Effectiveness of simulation-based training for obstetric internal medicine: Impact of cognitive load and emotions on knowledge acquisition and retention.

BACKGROUND: Simulation-based training's impact on learning outcomes may be related to cognitive load or emotions during training. We evaluated the association of validated measures of cognitive load and emotion with learning outcomes in simulation-based obstetric internal medicine cases. METHODS: All internal medicine learners (n = 15) who completed the knowledge test pre-training, post-training (knowledge acquisition), and at 3-6 months (knowledge retention) for all three simulation cases were included. RESULTS: Mean knowledge scores differed over time in all three cases (p < 0.0001 for all). Knowledge retention scores were significantly higher only for cases 1 and 3. Cognitive load associated with frustration was positively associated with knowledge acquisition for case 2 (beta = 5.18, P = 0.007), while excitement was negatively associated with knowledge retention in case 1 (beta = -33.07, p = 0.04). CONCLUSION: Simulation-based education for obstetric internal medicine can be effective in select cases. Attention to cognitive load and emotion may optimize learning outcomes.

Cognitive Load Theory for debriefing simulations: implications for faculty development.

The debriefing is an essential component of simulation-based training for healthcare professionals, but learning this complex skill can be challenging for simulation faculty. There are multiple competing priorities for a debriefer's attention that can contribute to a high mental workload, which may adversely affect debriefer performance and consequently learner outcomes. In this paper, we conceptualize the debriefer as a learner of debriefing skills and we discuss Cognitive Load Theory to categorize the many potential mental loads that can affect the faculty debriefer as learner. We then discuss mitigation strategies that can be considered by faculty development programmes to enhance professional development of debriefing staff.

The attributes of an effective teacher differ between the classroom and the clinical setting.

Most training programs use learners' subjective ratings of their teachers as the primary measure of teaching effectiveness. In a recent study we found that preclinical medical students' ratings of classroom teachers were associated with perceived charisma and physical attractiveness of the teacher, but not intellect. Here we explored whether the relationship between these variables and teaching effectiveness ratings holds in the clinical setting. We asked 27 Internal Medicine residents to rate teaching effectiveness of ten teachers with whom they had worked on a clinical rotation, in addition to rating each teacher's clinical skills, physical attractiveness, and charisma. We used linear regression to study the association between these explanatory variables and teaching effectiveness ratings. We found no association between rating of physical attractiveness and teaching effectiveness. Clinical skill and charisma were independently associated with rating of teaching effectiveness (regression coefficients [95 % confidence interval] 0.73 [0.60, 0.85], p < 0.001 and 0.12 [0.01, 0.23], p = 0.03, respectively). The variables associated with effectiveness of classroom and clinical teachers differ, suggesting context specificity in teaching effectiveness ratings. Context specificity may be explained by differences in the exposure that learners have to teachers in the classroom versus clinical setting-so that raters in the clinical setting may base ratings upon observed behaviours rather than stereotype data. Alternatively, since subjective ratings of teaching effectiveness inevitably incorporate learners' context-specific needs, the attributes that make a teacher effective in one context may not meet the needs of learners in a different context.