Cognitive Load Research Articles

English Enhancing Exercises: An effective strategy to upgrade and enhance the English proficiency of medical students in non-English speaking countries

English as a medium of Instruction (EMI) has been adopted by the majority of non-native English-speaking countries for teaching science subjects. Medicine is no exception. The decision is based on enormous associated advantages both during the undergraduate period and in professional life as a doctor. However, the linguistic barrier does impose numerous deficiencies related to proficiency in English. This, if not corrected, leads to suboptimal learning and affects the career and output. Formal and dense measures have been suggested but are against the cognitive load on a medical student. English Enhancing Exercises (EEE) is an easy-to-do student-friendly approach, that gradually and spirally helps out without any additional burden. doi: https://doi.org/10.12669/pjms.41.7.12632 How to cite this: Zubairi NA. English Enhancing Exercises: An effective strategy to upgrade and enhance the English proficiency of medical students in non-English speaking countries. Pak J Med Sci. 2025;41(7):2152-2155. doi: https://doi.org/10.12669/pjms.41.7.12632 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A - 38 Structural Prefrontal Changes in the Developing Brain Are Related to Amount of Time Spent Participating in Sports

A - 38 Structural Prefrontal Changes in the Developing Brain Are Related to Amount of Time Spent Participating in Sports

Creativity-related elements of cognition and emotions influenced by videogames

ABSTRACT To date, the impact of various types of videogame stimuli on creativity-related elements of cognition and emotions is unknown. The current research investigated the effects of action and non-action visual videogame stimuli on cognitive load, attentional breadth, and emotional processes. To measure cognitive load, participants responded to a red fixation cross during videogame presentation (RT task). Following the stimuli, the effects on attentional breadth were measured using the Navon letter task and emotional responses were obtained using a self-report scale. Results from the simple RT task showed that viewing the action videogame stimuli were associated with greater cognitive load compared to the no game condition. The Navon task revealed that attentional breadth was similar in the action game and the no-game condition, but that attentional breadth was narrowed in the non-action game condition. The emotional responses after viewing action videogame stimuli were less pleasant than viewing non-action videogame visual stimuli but more arousing than a no game control condition. These findings show that visual stimuli used in action and non-action videogames differentially affect creativity-related elements of cognition and emotions.

Modeling student satisfaction in online learning using random forest

The rapid expansion of online education has intensified the need to investigate the multifactorial determinants of university students’ satisfaction with digital learning platforms. While prior studies have often examined technical or pedagogical components in isolation, limited attention has been paid to their interaction with students’ psychological well-being, particularly through nonlinear mechanisms. To address this gap, this study employs a Random Forest–based framework to model satisfaction using a multidimensional dataset from 782 university students. Measured variables included platform usability, content quality, emotional experience, and self-regulation. Data were standardized via Z-scores, and class imbalance was addressed using the Synthetic Minority Over-sampling Technique (SMOTE). Model performance was evaluated using accuracy, F1-score, and area under the ROC curve (AUC). Results identified platform stability and content update frequency as the most influential predictors, with AUC values exceeding 0.95 across most satisfaction levels. Psychological factors—especially perceived enjoyment and emotional stability—also contributed significantly. Partial dependence plots revealed threshold and saturation effects, highlighting complex nonlinear patterns missed by traditional linear models. However, performance declined in predicting low-satisfaction cases (AUC = 0.70), likely due to subgroup underrepresentation. This study contributes theoretically by integrating cognitive-affective dimensions, methodologically by demonstrating the utility of machine learning in modeling nonlinear interactions, and practically by providing actionable insights for platform optimization. Future research should incorporate additional psychological constructs, such as cognitive load and resilience, and apply the model across more diverse learner populations to enhance generalizability and support inclusive, user-centered digital education.

The Effect of Ambient Artificial Intelligence Scribes on Trainee Documentation Burden.

