The effects of different interruption conditions on mental workload: an experimental study based on multimodal measurements.

Interruptions in the working environment cause extra mental workload for the operators, and this phenomenon has garnered significant research attention. This study designed four interruption conditions based on the perceptual and cognitive perspectives of human information processing, using a 2(perceptual primary task and cognitive primary task)*2(perceptual interruption task and cognitive interruption task) factorial design. Multimodal measurement methods were used to evaluate mental workload in different interruption conditions. The results show that when the primary task and the interruption task are different load types, they generate a higher mental workload than the same load type. It can be attributed to the fact that perceptual tasks and cognitive tasks increase mental workload during switching. In addition, based on the multimodal index data, the prediction model of interruption recovery delay time and the classification model of interruption conditions are established, which provides a basis for rational scheduling of work and preventing mental overload.

This study's results enhance our understanding of interruptions from the perspectives of perception and cognition, providing a more accurate theoretical basis for managing mental workload in interruption conditions. The proposed interruption recovery delay time prediction model and the interruption condition classification model have certain reference values for improving interruption management capabilities.

Cognitive load during driving: EEG microstate metrics are sensitive to task difficulty and predict safety outcomes.

Engaging in phone conversations or other cognitively challenging tasks while driving detrimentally impacts cognitive functions and has been associated with increased risk of accidents. Existing EEG methods have been shown to differentiate between load and no load, but not between different levels of cognitive load. Furthermore, it has not been investigated whether EEG measurements of load can be used to predict safety outcomes in critical events. EEG microstates analysis, categorizing EEG signals into a concise set of prototypical functional states, has been used in other task contexts with good results, but has not been applied in the driving context. Here, this gap is addressed by means of a driving simulation experiment. Three phone use conditions (no phone use, hands-free, and handheld), combined with two task difficulty levels (single- or double-digit addition and subtraction), were tested before and during a rear-end collision conflict. Both conventional EEG spectral power and EEG microstates were analyzed. The results showed that different levels of cognitive load influenced EEG microstates differently, while EEG spectral power remained unaffected. A distinct EEG pattern emerged when drivers engaged in phone tasks while driving, characterized by a simultaneous increase and decrease in two of the EEG microstates, suggesting a heightened focus on auditory information, potentially at a cost to attention reorientation ability. The increase and decrease in these two microstates follow a monotonic sequence from baseline to hands-free simple, hands-free complex, handheld simple, and finally handheld complex, showing sensitivity to task difficulty. This pattern was found both before and after the lead vehicle braked. Furthermore, EEG microstates prior to the lead vehicle braking improved predictions of safety outcomes in terms of minimum time headway after the lead vehicle braked, clearly suggesting that these microstates measure brain states which are indicative of impaired driving. Additionally, EEG microstates are more predictive of safety outcomes than task difficulty, highlighting individual differences in task effects. These findings enhance our understanding of the neural dynamics involved in distracted driving and can be used in methods for evaluating the cognitive load induced by in-vehicle systems.

Understanding, fast and shallow: Individual differences in memory performance associated with cognitive load predict the illusion of explanatory depth.

People are often overconfident about their ability to explain how everyday phenomena and artifacts work (devices, natural processes, historical events, etc.). However, the metacognitive mechanisms involved in this bias have not been fully elucidated. The aim of this study was to establish whether the ability to perform deliberate and analytic processes moderates the effect of informational cues such as the social desirability of knowledge on the Illusion of Explanatory Depth (IOED). To this purpose, the participants' cognitive load was manipulated as they provided initial estimates of causal understanding of national historical events in the standard IOED paradigm. The results showed that neither the social desirability of specific causal knowledge nor the cognitive load manipulations had direct effects on the IOED. However, subsequent exploratory analyses indicated that high cognitive load was related to lower performance on concurrent memory tasks, which in turn was associated with a higher IOED magnitude. Higher analytical processing was also related to lower IOED. Implications for both dual-process models of metacognition and the design of task environments that help to reduce this bias are discussed.

