Authors

1 Medical Education Research Center, Education Development Center, Isfahan University of Medical Sciences, Department of Occupational Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Medical Education Research Center, Education Development Center, Isfahan University of Medical Sciences

3 Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

INTRODUCTION: To design instructions in health sciences education, it is highly relevant to heed
the working memory and the approaches for managing cognitive load. In this article, we tried to
mention the implications of cognitive load theory (CLT) for optimizing teaching-learning in health
sciences education and discussing cognitive load from the perspective of cognitive neurosciences
as brain-aware medical education.
MATERIALS AND METHODS: We searched databases of Pubmed, Proquest, SCOPUS, and ISI
Web of Science for relevant literature in September 1, 2018.
RESULTS: The 27 articles out of a total of 46 records, along with 23 papers from snowballing and
hand searching were included in this study. Main items encompassed; “Various types of cognitive
loads,” “Aim of cognitive load theory,” “Strategies to managing Cognitive Load,” “Cognitive Load Theory
in novice and experienced learners and “expertise reversal effect,” Medical and Health Sciences
Curriculums and Cognitive Load Theory,” “Challenges of Cognitive Load Theory.”
CONCLUSIONS: We discussed six important themes for CLT in health sciences education according
to the literature. Mental imagery (visualization) as one of the useful techniques to optimize germane
load was suggested, as it processes further gain access to neural circuits that are engaged in sensory,
motor, executive, and decision-making pathways in the brain.


