Instructional Design Unlocks the Effects of Prior Knowledge Activation in Surgical Education

Prior knowledge activation (PKA) has long been considered a cornerstone of surgical education, yet recent meta-analyses reveal conflicting evidence regarding its effectiveness. This study examined when PKA enhances surgical education by investigating the role of different information processing channels outlined in the Cognitive Theory of Multimedia Learning.

In a randomized experiment, participants viewed laparoscopic minimally invasive surgery (MIS) training videos under factorial conditions manipulating PKA (via preparatory anatomical images), visual channel activation (via visual cues), and auditory channel activation (via verbal cues). Learning outcomes were assessed through landmark identification tasks. Data were analyzed using factorial ANOVA with covariates including baseline prior knowledge and sociodemographics.

Participants were recruited within their medical education program at an affiliated hospital of the Charité Berlin during 2024.

A total of 151 fourth-year medical students were included (Mean_age = 26 years ± 4 [standard deviation], 93 females, 57 males, 1 non-binary).

As expected, PKA alone showed no significant effect on learning. However, a new interaction emerged between PKA and verbal cues (η_p² = 0.04). Students benefited from PKA only when verbal cues were simultaneously provided during training. Without concurrent verbal instructions, PKA provided no learning advantage and in some cases even slightly hindered learning.

These findings challenge the widespread assumption that PKA is universally beneficial as a standalone intervention. Instead, PKA effectiveness seems to depend on instructional context, specifically the presence of concurrent verbal instruction. This may involve explicitly referencing activated knowledge during instruction, using narration to scaffold connections that prompt learners to integrate prior understanding with new material. Designing for such alignment seems key to realize the benefits of PKA in multimedia learning environments.