The extent of interruptions to primary care medical officers' consultations in the Western Cape.

BACKGROUND:  Administrative tasks are an increasing burden for primary care doctors globally and linked to burnout. Many tasks occur during consultations. They cause interruptions with possible effects on patients' and doctors' experiences and care. The burden and typology of interruptions of doctors in primary care consultations have not been studied in South Africa. Given the link between administrative loads and burnout, describing the extent of these interruptions would help. This study's aim was to assess the extent of interruptions on primary care doctors in the Western Cape. METHODS:  This was a descriptive cross-sectional survey. Doctors from rural and urban primary care clinics in the Western Cape answered an online self-administered survey on the types of interruptions experienced during consultations. Interruptions were categorised and their prevalence calculated. Clinical and non-clinical interruption categories were compared. RESULTS:  There were 201 consultations from 30 doctors. Most interruptions were from retrieving and recording the current patient's information (93.0%), paperwork for other patients (50.7%), and telephone calls about the current patient (41.8%). Other prevalent interruptions were for emergencies (39.8%) and acquiring consumables (37.3%). The median (interquartile range [IQR]) of four (2-4) interruption types per consultation was higher than global settings. CONCLUSION:  Doctors experienced many interruptions during consultations. Their wide range included interruptions unrelated to the current patient.Contribution: This study adds insights from the global south on clinicians' administrative burden. It elaborates on the types of activities that interrupt consultations in an upper-middle income primary care setting. Exploration of interventions to decrease this burden is suggested.

Taste or Health: The Impact of Packaging Cues on Consumer Decision-Making in Healthy Foods.

According to the theory of dietary regulation, consumers frequently encounter conflicts between healthiness and tastiness when selecting healthy foods. This study explores how packaging cue that highlight "tasty" versus "healthy" affect consumers' intentions to purchase healthy food. After an Implicit Association Test (IAT) confirmed a perceived lack of tastiness in health foods in the preliminary test, Study 1 analyzed pricing and packaging details of the top 200 most-popular items in each of the ten healthy food categories on a major online shopping platform. Results showed that products with taste-focused cues commanded higher prices, indicating stronger consumer acceptance of healthy foods marketed as delicious. To address the causality limitations of observational studies, Study 2 used an experimental design to directly measure the impact of these cues on purchase intentions and perceptions of energy, healthiness, and tastiness. Findings revealed that taste-focused cues significantly boosted purchase intentions compared to health-focused cues, although they also diminished the perceived healthiness of the products. Moreover, in the control group exposed to unhealthy food options, health-emphasized packaging also increased purchase intentions, indicating that consumers seek a balance between healthiness and tastiness, rather than prioritizing health alone. Study 3 further explored the impact of cognitive load over these cue influences, revealing a heightened inclination among consumers to purchase healthy products with taste-focused cue under high cognitive load state. These insights have direct implications for food packaging design, suggesting that emphasizing a balance of taste and health benefits can effectively enhance consumer engagement. The study, which conducted in China, also opens avenues for future research to explore similar effects, maybe in different cultural contexts, different consumer groups, and under varied cognitive conditions.

Feasibility of Wearable Sensors to Assess Cognitive Load During Clinical Performance: Lessons Learned and Blueprint for Success.

