Intrinsic Load Research Articles

An Investigative Study on the Effects of Pedagogical Agents on Intrinsic, Extraneous and Germane Cognitive Load: Experimental Findings With Dyscalculia and Non-Dyscalculia Learners

Several studies have warranted the need to explore the relationship between pedagogical agents in the learning environment and the cognitive load on the learners, specifically, to study the influence on learner populations with different learning and motivation needs. The present work investigates the effects of the presence of a pedagogical agent in the learning environment on intrinsic, extraneous, and germane cognitive load for the dyscalculia and non- learner population. The proposed system intelligently investigates the learner, recommends an exclusive learning dyscalculia path and after tutoring assesses learning gain, and retention. Learner experience and effects of the pedagogical agent on types of cognitive loads are discussed on basis of post tutoring analysis. Samples of 82 learners have been studied, experimental findings based on research questions have been reported and conclusions discussed. Our assumption that ‘a well-articulated and well-designed instructional design exerts a minimal extraneous cognitive load on learners and facilitates learning gain and retention’ is consistent with the obtained results. The result concludes that pedagogical agent does not add to intrinsic and extraneous cognitive load. An improved Germane Cognitive load and a good amount of knowledge retention are noticed post learning.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Virtual Learning in Graduate Medical Education: Applying Learning Theory for Effective Educational Videos.

Virtual Learning in Graduate Medical Education: Applying Learning Theory for Effective Educational Videos.

Teaching the technical performance of bronchoscopy to residents in a step-wise simulated approach: factors supporting learning and impacts on clinical work \u2013 a qualitative analysis

BackgroundThe ability to perform a bronchoscopy is a valuable clinical skill for many medical specialities. Learning this skill is demanding for residents, due to the high cognitive load. Lessons learned from cognitive load theory might provide a way to facilitate this learning. The aim of this study was to investigate residents’ perception of factors that support and hinder learning, as well as outcome and acceptance of a workshop on flexible bronchoscopy.MethodsThree half-day workshops were designed to teach 12 residents the basics of handling a flexible bronchoscope. They consisted of four phases that alternated between short theoretical aspects and longer practical situations. The practical phases focussed initially on manoeuvring a bronchoscope through holes in panels inside a box, and then on examination and practice using a three-dimensional printed model of the bronchial tree. Afterwards, three audio- and video-recorded focus groups were conducted, transcribed and coded, and underwent reflexive thematic analysis.ResultsAnalysis of the focus groups defined two themes: (1) factors that supported a safe and positive learning environment were optimised for intrinsic load, simulated setting, absence of pressure, dyad practice (working in pairs), small group sizes and playful learning; and (2) impacts on clinical work were perceived as high levels of learning and improved patient safety. The residents did not report factors that hindered their learning. Some suggestions were made to improve the set-up of the wooden box.ConclusionsThe half-day workshop was designed according to several factors, including cognitive load theory in a simulated setting, and creation of a safe and positive learning environment. The residents perceived this as supporting learning and patient safety. Further studies can be designed to confirm these results in a quantitative setting.Trial registrationThis study was not interventional, therefore was not registered.

A GIS-based analysis of intrinsic vulnerability, pollution load, and function value for the assessment of groundwater pollution and health risk

Groundwater pollution risk assessment is an effective tool for the control and prevention of groundwater pollution. However, the risk is generally difficult to interpret because it is affected by both natural and anthropic factors such as topography, aquifer characteristics, land-use changes, and mining process. In this study, a GIS-based analysis of aquifer vulnerability (V), groundwater pollution load (L), and groundwater function value (F) were combined to comprehensively evaluate the groundwater pollution risk in a typical mixed land use area of Chengdu Plain, in China. Groundwater pollution risk assessment was then validated by a groundwater quality evaluation using the comprehensive water quality index method. A health risk assessment was conducted to evaluate the susceptible population exposed to the groundwater pollution. The results showed that the estimated ‘high’ and ‘very high’ pollution risk areas together accounted for 24.85% of the study area, mainly located in the southeast and southwest of the plain area with highly permeable aquifer, abundant amounts of groundwater storage, a shallow water table, and near pollution sources. In addition, our results revealed that 14% of groundwater in the study area posed an unacceptable non-carcinogenic health risk to children. The risk assessment of groundwater pollution and human health in the study area can provide effective support for strengthening groundwater management and pollution control.

