Subjective Cognitive Load Research Articles

Three-dimensional (3D) stimuli are always better than two-dimensional (2D) multi-tasking? A high cognitive load in 3D-MATB-II

ObjectiveThe objective of this study is to investigate the whether multi-tasking performance in (three-dimensional) 3D aid or impede cognition compare to (two-dimensional) 2D environments, as reflected by cognitive load. Specifically, we aim to examine the mechanism of multi-tasking under 3D (virtual reality [VR]) and 2D (PC monitor) conditions using the widely used Multi-Attribute Task Battery (MATB) II paradigm. MethodologyThe MATB-II sub-tasks, namely “Tracking” and “System Monitoring,” were conducted with varying task demands in both 3D conditions (Tracking Far - System Monitoring Near [TF-SN], Tracking Near - System Monitoring Far [TN-SF]) and a 2D condition with no depth perception (No Depth [ND]). Participants' cognitive load was assessed using subjective reporting (NASA-TLX) and physiological measure (root mean square of successive difference (RMSSD) of heart rate variability (HRV)). ResultsThe study found that performance was significantly better in the ND condition compared to the TF-SN and TN-SF conditions. Furthermore, higher NASA-TLX scores and lower RMSSD values were observed in the TF-SN and TN-SN conditions compared to the ND condition, providing additional support for the overall findings of the MATB-II paradigm. ConclusionThese findings suggest that processing multiple tasks in different depth planes may lead to poorer performance and increased subjective and physiological cognitive load.

No Evidence for a Negative Effect of Realism When Learning About a Process Despite an Increase in Cognitive Load

ABSTRACTRealistic visualizations have been found to enhance the learning of object shapes, but regarding the learning of processes, the effects of realism are largely unclear. Previous findings indicate that realism can induce a higher level of extraneous cognitive load compared with schematics and that details are attention‐consuming. The present experiment was conducted to assess the effects of realism on learning about a process with combinations of texts and pictures. It was hypothesized that realism would be a hindrance in engaging with texts due to the potential for distraction exerted by details. Students either learned with a schematic or a realistic version of a life‐cycle diagram accompanied by texts. Realism increased participants' extraneous cognitive load, while there were no significant differences regarding retention performance. The results confirm previous results that realism can increase subjective extraneous cognitive load, but highlight that realism may not prevent learners from understanding textual information.

The Effects of Peer Competition-Induced Anxiety on Massive Open Online Course Learning: The Mediating Role of the Behavioral Inhibition System.

With the increased emphasis on competition in academic settings, anxiety is becoming more common, which inevitably has some impact on students' learning processes and results. This study aimed to explore how competition-induced anxiety influences students' subjective cognitive load (SCL), attention levels, and test scores. We also investigated the mediating role of the behavioral inhibition system/behavioral activation system (BIS/BAS) in those factors. A total of 101 college students were recruited in Study 1 to learn from five micro-lectures from massive open online courses (MOOCs) under competitive and non-competitive conditions. The results showed that participants' state anxiety (SA) scores were higher after the experiment, participants under the competition condition had higher test scores, and the relationship between SA/ trait anxiety (TA) and SCL could be mediated by the BIS. To obtain more objective data on learning processes (attention levels), we conducted Study 2, which collected behavioral and EEG data from 42 college students during the online learning. The results showed that the competition group had higher SA, lower attention levels, and worse test scores, and the relationship between SA/TA and attention levels could be mediated through the BIS. The present study not only expands previous research by finding that BIS functioning plays an important role in the effects of anxiety on cognitive load and attention but also offers implications for using competitive strategies to motivate students according to their aptitudes.

