load from various sources as defined by the SIM-TLX sub-scales to investigate the impact of simulated workplace environments.

Debriefer cognitive load during Traditional Reflective Debriefing vs. Rapid Cycle Deliberate Practice interdisciplinary team training

BackgroundCognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD.MethodsThis study was part of a large-scale, interdisciplinary team training program at Children’s Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups.ResultsFor all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (− 0.8, p = 0.004 and − 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p < 0.001). For RCDP, perceived performance success increased post-debriefing (+ 3.6, p < 0.001), time demands decreased (− 1.0, p = 0.04), and frustration decreased (− 2.0, p < 0.001). Comparing TRD directly to RCDP, perceived performance success was greater in RCDP than TRD (3.6 vs. 2.4, p = 0.04). Main facilitators had lower effort and mental demand in RCDP and greater perceived success (p < 0.001).ConclusionRCDP had greater perceived success than TRD for debriefers. Main facilitators also report reduced effort and baseline mental demand in RCDP. For less experienced debriefers, newer simulation programs, or large team training sessions such as our study, RCDP may be a less mentally demanding debriefing methodology for facilitators.

Multimodal Brain–Computer Interface for In-Vehicle Driver Cognitive Load Measurement: Dataset and Baselines

Multimodal Brain–Computer Interface for In-Vehicle Driver Cognitive Load Measurement: Dataset and Baselines

Enhancing computational thinking and spatial reasoning skills in gamification programming learning: A comparative study of tangible, block and paper‐and‐pencil tools

AbstractTangible programming tools have become a mainstream teaching aid in gamification programming learning (GPL) due to their interactivity and ability to enhance novice learners' computational thinking and spatial reasoning skills. However, comparing the relative efficacy of different programming tools that simultaneously support these skills was not adequately explored. This study designed and evaluated three programming tools: the tangible programming tool (TPG), which uses real touchable objects; the block programming tool (BPG), which employs virtual programming blocks and 3D game scenarios; and the paper‐and‐pencil programming tool (PPG), which uses paper and pen to draw. The study involved 112 seventh‐grade students from three natural classes: Class A (TPG, n1=37), Class B (BPG, n2=38), and Class C (PPG, n3=37). These students completed four gamification programming tasks and CT skills, spatial reasoning skills, enjoyment, cognitive load and GPL task list measurements. The results indicated that the tangible programming tool led to lower cognitive load, significant improvement in spatial reasoning skills and better abstraction and problem decomposition skills. The block programming tool provided a more enjoyable experience and facilitated students' algorithm design and efficiency. The paper‐and‐pencil programming tool was found to be less effective in improving spatial reasoning skills. This study's findings can help programming educators cultivate students' thinking skills and improve their learning experience by effectively selecting the most appropriate programming tools.

Telling stories as preparation for learning: A Bayesian analysis of transfer performance and investigation of learning mechanisms

BackgroundTextbooks are essential for natural science university education. However, recent evidence indicates that their design may not be ideal for learning, whereas narratives might overcome the associated limitations. AimThis study compares transfer performance and involved learning mechanisms upon learning scientific concepts either provided in an expository text alone, embedded in a historical narrative, or as expository text prefaced with the historical background. SampleParticipants were 163 undergraduate natural science students. MethodsWe randomly assigned students to one of the three conditions and used a Bayesian modeling approach to compare the prior knowledge-dependent transfer performance upon instruction. Additionally, we investigated the impact of the different conditions on affective and cognitive mechanisms. ResultsResults indicate that students with lower prior knowledge benefit most from narrative-embedded content. Students with higher prior knowledge profited if narratives were used as preparation for follow-up expository instruction. Self-efficacy and cognitive load measures were positively related to the narrative conditions and partly mediated learning from narrative instruction. ConclusionThe study conceptualized and offers support for using narratives as preparation for future learning for enhancing transfer performance in university natural science education, additionally highlighting when and why narratives might support learning.

