Young John Q, Boscardin Christy K, van Dijk Savannah M, Abdullah Ruqayyah, Irby David M, Sewell Justin L, Ten Cate Olle, O'Sullivan Patricia S
Hofstra Northwell School of Medicine, Zucker Hillside Hospital, Glen Oaks, NY, USA.
UCSF School of Medicine, University of California-San Francisco, San Francisco, CA, USA.
SAGE Open Med. 2016 Dec 14;4:2050312116682254. doi: 10.1177/2050312116682254. eCollection 2016.
Advancing patient safety during handoffs remains a public health priority. The application of cognitive load theory offers promise, but is currently limited by the inability to measure cognitive load types.
To develop and collect validity evidence for a revised self-report inventory that measures cognitive load types during a handoff.
Based on prior published work, input from experts in cognitive load theory and handoffs, and a think-aloud exercise with residents, a revised Cognitive Load Inventory for Handoffs was developed. The Cognitive Load Inventory for Handoffs has items for intrinsic, extraneous, and germane load. Students who were second- and sixth-year students recruited from a Dutch medical school participated in four simulated handoffs (two simple and two complex cases). At the end of each handoff, study participants completed the Cognitive Load Inventory for Handoffs, Paas' Cognitive Load Scale, and one global rating item for intrinsic load, extraneous load, and germane load, respectively. Factor and correlational analyses were performed to collect evidence for validity.
Confirmatory factor analysis yielded a single factor that combined intrinsic and germane loads. The extraneous load items performed poorly and were removed from the model. The score from the combined intrinsic and germane load items associated, as predicted by cognitive load theory, with a commonly used measure of overall cognitive load (Pearson's r = 0.83, p < 0.001), case complexity (beta = 0.74, p < 0.001), level of experience (beta = -0.96, p < 0.001), and handoff accuracy (r = -0.34, p < 0.001).
These results offer encouragement that intrinsic load during handoffs may be measured via a self-report measure. Additional work is required to develop an adequate measure of extraneous load.
在交接班过程中提高患者安全仍然是公共卫生的一个优先事项。认知负荷理论的应用带来了希望，但目前受到无法测量认知负荷类型的限制。
开发并收集一份经过修订的自我报告量表的效度证据，该量表用于测量交接班过程中的认知负荷类型。
基于先前发表的研究、认知负荷理论和交接班方面专家的意见，以及与住院医师进行的出声思维练习，开发了一份经过修订的交接班认知负荷量表。交接班认知负荷量表包含有关内在负荷、外在负荷和相关负荷的项目。从一所荷兰医学院招募的二年级和六年级学生参与了四次模拟交接班（两个简单病例和两个复杂病例）。在每次交接班结束时，研究参与者分别完成交接班认知负荷量表、帕阿斯认知负荷量表，以及关于内在负荷、外在负荷和相关负荷的一个整体评分项目。进行了因子分析和相关分析以收集效度证据。
验证性因子分析得出一个将内在负荷和相关负荷合并的单一因子。外在负荷项目表现不佳，被从模型中剔除。如认知负荷理论所预测，合并的内在负荷和相关负荷项目得分与常用的整体认知负荷测量指标相关（皮尔逊相关系数r = 0.83，p < 0.001）、与病例复杂性相关（β = 0.74，p < 0.001）、与经验水平相关（β = -0.96，p < 0.001），以及与交接班准确性相关（r = -0.34，p < 0.001）。
这些结果表明，通过自我报告测量来测量交接班过程中的内在负荷可能是可行的。还需要开展更多工作来开发一种合适的外在负荷测量方法。