Safety evaluation and prediction of takeover performance in automated driving considering drivers’ cognitive load: A driving simulator study

Automated vehicles alleviate the need for driver attention and control. However, a takeover request (TOR) to the driver remains essential for emergencies and safety–critical scenarios beyond automation's capability. Thus, accessing drivers’ safety performance in various TOR scenarios is crucial for conditionally automated driving (SAE L3). However, TOR safety performance is seldom examined concerning drivers' cognitive load, despite its presumed relevance to TOR scenarios and human–machine interaction. Moreover, the adequacy of the time window preceding a TOR, critical for TOR safety prediction, remains inadequately explored. This study aims to assess safety performance across diverse TOR scenarios in Level 3 conditional automation, incorporating drivers’ cognitive load, and predict TOR safety by considering the time window's impact. A driving simulator experiment gathered eye movement and driving behavior data from 37 recruited participants. Participants were instructed to take control of the vehicle from automated driving within a time budget (TB) of 3 s or 7 s in obstacle avoidance (OA) or lane keeping (LK) scenarios while engaging in non-driving-related tasks (NDRTs). Participants’ subjective cognitive load in the different TOR scenarios was scaled using NASA-TLX. Furthermore, safe TOR performance was predicted utilizing Convolutional Neural Networks (CNNs) across different time window sizes preceding a TOR. The results indicate that: 1) cognitive loads in takeover scenarios ranked from highest to lowest as TB = 3s_OA, TB = 3s_LK, TB = 7s_OA, TB = 7s_LK; and the cognitive loads of the NDRTs ranked from highest to lowest as mistake finding, texting, chatting, monitoring; 2) the takeover safety performance in the four scenarios from lowest to highest was TB = 3s_OA, TB = 3s_LK, TB = 7s_OA, TB = 7s_LK; likewise, the takeover safety performance during the four NDRTs ranked from lowest to highest as mistake finding, monitoring, texting, chatting; 3) the time window size before the TORs significantly affected the prediction performance of the model. A 30-second window was recommended as optimal for predicting takeover safety using the CNN model, achieving an average F1 score of 0.8120 and 81.98 % accuracy. This study's findings enhance our comprehension of driving behavior characteristics during TOR and offer valuable insights for detecting driver states in conditionally automated driving contexts.

Are realistic details important for learning with visualizations or can depth cues provide sufficient guidance?

The optimal choice of the level of realism in instructional visualizations is a difficult task. Previous studies suggest that realism can overwhelm learners, but a growing body of research demonstrates that realistic details can enhance learning. In the first experiment (n = 107), it was assessed whether learning using realistic visualizations can be distracting and therefore particularly benefits from pre-training. Participants learned the anatomy of the parotid gland using labeled visualizations. While pre-training did not have an effect, a more realistic visualization enhanced learning compared to a schematic visualization. In the second experiment (n = 132), a schematic diagram was compared to a more realistic style featuring basic depth cues, and a highly realistic visualization containing a detailed surface. Regarding retention performance, no significant differences were found. However, an interesting pattern regarding subjective cognitive load ratings emerged: the schematic version received the highest cognitive load ratings, while the version featuring simplified shading was rated as least demanding. The version containing simplified depth cues also elicited lower cognitive load ratings than the detailed visualization. The two experiments demonstrate that fears concerning a detrimental effect of realistic details should not be over-generalized. While schematic visualizations may be easier to visually process in some cases, extracting depth information from contour drawings adds cognitive demands to a learning task. Thus, it is advisable that computer-generated visualizations contain at least simplified forms of shading, while the addition of details does not appear to have a strong positive effect.

Effects of Exercise Habits and Gender on Sports e-Learning Behavior: Evidence from an Eye-Tracking Study.

