Managing cognitive load and enhancing metacognitive learning in postgraduate training and practice

The phase of postgraduate medical training and practice is notoriously difficult because junior physicians or medical residents find themselves stuck in a tenuous situation of having to handle newfound heavy clinical work and responsibilities while scaling a steep learning curve on the job. In recent years, increased focus on diagnostic error has led to increasing calls to re-evaluate how clinical reasoning is cultivated in medical training, with emphasis on pedagogical interventions that aim to sharpen clinical judgments while minimising cognitive errors. Against this backdrop, we herein review the concept of "cognitive load" in post-graduate training and clinical practice, and discuss its relevance to effective metacognitive learning amidst clinical duties and to optimisation of medical decision-making in real-world settings by reducing cognitive errors in the form of bias and noise. We then outline pedagogical and workplace-based interventions that may target the twin problem of intrinsic and extrinsic cognitive load in clinical learning and work, and specifically advocate metacognitive-based practices that promote iterative cycles of cognitive schema re-calibration and professional development.