Cognitive load has a crucial role in healthcare simulation and influences how all clinicians process and retain information in clinical simulation based educational experiences. In regards to the management of experienced clinicians’ educational experiences, the management of cognitive load as best able means that clinical simulation-based education will enhance learning rather than overwhelm participants which includes the most experienced of the team. This article by Erin Carn-Bennett, RN, MSN will explore the concept of management of cognitive load for the experienced clinician within a healthcare simulation scenario and debrief.
The management of an experienced clinicians cognitive load begins with the process to understand cognitive load theory and also the implementation of these strategies to be able to optimize learning. Through these continuous processes as a clinical simulation educator, this can assist to create effective and also engaged clinical simulation experiences. There is difficulty in interprofessional simulation experiences to manage the cognitive load to meet the educational needs of all team members from the most junior through to the most senior members of the team.
The Importance to Understand Cognitive Load Theory
Cognitive load theory is a description of how the human memory processes information and categorizes cognitive demands into intrinsic, extraneous, and germane loads. Intrinsic load relates to the inherent complexity of the material that is learned. For example, advanced procedures or rare medical cases naturally impose a high intrinsic load due to the complex nature.
Extraneous load, results from poor instructional design and unnecessary distractions such as unclear guidance, which can then go on to hinder learning. Germane load refers to the cognitive effort to be able to integrate new knowledge into pre-existed mental frameworks and long-term retention and skill development. In healthcare simulation, an optimal learning zone will balance all three of these types of cognitive loads. The intention with forward planning and structures to minimize experienced participants extraneous load while also optimizing the germane load.
Challenges of Cognitive Load Management for Experienced Clinicians
Experienced clinicians will usually already have well-developed mental schemas for patient care. However, there is no immunity to cognitive overload for all healthcare staff despite their level of experience or role on the day of the clinical simulation experience. The complexity of clinical simulation scenarios alongside time constraints, high stress decision-making and team management can place large demands on working memory.Factors within control of the clinical simulation facilitators control require careful consideration. Some examples include: an overabundance or not enough scenario details, unclear learning objectives or an excessive amount of interruptions can detract from the intended educational experience.
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Unrealistic pace of a case can potentially cause cognitive dissonance which can affect participant engagement and attention retention.Healthcare simulation scenario design which is carefully considered and tailored to meet learning objectives for everyone’s expertise level is essential. Participants on the course should have a range of experience levels as per usual clinical practice and also so that the experienced clinicians cognitive load is challenged to engage teamwork principles and also ensure best outcomes for the patient.
For experienced clinicians, challenges often do not surface from medical knowledge foundations but are more applicable to teamwork management. Although an experienced clinician may have all the medical management answers, there still needs to be relay of this information to the rest of the team. The communication of vital information such as prioritisation of certain clinical care tasks and management of and orchestration of the team to provide clinical care means that despite their experience their cognitive load will still be increased if managed appropriately by healthcare simulation facilitators.
Strategies to Optimize Cognitive Load in Healthcare Simulation
Realistic clinical simulation scenarios are valuable but excessive complexity can also hinder learning for participants. Instead of overwhelming clinical simulation participants with multiple concurrent challenges, scenarios should remain focused on key learning objectives. For experienced clinicians, high-fidelity healthcare simulations scenarios should be based on decision-making, communication, prioritization, and teamwork rather than excessive procedural steps.
A structured pre-brief will assist to set the stage for an effective healthcare simulation scenario experience. A clear outline of the session’s objectives and times of the clinical simulation scenario and debrief helps clinicians allocate their cognitive resources efficiently. For example, if the primary goal is to refine crisis resource management, unnecessary interruptions and also distractions should be minimized to allow for full engagement and immersion.
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Unnecessary distractions, such as irrelevant alarms, overly complex instructions, or unrealistic scenario case presentations, should be minimized. While some level of stress inoculation is beneficial, excessive cognitive noise can reduce germane load and prevent clinicians from full engagement with the educational process. Although minor segments of the overall scenario design, these factors should always be considered due to the impact that can occur overall.
Debriefing plays a crucial role in the transference of acquired experiential knowledge from working memory to long-term memory. Guided reflection that is facilitated by experienced clinical simulation educators can assist participants to be able to integrate new insights into their knowledge base. The use of structured debriefing models, such as the PEARLS or advocacy-inquiry approach, ensures useful discussion and consolidation of learning from all team members perspectives. For the experienced clinician, to hear the perspectives of other team members and their challenges within the scenario can often be the most profound space of reflection for them in the experience.
Experienced clinicians use pattern recognition to lean on and to make rapid, informed decisions in clinical practice. Healthcare simulation scenarios should reinforce these usual patterns through exposure for participants to scenarios that strengthen clinical diagnostic and treatment schemas. Repeated exposure to scenarios with a variety of presentations will help to enhance the experienced clinicians decision-making efficiency. This process is also then role modelled to other team members in the scenario and will assist with others knowledge acquisition and transference to clinical cases outside of the scenario.
Healthcare simulation scenarios should be designed to reflect realistic cognitive demands and not reach participant decision fatigue. The implementation of progressive scenario complexity, where complexity gradually builds will allow the experienced clinician to adapt in the moment without overwhelm. Breaks that are timetabled at known intervals can help reset cognitive load and also maintain focus and engagement.
For the experienced clinician, clinical simulation scenarios should closely mirror real-world clinical environments. This will enhance the relevance of the clinical simulation scenario and participant engagement. The use of real clinical workflows, equipment, and realistic patient presentations allows for an easier transition from simulated to real-world practice and cognitive integration.
The management of cognitive load in healthcare simulation scenarios is essential for optimization of learning for experienced clinicians. The balance of intrinsic, extraneous, and germane load by healthcare simulation educators can create experiences that enhance expertise but do not overwhelm participants. Thoughtful scenario design, structured debriefing and clear learning objectives contribute to an environment that supports long-term knowledge retention.
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