In the post-epidemic era, an increasing number of individuals were accustomed to learning sports and physical activity knowledge online for fitness and health demands. However, most previous studies have examined the influence of e-learning materials and resources on learners and have neglected intrinsic factors such as experience and physiological characteristics. Therefore, we conducted a study to investigate the effect of exercise habits and gender on sports e-learning behavior via eye-tracking technology. We recruited a sample of 60 undergraduate students (mean age = 19.6) from a university in Nanjing, China. They were randomly assigned into 4 groups based on 2 genders × 2 exercise habits. Their gaze behavior was collected by an eye-tracking device during the experiment. The cognitive Load Test and Learning Effect Test were conducted at the end of the individual experiment. (1) Compared to the non-exercise habit group, the exercise habit group had a higher fixation count (P<0.05), a shorter average fixation duration (P<0.05), a smaller average pupil diameter (P<0.05), and a lower subjective cognitive load (P<0.05) and better learning outcome (P<0.05). (2) Male participants showed a greater tendency to process information from the video area of interest (AOIs), and had lower subjective cognitive load (P < 0.05) and better learning outcomes (P < 0.05). (3) There was no interaction effect between exercise habits and gender for any of the indicators (P > 0.05). Our results indicate that exercise habits effectively enhance sports e-learning outcomes and reduce cognitive load. The exercise habits group showed significant improvements in fixation counts, average fixation duration, and average pupil diameter. Furthermore, male subjects exhibited superior learning outcomes, experienced lower cognitive load, and demonstrated greater attentiveness to dynamic visual information. These conclusions are expected to improve sports e-learning success and address educational inequality.

Does listening to audiobooks affect gait behavior?

BackgroundThe effect of listening to audiobooks, podcasts, and other audio files while walking on gait performance has not been well studied. Although the number of audio users is growing annually. Evidence suggests that a posture-first strategy contributes to gait stability in healthy individuals during dual-task conditions, but this effect may be diminished when the cognitive task is consciously prioritized. Objectives: To study the effect of listening to an audiobook while walking, as a daily life-like dual-task, on spatiotemporal gait parameters.MethodsForty young healthy (24.05 ± 3.66) subjects participated in the study. Spatiotemporal gait parameters were measured for 5 min on a treadmill once without (single-task) and once while listening to an audiobook through over-ear headphones (dual-task). Measured parameters included spatiotemporal parameters, gait phases, maximum pressure, and dual-task cost. Data were statistically analyzed using SPSS software.ResultsThere were no significant differences in any of the studied parameters between the single- and dual-task conditions, even though the subjective cognitive load of listening to audiobooks while walking was high. However, participants with different habits had significant differences in gait phases and maximum pressure. Rare listeners had a shorter stance phase, a longer swing phase, and a higher maximum pressure on the dominant heel. They also had significant differences in dual-task costs.ConclusionNo differences in the spatiotemporal gait parameters for walking with and without listening to audiobooks, as a daily life-like dual-task, were observed. However, the difference between participants who listened rarely and participants who listened often may confirm the “posture first” strategy in young healthy people.Trial registrationDRKS00025837, retrospectively registered on 23.11.2021.

Subjective Cognitive Load Evaluation of a Mobile Personal Health Record Application.

Mobile Personal Health Records (mPHRs), which make it possible to track and manage users' health information, can be an important aid in improving people's health. Despite its potential benefits, poor usability of systems can hinder the adoption and use of mPHRs. This study aims to evaluate the usability of a mobile health application in terms of perceived cognitive workload and performance. The cognitive workload experienced by 30 volunteers (15 experienced and 15 inexperienced), was measured while performing the given tasks with the NASA-Task Load Index (NASA-RTLX) scale, and the duration of the fulfillment of the tasks by eye tracking device. While there was no significant difference between the two user groups in the completion time of the tasks, a significant difference was found in the perceived cognitive load. "Making an appointment", which could take much longer to complete than other tasks, resulted in the highest cognitive load for all users. Further usability research using think-aloud protocols and user interviews could provide insights into design improvements for reducing cognitive load and enhancing performance.

