Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
BMC Med Educ. 2023 May 17;23(1):345. doi: 10.1186/s12909-023-04325-x.
Preclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as "efficient" if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).
We conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017-2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.
The average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.
Cognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.
医学预科教育内容丰富，时间紧迫。翻转课堂方法促进了持久的学习，但仍存在学生准备不充分和工作量大的问题。认知负荷理论将教学设计定义为“有效”，如果学习者可以在没有认知过载的情况下掌握呈现的概念。我们创建了预备评估过程（PREP），以系统地评估和衡量预备材料的认知负荷效率的提高，并评估其对学习时间（时间效率）的影响。
我们在哈佛医学院的一门翻转式多学科课程中进行了这项研究，该课程面向约 170 名一年级学生，采用自然测试后设计。对于每个翻转课程（n=97），我们通过在学生课前完成的简短主题测验中嵌入的 3 项 PREP 调查来评估认知负荷和预备学习时间。在三年（2017-2019）中，我们通过内容专家对材料进行迭代修订，评估了认知负荷和时间效率，以指导迭代修订。通过对材料进行手动审核，验证了 PREP 检测教学设计变化的能力（敏感性）。
调查的平均回复率≥94%。不需要内容专业知识即可解释 PREP 数据。最初，学生不一定将最多的学习时间分配给最难的内容。随着时间的推移，教学设计的迭代变化提高了预备材料的认知负荷和时间效率，效果显著（p<0.01）。此外，这增加了认知负荷与学习时间的整体一致性：学生在不增加总体工作量的情况下，将更多的时间分配给较难的内容，而不是更熟悉、较简单的内容。
在设计课程时，认知负荷和时间限制是需要考虑的重要参数。PREP 过程以学习者为中心，基于教育理论，并且独立于内容知识。它可以为翻转课堂的教学设计提供丰富而可行的见解，而这些见解是传统基于满意度的评估无法捕捉到的。
