Measurement and Management of Cognitive Load in Surgical Education: A Narrative Review

Elsevier

Available online 2 November 2022

Journal of Surgical EducationBackground

Cognitive load should be considered in designing optimal educational programs in health care. Despite the highly demanding nature of surgery and surgical education, a consensus on how to manage cognitive load has not been established. The objective of this review is to map out how recent surgical education research incorporates cognitive load.

Methods

A literature search was performed using keywords related to cognitive load and digital education up to December 2021. Studies published in English relevant to assessment and management of cognitive load in surgical education were included. Terminology, assessment tools, association with different surgical procedures and training modalities, and programs considering cognitive load were reported.

Results

We identified several terms to describe cognitive load. Cognitive load was measured by subjective, self-reported questionnaires and by objective measurements, such as physiological parameters or estimated by reaction time to secondary tasks. Subjective measurements reported cognitive load in one or multiple dimensions. Correlations between subjective and objective measurements were shown in multiple studies. Overall, higher cognitive load was observed in training for more complex tasks and high-fidelity modalities, and among less experienced trainees. Cognitive load theory has been lately incorporated into designing teaching programs.

Conclusions

A broad range of terms and assessment tools were identified for cognitive load. To maximize the learning outcome, management of cognitive load is necessary in surgical education. This review summarizes the current knowledge in assessment and management of cognitive load in surgical education and provides suggestions for future studies.

Section snippetsINTRODUCTION

The introduction of truly novel surgical approaches, such as in minimally invasive (MIS), and endovascular approaches, has taught us that learning these challenging techniques within limited working hours is mentally demanding.1 Because this escalation of demands can lead to frustration and burnout,2 it is important to monitor the mental workload of learners towards different tasks and approaches in surgical education.

Cognitive load theory provides a theoretical framework of the cognitive

METHODS

To identify relevant literature for this review, the authors conducted a preliminary literature review to find keywords related to cognitive load and surgical education (i.e., cognitive load, mental effort, and surgical education). Then, the final search was performed in MEDLINE and Scopus for English language publications. Search strategy in MEDLINE is shown in Appendix 1. Search criteria included peer-reviewed journal articles written in English that reported empirical research. Only articles

Terminology

We identified nine different terms to describe cognitive load: Cognitive Load, Cognitive Workload, Cognitive Cost, Cognitive Demand, Cognitive Effort, Cognitive Engagement, Mental Workload, Mental Strain, and Mental Effort. These terms have been often used interchangeably.

Assessment Tools

A variety of measurements have been used for cognitive load; some studies used multiple assessment tools. Both subjective and objective evaluations are included. Self-report techniques generally use rating scales involving one

DISCUSSION

This review explored studies focusing on cognitive load in surgical education to gain insight on optimizing learners’ cognitive load. Several different terms are used in the literature to describe cognitive load and its measurement. Although some studies demonstrated correlations between cognitive load assessed by self-reported measurements, physiological parameters, and secondary-task techniques, the variety of terminology and assessment tools may be a barrier to understanding and implementing

CONCLUSION

Application of cognitive load theory in surgical education can improve educational programs while diminishing the risk of overload and burnout in learners. This theory has the potential to be applied in many areas to provide better training curricula, working environment, and safer clinical practice. In planning surgical education, educators should understand cognitive load theory and know how to measure cognitive load. These concepts can then be incorporated to develop an optimal learning

Conflict of Interest

The authors have no conflict of interest to disclosure.

Funding Statement

This work is supported by Satoko and Richard Ingram McGill Surgical Education Scholarship.

ACKNOWLEDGEMENTS

We would like to thank Andrea Quaiattini for helping with the development of the search strategy (Librarian at Schulich Library of Physical Sciences, McGill University).

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© 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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