a Department of Biomedical Dental Sciences , College of Dentistry, Imam Abdulrahman Bin Faisal University , Saudi Arabia.
b School of Health Professions Education , Maastricht University , the Netherlands.
Med Teach. 2019 Mar;41(3):332-339. doi: 10.1080/0142159X.2018.1472372. Epub 2018 May 25.
The use of virtual patients (VPs), due to their high complexity and/or inappropriate sequencing with other instructional methods, might cause a high cognitive load, which hampers learning.
To investigate the efficiency of instructional methods that involved three different applications of VPs combined with lectures.
From two consecutive batches, 171 out of 183 students have participated in lecture and VPs sessions. One group received a lecture session followed by a collaborative VPs learning activity (collaborative deductive). The other two groups received a lecture session and an independent VP learning activity, which either followed the lecture session (independent deductive) or preceded it (independent inductive). All groups were administrated written knowledge acquisition and retention tests as well as transfer tests using two new VPs. All participants completed a cognitive load questionnaire, which measured intrinsic, extraneous and germane load. Mixed effect analysis of cognitive load and efficiency using the R statistical program was performed.
The highest intrinsic and extraneous load was found in the independent inductive group, while the lowest intrinsic and extraneous load was seen in the collaborative deductive group. Furthermore, comparisons showed a significantly higher efficiency, that is, higher performance in combination with lower cognitive load, for the collaborative deductive group than for the other two groups.
Collaborative use of VPs after a lecture is the most efficient instructional method, of those tested, as it leads to better learning and transfer combined with lower cognitive load, when compared with independent use of VPs, either before or after the lecture.
由于虚拟患者（VP）的高度复杂性和/或与其他教学方法的不当排序，可能会导致高认知负荷，从而阻碍学习。
研究涉及三种不同 VP 应用与讲座相结合的教学方法的效率。
从两个连续的批次中，183 名学生中有 171 名参加了讲座和 VP 课程。一组学生先参加讲座，然后参加协作式 VP 学习活动（协作演绎法）。另外两组学生先参加讲座，然后分别参加独立式 VP 学习活动（独立演绎法）或先参加独立式 VP 学习活动（独立归纳法）。所有组都接受了书面知识获取和保留测试以及使用两个新的 VP 进行的转移测试。所有参与者都完成了认知负荷问卷，该问卷衡量了内在、外在和固有负荷。使用 R 统计程序对认知负荷和效率进行了混合效应分析。
独立归纳组的内在和外在负荷最高，而协作演绎组的内在和外在负荷最低。此外，比较表明，协作演绎组的效率明显更高，即结合更低的认知负荷，表现更好，与独立使用 VP 无论是在讲座之前还是之后相比。
与独立使用 VP 相比，讲座后协作使用 VP 是最有效的教学方法，因为它可以在结合更低的认知负荷的情况下带来更好的学习和转移效果。