INTRODUCTION: Cognitive load (CogL) is increasingly recognized as an important resource underlying operative performance. Current innovations in surgery aim to develop objective performance metrics via physiological monitoring from wearable digital sensors. Surgeons have access to consumer technology that could measure CogL but need guidance regarding device selection and implementation. To realize the benefits of surgical performance improvement these methods must be feasible, incorporating human factors usability and design principles. This paper aims to evaluate the feasibility of using wearable sensors to assess CogL, identify the benefits and challenges of implementing devices, and develop guidance for surgeons planning to implement wearable devices in their research or practice. METHODS: We examined the feasibility of wearable sensors from a series of empirical studies that measured aspects of clinical performance relating to CogL. Across four studies, 84 participants and five sensors were involved in the following clinical settings: (i) real intraoperative surgery; (ii) simulated laparoscopic surgery; and (iii) medical team performance outside the hospital. RESULTS: Wearable devices worn on the wrist and chest were found to be comfortable. After a learning curve, electrodermal activity data were easily and reliably collected. Devices using photoplethysmography to determine heart rate variability were significantly limited by movement artifact. There was variable success with electroencephalography devices regarding connectivity, comfort, and usability. CONCLUSIONS: It is feasible to use wearable sensors across various clinical settings, including surgery. There are some limitations, and their implementation is context and device dependent. To scale sensor use in clinical research, surgeons must embrace human factors principles to optimize wearability, usability, reliability, and data security.

Exploring challenges in learning and study skills among first-year medical students: a case study.

BACKGROUND: Despite being high-achieving students, many medical students face academic challenges, particularly during their first year of study. Research indicates that self-regulated learning, involving metacognitive processes and adaptive strategies, can positively influence academic achievement. This study aimed to assess the early learning and study skills of first-year medical students in an international medical school with the goal of developing a learner-centered educational intervention to promote self-regulated learning. METHODS: We conducted a retrospective analysis of the Learning and Study Skills Inventory (LASSI) questionnaire that was administered annually each August to first-year medical students from 2019 to 2022. The distribution of students across different percentile ranges for each selected variable was determined for each year and all years collectively. Students were counted within distinct percentile brackets (50th and below, between 51st and 75th, and above 75th ) for each variable. RESULTS: A total of 147 students completed the LASSI questionnaire over the 4-year time period. Using academic resources was the greatest concern, with 67% of students in the 50th or below percentile, followed by selecting the main idea (56%), motivation (51%), and concentration (50%). Attitude scored highest across all cohorts, scoring between 21.55 ± 0.73 and 26.49 ± 0.34. In comparing mean scores of LASSI variables across all cohorts, attitude, motivation, test-taking strategies, time management, and the use of academic resources differed significantly (p < 0.05). CONCLUSION: LASSI data can provide an early picture of students' support needs. We posit that early identification of student learning and study skills and areas of struggle can inform personalized educational interventions and programs to support first-year medical students.

The Impact of Cognitive Load on Cooperation and Antisocial Punishment: Insights from a Public Goods Game Experiment.

This paper investigates the impact of cognitive load on the formation and maintenance of cooperation within a public goods game experiment featuring a punishment option. By integrating the experimental designs of prior studies and manipulating cognitive load through the memorization of numbers with varying digits, we reveal that high cognitive load accelerates the breakdown of cooperation, irrespective of the presence of a punishment system. Furthermore, under high cognitive load, participants are more likely to engage in antisocial punishment, while the punishment of free riders remains unaffected. These findings suggest that increased cognitive load depletes the cognitive resources needed for deliberative decision-making, leading to a higher propensity for antisocial punishment. Our study contributes to the literature by demonstrating the significant influence of cognitive load on cooperative behavior and providing new insights into the causes of antisocial punishment.

EXPRESS: Personal Sense of Power Predicts Financial Risk-Taking Propensity - But Only When Risk-Related Decisions Are Made Without Cognitive Load.

A significant relationship between a sense of power and financial risk-taking has been established in the literature. However, the boundary conditions for this relationship remain unclear. This article presents the results of an online experimental study (N = 192) that explores the moderating role of cognitive load in the relationship between power and financial risk-taking in the domains of gambling and investing. The findings validate a positive association between a sense of power and financial risk-taking, alongside a negative impact of cognitive load on financial risk. Notably, cognitive load moderates the relationship between power and financial risk-taking in a way that the link is positive when individuals have full access to their cognitive resources, but it becomes non-significant when they are under cognitive load.

Gaze cueing improves pattern recognition of histology learners.

