Measuring cognitive load during procedural skills training with colonoscopy as an exemplar

Area of Science:

• Medical Education
• Cognitive Psychology
• Procedural Skill Acquisition

Background:

• Cognitive load theory is crucial for understanding working memory limitations in learning.
• Measuring cognitive load during procedural training is not well-established.
• Colonoscopy training is a complex procedural skill where cognitive load can impact learning.

Purpose of the Study:

• To develop and validate a self-report instrument, the Cognitive Load Inventory for Colonoscopy (CLIC), based on cognitive load theory.
• To measure three distinct types of cognitive load: intrinsic, extraneous, and germane.
• To provide evidence for the validity of the CLIC in assessing cognitive load during colonoscopy training.

Main Methods:

• A multi-step process was used to develop the 19-item CLIC, including global rating items and demographics.
• A cross-sectional survey was electronically administered to 1061 gastroenterology trainees in the USA.
• Exploratory and confirmatory factor analyses were used to determine the instrument's factor structure and assess model fit.

Main Results:

• A total of 477 trainees participated in the study.
• Confirmatory factor analysis supported a three-factor model aligning with intrinsic, extraneous, and germane cognitive load.
• The CLIC demonstrated high internal consistency and correlated as expected with training year and global cognitive load assessments.

Conclusions:

• The Cognitive Load Inventory for Colonoscopy (CLIC) is a valid instrument for measuring three types of cognitive load during colonoscopy training.
• The methodology used for CLIC development can be adapted for other medical education procedural training settings.
• The CLIC can aid in understanding and optimizing cognitive load during the acquisition of procedural skills in medical education.