Dramatic changes to healthcare systems globally have led to increased use of simulation as a pedagogical tool in health professions education. An impressive evidence base has accrued in support of simulation-based education and training, leaving little doubt that ‘it works’. As a result, scholarship in the field is shifting toward clarifying the features of simulation instructional design that optimize learning outcomes. Many scholars advocate for the use of established instructional frameworks to advance this agenda.
In this dissertation, the author employed Cognitive Load Theory (CLT) and related instructional frameworks to investigate the relationship between task complexity, cognitive load (CL), and learning among novices engaged in simulation-based procedural skills training. Phase one of this research program established the sensitivity of two CL measures (subjective ratings of mental effort and secondary task performance) to predicted differences in load related to learners’ proficiency with a procedural skill and simulation training task complexity. As a result, these measures may be used to track changes in CL during simulation training and distinguish between the CL imposed by different instructional designs.
Phase two operationalized Elaboration Theory (ET) to identify the task-conditions that impact training complexity of a prototypical procedural skill (lumbar puncture). The results of this phase demonstrate the methodological and theoretical advantages of combining a structured instructional design framework with expert consensus (via the Delphi technique) when developing healthcare simulation curricula.
The final phase examined the competing effects of task complexity and context similarity on novices’ skills transfer. The results demonstrate that higher task complexity increases load during training, which may impede initial learning and subsequent transfer of skills ‘peripheral’ to the task (e.g. sterility). However, the findings also suggest that other variables (i.e. context or information processing specificity and learners strategies to manage load) may have important effects on these learning outcomes.
At a broader level, the systematic, multi-phased approach employed in this dissertation provides a framework to guide future research in simulation instructional design. Furthermore, the application of CLT in this work exposes strengths and shortcomings in the theory that educators and researchers should be aware of, and highlights avenues for future inquiry.Ph.D