Targeted False Data Injection Attacks Against AC State Estimation Without Network Parameters

State estimation is a data processing algorithm for converting redundant meter measurements and other information into an estimate of the state of a power system. Relying heavily on meter measurements, state estimation has proven to be vulnerable to cyber attacks. In this paper, a novel targeted false data injection attack (FDIA) model against AC state estimation is proposed. Leveraging on the intrinsic load dynamics in ambient conditions and important properties of the Ornstein-Uhlenbeck process, we, from the viewpoint of intruders, design an algorithm to extract power network parameters purely from PMU data, which are further used to construct the FDIA vector. Requiring no network parameters and relying only on limited phasor measurement unit (PMU) data, the proposed FDIA model can target specific states and launch large deviation attacks. Sufficient conditions for the proposed FDIA model are also developed. Various attack vectors and attacking regions are studied in the IEEE 39-bus system, showing that the proposed FDIA method can successfully bypass the bad data detection and launch targeted large deviation attacks with very high probabilities.

Influence of Emotion on Cognitive Load Experienced by Trainees While Performing Patient Handoffs.

Introduction: Patient handoffs remain a significant patient safety challenge. Researchers have used cognitive load theory (CLT) to unpack the complexity of health professions workplace learning tasks including handoffs. 1 When the cognitive load of a handoff exceeds the working memory capacity of the trainee, learning and performance suffer. CLT focuses on the development of instructional strategies that match intrinsic load (IL) to the developmental stage of the learner, decrease extraneous load (EL), and optimize germane load (GL). CLT strategies have traditionally focused on modifying the complexity of the task, the knowledge of the learner, and/or the design of the instruction. CLT researchers have given little attention to how the learner’s emotions influence cognitive load. 2 Yet, we know that emotion modulates learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. 3 To address this gap, this study explores how emotion influenced the IL, EL, and GL imposed upon the working memory of trainees performing patient handoffs. Methods: From January to March 2019, we administered a cross-sectional survey to 1,807 residents and fellows from a large 24-hospital health system in the United States. Participants completed the survey after performing a handoff. The survey included questions about features of the learner, task, and instructional environment. IL, EL, and GL were measured with the 16-item Cognitive Load Inventory for Handoffs. 4 Emotions were assessed with an 8-item scale based on the circumplex model of affect. 5 The authors used factor analysis to identify the core dimensions of emotion and then explored the relationship between emotion and cognitive load with 3 types of analyses. First, bivariate correlational analyses examined the relationship between the emotion factors and learner, task, and environment features known to predict cognitive load. Second, we conducted univariate regression analyses to investigate whether emotion factor scores predicted IL, EL, and GL. Third, multivariate regression determined whether the addition of the emotion factors to models including these previously established predictors of cognitive load types increased the variance explained (Δ R2). Results: Six hundred and ninety-three (38.7%) of 1,807 residents and fellows completed a survey. Exploratory and confirmatory factor analysis identified 2 dimensions of emotion representing positive activation (labeled invigoration) and positive deactivation (labeled tranquility). The correlational analyses revealed that higher invigoration was associated with higher levels of training and use of a standardized verbal protocol, while lower levels of invigoration were associated with interruptions, difficulty obtaining essential information, and fatigue. Higher tranquility was associated with higher levels of training and lower levels of tranquility with interruptions, difficulty obtaining information, fatigue, longer handoffs, and greater number of patients. In univariate regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. Finally, in the multivariate models of predictors for each type of cognitive load, the addition of the emotion term increased the amount of variance explained from 0.10 to 0.16 for IL, 0.15 to 0.27 for EL, and 0.11 to 0.14 for GL. Discussion: Emotion significantly influenced the cognitive load experienced by trainees while performing in vivo handoffs. Like studies in the simulation context, the structure of emotion during patient handoffs consisted of 2 factors. Higher invigoration/tranquility predicted lower IL, El, and GL. Traditionally, CLT researchers assumed that emotion primarily affected EL. Our results suggest a much broader impact of emotion. Significance: The study models how emotion and cognitive load can be measured during a workplace learning activity. These results suggest that enhancing invigoration and tranquility will reduce cognitive load and improve learning and performance. This highlights the importance of developing instructional strategies that help trainees regulate their emotions.

The Cognitive Load of Inpatient Consults: A Convergent Parallel Mixed Methods Study Using the Consult Cognitive Load Instrument.

