Cognitive Load Theory: how to apply it in your practice as a medical educator Justin Sewell, MD, MPH

Cognitive Load Theory (CLT) is a learning theory focused on the limited capacity of working (or short-term) memory. When the cognitive load associated with learning task exceeds working memory capacity, learning and memory suffer. Figure adapted from Young JQ. Med Teach 2014.

There are three types of cognitive load. Intrinsic load arises from essential components of learning task. Extraneous load occurs when learners pay attention to non-essential parts of learning environment like distractions and confusing instructions or teaching. Germane load occurs when learners use cognitive processes to form learning schemas.

To optimize learning, intrinsic load should be matched to the prior experience and level of the learner, extraneous load should be minimized, and germane load should be optimized. The literature suggests approaches to manage these goals within both classroom and workplace settings.

Goal Ideas for classroom learning Ideas for workplace learning Match intrinsic load • Match complexity of task to learners’ prior • Prepare learners for workplace expectations experience, progressively increasing • Use simulation to familiarize learners with complexity workplace tasks • Use worked examples with early learners • Use part-task approach for early learners • Avoid split-attention effect • Identify aspects of workplace with high • Use 4C/ID approach to design tasks potential for cognitive overload • Use 4C/ID approach to design tasks Minimize extraneous load • Identify and minimize distractions • Identify and minimize distractions • Design clear instructions and • Avoid tangential/unrelated conversations communicate clear expectations • Familiarize learners with workplace • Critically evaluate teaching materials for information interfaces, graphical displays, clarity and relevance and other technologies • Engineer workplace environments to minimize distractions Optimize germane load • Facilitate mixed or random practice over blocked practice • Guide learners where to direct limited working memory resources • Teach learners to use metacognitive techniques to monitor learning • Teachers share learning schema (“this is how I approach this complex task”) Overall recommendations • Teach learners and teachers about cognitive load, including how to recognize cognitive overload and how to communicate feelings of cognitive overload • Monitor for, and mitigate effects of, learner fatigue • Attend to learner emotion, especially in crisis or other high-stress situations REFERENCES: Van Merrienboer JJG, Kirschner P. 2013. Ten steps to complex learning: A systematic approach to four-component instructional design. New York, London: Routledge. Young JQ et al. Cognitive Load Theory: Implications for medical education: AMEE Guide No. 86. Med Teach 2014;36(5):371-84.

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