Ambient artificial intelligence scribes have become widespread commercial products in the era of generative artificial intelligence. While studies have examined the effect of these tools on the experience of attending physicians, little evidence is available regarding their use by resident physician trainees. To assess trainee experience with an ambient artificial intelligence scribe using measures of usability, acceptability, and documentation burden. This prospective observational study enrolled 47 trainees in a 2-month pilot. Pre/post surveys were conducted with the NASA Task Load Index (NASA-TLX, raw unweighted form, pre/post, for cognitive load during the documentation), the System Usability Scale (post, general usability), the Net Promoter Score (post, acceptability), and the AMIA TrendBurden Survey (pre/post, documentation burden). EHR utilization metrics were obtained from Epic Signal for both the pilot period and a 6-month baseline. In total, 43/47 (91.5%) of participants adopted the intervention in practice. NASA-TLX scores improved from 56.3 to 43.3 (p<.001) and multiple items on the TrendBurden survey improved with high measures of acceptability. No significant difference in time spent in notes activity per note written was observed, with a median increase of 0.4 minutes (p=.568). Trainee use of an ambient artificial intelligence scribe was associated with improvements in documentation burden. Additional research on the effect of this technology on trainee learning and expertise development is needed.

Adaptive Explainable AI: Personalizing Machine Explanations Based on User Expertise Levels

Explainable Artificial Intelligence (XAI) is critical for bridging the gap between opaque machine decision-making and human comprehension. Despite advances, most XAI systems deliver static explanations that fail to account for users' diverse expertise levels. This study proposes an adaptive XAI framework that personalizes explanations according to individual user expertise. Grounded in cognitive load theory and trust calibration principles, the system dynamically adjusts explanation complexity, depth, and modality. Through a mixed-methods experimental design involving 150 participants classified as novices, intermediates, and experts, results show that adaptive explanations significantly enhance understanding (+27%), trust calibration (+19%), and decision-making accuracy (+22%) compared to static explanations. The findings provide strong empirical support for user-centered XAI models and offer actionable design guidelines for adaptive explainability in critical sectors such as healthcare, finance, and education.

The relationship between grip strength, 6 minute walking distance and working memory in older adults with mild cognitive impairment: an fNIRS study

ObjectiveFunctional near-infrared spectroscopy (fNIRS) was employed to explore the potential relationship between grip strength, 6-minute walking distance (6MWD), and working memory in older adults with mild cognitive impairment (MCI).MethodsParticipants aged 60 years and above were recruited and assessed using the Montreal Cognitive Assessment (MoCA). Grip strength and 6MWD were measured, and fNIRS was utilized to monitor blood flow changes in the prefrontal lobe during an N-back task.ResultsA total of 72 participants were recruited, aged between 70 and 95 years, with MoCA scores ranging from 10 to 25 points. The MoCA score was most strongly correlated with 1-back performance (r = -0.423, p < 0.001), followed by 0-back performance, and showed no significant correlation with 2-back performance. The activation levels of several channels in the left dorsolateral prefrontal cortex (ch17, ch19, ch23), right dorsolateral prefrontal cortex (ch8), and right ventrolateral prefrontal cortex (ch2) were significantly higher in the high-performance group for 1-back compared to the low-performance group (p = 0.016, p = 0.008, p = 0.013; p = 0.018; p = 0.043). Grip strength and 6MWD were both significantly correlated with working memory performance under all three levels of cognitive load, with the strongest correlation observed for 1-back performance (grip strength: r = -0.377, p = 0.001; 6MWD: r = -0.382, p = 0.001). Grip strength was positively correlated with the activation levels of ch17 and ch19 (r = 0.234, p = 0.048; r = 0.249, p = 0.035), and significant inter-group differences were found for the activation level of ch19 (p = 0.032). Similarly, 6MWD was positively correlated with the activation levels of ch17 and ch2 (r = 0.312, p = 0.008; r = 0.256, p = 0.030), with significant inter-group differences observed in the activation levels of ch17, ch19, and ch2 (p = 0.007; p = 0.022; p = 0.029).ConclusionCognitive decline in older adults with MCI was associated with a decline in working memory, with 1-back performance being the most sensitive measure. The brain mechanisms underlying this sensitivity involved higher activation levels in the left dorsolateral prefrontal cortex, right dorsolateral prefrontal cortex, and right ventrolateral prefrontal cortex. Older adults with stronger muscle strength and better cardiopulmonary function maintained better working memory, with higher activation levels in the left dorsolateral prefrontal cortex. However, the specific activation channels were not entirely consistent across individuals.Clinical trial numberNot applicable.

