Optimizing Cognitive Load for Learning and Efficiency

Posted on by Guest Author

Contributor: Amie Davis

1- DECREASE INTRINSIC LOAD – “COMPLEXITY OF NEW INFORMATION”
• Use a spiral curriculum where learners are introduced and re-introduced to increasingly complex topics and encounters
• Encourage continuity with patients over time (allowing familiarization with complexity)
• ”Chunk” or “Sort” encounter into smaller pieces (e.g. Sort information by system)

2. DECREASE EXTRANEOUS LOAD – “UNNECESSARY AND DISTRACTING INFORMATION”
• EXTERNAL EXTRANEOUS LOADS
Optimize learning environment: Decrease interruptions (pages, message alerts, voice interruptions) during a tasks. Ensure all equipment is available and ready including technology and charting equipment. Clearly mark/hold times for tasks that can be seen and respected by others

• INTERNAL EXTRANEOUS LOADS
Manage fatigue – Micro-breaks between tasks to allow re-focus, allow time for nutrition and “bio-breaks”, ensure adequate time held in the day for the tasks needed (so that can be present and not focused on “what comes next/feeling rushed”), wear clothing that is comfortable and adjustable to temperature throughout the day

3. INCREASE GERMANE LOAD – “LINKING NEW INFORMATION WITH CURRENT/PREVIOUSLY STORED INFORMATION SCHEMAS”
• Introduce learning aids (e.g. Mnemonics, rhymes, common links, pattern recognition)
• Link to similar previous presentations or patients seen in the past (also increases spiral learning)
• Use low-fidelity simulation to high fidelity (patient encounters) when possible (e.g. Practice first)


References:
1. Atkinson,R.C and Shiffrin, R.M.(1968). Human memory: A proposed system and its control processes. The psychology of learning and motivation Vol.2 (89-195)
2. Baddeley, A.D. Working Memory. Phil. Trans.R.Soc.Lond.B. Vol 302,311-324(1983)
3. Steven E Roskos, Laurie Fitzpatrick, Bengt Arnetz, Judy Arnetz, Shiva Shrotriya, Elizabeth Hengstebeck, Complex patients’ effect on family physicians: high cognitive load and negative emotional impact, Family Practice, Volume 38, Issue 4, August 2021, Pages 454–459,https://doi.org/10.1093/fampra/cmaa137

Info-morsal – Cognitive LoadDownload

Learning Through Error: Guiding Residents in Conversations About Mistakes

Posted on by Guest Author

Contributor: Nathalie Desbois

Medical errors are an inevitable part of residency training and remain a challenge throughout a physician’s career. These events can have profound psychological and interpersonal consequences for our residents, including sadness, guilt, reduced self-confidence, and strained personal relationships. Despite the high prevalence and emotional impact of such errors, formal education on error management and professional recovery is often lacking in residency training. Barriers to fully disclosing an error include the culture of perfection in medicine, the psychological impact of facing mistakes and apologizing for them, ethical complexities (level of harm done), lack of formal training on disclosing medical error, and fear of malpractice litigation (1). Primary preceptors are in a unique position to guide residents through these experiences by fostering a supportive learning environment, modeling appropriate responses to errors, and facilitating reflective practice. Targeted educational interventions—such as a faculty-led series of three one-hour sessions incorporating personal narratives, guided reflection, small-group discussions, and role-playing exercises—have demonstrated substantial improvements in residents’ confidence in managing medical errors, increasing from 46% pre-intervention to 93% post-intervention (1). The authors hypothesize that intentional integration of this curriculum into daily practice is critical to fostering a growth response among physicians, and effecting better outcomes for patients.

Take-away Tidbits:
1. Medical errors are common and emotionally impactful for residents and practicing physicians, often leading to psychological distress and strained personal relationships.

2.There is a lack of formal training in residency programs on how to manage and recover from medical errors, which contributes to underreporting due to fear of repercussions.

3. Mentorship, particularly from primary preceptors, along with structured educational sessions can significantly improve residents’ confidence in handling medical errors promoting a culture of openness and support.

Resources:

(1)Adkins, S., Reynolds, P., Rabah, K., & Flowers, S. (2024). Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors. MedEdPORTAL, 20, 11451.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11325321

(2)Fatima, S., Soria, S., & Esteban-Cruciani, N. (2021). Medical errors during training: how do residents cope?: a descriptive study. BMC Medical Education, 21(1), 408.

https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02850-1