Consultation is crucial for patient 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 inpatient consults specifically, align these themes with Consult Cognitive Load (CCL) scores, and identify strategies to manage cognitive load to enhance fellow education and performance, and, consequently, patient care. The authors studied 16 fellows using mixed methods. Fellows who accepted an invitation completed an inpatient 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 supported theme trustworthiness. Subsequently, 3 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. Analysis revealed 4 themes: "nature and scope," which conceptually aligned with intrinsic load (IL); "leveraging resources," which had elements of both IL and extraneous load (EL); "extraneous factors," which aligned with EL; and "drivers," which aligned with germane 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. This study provided deep insight into the fellow consult experience and suggested strategies for educators to guide consult learning. The theme "leveraging resources" merits further exploration.

COVID-19 Disruptions in Health Professional Education: Use of Cognitive Load Theory on Students' Comprehension, Cognitive Load, Engagement, and Motivation.

This study explored the impact of online lectures that were developed using principles of cognitive load theory (CLT) and cognitive theory of multimedia learning (CTML) on health profession students' lecture comprehension, cognitive load, cognitive engagement, and intrinsic motivation in learning. A total of 215 first-year undergraduate students in medical, dentistry, and nutrition programs participated in this pre-post quasi experimental study. The students attended a typical face-to-face lecture on Day-1 of the intervention, followed by a CLT-based online lecture 8 weeks thereafter. Their comprehension of the lecture topics was measured through pre- and post-lecture assessments, and their cognitive load, cognitive engagement, and motivation were measured immediately after each lecture session. The analysis revealed that the CLT-based online lectures promoted the students' comprehension of the lecture content (p < 0.001), self-perceived learning (p < 0.001), engagement toward the learning material, and motivation to learn (p = 0.025). It was also effective at reducing the students' intrinsic and extraneous cognitive loads (p < 0.001). Hence, designing online lectures using CLT and CTML principles could be an effective method to promote students' knowledge and comprehension, cognitive engagement, and learning motivation. However, further research is needed to investigate the applicability and impact of CLT-based online lectures in non-health profession disciplines.

Pilot Evaluation of Pharmacists’ and Pharmacy Technicians’ Knowledge and Understanding of a Medication Synchronization Program

Background: Medication synchronization (MS) improves adherence by allowing patients to pick up all medications at the same time. Pharmacy staff need training to utilize a MS program effectively. Objective: Evaluate the impact of a video tutorial with decreased extraneous and intrinsic load on pharmacists’ and pharmacy technicians’ knowledge and understanding of a MS program. Study Method: Participants completed a prequestionnaire to assess knowledge and understanding of the MS process. They then watched a step-by-step video tutorial and were reassessed by a postquestionnaire 2 weeks later. Study participants included pharmacists and pharmacy technicians employed at 1 of 2 pharmacies in 1 regional division of a large community-based chain pharmacy. Participants were eligible if they were registered and in good standing with the Kansas Board of Pharmacy and employed for greater than 30 days since July 1, 2018. Results: Twenty participants were included in the final analysis. The median age was 36 years, 14 (70%) were female, 13 (65%) were pharmacy technicians, and each study site had equal representation. Most participants, 15 (75%), had previously completed the standard MS training. There was a significant improvement in number of correct responses after the intervention with a prequestionnaire score of 61.3% to postquestionnaire score of 70% (P=.002). Significant improvement in knowledge was seen in participants who completed the previous training as well as first-time learners of the MS process. Conclusion: Optimizing training on MS processes by decreasing extraneous and intrinsic load improved the pharmacy team’s knowledge and understanding of the MS process.

A growth mindset lowers perceived cognitive load and improves learning: Integrating motivation to cognitive load.

Many large-scale, school-based interventions have attempted to improve academic performance through promoting students’ growth mindset, defined as the belief that one’s intellectual ability can increase with practice and time. However, most have shown weak to no effects. Thus, it is important to examine how growth mindset might affect retention and transfer of learning, as well as process-related variables such as cognitive load. In a double-blind, randomized controlled experiment based on 138 secondary school students, the effects of an experimentally induced growth mindset belief were examined during a learning phase in a classroom setting. Participants in the growth mindset condition perceived a lower intrinsic load and extraneous load and performed better on retention and transfer tests. Students with some prior knowledge also reported a higher mastery goal orientation. Supplementary mediation analysis suggested that the effect on transfer could be fully accounted for by changes in cognitive load perceptions. Future interventions may benefit from designs that promote motivational beliefs that reduce intrinsic and extraneous cognitive load perceptions. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Brief Research Report: Psychometric Properties of a Cognitive Load Measure When Assessing the Load Associated With a Course

