Debriefing Is Germane to Simulation-Based Learning: Parsing Cognitive Load Components and the Effect of Debriefing

Introduction Cognitive load (CL) theory provides a framework for optimizing learning in simulation. Measures of CL components (intrinsic [IL], extraneous [EL] and germane [GL]) may inform simulation design but lack validity evidence. The optimal timing for CL assessment and contributions of debriefing to CL are not established. Methods This prospective observational study assessed self-reported CL for first-year anesthesiology residents during 10 individual-learner simulations. Following each simulation and before debriefing, participants completed 4 CL measures: Paas scale, National Aeronautics and Space Administration-Task Load Index (NASA-TLX), Cognitive Load Component questionnaire (CLC) and Cognitive Load Assessment Scales in Simulation (CLAS-Sim). After debriefing, participants repeated the Paas and CLAS-Sim. Results Twenty-nine first-year anesthesiology residents participated. Correlations were significant among all total CL measures (r range = 0.51-0.69) and between CLC and CLAS-Sim IL (r = 0.66), EL (r = 0.41), and GL (r = 0.61) (all P < 0.01). We observed a significant interaction between total CL measures and case complexity, and a significant main effect of case complexity for CLC and CLAS-Sim IL, with no main effect for IL measure. The CLAS-Sim EL was higher (P = 0.001) than respective CLC scales across cases, with no difference for GL. Participants reported higher CLAS-Sim GL after (versus before) debriefing (P < 0.001), with no difference in IL, EL, or Paas scores. Conclusions This study provides further validity evidence for the CLAS-Sim and demonstrates generalizability in a different population of medical trainees. The CLAS-Sim GL increases following debriefing, reflecting expected learning, demonstrating initial GL scale validity evidence.