“Out Of Storage”: How Cognitive Load Theory Could Help Us Rethink Teaching Strategies 

By: Nicolas Wagner, PharmD Candidate 2024 and Jaclyn Boyle, PharmD, MS, MBA, BCACP, FASHP

Students can be faced with stark (and potentially overwhelming) transitions in their academic journey like memorizing hundreds of key facts about the top 300 drugs, transitioning from primarily exam-based assessments to determining assessments and plans for patients on over 20 prescription and herbal medications, or integrating complex healthcare situations such as drug pricing and formulary navigation to help a patient work through a prior authorization. When we step back and think about these situations as an educator, it may be easy to overlook the large cognitive load imposed by learning this large amount of information all at once.

What is Cognitive Load Theory? 

Cognitive Load Theory (CLT) proposes that a person only possesses a limited amount of working memory.¹ Working memory can be filled with information about the task-at-hand, problem solving, and learning; however, there is often not memory space for all of these.  When learning new processes and information that are unfamiliar to the learner, having too many new ideas present can inhibit learning.  Sweller proposed that cognitive load can be reduced by decreasing the number of unknowns present, therefore increasing learning capacity.¹ This strategy leads to better learning and the ability for learners to acquire problem-solving schemas rather than the ability to solve a single problem. As the 2022 Curricular Outcomes and Entrustable Professional Activities Educational Outcome 2.1 cites problem solving is a key skill for student pharmacists, it is imperative that faculty consider how CLT can be implemented in our teaching, learning, and assessment strategies.

Also, the information related to changing disease state guidelines, navigating new relationships with peers or preceptors/faculty, and exploring new professional interests, amounts to more new information that learners are managing every day. Why should faculty care about CLT?

With exponential expansion of medical information and the transformation that students may be working through as they grow professionally, it can be difficult for faculty to distill excessive amounts of information into what students must acquire to be Practice Ready. And while faculty use many different pedagogies in the classroom, such as creative pedagogies (which could incorporate technology) rather than strictly didactic lecturing, these may help alleviate potential cognitive overload for learners.

Another interesting intersection to consider is the interface of cognitive load and attention span. Although there is conflicting literature regarding the ‘exact’ amount of time learners can pay attention  – Brain Rules cites an average adult attention span of 10 minutes. A different perspective proposes that attention could be rather focused on a combination of excitement and motivation.² In that regard, what strategies can faculty use to link the importance of an assigned educational activity to a student’s future career goals? 

What teaching strategies impact cognitive load? 

As faculty aim to deliver high-quality education that translates to positive student outcomes, colleges and schools should consider evaluating how current pedagogies are managing CLT for learners. Traditional lectures which rely on audio delivery of information with little visual complement can overload one’s audio working memory. Mayer demonstrated that accompanying auditory teaching with a visual aid assists in better learning, due to the brain having separate working memory capacities in the visual and auditory senses.⁴

When including patient cases in introductory material, including a complex patient has the potential to limit learning. This occurs when a student focuses on getting to the right answer to a problem instead of focusing on learning problem-solving skills and the patient care process.¹ Presenting a high-complexity case in initial learning can provide the learner with too many unknowns – filling their working memory and leaving no space for incorporating new information. While complex patient cases can help students apply problem-solving skills, faculty should consider evaluating the patient care activities in their curriculum to determine if they are effectively evolving a learner’s thought process. 

To prepare ‘Practice Ready’ pharmacists, here are a few ways we could manage cognitive load in a productive way: 

• Highlight parts of complex diagrams while teaching, working through one part at a time
• Avoid unnecessary graphics and visual repetition in presentations
• Create an environment with limited distractions
• Integrate audio and visual learning

The future of CLT and Pharmacy Education

To date, little is known in pharmacy education about the impact of CLT on student pharmacists and faculty, so there is a need for the Academy to study this topic further to determine its relevance. This topic could be informative in how we approach curricular design, student success, communication strategies, and college/school work and learning environments overall. When our learners’ storage capacity is running low, how can we tell when we have ‘freed up’ enough space to learn and process new things, and could faculty also benefit from a reduction in their own cognitive load? ⁵

References

1. Sweller J. Cognitive load during problem solving: Effects on learning. Cognitive Science; 1988;12:257-285. doi:10.1016/0364- 0213(88)90023-7.
2. Bradbury NA. Attention span during lectures: 8 seconds, 10 minutes, or more? Adv Physiol Educ;2016;40:509-513.
3. Wilby KJ, Paravattil B. Cognitive Load Theory: Implications for Assessment in Pharmacy Education. Research in Social and Administrative Pharmacy. 2021;17:1645-1649.
4. Mayer RE and Moreno R. A Split-Attention Effect in Multimedia Learning: Evidence for Dual Processing Systems in Working Memory. Journal of Educational Psychology;1998;90, 312-320.
5. Young JQ, Van Merrienboer J, Durning S, Ten Cate O. Cognitive Load Theory: Implications for medical education. Medical Teacher. 2014;36(5):371-384.

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Author Bio(s):

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Pulses is a scholarly blog supported by a team of pharmacy education scholars.