Manipulation of Cognitive Load in Simulation-Based Medical Education
In order to maximize the educational benefits of simulation based medical education (SBME) on an individual level, medical educators can manipulate simulation scenarios in real time, using the fundamentals of cognitive load theory. This approach requires accurate measurement of cognitive load. In this study, we investigate whether self-reported assessment of cognitive load using a visual analogue scale (VAS), and measurement of the galvanic skin response (GSR) are able to reliably and accurately measure cognitive load during SBME. Five separate experimental conditions are reported, and self-reported VAS and GSR measurements of cognitive load are compared before and after interventions designed to either increase or decrease cognitive load. Twenty-one junior postgraduate medical trainees participated in this study. Data were analyzed using repeated measures ANCOVA. VAS and GSR were highly correlated with each other, and with increasing numbers of recall items in a standard visual spatial memory task. While VAS was more sensitive for discriminating between varying levels of cognitive load during the visual spatial memory task, both VAS and GSR were able to do so. In two simulation scenarios designed to increase cognitive load, increases in VAS measures of cognitive load were statistically significant, while GSR measures were not. GSR decreased significantly in an exercise designed to decrease cognitive load, while VAS did not. Introduction of the worked examples effect in final simulation exercise resulted in statistically significant reductions in both VAS and GSR measures of cognitive load. Limitations and applications of the results are discussed.
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