Anxiety is associated with extraneous cognitive load during teaching using high-fidelity clinical simulation

Figures & data

Figure 1. Data collection time-points in relation to the structure of each clinical simulation teaching session. STAI: State-Trait Anxiety Inventory, CLS: cognitive load scale

Table 1. Median (interquartile range) STAI-state scores for demographic data across the three data collection points. Friedman test was used to compare the STAI-state scores across the three time points. Significant differences were seen between; male v female, low v high trait-anxiety, 1^st v 2^nd exposure to simulation and medicine v surgery scenarios as indicated: ^† p < 0.05 and ^‡ p < 0.01

	N	Pre-scenario	Post-scenario	Post-debrief	Friedman test
All	59	41 (33–50)	46 (33–52)	31 (23–39)	χ^[2]= 45.313, p < 0.001
Male	27	35 (27–49) ^‡	37 (26–48) ^†	27 (22–35) ^†	χ^[2]= 24.263, p < 0.001
Female	32	45 (39–51)	48 (38–57)	34 (27–40)	χ^[2]= 22.563, p < 0.001
Low trait-anxiety	26	32 (26–35) ^‡	37 (25–48) ^‡	28 (22–32) ^‡	χ^[2]= 16.227, p < 0.001
High trait-anxiety	33	49 (42–53)	48 (39–57)	35 (27–43)	χ^[2]= 32.508, p < 0.001
Non leader	51	41 (33–52)	47 (34–53)	32 (25–39)	χ^[2]= 36.437, p < 0.001
Leader	8	41 (33–48)	39 (21–48)	23 (20–35)	χ^[2]= 9.867, p = 0.007
1^st exposure	18	42 (36–52)	48 (41–59) ^†	32 (26–41)	χ^[2]= 15.114, p = 0.001
2^nd exposure	21	40 (32–53)	37 (25–50)	29 (20–38)	χ^[2]= 20.632, p < 0.001
Medicine	30	46 (35–53) ^†	45 (37–56)	32 (23–42)	χ^[2]= 28.394, p < 0.001
Surgery	29	38 (31–44)	47 (28–51)	31 (22–37)	χ^[2]= 20.685, p < 0.001

Table 2. Median (interquartile range) rating for: intrinsic cognitive load (ICL); extraneous cognitive load (ECL); and self-perceived learning (SPL) as related to low and high anxiety groups. Anxiety was assessed using State Trait Anxiety Inventory – Trait (STAI-T) and State Trait Anxiety Inventory – State (STAI-S) at pre-scenario, post- scenario, and post-debriefing time points. Mann-Whitney U test was used to compare median cognitive load rating from low and high anxiety groups

	STAI-T		STAI-S pre-scenario		STAI-S post-scenario		STAI-S post-debriefing
	low	high	low	high	low	high	low	high
	(n = 27)	(n = 32)	(n = 21)	(n = 38)	(n = 16)	(n = 43)	(n = 41)	(n = 18)
ICL	4.2 (2.0–5.7)	3.7 (2.7–5.0)	4.2 (2.4–5.7)	3.7 (2.5–4.7)	3.7 (1.6–5.2)	3.7 (2.7–5.5)	3.7 (2.5–5.5)	4.2 (2.5–5.5)
	U = 417.5, p = 0.677		U = 354.5, p = 0.393		U = 257.0, p = 0.239		U = 374.5, p = 0.702
ECL	2.0 (0.7–2.7)	1.0 (0.5–3.0)	2.0 (0.6–2.9)	1.0 (0.5–3.0)	0.9 (0.6–1.9)	2.0 (0.7–3.0)	1.6 (0.5–2.7)	1.5 (1.0–3.5)
	U = 391.0, p = 0.417		U = 355.0, p = 0.397		U = 220.0, p = 0.034		U = 323.5, p = 0.238
SPL	6.0 (4.2–8.0)	6.2 (5.1–8.0)	6.8 (4.2–8.1)	6.0 (5.0–7.8)	6.6 (4.5–8.1)	6.0 (4.8–8.9)	6.6 (4.7–8.2)	6.0 (5.0–7.0)
	U = 401.5, p = 0.513		U = 375.5, p = 0.598		U = 302.5, p = 0.479		U = 323.5, p = 0.239

Issenberg SB, McGaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.

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