Integrating cognitive load theory with other theories, within and beyond educational psychology

Electronic feedback alone vs. electronic feedback plus in-person debriefing, for a serious game designed to teach novice anesthesiology residents to perform general anesthesia for cesarean delivery: a randomized controlled trial

BACKGROUND

EmergenCSimTM, is a novel researcher-developed serious game (SG) with an embedded scoring and feedback tool that reproduces an obstetric operating room environment. The learner must perform general anesthesia (GA) for emergent cesarean delivery (CD) for umbilical cord prolapse. The game was developed as an alternative teaching tool because of diminishing real-world exposure of anesthesiology trainees to this clinical scenario. Traditional debriefing (facilitator-guided reflection) is considered to be integral to experiential learning but requires the participation of an instructor. The optimal debriefing methods for SGs have not been well-studied. Electronic feedback is commonly provided at the conclusion of SGs, so we aimed to compare the effectiveness of learning when an in-person debrief is added to electronic feedback compared to using electronic feedback alone.

OBJECTIVE

We hypothesized that an in-person debriefing in addition to the SG-embedded electronic feedback will provide superior learning than electronic feedback alone.

METHODS

Novice 1st year anesthesiology residents (CA-1) (n=51) (i) watched a recorded lecture on GA for emergent CD, (ii) took a 26-item multiple-choice question (MCQ) pre-test, and (iii) played EmergenCSimTM (maximum score 196.5). They were randomized to either the control group which experienced the electronic feedback alone (Group EF, n=26) or the intervention group, which experienced the SG-embedded electronic feedback and an in-person debriefing (Group IPD+EF, n=25). All subjects played the SG a 2nd time, with instructions to try to increase their score, then they took a 26-item MCQ post-test. Pre-and post-tests (maximum score of 26 points each), were validated parallel forms.

RESULTS

For Groups EF and IPD+EF respectively, mean pre-test scores were18.6 (SD 2.5) and 19.4 (SD 2.3), and mean post-test scores were 22.6 (SD 2.2) and 22.1 (SD 1.6); F=1.8, P =.19. SG scores for Groups EF and IPD+EF respectively were - mean 1st play SG scores of 135 (SE 4.4) and 141 (SE 4.5), and mean 2nd play SG scores were 163.1 (SE 2.9) and 173.3 (SE 2.9); F= 137.7, P < .001.

CONCLUSIONS

Adding an in-person debriefing experience led to greater improvement in SG scores, emphasizing the learning benefits of this practice. Improved SG performance in both groups suggests that SGs have a role as independent, less resource-intensive educational tools.

CLINICALTRIAL

None.

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

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

Biological evolution and human cognition are analogous information processing systems

The mechanisms that govern biological evolution and human cognition are analogous, as both follow the same principles of natural information processing systems. In this article, we describe the following five principles that provide an analogy between biological evolution and human cognition: (a) Randomness as Genesis Principle and (b) Borrowing and Reorganizing Principle, which indicate how natural information processing systems obtain information; (c) Narrow Limits of Change Principle and (d) Information Store Principle, which indicate how information is processed and stored; and (e) Environmental Organizing and Linking Principle, which indicate how stored information is used to generate actions appropriate to an environment. In human cognition, these analogs only apply to cognitive processes associated with biologically secondary knowledge, the knowledge typically taught in educational institutions. Based on these five principles, cognitive load theory researchers have provided diverse prescriptions to optimize instructional activities and materials. We conclude by discussing general instructional implications and future research directions based on this analogy.