From Driver to Supervisor: Comparing Cognitive Load and EEG-Based Attentional Resource Allocation Across Automation Levels

With increasing automation, drivers’ roles transition from active operators to passive system supervisors, affecting their behaviour and cognitive processes. This study addresses the attentional resource allocation and subjective cognitive load during manual, SAE Level 2, and SAE Level 3 driving in a realistic environment. An experiment was conducted on a test track with 30 participants using a prototype automated vehicle. While driving, participants were subjected to a passive auditory oddball task and their electroencephalogram was recorded. The study analysed the amplitude of the P3a event-related potential component elicited by novel environmental stimuli, an objective measure of attentional resource allocation. The subjective cognitive load was assessed using the NASA Task Load Index. Results showed no significant difference in subjective cognitive load between manual and Level 2 driving, but a decrease in subjective cognitive load in Level 3 driving. The P3a amplitude was highest during manual driving, indicating increased attentional resource allocation to environmental sounds compared to Level 2 and Level 3 driving. This may suggest that during automated driving, drivers allocate fewer attentional resources to processing environmental information. It remains unclear whether the decreased processing of environmental stimuli in automated driving is due to top-down attention control (leading to attention withdrawal) or bottom-up competition for resources induced by cognitive load. This study provides novel empirical evidence on resource allocation and subjective cognitive load in automated driving. The findings highlight the importance of managing drivers’ attention and cognitive load with implications for enhancing automation safety and the design of user interfaces.

Craving modulates attentional bias towards alcohol in severe alcohol use disorder: An eye-tracking study.

Competing models disagree on three theoretical questions regarding alcohol-related attentional bias (AB), a key process in severe alcohol use disorder (SAUD): (1) is AB more of a trait (fixed, associated with alcohol use severity) or state (fluid, associated with momentary craving states) characteristic of SAUD; (2) does AB purely reflect the over-activation of the reflexive/reward system or is it also influenced by the activity of the reflective/control system and (3) does AB rely upon early or later processing stages? We addressed these issues by investigating the time-course of AB and its modulation by subjective craving and cognitive load in SAUD. A free-viewing eye-tracking task, presenting pictures of alcoholic and non-alcoholic beverages, combined with a concurrent cognitive task with three difficulty levels. A laboratory setting in the detoxification units of three Belgian hospitals. We included 30 patients with SAUD self-reporting craving at testing time, 30 patients with SAUD reporting a total absence of craving and 30 controls matched on sex and age. All participants from SAUD groupsmet the DSM-5 criteria for SAUD. We assessed AB through early and late eye-tracking indices. We evaluated the modulation of AB by craving (comparison between patients with/without craving) and cognitive load (variation of AB with the difficulty level of the concurrent task). Dwell time measure indicated that SAUDpatients with craving allocated more attention towards alcohol-related stimuli than patients without craving (P < 0.001, d = 1.093), resulting in opposite approach/avoidance AB according to craving presence/absence. SAUD patients without craving showed a stronger avoidance AB than controls (P = 0.003, d = 0.806). AB did not vary according to cognitive load (P = 0.962, η2 p = 0.004). The direction of alcohol-related attentional bias (approach/avoidance) appears to be determined by patients' subjective craving at testing time and does not function as a stable trait of severe alcohol use disorder. Alcohol-related attentional bias appears to rely on later/controlled attentional stages but is not modulated by the saturation of the reflective/control system.

Exploring Enhancement of AR-HUD Visual Interaction Design Through Application of Intelligent Algorithms

This study aims to optimize the visual interaction design of AR-HUD and reduce cognitive load in complex driving situations. An immersive driving simulation incorporating eye-tracking technology was utilized to analyze objective physiological indices and measure subjective cognitive load using the NASA-TLX. Additionally, a visual cognitive load index was integrated into a BP-GA neural network model for load prediction, enabling the derivation of an optimal solution for AR-HUD design. The optimized AR-HUD interface demonstrated a significant reduction in cognitive load compared to the previous prototype. The experimental group achieved a mean total score of 25.63 on the WP scale, whereas the control group scored 43.53, indicating a remarkable improvement of 41.1%. This study presents an innovative approach to optimizing AR-HUD design, effectively reducing cognitive load in complex driving situations. The findings demonstrate the potential of the proposed algorithm to enhance user experience and performance.

