Cognitive load theory in simulations to facilitate critical thinking in radiography students

Background. Problem solving and critical thinking are top future skills. High-fidelity simulations improve critical thinking, but also increase students' cognitive load, possibly limiting their learning. Educators should therefore consider learning outcomes, problems that require critical thinking, the relationship between working and long-term memory, and intrinsic and extraneous cognitive loads when developing simulation scenarios. Objective. To report on the application of cognitive load theory (CLT) and students' responses in terms of problem solving and new insights during and after a simulation experience. Methods. A high-fidelity simulation, targeting multilevel communication, teamwork and prioritisation of learning outcomes, was designed according to CLT. Eighty students participated in presimulation knowledge, skills and attitudes acquisition and 10 participated in the simulation. A qualitative descriptive design was followed and data were collected through video/audio recordings of the simulation and reflection session, supported by educator and critical observer notes. Qualitative content analysis allowed comprehensive summarisation of students' problem-solving abilities and emerging new insights. Results. Eighty second-year radiography students formed the target population, with 10 simulation participants comprising the sample. Communication with health professionals was good, but lacking towards patients. Intraprofessional team collaboration was suboptimal, but interprofessional team collaboration was good. Students were mostly unfamiliar with the prioritisation responsibility. Upon reflection, students came to new insights regarding teamwork and prioritisation. Conclusion. After application of CLT, critical thinking to facilitate problem solving during simulation was suggested and post-simulation reflection facilitated new insights. The exposure of large groups to the benefits of simulation validates further investigation.