Performance of a cognitive load inventory during simulated handoffs: Evidence for validity

Area of Science:

• Medical education research
• Human factors engineering
• Cognitive psychology

Background:

• Patient safety during clinical handoffs is a critical public health concern.
• Cognitive load theory offers a framework for understanding performance during handoffs, but lacks validated measurement tools.
• Existing methods cannot adequately differentiate types of cognitive load experienced by healthcare professionals.

Purpose of the Study:

• To develop and validate a revised self-report inventory for measuring cognitive load types specifically during medical handoffs.
• To provide a reliable instrument for assessing intrinsic, extraneous, and germane cognitive load in this context.

Main Methods:

• A revised Cognitive Load Inventory for Handoffs (CLIH) was developed based on expert input and think-aloud exercises.
• Second- and sixth-year medical students participated in simulated handoffs (simple and complex).
• Participants completed the CLIH, Paas' Cognitive Load Scale, and global ratings post-handoff; factor and correlational analyses were performed.

Main Results:

• Confirmatory factor analysis supported a single factor combining intrinsic and germane loads; extraneous load items were removed due to poor performance.
• The combined intrinsic/germane load score correlated significantly with overall cognitive load, case complexity, and level of experience.
• Handoff accuracy was inversely correlated with the measured intrinsic and germane cognitive load.

Conclusions:

• The revised CLIH shows promise for measuring intrinsic cognitive load during handoffs using a self-report method.
• Further research is necessary to develop a robust measure for extraneous cognitive load in this setting.
• Improved measurement of cognitive load can contribute to enhanced patient safety protocols during clinical transitions.