Biosignals Monitoring of First Responders for Cognitive Load Estimation in Real-Time Operation

During the last decade, new technological tools have emerged to provide first responders with augmented senses in emergency and disaster situations. Some of these tools focus on providing extra information about their surroundings. However, despite augmenting first responders’ capabilities, the quantity and the way that this information is presented can affect their cognitive load. This manuscript presents an integrated framework that allows real-time biosignals monitoring to analyze physical constants and correlate them with subjective cognitive load tests. Biosignals monitoring allows alarms to be raised related to the physical status while cognitive load values will allow modulation of the amount of information that can be assimilated by the first responder in operation. In-lab and practice experimental tests have been conducted to create a fully functional framework. During the technical validation, a strong dispersion of subjective cognitive load by means of NASA-TLX questionnaires has been found between participants. Nonetheless, the developed framework allows extraction of relationships between biosignals and cognitive load, with special attention to the respiration rate and eye movements.

Digital ink and differentiated subjective ratings for cognitive load measurement in middle childhood.

New methods are constantly being developed to adapt cognitive load measurement to different contexts. However, research on middle childhood students' cognitive load measurement is rare. Research indicates that the three cognitive load dimensions (intrinsic, extraneous, and germane) can be measured well in adults and teenagers using differentiated subjective rating instruments. Moreover, digital ink recorded by smartpens could serve as an indicator for cognitive load in adults. With the present research, we aimed at investigating the relation between subjective cognitive load ratings, velocity and pressure measures recorded with a smartpen, and performance in standardized sketching tasks in middle childhood students. Thirty-six children (age 7-12) participated at the university's laboratory. The children performed two standardized sketching tasks, each in two versions. The induced intrinsic cognitive load or the extraneous cognitive load was varied between the versions. Digital ink was recorded while the children drew with a smartpen on real paper and after each task, they were asked to report their perceived intrinsic and extraneous cognitive load using a newly developed 5-item scale. Results indicated that cognitive load ratings as well as velocity and pressure measures were substantially related to the induced cognitive load and to performance in both sketching tasks. However, cognitive load ratings and smartpen measures were not substantially related. Both subjective rating and digital ink hold potential for cognitive load and performance measurement. However, it is questionable whether they measure the exact same constructs.

The Effect of Audiovisual Spatial Design on User Experience of Bare-Hand Interaction in VR

This study investigated whether the audio-visual spatial design could improve and how it improved the user experience of bare-hand interaction (BHI) in virtual reality (VR), by adjusting spatial audio accordingly (no sound, audiovisual spatial congruency, audio-visual spatial in congruency). We asked 32 participants to complete the grasping task in two interaction scenarios with three audio-visual spatial conditions. We evaluated the user experience in terms of both intrinsic cognitive load and usability through four metrics: subjective cognitive load scores, HbO2 data in the corresponding brain regions, task time, and user satisfaction. The results showed that in near range interaction, although there was no significant difference between audio-visual spatial in congruency and congruency in terms of cognitive load and usability, they both significantly improved the user experience compared to the no sound group. In distant range interaction, audio-visual spatial in congruency significantly reduced the cognitive load and increased usability, thus improving the user experience.

Realistic details impact learners independently of split-attention effects

Realistic visualizations are considered to introduce the risk of distracting learners from relevant information. In two experiments, the interplay between realism and a known form of distraction, the split-attention effect, were investigated. This effect describes that spatially separating relevant information can have a substantial negative effect on learning. The experiments were conducted using short anatomy learning tasks to test whether a combination of realism and split attention would lead to the worst retention performance or, alternatively, whether realism can counteract the negative effects of split attention. The first experiment (n = 125) revealed that realism attenuated the cognitive load induced by split attention, suggesting a compensatory effect of realism (i.e., realism may have helped learners to deal with the detrimental influence of split attention). However, retention performance was not impacted in a similar way, indicating that this compensatory effect on subjective cognitive load may actually be the result of learners’ illusion that realistic details are helpful. Split attention significantly reduced retention performance. Experiment 2 (n = 152) resulted in negative effects of realism and split attention on retention. In sum, the experiments suggest that realistic details can affect learners independently of other visual design factors as exemplified by the split-attention effect. Thus, the assumption that realism is likely to distract learners is rendered implausible by the experiments, as the distraction of split attention should have amplified any distractive potential of realistic details. However, the results also suggest that the effects of realism on learning are still somewhat unpredictable.