Keywords

  1. Gooding HC, Mann K, Armstrong E. Twelve tips for applying the
    science of learning to health professions education. Med Teach
    2017;39:26-31.
    2. Qiao YQ, Shen J, Liang X, Ding S, Chen FY, Shao L, et al. Using
    cognitive theory to facilitate medical education. BMC Med Educ
    2014;14:79.
    3. Dennick R. Twelve tips for incorporating educational theory into
    teaching practices. Med Teach 2012;34:618-24.
    4. van Merriënboer JJ, Sweller J. Cognitive load theory in health
    professional education: Design principles and strategies. Med
    Educ 2010;44:85-93.
    5. Sewell JL, Maggio LA, Ten Cate O, van Gog T, Young JQ,
    O’Sullivan PS. Cognitive load theory for training health
    professionals in the workplace: A BEME review of studies
    among diverse professions: BEME Guide No. 53. Med Teach
    2019;41:256-70.
    6. Kavic MS. Cognitive load theory and learning medicine.
    Photomed Laser Surg 2013;31:357-9.
    7. Wissman AW. Cognitive Load Theory: Applications in Medical
    Education. Technical Communication Capstone Course; 2018.
    p. 25.
    8. Young JQ, van Merrienboer J, Durning S, Ten Cate O. Cognitive
    load theory: Implications for medical education: AMEE Guide
    No. 86. Med Teach 2014;36:371-84.
    9. Sharma N. Cognitive load theory and teaching in primary care.
    Br J Gen Pract 2016;66:430
    10. Schumacher DJ, Englander R, Carraccio C. Developing the master
    learner: Applying learning theory to the learner, the teacher, and
    the learning environment. Acad Med 2013;88:1635-45.
    11. Leppink J. Cognitive load theory: Practical implications and an
    important challenge. J Taibah Univ Med Sci 2017;12:385-91.
    12. Young JQ, Wachter RM, Ten Cate O, O’Sullivan PS, Irby DM.
    Advancing the next generation of handover research and practice
    with cognitive load theory. BMJ Qual Saf 2016;25:66-70.
    13. Mulcock PM, Grassley J, Davis M, White K. Beyond the dedicated
    education unit: Using cognitive load theory to guide clinical
    placement. J Nurs Educ 2017;56:105-9.
    14. Fraser KL, Ayres P, Sweller J. Cognitive load theory for the design
    of medical simulations. Simul Healthc 2015;10:295-307.
    15. Hadie SN, Abdul Manan Sulong H, Hassan A, Mohd Ismail ZI,
    Talip S, Abdul Rahim AF. Creating an engaging and stimulating
    anatomy lecture environment using the cognitive load theorybased lecture model: Students’ experiences. J Taibah Univ Med
    Sci 2018;13:162-72.
    16. Hazan-Liran B, Miller P. Stroop-like effects in a new-code learning
    task: A cognitive load theory perspective. Q J Exp Psychol (Hove)
    2017;70:1878-91.
    17. Hessler KL, Henderson AM. Interactive learning research:
    Application of cognitive load theory to nursing education. Int
    J Nurs Educ Scholarsh 2013;10. pii:/j/ijnes.2013.10.issue-1/
    ijnes-2012-0029/ijnes-2012-0029.xml.
    18. Schilling J. In respect to the cognitive load theory: Adjusting
    instructional guidance with student expertise. J Allied Health
    2017;46:e25-30.
    19. Khalil MK, Paas F, Johnson TE, Payer AF. Design of interactive and
    dynamic anatomical visualizations: The implication of cognitive
    load theory. Anat Rec B New Anat 2005;286:15-20.
    20. Kluge A, Grauel B, Burkolter D. Combining principles of cognitive
    load theory and diagnostic error analysis for designing job aids:
    Effects on motivation and diagnostic performance in a process
    control task. Appl Ergon 2013;44:285-96.
    21. Leppink J, Duvivier R. Twelve tips for medical curriculum design
    from a cognitive load theory perspective. Med Teach 2016;38:669-74.
    22. Mitra R, McNeal KS, Bondell HD. Pupillary response to complex
    interdependent tasks: A cognitive-load theory perspective. Behav
    Res Methods 2017;49:1905-19.
    23. Devolder P, Pynoo B, Voet T, Adang L, Vercruysse J, Duyck P.
    Optimizing physicians’ instruction of PACS through e-learning:
    Cognitive load theory applied. J Digit Imaging 2009;22:25-33.
    24. Tabbers HK, Martens RL, van Merriënboer JJ. Multimedia
    instructions and cognitive load theory: Effects of modality and
    cueing. Br J Educ Psychol 2004;74:71-81.
    25. Sharma N. Colonoscopy adenoma detection rates: Room for
    cognitive load theory? Gastrointest Endosc 2016;84:547-8.
    26. Kaylor SK. Preventing information overload: Cognitive load
    theory as an instructional framework for teaching pharmacology.
    J Nurs Educ 2014;53:108-11.
    27. Young JQ, Ten Cate O, O’Sullivan PS, Irby DM. Unpacking the
    complexity of patient handoffs through the lens of cognitive load
    theory. Teach Learn Med 2016;28:88-96.
    28. Rana J, Burgin S. Teaching learning tips 2: Cognitive load theory.
    Int J Dermatol 2017;56:1438-41.
    29. Reedy GB. Using cognitive load theory to inform simulation
    design and practice. Clin Simul Nurs 2015;11:355-60.
    30. van Gerven PW, Paas FG, van Merriënboer JJ, Schmidt HG.