The effects of physical exercise on the time management of college students: a chain mediation effect test

In an era of increasing academic pressures and digital distractions, time management has become an important competency for college students, with significant implications for their academic performance, psychological wellbeing, and lifelong success. Drawing on the frameworks of social cognitive theory and neurobehavioral science, the present study aimed to investigate the effects of physical activity on college students’ time management ability and its psychotransmission mechanisms, with a particular focus on the interlocking mediating roles of sensation-seeking and self-efficacy. A questionnaire was administered to 714 Chinese university students (mean age 20.3 ± 1.8 years), and the data were analyzed using structural equation modeling (SEM, a statistical method for analyzing complex relationships among variables) and the Bootstrap method (a re-sampling technique for assessing statistical significance). The results indicated that (1) physical activity had a significant and strong positive predictive effect on college students’ time management ability (β = 0.416, p &amp;lt; 0.001); (2) sensation seeking (effect size = 0.067) and self-efficacy (effect size = 0.065) each played a moderately independent mediator role; and (3) the chained mediation paths formed by the two (effect size = 0. 017) further explained 3.31% of the variance, suggesting that physical activity indirectly optimized time management through the sequential path of “stimulus-driven behavioral choice → reinforcing efficacy beliefs → optimizing goal execution.” In addition, it was found that the degree of exercise structuring (e.g., a team training program) significantly enhanced the cascade effect (β = 0.15, p &amp;lt; 0.05), whereas high-intensity interval training (HIIT) may weaken the transfer efficiency due to short-term cognitive load. The findings contribute to the construction of an integrated “behavioral-psychological-behavioral” model that reveals the complex mechanisms by which physical activity affects time management, and practically suggests that colleges and universities should design a collaborative program of “structured physical education curriculum + cognitive training” to systematically improve students’ time management ability and academic efficacy.

How Self-Involvement affects miners’ safety risk Decision-Making: an ERP study

Unsafe decision-making in coal mining can endanger not only the individual making the decision but also their colleagues and the overall safety of the mine. While prior studies have mainly examined decisions in self-involved safety risk scenarios, the impact of non-self-involved scenarios, where the risk affects others, remains underexplored.This study combines questionnaire surveys with an event-related potential (ERP) experiment to investigate how miners with varying levels of unsafe psychology make decisions in self–involved and non-self-involved safety risk scenarios.Behavioral findings indicate that both low and high unsafe psychology groups are more prone to unsafe decisions in non-self-involved scenarios, suggesting that self-involvement significantly influences decision-making. ERP results revealed that safety risk tasks elicited significant P300 and LPC components, with greater amplitudes observed in self-involved scenarios, reflecting higher attentional engagement. Furthermore, miners with low unsafe psychology showed larger P300 amplitudes and shorter latencies in self-involved scenarios, likely due to deeper cognitive processing and similar cognitive load. In non-self-involved scenarios, latency differences between groups were not significant, possibly due to stronger negative emotional responses among low unsafe psychology individuals.This study underscores the role of self-involvement in safety risk decision-making and provides new neurophysiological evidence (P300, LPC) to better understand the cognitive and emotional processes influencing mining safety behavior.

Educational multimedia design principles affect local and global information processing in functional brain networks

Educational multimedia has become increasingly important in modern learning environments because of its cost-effectiveness and its ability to overcome the temporal and spatial constraints of traditional methods. However, the complex cognitive processes involved in multimedia learning present challenges for understanding its neural mechanisms. This study employs network neuroscience to investigate how multimedia design principles influence the underlying neural mechanisms by examining interactions among various brain regions. Two distinct multimedia programs were constructed using identical auditory content but differing visual designs: one adhered to five guidelines for optimizing multimedia instruction, referred to as principal multimedia, while the other intentionally violated these guidelines, referred to as non-principal multimedia. Cortical functional brain networks were then extracted from EEG data to evaluate local and global information processing across the two conditions. Network measurements revealed that principal networks exhibited more efficient local information processing, whereas non-principal networks demonstrated enhanced global information processing and hub formation. Network modularity analysis also indicated two distinct modular organizations, with modules in non-principal networks displaying higher integration and lower segregation than those in principal networks, aligning with initial findings. These findings suggest that the brain may employ compensatory mechanisms to support learning and manage cognitive load despite less effective instructional designs.