Do Skills Naturally Transfer Between Multiport and Single-Port Robotic Platforms? A Comparative Study in a Simulated Environment.

Introduction and Objective: With introduction of the da Vinci single-port (SP) system, we evaluated which multiport (MP) robotic skills are naturally transferable to the SP platform. Methods: Three groups of urologists: Group 1 (5 inexperienced in MP and SP), Group 2 (5 experienced in MP without SP experience), and Group 3 (2 experienced in both MP and SP) were recruited to complete a validated urethrovesical anastomosis simulation using MP followed by SP robots. Performance was graded using both GEARS and RACE scales. Subjective cognitive load measurements (Surg-TLX and difficulty ratings [/20] of instrument collisions camera and EndoWrist movement) were collected. Results: GEARS and RACE scores for Groups 1 and 3 were maintained on switching from MP to SP (Group 3 scored significantly higher on both systems). Surg-TLX and difficulty scores were also maintained for both groups on switching from MP and SP except for a significant increase in SP camera movement (+7.2, p = 0.03) in Group 1 compared to Group 3 that maintained low scores on both. Group 2 demonstrated significant lower GEARS (-2.9, p = 0.047) and RACE (-5.1, p = 0.011) scores on SP vs MP. On subanalysis, GEARS subscores for force sensitivity and robotic control (-0.7, p = 0.04; -0.9, p = 0.02) and RACE subscores for needle entry, needle driving, and tissue approximation (-0.9, p = 0.01; -1.0, p = 0.02; -1.0, p < 0.01) significantly decreased. GEARS (depth perception, bimanual dexterity, and efficiency) and RACE subscores (needle positioning and suture placement) were maintained. All participants scored significantly lower in knot tying on the SP robot (-1.0, p = 0.03; -1.2, p = 0.02, respectively). Group 2 reported higher Surg-TLX (+13 pts, p = 0.015) and difficulty ratings on SP vs MP (+11.8, p < 0.01; +13.6, p < 0.01; +14 pts, p < 0.01). Conclusions: The partial skill transference across robots raises the question regarding SP-specific training for urologists proficient in MP. Novices maintained difficulty scores and cognitive load across platforms, suggesting that concurrent SP and MP training may be preferred.

Towards reducing visual workload in surgical navigation: proof-of-concept of an augmented reality haptic guidance system

ABSTRACT The integration of planning and navigation capabilities into the operating room has enabled surgeons take on more precise procedures. Traditionally, planning and navigation information is presented using monitors in the surgical theatre. But the monitors force the surgeon to frequently look away from the surgical area. Augmented reality technologies have enabled surgeons to visualise navigation information in-situ. However, burdening the visual field with additional information can be distracting. We propose integrating haptic feedback into a surgical tool handle to enable surgical guidance capabilities. This property reduces the amount of visual information, freeing surgeons to maintain visual attention over the patient and the surgical site. To investigate the feasibility of this guidance paradigm we conducted a pilot study with six subjects. Participants traced paths, pinpointed locations and matched alignments with a mock surgical tool featuring a novel haptic handle. We collected quantitative data, tracking user’s accuracy and time to completion as well as subjective cognitive load. Our results show that haptic feedback can guide participants using a tool to sub-millimetre and sub-degree accuracy with only little training. Participants were able to match a location with an average error of mm, desired pivot alignments with an average error of ° and desired rotations to °.

Evaluation of children's cognitive load in processing and storage of their spatial working memory.

