Cited by 299Innovations in Medical EducationVisual and Cognitive Learning ProcessesClinical Reasoning and Diagnostic Skills

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The evolution of cognitive load theory and its application to medical education

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Leppink, Jimmie, Van den Heuvel, Angelique·2015·Perspectives on Medical Education

DOI 10.1007/s40037-015-0192-xPMC PMC4456454

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Abstract

Cognitive Load Theory (CLT) has started to find more applications in medical education research. Unfortunately, misconceptions such as lower cognitive load always being beneficial to learning and the continued use of dated concepts and methods can result in improper applications of CLT principles in medical education design and research. This review outlines how CLT has evolved and presents a synthesis of current-day CLT principles in a holistic model for medical education design. This model distinguishes three dimensions: task fidelity: from literature (lowest) through simulated patients to real patients (highest); task complexity: the number of information elements; and instructional support: from worked examples (highest) through completion tasks to autonomous task performance (lowest). These three dimensions together constitute three steps to proficient learning: (I) start with high support on low-fidelity low-complexity tasks and gradually fade that support as learners become more proficient; (II) repeat I for low-fidelity but higher-complexity tasks; and (III) repeat I and II in that order at subsequent levels of fidelity. The numbers of fidelity levels and complexity levels within fidelity levels needed depend on the aims of the course, curriculum or individual learning trajectory. This paper concludes with suggestions for future research based on this model.

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Fig. 1 A holistic model for the design of medical education. The numbers in Fig. 1 represent the order of green (decreasing support) paths to walk. Thus: (1) decrease support for low-complexity low-fidelity tasks (path 1, down left); (2) repeat that process for medium-complexity low-fidelity tasks (path 2) and subsequently high-complexity low-fidelity tasks (path 3); and (3) repeat the first two in that order (first decrease support, then increase complexity) for medium-fidelity tasks (paths 4–6) and ultimately for high-fidelity tasks (paths 7–9)CC BY · PubMed Central

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Authors: Leppink, J., & Van den Heuvel, A.
Affiliations: Maastricht University (NL)
Corresponding author: Leppink, Jimmie
ORCID: Leppink, Jimmie
Venue: Perspectives on Medical Education
Publisher: Ubiquity Press, Ltd.
Published: 2015-05-28
Volume: 4
Issue: 3
Pages: 119-127
ISSN: 2212-2761 (ISSN-L)
2212-277X
DOI: 10.1007/s40037-015-0192-x
PMC: PMC4456454
OpenAlex: W1499793228
Cited by: 299
References: 62
Citations by year: 2026: 40 · 2025: 28 · 2024: 20 · 2023: 29 · 2022: 35 · 2021: 35 · 2020: 31 · 2019: 28 · 2018: 21 · 2017: 13 · 2016: 17 · 2015: 2
FWCI: 18.95
Type: journal article
Language: en
Open access: diamond
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Perspectives on Medical Education (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Topics: Social Sciences › Education › Innovations in Medical Education
Social Sciences › Psychology › Experimental and Cognitive Psychology › Visual and Cognitive Learning Processes
Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
Keywords: cognitive load theory, medical education, instructional design, task complexity, pedagogical support, worked examples, standardized patients

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The evolution of cognitive load theory and its application to medical education

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