“There are no evidence-based guidelines that help us understand the ideal workload for an academic hospitalist or intensivist,” Natalie Held, MD, a faculty member at the university, said in a Feb. 5 news release. “But there are other ways that we can think about this. Cognitive load theory offers an alternative approach to understanding this workload problem.”
Cognitive load theory suggests that excessive stress on working memory can overwhelm a person’s ability to process information. When cognitive load exceeds working memory capacity, learning and performance decline. Cognitive load is influenced by emotions, stress and uncertainty — all common experiences among medical trainees.
Dr. Held studied ICU rounds to identify factors that contribute to higher cognitive load. She recorded how often trainees were interrupted while presenting patient information, the duration of rounds, patient caseload, and the number of new and critically ill patients.
She found that interruptions during round presentations were the greatest contributor to cognitive load.
“Interruptions to learners, specifically by more senior rounding providers, decrease the perception of psychological safety and reduce their availability to learn,” she said.
However, cognitive load was reduced when educators:
- Assigned consistent role expectations during rounds
- Designated who speaks and when
- Clarified trainee responsibilities for communicating with patients and families
Systems can improve cognitive load for trainees by establishing a psychologically safe rounding environment, implementing clear expectations and roles, minimizing speaker interruptions, and being mindful of body language and the need for strategic breaks.