The cognitive load imposed by instruction is an important consideration for instructional designers. Theoretical models have traditionally divided total cognitive load into intrinsic, extrinsic, and germane load. The 10-item Cognitive Load Inventory (CLI-10) is designed to measure these three types of cognitive load. It is typically administered immediately following a discrete learning activity (e.g., a lecture). This study assesses the properties of the CLI-10 when used to measure the “long-term” cognitive load experienced in a course, over a semester. To do this, the instrument was given to a group of students enrolled in a veterinary anatomy course (N = 94), toward the end of a 13-week semester. Students were asked to indicate the cognitive load they experienced across this course. Confirmatory factor analysis supported the instrument’s three-factor structure when used in this way. Further, the instrument’s three subscales performed well in terms of internal reliability and convergent and discriminant validity.

The use of Talking Toys in reducing the cognitive loads of elementary school students in science learning

This research aimed to reduce the intrinsic cognitive load of student in learning science subject by implementing Talking Toys media. The research conducted in one of the elementary school in Garut by using post-test only control group design. 60 student of class X become the sample of the research that divided into two Classes namely experimental and control class. Students intrinsic load was measured from students capacity in processing information. Data was obtained through essay test which compiled in the form of task complexity worksheet. Students learning result was measured by written test of their reasoning ability. The result shows that students who got treatment by talking toys media has higher ability in processing information compare to students who did not receive it. Research result illustrate that elementary school students intrinsic load while learning science subject in experimental class is lower than in control class. The low level of students intrinsic load has correlation with the high level of students learning result.

Cognitive Load Theory and the English Language Instruction

Working memory is used to process information of our mental representations and new knowledge. In learning English language, students are faced with various kinds of material and instruction that relate to the development of their knowledge and skills. However, extraneous information may overload their cognitive load and inhibit their knowledge and performances. Therefore, the theory of cognitive load effects provides a solution towards the overloading of cognitive capacity by introducing cognitive load effects. Cognitive load theory itself deals with the instructional design methods that use the limited cognitive capacity of learners. There are three sources or types of cognitive load: the intrinsic load, extraneous load, and germane load. By analyzing an English textbook for class VIII secondary level in Indonesia designed by the Ministry of Education and Culture for distance learning in the Covid-19 pandemic era, this paper points out several cognitive load principles that create a better schema construction and automation that contribute to the decreased cognitive load.

Exploring the relationship between emotion and cognitive load types during patient handovers.

Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.

Three Weeks of Team-Based Leaning Do Not Overload Undergraduate Students.

Team-based learning (TBL) is a flipped-classroom approach requiring students to study before class. Fully flipped curricula usually have fewer in-class hours. However, for practical reasons, several programs implement a few weeks of TBL without adjusting the semester timetable. Students fear that they will be overloaded by the individual and collaborative study hours needed to prepare for TBL. We implemented three consecutive weeks of TBL in a 15-week lecture-based course on the renal system. In-class time and assessments were unchanged for all courses. Four hundred fifty-nine first-year undergraduate medical students (229 in 2018; 230 in 2019) were invited to complete weekly logs of their individual and collaborative study hours during lectures and TBL, along with questionnaires on cognitive load and perception of the course. Our program changed from A to E grading in 2018 to pass-fail grading in 2019. Participants (n = 324) spent a similar number of hours studying for TBL vs. lectures with a mean of 3.1h/week. Collaborative study was minimal outside class (median 0.1h/week). Results remained similar with pass-fail grading. If in-class time were reduced, 18% of participants said they would have used freed-up time to study for TBL. Studying for TBL generated similar extraneous cognitive load and lower intrinsic load compared to studying for lectures; students were less stressed, and maintained high levels of motivation and self-perceived learning. Three weeks of lectures were replaced by TBL without reducing in-class time. Students did not report overload in study hours or in cognitive load. The online version contains supplementary material available at 10.1007/s40670-021-01314-x.