Virtual Assistants and AI Chat bots for Home Management and Family Organization

In the digital age, the integration of artificial intelligence (AI) into daily life has become increasingly prevalent, particularly through virtual assistants and AI chatbots. These intelligent systems are now playing a pivotal role in home management and family organization, transforming the way households operate. This research paper explores the impact, applications, and implications of AI-powered virtual assistants and chatbots in managing home tasks, improving communication, and enhancing overall family coordination.The study investigates how AI tools such as Amazon Alexa, Google Assistant, and customized chatbots streamline routine activities such as scheduling, grocery management, reminders, and household automation. Furthermore, it delves into how these technologies foster better time management, task delegation, and reduce cognitive load among family members. By leveraging natural language processing, machine learning, and smart home integrations, these tools offer personalized and context-aware assistance that adapts to the evolving needs of modern families. Keywords : Virtual Assistants, AI Chatbots ,Home Management ,Family Organization ,Smart Home Technology, Artificial Intelligence

Turkish validity and reliability study of the simulation self-report cognitive load measurement tool 2.0

BackgroundDuring simulations, a student’s effort to perform the multiple tasks expected of them and the emotional burden arising from the nature of the simulation can create an excessive cognitive load for the student, negatively affecting learning results. Understanding and managing this cognitive load is crucial because it affects how well students can process information and achieve learning objectives.ObjectiveThe aim of this study was to collect evidence of the validity and reliability of the use of the Turkish-adapted Simulation Self-Report Cognitive Load Measurement Tool 2.0, which measures three aspects of cognitive load in nursing students during simulation-based experiences.Design and methodsThis was a cross-sectional methodological study of instrument translation and validation. The sample of the study consisted of 101 students in the second year of a nursing undergraduate program at a foundation university. The Turkish-adapted version of the tool was used for data collection. It measures intrinsic cognitive load (five items), extraneous cognitive load (five items), germane cognitive load (five items), and overall cognitive load (one item). Language validity was ascertained via ISPOR’s ten-step translation and cultural adaptation guide. Expert opinion was obtained for content validity, and a confirmatory factor analysis for construct validity was performed. Cronbach’s alpha coefficient, the split-half method, and item analysis were used to assess the reliability of the tool, and Pearson correlation analysis was used to evaluate relationships between items. Significance was accepted at p < 0.05.ResultsThe tool measures a three-factor structure—intrinsic load, extraneous load, and germane load—and consists of 16 items. In the confirmatory factor analysis, all the factor loadings were greater than 0.30. The fit indices for the model were calculated as χ2/df = 1.423, with a root mean square error of approximation of 0.0643; the comparative fit index was 0.950; and the standardized root mean square residual was 0.084. The Cronbach’s alpha for the tool was 0.822.ConclusionThe analysis provided evidence supporting the validity and reliability of the Turkish-adapted version of the tool for use with a Turkish sample. The use of this tool can aid in developing and enhancing strategies to achieve learning objectives in the design and implementation of clinical simulations.Clinical trial numberNot applicable.

Impact of motor error processing on performance on a working memory task: effect of modulating cognitive load in high and low span groups.

Impact of motor error processing on performance on a working memory task: effect of modulating cognitive load in high and low span groups.

The modulation of cognitive load on speech normalization: A neurophysiological perspective.

The modulation of cognitive load on speech normalization: A neurophysiological perspective.