Research on the Design of Online Course Teaching Interfaces and Knowledge Presentation Methods under Balanced Cognitive Load

This paper aims to explore the impact of high or low cognitive load on learners' learning effectiveness during the online learning process, as well as to achieve the goal of learners efficiently completing online learning tasks. Based on the theory of balanced cognitive load, the paper delves into the factors that may cause changes in learners' cognitive load within online courses. Through methods such as in-depth user interviews, negative experience points in the online learning process were collected and a detailed analysis of the corresponding types of cognitive load was conducted. The PAAS scale was utilized for the measurement and assessment of cognitive load, determining the extent of cognitive load at each negative experience point. In response to the issues identified, the paper proposes strategies to improve or eliminate learners' negative touchpoints from the following aspects: first, optimizing the hierarchical design of the instructional interface; second, implementing multi-channel information input; third, reinforcing the guidance of key information; and fourth, split-attention effect. These measures are intended to optimize the presentation of information on the instructional interface, reduce the cognitive burden on learners, and thereby enhance their cognitive validity, ensuring the efficiency of online learning.

Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory.

Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.

Neurodiversity and cognitive load in online learning: A systematic review with narrative synthesis

This systematic review with narrative synthesis aimed to examine the available evidence on the relationship between neurodiversity and cognitive load in online learning. Despite the known relationship between working memory impairments and neurodiversity, there has been a lack of systematic investigation into how cognitive load impacts neurodivergent students in online learning environments. This review, which includes 90 studies conducted in 21 countries, reveals that the majority (92%) did not consider neurodiversity as a potential factor influencing cognitive load in online learning. The few that did suggest distinct patterns of cognitive load in online learning for neurodivergent students, suggesting a need for more research in this area. The results also point to the potential for methodological advancements in measuring cognitive load in online learning, highlighting that 80% of studies with only neurotypical participants and 60% of studies including neurodivergent participants relied solely on subjective measures of cognitive load. This review contributes to the field by offering a comprehensive overview of our current knowledge of the relationship between neurodiversity and cognitive load in online learning, identifying significant gaps and suggesting directions for future studies.

Evaluating the performance of the cognitive workload model with subjective endorsement in addition to EEG.

The aptitude-oriented exercises from almost all domains impose cognitive load on their operators. Evaluating such load poses several challenges owing to many factors like measurement mode and complexity, nature of the load, overloading conditions, etc. Nevertheless, the physiological measurement of a specific genre of cognitive load and subjective measurement have not been reported along with each other. In this study, the electroencephalography (EEG)-driven machine learning (Support Vector Machine (SVM)) model is sought along with the support of NASA's Task Load Index (NASA-TLX) rating scale for a novel purpose in workload exploration of operators. The Cognitive Load Theory (CLT) was used as the foundation to design the intrinsic stimulus (Spot the Difference task), as most workloads operators are exposed to are notably intrinsic. The SVM-based three-level classification accuracy ranged from 85.4 to 97.4% (p < 0.05), and the NASA-TLX-based three-level classification accuracy ranged from 88.33 to 97.33%. The t-test results show that the neurometric indices contributing to the classification significantly differed (p < 0.05) for every level. The NASA-TLX scale was utilised for validation in its basic form after the validity (Pearson correlation coefficients 0.338 to 0.805 (p < 0.05)) and reliability (Cronbach's α = 0.753) test. This modeling is beneficial to phase out particular-level cognitive exercises from the curriculum during under or overload workload (critical) conditions.

Feasibility and Acceptability of Implementing a Job Search Intervention for Adults With Visual Impairments via Videoconferencing.

Research supports the benefits of job search interventions in improving employment outcomes for various populations, but previous studies involved face-to-face implementation and did not include adults with visual impairments. The purpose of this study was to investigate the feasibility and acceptability of a job search intervention designed for synchronous distance implementation with adults with visual impairments. Two trainers implemented a 5-day job search skills training program with 12 job seekers with visual impairments, ages 22 to 63 years, via Zoom videoconferencing software. Researchers documented participant attendance and intervention fidelity during the program. Participants completed electronic surveys that included quantitative measures of cognitive load and acceptability, plus open-ended questions about their overall perceptions of the program. Attendance, intervention fidelity, and germane cognitive load were high, whereas intrinsic and extraneous cognitive load were low. Most implementation issues resulted from participants' technical difficulties, which were most prevalent on the first day. Acceptability ratings indicated high levels of engagement; relevance; interactivity; and satisfaction with the trainers, group processes, and virtual format. Participants commented on many positive aspects of the program, and some acknowledged the technical issues that occurred. The results support the acceptability and feasibility of the job search intervention. The trainers successfully implemented the program via videoconferencing with adults with visual impairments and developed a positive group atmosphere with high social support. Our findings have implications for facilitating group interventions through videoconferencing, including strategies for building group cohesion and social support.

