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Cognitive Load Effect on Intraoperative Learning - A Randomized Trial in Simulation-Based Settings
Mohammed F Shaheen1, Abdulrahman Alhabeeb2, Fareeda Mukhtar3
1College of Medicine, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Hepatobiliary Sciences Department and Organ Transplant Center, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia.
Background:
Surgical trainees in the operating room (OR) face numerous stressful distractions, that increase cognitive load (CL) and potentially hinder learning. While the challenging nature of the OR environment is known, its specific effects on CL and knowledge acquisition in the setting of intraoperative teaching remain underexplored. This study addresses this gap.
Methods:
A randomized controlled trial was conducted with 61 medical students at King Saud bin Abdulaziz University for Health Sciences. Participants were divided into a control group (CG), exposed to a low-stress simulation, and an experimental group (EG), subjected to a noisy OR simulation. Both groups participated in a chest tube insertion scenario with intraoperative teaching. CL was measured subjectively using the Modified Multidimensional Cognitive Load Scale (m-MCLS) and objectively via heart rate monitoring and a tactile response task (TRT). Postsimulation quiz scores assessed knowledge acquisition.
Results:
The EG exhibited significantly higher extraneous CL due to environmental noise (p < 0.001). Objective measures supported this; the EG showed more skipped TRT responses (19% vs. 5.3%, p < 0.001), indicating attentional lapses. Quiz scores were also lower in the EG (57.4% vs. 67.5%, p = 0.02), reflecting impaired knowledge acquisition. Prior meaningful hands-on exposure improved performance on univariate analysis but lost significance after accounting for group assignment.
Conclusion:
Simulating a realistic OR environment intensified cognitive load and trainees impaired knowledge acquisition. Incorporating CL management strategies into surgical training may enhance trainee performance and adaptability in similar real-time encounters. Further research should explore optimal simulation realism levels and interventions to mitigate negative impacts on OR knowledge acquisitions.
