Evaluation of 3 cognitive load measures during repeated simulation exercises for novice anesthesiology residents

Serkan Toy, Christina R. Miller, Rodrigo J.Daly Guris, Shirley S. Duarte, Sophia Koessel, Adam Schiavi

Research output: Contribution to journalArticlepeer-review


Introduction: Maintaining an appropriate level of cognitive load during simulations is crucial to optimize learning.We evaluated 3 subjective measures of cognitive load in a simulated operating room (OR) context across multiple scenarios of varying complexity. Methods: This observational study of 25 first-year anesthesiology residents took place during a 5-day simulation "Boot Camp." Each day, participants completed 2 different high-fidelity scenarios in a fully equipped simulatedOR. After each simulation, participants completed 3 cognitive load measures: The Paas scale, NASA Task Load Index (TLX), and Cognitive Load Component (CLC) questionnaire. Two-way repeated-measures and mixed-design analyses of variance, with the cognitive load measures and scenarios as independent factors, were used to determine the effect of using different measures to report cognitive load. Results: Cognitive load scores reported by all measures correlated significantly with one another (P < 0.01): TLX and Paas (r = 0.65); Paas and CLC (r = 0.63); and TLX and CLC (r = 0.61). The CLC subscale scores (intrinsic, extraneous, germane) also correlated significantly with composite TLX and Paas scores (P < 0.01). Scenarios and measures displayed significant interaction: F(10, 210) = 3.01, P = 0.001. Participants reported highest overall cognitive load using the Paas scale. Conclusions: All cognitive load measures were sensitive to scenario variability and showed similar fluctuation patterns across the 10 scenarios. The findings suggest that cognitive load measures can help create benchmarks based on learner perceptions of cognitive burden for different simulation scenarios.

Original languageEnglish (US)
Pages (from-to)388-396
Number of pages9
JournalSimulation in Healthcare
Issue number6
StatePublished - Dec 2020


  • Cognitive load theory
  • Cognitive load types
  • Self-report measures of cognitive load
  • Simulation design; anesthesiology simulations

ASJC Scopus subject areas

  • Medicine(all)


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