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Understanding the Cognitive Load of Cross-Cover Care: The Resident's Perspective
Catherine McDermott1, Molly McNeely2, Alexandra Vinson3
1is a Clinical Assistant Professor, Departments of Internal Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Extraneous cognitive load, like understaffing and competing duties, significantly hinders resident cross-cover care. Junior residents (PGY-1) also face greater challenges with intrinsic and germane loads compared to senior residents.
Area of Science:
- Medical Education
- Cognitive Psychology
- Healthcare Management
Background:
- Cross-cover is a complex, understudied area in graduate medical education.
- Cognitive load theory offers a framework to understand and mitigate excessive cognitive demands.
- Identifying cognitive load issues can improve resident reasoning and learning during cross-cover shifts.
Purpose of the Study:
- To identify and characterize resident-perceived challenges during cross-cover using cognitive load theory.
- To assess the impact of different types of cognitive load (intrinsic, extraneous, germane) on cross-cover effectiveness.
- To compare the burden of these challenges between junior (PGY-1) and senior (PGY-2+) residents.
Main Methods:
- Anonymous electronic survey distributed to 329 residents across five specialties.
- Residents rated the frequency and adverse event likelihood of cross-cover challenges on Likert scales.
- Challenges were categorized by cognitive load type, and an impact score was calculated.
Main Results:
- Extraneous load challenges, such as hospital understaffing and competing responsibilities, had the highest impact.
- Junior residents (PGY-1) experienced a greater impact from intrinsic load (e.g., knowledge gaps) and germane load (e.g., process delays) compared to senior residents.
- Key impactful extraneous load issues included understaffing, unnecessary notifications, and competing responsibilities.
Conclusions:
- Extraneous cognitive load presents the most significant barrier to effective cross-cover care.
- Junior residents bear a disproportionately higher burden from intrinsic and germane cognitive loads during cross-cover.
- Addressing extraneous load issues and supporting junior residents with intrinsic/germane loads are crucial for improving graduate medical education cross-cover.
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