    Cognitive load theory and the acquisition of complex cognitive
    skills in the elderly: Towards an integrative framework. Educ
    Gerontol 2000;26:503-21.
    31. Adams T. The application of cognitive load theory to dual-task
    simulation training. Simul Healthc 2016;11:66-7.
    32. Sun NZ, Anand PA, Snell L. Optimizing the design of high-fidelity
    simulation-based training activities using cognitive load theory –
    Lessons learned from a real-life experience. J Simul 2017;11:151-8.
    33. Schilling JF. Cognitive load theory of learning: Underpinnings
    and model. Int J Athletic Ther Train 2016;21:12-6.
    34. Young JQ, Sewell JL. Applying cognitive load theory to medical
    education: Construct and measurement challenges. Perspect Med
    Educ 2015;4:107-9.
    35. Leppink J, Paas F, van Gog T, van Der Vleuten CP, van
    Merrienboer JJ. Effects of pairs of problems and examples on task
    performance and different types of cognitive load. Learn Instr
    2014;30:32-42.
    36. Ortony A, Rumelhart DE. The representation of knowledge in
    memory 1. In: Schooling and the Acquisition of Knowledge.
    Lawrence Erlbaum Associates London: Routledge; 2017. p. 99-135.
    37. Sweller J, van Merrienboer JJ, Paas FG. Cognitive architecture
    and instructional design. Educ psychol Rev 1998;10:251-96.
    38. Sweller J. Cognitive load theory, learning difficulty, and
    instructional design. Learn Instr 1994;4:295-312.
    39. Sweller J, Chandler P. Why some material is difficult to learn.
    Cogn Instr 1994;12:185-233.
    40. Sweller J. Cognitive load during problem solving: Effects on
    learning. Cogn Sci 1988;12:257-85.
    41. Cook MP. Visual representations in science education: The
    influence of prior knowledge and cognitive load theory on
    instructional design principles. Sci Educ 2006;90:1073-91.
    42. Norman GR, Eva KW. Diagnostic error and clinical reasoning.
    Med Educ 2010;44:94-100.
    43. Pretz JE. Intuition versus analysis: Strategy and experience in
    complex everyday problem solving. Mem Cognit 2008;36:554-66.
    44. Rencic J. Twelve tips for teaching expertise in clinical reasoning.
    Med Teach 2011;33:887-92.
    45. Sweller J. Cognitive load theory, evolutionary educational
    psychology, and instructional design. In: Geary D., Berch D. (eds)
    Evolutionary Perspectives on Child Development and Education.
    Evolutionary Psychology. 2016; Springer, Cham291-306.
    46. Sweller J. Measuring cognitive load. Perspect Med Educ 2018;7:1-2.
  2. 47. Chen F, Zhou J, Wang Y, Yu K, Arshad SZ, Khawaji A, et al.
    Emotion and cognitive load. In: Robust Multimodal Cognitive
    Load Measurement. Human–Computer Interaction Series.
    Springer, Cham; 2016. p. 173-83.
    48. Fraser K, Ma I, Teteris E, Baxter H, Wright B, McLaughlin K.
    Emotion, cognitive load and learning outcomes during simulation
    training. Med Educ 2012;46:1055-62.
    49. Pawar S, Jacques T, Deshpande K, Pusapati R, Meguerdichian
    MJ. Evaluation of cognitive load and emotional states during
    multidisciplinary critical care simulation sessions. BMJ Simul
    Technol Enhanc Learn 2018;4:87-91.
    50. Fraser K, McLaughlin K. Temporal pattern of emotions and
    cognitive load during simulation training and debriefing. Med
    Teach 2019;41:184-9.
    51. Seufert T. The interplay between self-regulation in learning and
    cognitive load. Educ Res Rev 2018;24:116-29.
    52. Sörqvist P, Dahlström Ö, Karlsson T, Rönnberg J. Concentration:
    The neural underpinnings of how cognitive load shields against
    distraction. Front Hum Neurosci 2016;10:221.
    53. Borst JP, Taatgen NA, van Rijn H. The problem state: A cognitive
    bottleneck in multitasking. J Exp Psychol Learn Mem Cogn
    2010;36:363-82.
    54. Mayer RE. Applying the science of learning to medical education.
    Med Educ 2010;44:543-9.
    55. Saif AA. Modern Educational Psychology (Psychology of Learning
    and Instruction). 7th ed. Tehran: Dowran Publishing Company;
    2017. p. 726.
    56. Eriksson J, Vogel EK, Lansner A, Bergström F, Nyberg L.
    Neurocognitive architecture of working memory. Neuron
    2015;88:33-46.
    57. Logie RH, Morris RG. Working Memory and Ageing. Hove,
    United Kingdom: Psychology Press; 2014.
    58. Dirette DP, Anderson MA. The relationship between learning
    style preferences and memory strategy use in adults. Occup Ther
    Health Care 2016;30:245-54.
    59. Karlsgodt KH. Working memory. In: Toga AW, editor. Brain
    Mapping. Waltham: Academic Press; 2015. p. 319-26.
    60. Brain science, learning and teaching. Clin Teach 2009;6:283-4.
    61. Salvetti F, Bertagni B. e-REAL: Enhanced reality lab. Int J Adv
    Corp Learn 2014;7:41-9.
    62. Friedlander MJ, Andrews L, Armstrong EG, Aschenbrenner C,
    Kass JS, Ogden P, et al. What can medical education learn from
    the neurobiology of learning? Acad Med 2011;86:415-20.