Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53

Abstract

Aim: Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear.

Method: To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks.

Result: Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found distractions and other aspects of workplace environments as contributing to extraneous load. Studies outside the health professions documented similar findings to those within the health professions, supporting relevance of CLT to workplace learning.

Conclusion: The authors discuss implications for workplace teaching, curricular design, learning environment, and metacognition. To advance workplace learning, the authors suggest future CLT research should address higher-level questions and integrate other learning frameworks.

Acknowledgments

We thank members of BEME and the BEME International Collaborating Centre for their expert input into protocol development and manuscript review.

We thank Holly Nishimura for her assistance in executing the literature searches and retrieving full-text articles.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

1. Cognitive load theory: A theory of instructional design based on our knowledge of human cognitive architecture, in particular, the limitations of working memory (Sweller et al. 2011).

2. Cognitive load: Working memory demands imposed by performing a task (Young et al. 2014).

3. Intrinsic load: Cognitive load that occurs as learners accomplish the essential elements of a task (Young et al. 2014).

4. Extraneous load: Cognitive load that is not essential to completing the task (e.g. distractions) (Young et al. 2014).

5. Germane load: Cognitive load imposed by the learner’s deliberate use of cognitive strategies to generate or refine learning schemas (Young et al. 2014).

6. Mental effort: The aspect of cognitive load related to cognitive capacity that is actually allocated to accommodate demands imposed by a task (Paas et al. 2003).

7. Mental workload: The aspect of cognitive load related to the interaction between characteristics of the learner and characteristics of the task (Paas et al. 2003).

Additional information

Funding

The study was funded in part by an award from the Society of Directors of Research in Medical Education (SDRME). The funding source played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit for publication.

Notes on contributors

Justin L. Sewell

Justin L. Sewell, MD, MPH, is an academic gastroenterologist and Associate Professor of Medicine at the University of California San Francisco (UCSF). Dr. Sewell is currently pursuing a PhD in Health Professions Education through a joint program of UCSF and Utrecht University in the Netherlands. His thesis work is focused on implications of cognitive load theory for workplace learning in the health professions.

Lauren A. Maggio

Lauren A. Maggio, PhD, MS(LIS), is an Associate Professor of Medicine at the Uniformed Services University of the Health Sciences in Bethesda, MD. She has training in information science and holds a PhD in Health Professions Education from Utrecht University.

Olle ten Cate

Olle ten Cate, PhD, is a Full Professor of Medical Education and Senior Scientist in the Center for Research and Development of Education at UMC Utrecht.

Tamara van Gog

Tamara van Gog, PhD, is a Professor of Educational Sciences at Utrecht University with substantial expertise and experience in research related to cognitive load theory.

John Q. Young

John Q. Young, MD, MPP, PhD, is an academic psychiatrist, Professor of Psychiatry, and the Vice Chair for Education, Zucker School of Medicine at Hofstra/Northwell in Hemstead, NY. He received a PhD in Health Professions Education from Utrecht University, and is an expert in cognitive load theory.

Patricia S. O’Sullivan

Patricia S. O’Sullivan, EdD, is a Professor of Medicine and the Director of Research and Development in Medical Education at UCSF.