Physiologic measurements of cognitive load in clinical reasoning.

Cognitive load is postulated to be a significant factor in clinical reasoning performance. Monitoring physiologic measures, such as heart rate variability (HRV) may serve as a way to monitor changes in cognitive load. The pathophysiology of why HRV has a relationship to cognitive load is unclear, but it may be related to blood pressure changes that occur in a response to mental stress. Fourteen residents and ten attendings from Internal Medicine wore Holter monitors and watched a video depicting a medical encounter before completing a post encounter form used to evaluate their clinical reasoning and standard psychometric measures of cognitive load. Blood pressure was obtained before and after the encounter. Correlation analysis was used to investigate the relationship between HRV, blood pressure, self-reported cognitive load measures, clinical reasoning performance scores, and experience level. Strong positive correlations were found between increasing HRV and increasing mean arterial pressure (MAP) (p=0.01, Cohen's d=1.41). There was a strong positive correlation with increasing MAP and increasing cognitive load (Pearson correlation 0.763; 95 % CI [; 95 % CI [-0.364, 0.983]). Clinical reasoning performance was negatively correlated with increasing MAP (Pearson correlation-0.446; 95 % CI [-0.720,-0.052]). Subjects with increased HRV, MAP and cognitive load were more likely to be a resident (Pearson correlation-0.845; 95 % CI [-0.990, 0.147]). Evaluating HRV and MAP can help us to understand cognitive load and its implications on trainee and physician clinical reasoning performance, with the intent to utilize this information to improve patient care.

Processing manner under high cognitive pressure: Evidence from French–English and English–French simultaneous interpreting

Abstract The expression of manner has been extensively studied in the case of motion event descriptions, unveiling significant typological differences between satellite-framed and verb-framed languages and cognitive differences between speakers of these languages. However, far from being restricted to this semantic domain, the expression of manner extends to other types of event descriptions and across virtually all verb classes. In this paper, by considering all the means of expressing manner and grounding our research in a domain-independent definition of this component, we investigate the expression and the transfer of manner under high cognitive pressure as evidenced by corpus data from French–English (FE) and English–French (EF) simultaneous interpreting. Unexpectedly, both French and English displayed an overall cross-domain preference for the verbal-lexical coding of manner in event descriptions, while still differing in the degree to which it was favored. In addition, although our study does not allow a direct measure of cognitive load, the FE interpreters transfer more manner from the source to the target speeches than the EF interpreters do, despite high pressure on cognitive resources, supporting the claim that manner can be cognitively more salient and accessible for English than for French speakers, not only in the domain of motion but also at a more general level, potentially in any semantic domain.

Veterinary High-Stakes Immersive Simulation Training With Repeat Practice Following Structured Debriefing Improves Students' Ability to Cope With High-Pressure Situations.

Immersive simulation is used increasingly in medical education, and there is increasing awareness of the impact of simulation scenarios on emotional state and cognitive load and how these impact learning. 1 There is growing awareness of the requirement to equip veterinarians with skills for managing high-pressure environments and provide training on human factors. Veterinary students participated in a high-fidelity immersive simulation of a road traffic collision involving multiple casualties. The students took part in the same simulation twice, the second time after a debrief. Each participant's emotional state and cognitive load were assessed after participating in each simulation. Each participant was asked to score the effect of pressure on their performance. One hundred twenty-five students participated and demonstrated a higher cognitive load with more positive emotional states during the second scenario after the completion of a structured debrief and discussion focusing on pressure relief techniques (cognitive load - ¯ μ Scenario run 1 = 4.44 ± 1.85 [SD], ¯ μ Scenario2 = 5.69 ± 1.74 [SD]). Most (63%) participants described being in a low-performance state of frazzle during the first scenario compared with most (61%) who described being in a high-performance state of flow during the second. Immersive simulation scenarios, with structured debriefing, may allow the measurement of emotional state and cognitive load in participants. Furthermore, this study suggests that curriculum training in human factors and pressure relief techniques, coupled with immersive simulation and debrief, may improve future performance in high-stakes and high-pressure scenarios.