Subjective Measure of Cognitive Load Depends on Participants’ Content Knowledge Level

Cognitive load theory (CLT) posits the classic view that cognitive load (CL) has three-components: intrinsic, extraneous and germane. Prior research has shown that subjective ratings are valid measures of different CL subtypes. To a lesser degree, how the validity of these subjective ratings depends on learner characteristics has not been studied. In this research, we explored the extent to which the validity of a specific set of subjective measures depends upon learners’ prior knowledge. Specifically, we developed an eight-item survey to measure the three aforementioned subtypes of CL perceived by participants in a testing environment. In the first experiment (N = 45) participants categorized the eight items into different groups based on similarity of themes. Most of the participants sorted the items consistent with a threefold construct of the CLT. Interviews with a subgroup (N = 13) of participants provided verbal evidence corroborating their understanding of the items that was consistent with the classic view of the CLT. In the second experiment (N = 139) participants completed the survey twice after taking a conceptual test in a pre/post setting. A principal component analysis (PCA) revealed a two-component structure for the survey when the content knowledge level of the participants was initially lower, but a three-component structure when the content knowledge of the participants was improved to a higher level. The results seem to suggest that low prior knowledge participants failed to differentiate the items targeting the intrinsic load from those measuring the extraneous load. In the third experiment (N = 40) participants completed the CL survey after taking a test consisting of problems imposing different levels of intrinsic and extraneous load. The results reveals that how participants rated on the CL survey was consistent with how each CL subtype was manipulated. Thus, the CL survey developed is decently effective measuring different types of CL. We suggest instructors to use this instrument after participants have established certain level of relevant knowledge.

The effects of a virtual simulation-based, mobile technology application on nursing students’ learning achievement and cognitive load: Randomized controlled trial

BackgroundThe use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences. ObjectiveThe study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group. DesignA randomized experimental study with pretest and posttest design. Settings and participantsOne hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing. MethodsThe experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention. ResultsThe experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group. ConclusionsThe implementation of a mobile app for simulation learning had a positive impact on nursing students’ knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education.Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load.

Effects of teaching a computer programming language via hybrid interface on anxiety, cognitive load level and achievement of high school students

In this study, based on quasi-experimental research, was investigated the effects of teaching Python programming language via Blockly tool, which had hybrid interface, on students’ computer programming anxiety, cognitive load level, and achievement. Participants were 90 high school students, 44 of them in experimental group (hybrid interface) and 46 of them in control group (non-hybrid interface). According to results, there was a meaningful difference between programming achievement scores of students in favor of experimental group while there was no difference in terms of computer programming anxiety between groups. Moreover, after 10-week implementation process, students’ anxiety increased in each group. It was found out cognitive load levels of both groups in the first week were higher than final week. Although both weekly and 10-week intrinsic, extraneous, germane, and total cognitive load levels of experimental group were lower than control group, there was no significantly difference between groups. Consequently, it can be said that programming via hybrid interface, using Blockly, has not an effect on students’ computer programming anxiety positively whereas it helps to keep cognitive load at low level and to increase students’ programming success more. It is recommended that considering these results to make computer programming education is more efficient in high schools and administrators encourage the teachers to use programming tool had hybrid interface such as Blockly.

Cognitive load theory in simulations to facilitate critical thinking in radiography students

Background. Problem solving and critical thinking are top future skills. High-fidelity simulations improve critical thinking, but also increase students’ cognitive load, possibly limiting their learning. Educators should therefore consider learning outcomes, problems that require critical thinking, the relationship between working and long-term memory, and intrinsic and extraneous cognitive loads when developing simulation scenarios. Objective. To report on the application of cognitive load theory (CLT) and students’ responses in terms of problem solving and new insights during and after a simulation experience. Methods. A high-fidelity simulation, targeting multilevel communication, teamwork and prioritisation of learning outcomes, was designed according to CLT. Eighty students participated in presimulation knowledge, skills and attitudes acquisition and 10 participated in the simulation. A qualitative descriptive design was followed and data were collected through video/audio recordings of the simulation and reflection session, supported by educator and critical observer notes. Qualitative content analysis allowed comprehensive summarisation of students’ problem-solving abilities and emerging new insights. Results. Eighty second-year radiography students formed the target population, with 10 simulation participants comprising the sample. Communication with health professionals was good, but lacking towards patients. Intraprofessional team collaboration was suboptimal, but interprofessional team collaboration was good. Students were mostly unfamiliar with the prioritisation responsibility. Upon reflection, students came to new insights regarding teamwork and prioritisation. Conclusion. After application of CLT, critical thinking to facilitate problem solving during simulation was suggested and post-simulation reflection facilitated new insights. The exposure of large groups to the benefits of simulation validates further investigation.