Dworkis Daniel A, Jain Aarti, Wolfe Marissa, Sanko Stephen, Arora Sanjay
Department of Emergency Medicine Keck School of Medicine of USC Los Angeles California USA.
AEM Educ Train. 2022 Jun 1;6(3):e10742. doi: 10.1002/aet2.10742. eCollection 2022 Jun.
Emergency medicine (EM) physicians sometimes respond to critical events outside the emergency department. To prepare for these complex cases-typically called "rapid responses" (RRs)-EM residents receive simulation-based training involving four practice tasks and three exam tasks during a 1-day session. Cognitive load (CL) theory describes how humans function with limited working memories to perform complex tasks. RRs are expected to generate high levels of CL, but the profile of CL across providers and RR cases is not well understood. In this study, we analyzed resident's CL during RR training. We hypothesized variations in CL across individual and case and that exam cases would cause higher CLs than practice cases.
Residents anonymously self-reported CL levels after each case using the Paas scale, a single-item, 9-point scale from "very, very low CL" to "very, very high CL." To examine case-based differences in CL, data were rescaled by individual residents. "High CL" was defined as a score of 9/9.
Among 18 residents participating, CLs ranged from 4 to 9, with median of 7 and interquartile range of 7-8. While many cases showed bell curve-like distributions of CLs, one case-a bleeding tracheostomy-showed a rightward skew reflecting higher levels of CL. No significant difference was found in CL between practice and exam cases. There were 20 reports (16.5%) of "high" CL with variation across residents (0/7 [0%] to 5/6 [83.3%] cases) and across cases (1/18 [5.6%) to 8/18 [44.4%]).
The CL that EM residents experienced did show considerable interpersonal and intercase variation, but there was no significant difference between practice and exam cases. These results highlight several questions about how to optimally design future training, including how best to balance low and high CL training cases and which cases may require further training.
急诊医学（EM）医生有时需要对急诊科以外的危急事件做出响应。为了应对这些复杂病例——通常称为“快速反应”（RRs）——急诊住院医师在为期一天的课程中接受基于模拟的培训，包括四项实践任务和三项考核任务。认知负荷（CL）理论描述了人类如何利用有限的工作记忆来执行复杂任务。RRs预计会产生高水平的CL，但不同提供者和RR病例的CL情况尚不清楚。在本研究中，我们分析了住院医师在RR培训期间的CL。我们假设个体和病例之间的CL存在差异，并且考核病例会比实践病例导致更高的CL。
住院医师在每个病例后使用帕阿斯量表匿名自我报告CL水平，该量表是一个单项9分制量表，从“非常非常低的CL”到“非常非常高的CL”。为了研究基于病例的CL差异，数据按个体住院医师进行了重新缩放。“高CL”定义为9/9分。
在参与的18名住院医师中，CL范围为4至9，中位数为7，四分位间距为7 - 8。虽然许多病例显示出CL的钟形曲线分布，但一个病例——出血性气管切开术——显示出向右的偏态，反映出更高水平的CL。实践病例和考核病例之间的CL没有显著差异。有20份（16.5%）“高”CL报告，在住院医师之间（0/7 [0%]至5/6 [83.3%]病例）和病例之间（1/18 [5.6%]至8/18 [44.4%]）存在差异。
急诊住院医师经历的CL确实显示出相当大的人际和病例间差异，但实践病例和考核病例之间没有显著差异。这些结果突出了几个关于如何优化未来培训的问题，包括如何最好地平衡低CL和高CL培训病例，以及哪些病例可能需要进一步培训。