Entrustable Professional Activities for Musculoskeletal Ultrasound Training in a Canadian Rheumatology Residency Program: A Pilot Study

ObjectivesPoint-of-care musculoskeletal ultrasound (MSUS) training is increasingly being implemented in the rheumatology training programs. However, a validated framework to reliably assess MSUS competency is needed. Recommendations for MSUS education in Canadian rheumatology residency programs were recently established by a national expert consensus panel.[1] Our study aimed to develop, evaluate, and implement MSUS Entrustable Professional Activities (EPAs) within the Adult Rheumatology residency program at the University of Toronto.MethodsMSUS EPAs were developed by an expert MSUS panel of rheumatologists to define the progress in MSUS skill competency level on a 5-point entrustability scale indicating the resident’s level of independence. The EQual rubric was employed to appraise the quality of the EPAs through soliciting input from 5 clinical educators with substantial expertise in MSUS.[2] Data aggregation was performed to determine if the quality of the EPAs met satisfactory standards. Post-Graduate Year (PGY) 4 and 5 rheumatology residents enrolled in a two-year longitudinal MSUS curriculum at the University of Toronto participated in this study during 2023-2024. As part of the curriculum, they received fundamental MSUS teaching and participated in bimonthly hands-on MSUS clinic where they had EPAs completed. The residents self-reported their cognitive load level following completion of the EPA task using the NASA Task Load Index.ResultsFive EPAs were developed by a panel of 6 expert rheumatology ultrasonographers for 5 joint regions including the finger, wrist, knee, ankle and foot. Pooled data from EQual rubric ranged between 4.2-4.3 for all EPAs, passing the satisfaction cutoff (4.07). Eighteen EPAs were completed by 3 PGY4/5 rheumatology residents enrolled in the longitudinal MSUS curriculum. Of all EPAs, 83% were entrustable (score of &gt; 3/5). The wrist joint was the most difficult to entrust (40% entrustable). All the MSUS tasks were rated by the residents to be associated with high level of cognitive load (55%, N = 5) or somewhat high (45%, N = 4).ConclusionThe quality of the 5 EPAs developed was deemed satisfactory, indicating their educational effectiveness. The implementation of MSUS EPAs offers a viable approach for assessing MSUS competencies in rheumatology residents receiving MSUS training. Innovative educational strategies are needed to reduce the cognitive load associated with trainees performing the MSUS tasks. [1.] Powell M. Arthritis Rheumatol 2023;75 (suppl 9). [2.] Taylor D. Academic Medicine 2017;92:S110-7.

Is control necessary for drivers? Exploring the influence of human-machine collaboration modes on driving behavior and subjective perception under different hazard visibility scenarios.

Is control necessary for drivers? Exploring the influence of human-machine collaboration modes on driving behavior and subjective perception under different hazard visibility scenarios.

Design and evaluation of a surgical boot camp: a step-by-step guide to curriculum development and impact assessment

BackgroundThe transition from medical school to surgical residency often leaves students underprepared for essential technical procedures, impacting their confidence and patient safety. Surgical boot camps can help address this skill gap, but few articles have described exactly how to organize a boot camp. We aimed to precisely describe the simulation stations and evaluate the effectiveness of the boot camp.MethodsWe conducted a prospective, monocentric, observational study at the University Hospital of Clermont-Ferrand (France) over a 3-year period, assessing technical skills and cognitive workload before and after boot camp using a validated questionnaire. We included sixty-five medical students (34 female, 31 male) who had been accepted into a general surgery residency program were included. We described precisely the 9 simulation stations.ResultsAfter the boot camp, participants reported increased confidence in basic surgical skills, with significant improvements in technical performance. Satisfaction scores were high, averaging 8.8 out of 10 for women and 9.0 for men. Segmenting the boot camp into multiple workshops made it easy to organize.ConclusionThis surgical boot camp significantly reduced the perceived cognitive workload and improved the confidence of incoming residents, addressing key challenges in pre-residency preparation. By providing a detailed description of our simulation workshops, we aim to facilitate the implementation of similar programs in other institutions.

Identifying smart technology and artificial intelligence solutions for human factors and ergonomic challenges in all-hazard response: A survey study.

Identifying smart technology and artificial intelligence solutions for human factors and ergonomic challenges in all-hazard response: A survey study.

The influence of interface attributes and interaction elements on user performance and cognitive load in task interruption scenarios

The influence of interface attributes and interaction elements on user performance and cognitive load in task interruption scenarios

Infographics as a communication tool in pharmacy and pharmaceutical sciences.

Infographics as a communication tool in pharmacy and pharmaceutical sciences.