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How Many Is Too Many? Using Cognitive Load Theory to Determine the Maximum Safe Number of Inpatient Consultations for

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    Summary
    This summary is machine-generated.

    Trainees experience distracting cognitive load (EL) from interruptions, extraneous information, and technology, especially after four inpatient consultations. A safety limit of four consultations per shift is proposed to mitigate cognitive overload and enhance patient safety.

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    Area of Science:

    • Medical Education
    • Patient Safety
    • Cognitive Psychology

    Background:

    • Extraneous load (EL), a measure of cognitive distraction, can indicate a lack of focus and potentially compromise patient safety during medical training.
    • Assessing trainees during inpatient consultations offers a model to study the impact of cognitive load on performance and safety.
    • Optimizing inpatient consultation services and rotations is crucial for enhancing patient safety and trainee education.

    Purpose of the Study:

    • To quantify the relationship between the number of inpatient consultations and trainees' perceived extraneous load (EL).
    • To provide data-driven recommendations for clinical and educational leaders to optimize consultation services.
    • To mitigate potential patient safety risks associated with trainee cognitive overload.

    Main Methods:

    • In 2019, extraneous load (EL) data were collected from internal medicine fellows and psychiatry residents across five University of California hospitals using the Consult Cognitive Load instrument.
    • In 2023, a Wright map was utilized to compare participants' EL data with the number of prior initial consultations completed during a shift.

    Main Results:

    • Out of 326 trainees, 139 (43%) completed the EL survey.
    • Trainees reported that interruptions were distracting even from the first consultation.
    • After four consultations, trainees strongly agreed that interruptions were distracting and agreed that emotions, extraneous information, and technology contributed to cognitive overload.

    Conclusions:

    • A quantitative, empirically derived safety limit of four new inpatient consultations per trainee per shift is proposed to prevent cognitive overload and support patient safety.
    • Clinical and educational leaders can adapt this proposed limit based on their specific practice settings.
    • The methodology, integrating cognitive load assessment with item response theory, can be applied to patient safety research in other medical domains.