Haji Faizal A, Cheung Jeffrey J H, Woods Nicole, Regehr Glenn, de Ribaupierre Sandrine, Dubrowski Adam
Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
Med Educ. 2016 Sep;50(9):955-68. doi: 10.1111/medu.13086.
Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded.
In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training.
Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures.
In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80).
Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.
基于逼真度与学习迁移之间的所谓关系，逼真度被广泛视为模拟教学设计的一个重要元素。然而，更高水平的逼真度可能会将任务复杂性增加到新手认知资源过载的程度。
在本实验中，我们研究了任务复杂性变化对新手在基于模拟的程序技能训练期间的认知负荷和学习的影响。
38名医科学生被随机分配到简单或复杂腰椎穿刺（LP）任务的模拟训练中。参与者完成了该任务的四次练习试验（技能习得）。休息10天后，所有参与者完成了一次关于其分配任务的额外试验（保持）以及一次关于设计得类似于复杂任务的“非常复杂”模拟试验（迁移）。我们使用多种测量方法评估了每次试验中的LP表现和认知负荷。
在两个组中，LP表现在技能习得期间均显著提高（p≤0.047，f = 0.29 - 0.96），并在保持阶段得以维持。在这些阶段中，简单任务组与复杂任务组相比表现更优（p≤0.002，d = 1.13 - 2.31）。在技能习得期间，简单任务组的认知负荷显著下降（p < 0.009，f = 0.48 - 0.76），而复杂任务组则没有，并且在保持阶段保持较低水平（p≤0.024，d = 0.78 - 1.39）。在保持和迁移之间，简单任务组的LP表现下降且认知负荷增加，而复杂任务组的两者均保持稳定。在迁移时，除了简单任务组的无菌操作违规显著更少外（p = 0.023，d = 0.80），在LP表现和认知负荷方面未观察到组间差异。
在技能习得和保持期间，任务复杂性降低与更优的LP表现及更低的认知负荷相关，但在向更复杂任务迁移时结果不一。这些结果表明，任务复杂性是一个重要因素，可能（通过认知过载）介导教学设计元素（如逼真度）与基于模拟的学习结果之间的关系。