Working memory performance affects children’s learning. This study examined objective (task performance), subjective (self-report), and physiological (pupil dilation) cognitive load (CL) while children completed a spatial working memory complex span task. Frist, 80 Taiwanese 11-year-olds (40 boys) who participated in Experiment 1 confirmed the suitability of the materials. Then, 72 Taiwanese 11-year-olds (35 boys) were assigned to high and low complexity groups to participate in Experiment 2 to test the study hypothesis. Children had to recall at the end of a dual-task list and answer two questions regarding the difficulty and mental effort involved in processing and storage. Their pupil diameters were recorded using an eye-tracker. Two-way mixed ANOVA found that the processing requirements and memory load reduced storage and aggravated the subjective CL of storage; the subjective CL of processing was higher under highly complex conditions. Stepwise regression analysis indicated that subjective CL of processing predicted memory performance in low CL conditions, and physiological CL of processing predicted it in high CL conditions.

Association between Clinical Simulation Design Features and Novice Healthcare Professionals’ Cognitive Load: A Systematic Review and Meta-Analysis

Background Clinical simulations are complex educational interventions characterized by several design features, which have the potential to influence cognitive load, that is, the mental effort required to assimilate new information and learn. This systematic review and meta-analysis explored the associations between simulation design features and cognitive load in novice healthcare professionals. Methods Based on the Joanna Briggs Institute methodology, a search was performed in five databases for quantitative studies in which the cognitive load of novice healthcare professionals was measured during or after a simulation activity. Each clinical simulation was coded to describe its design features. Univariate and multivariate mixed model analyses were performed to explore the associations between simulation design features and cognitive load. Results From 962 unique records, 45 studies were included and 27 provided enough data on subjective cognitive load (i.e., Paas Scale and NASA-Task Load Index scores) to be meta-analyzed. In the multivariate analysis for the NASA-Task Load Index scores, each repetition of a simulation using the same scenario resulted in a linear decrease in cognitive load. In contrast, technology-based instruction before or during a simulation activity was associated with higher cognitive load. In the univariate analyses, other features such as feedback and instructor presence were also statistically associated with cognitive load. Regarding the univariate analyses of the Paas Scale scores, simulator type, briefing, debriefing, and repetitive practice were statistically associated with cognitive load. Conclusion This is the first meta-analysis exploring the relationship between clinical simulation design features and novice healthcare professionals’ cognitive load. Although the findings show that several design features can potentially increase or decrease cognitive load, several gaps and inconsistencies in the current literature make it difficult to appreciate how such reciprocity influences novice healthcare professionals’ learning. These limitations are discussed and avenues for educators and further research are suggested.

Applying Interleaving Strategy of Learning Materials and Perceptual Modality to Address Secondary Students' Need to Restore Cognitive Capacity.

Online courses are prevalent around the world, especially during the COVID-19 pandemic. Long hours of highly demanding online learning can lead to mental fatigue and cognitive depletion. According to Attention Restoration Theory, ‘being away’ or a mental shift could be an important strategy to allow a person to recover from the cognitive overload. The present study aimed to test the interleaving strategy as a mental shift method to help sustain students’ online learning attention and to improve learning outcomes. A total of 81 seventh-grade Chinese students were randomly assigned to four learning conditions: blocked (by subject matter) micro-lectures with auditory textual information (B-A condition), blocked (by subject matter) micro-lectures with visual textual information (B-V condition), interleaved (by subject matter) micro-lectures with auditory textual information (I-A condition), and interleaved micro-lectures by both perceptual modality and subject matter (I-all condition). We collected self-reported data on subjective cognitive load (SCL) and attention level, EEG data during the 40 min of online learning, and test results to assess learning outcomes. The results showed that the I-all condition showed the best overall outcomes (best performance, low SCL, and high attention). This study suggests that interleaving by both subject matter and perceptual modality should be preferred in scheduling and planning online classes.