Experts perceive and evaluate domain-specific visual information with high accuracy. In doing so, they exhibit eye movements referred to as "expert gaze" to rapidly focus on task-relevant areas. Using eye tracking, it is possible to record these implicit gaze patterns and present them to histology novice learners during training. This article presents a comprehensive evaluation of such expert gaze cueing on pattern recognition of medical students in histology. For this purpose, 53 students were randomized into two groups over eight histology sessions. The control group was presented with an instructional histology video featuring voice commentary. The gaze cueing group was presented the same video, but with an additional overlay of a live recording of the expert's eye movements. Afterward, students' pattern recognition was assessed through 20 image-based tasks (5 retention, 15 transfer) and their cognitive load with the Paas scale. Results showed that gaze cueing significantly outperformed the control group (p = 0.007; d = 0.40). This effect was evident for both, retention (p = 0.003) and transfer tasks (p = 0.046), and generalized across different histological contexts. The cognitive load was similar in both groups. In conclusion, gaze cueing helps histology novice learners to develop their pattern recognition skills, offering a promising method for histology education. Histology educators could benefit from this instructional strategy to provide new forms of attentional guidance to learners in visually complex learning environments.

Effects of adaptive scaffolding on performance, cognitive load and engagement in game-based learning: a randomized controlled trial.

BACKGROUND: While game-based learning has demonstrated positive outcomes for some learners, its efficacy remains variable. Adaptive scaffolding may improve performance and self-regulation during training by optimizing cognitive load. Informed by cognitive load theory, this study investigates whether adaptive scaffolding based on interaction trace data influences learning performance, self-regulation, cognitive load, test performance, and engagement in a medical emergency game. METHODS: Sixty-two medical students from three Dutch universities played six game scenarios. They received either adaptive or nonadaptive scaffolding in a randomized double-blinded matched pairs yoked control design. During gameplay, we measured learning performance (accuracy, speed, systematicity), self-regulation (self-monitoring, help-seeking), and cognitive load. Test performance was assessed in a live scenario assessment at 2- and 6-12-week intervals. Engagement was measured after completing all game scenarios. RESULTS: Surprisingly, the results unveiled no discernible differences between the groups experiencing adaptive and nonadaptive scaffolding. This finding is attributed to the unexpected alignment between the nonadaptive scaffolding and the needs of the participants in 64.9% of the scenarios, resulting in coincidentally tailored scaffolding. Exploratory analyses suggest that, compared to nontailored scaffolding, tailored scaffolding improved speed, reduced self-regulation, and lowered cognitive load. No differences in test performance or engagement were found. DISCUSSION: Our results suggest adaptive scaffolding may enhance learning by optimizing cognitive load. These findings underscore the potential of adaptive scaffolding within GBL environments, cultivating a more tailored and effective learning experience. To leverage this potential effectively, researchers, educators, and developers are recommended to collaborate from the outset of designing adaptive GBL or computer-based simulation experiences. This collaborative approach facilitates the establishment of reliable performance indicators and enables the design of suitable, preferably real-time, scaffolding interventions. Future research should confirm the effects of adaptive scaffolding on self-regulation and learning, taking care to avoid unintended tailored scaffolding in the research design. TRIAL REGISTRATION: This study was preregistered with the Center for Open Science prior to data collection. The registry may be found at https://osf.io/7ztws/ .

The enhancing effect of social reward on inhibitory control in smokers: Evidence from behaviour and ERP studies.

OBJECTIVE: Prior research has revealed impaired inhibitory control as a pivotal factor contributing to smokers' struggle to control smoking impulses. However, few studies focus on enhancing smokers' inhibitory control. This study investigates the potential of social rewards to bolster inhibitory control among smokers and elucidates the underlying mechanisms. METHODS: In Experiment 1, a reward-based Go/Nogo paradigm assessed error rates and reaction times for 30 smokers exposed to social reward and neutral feedback in distinct contexts (smoking-related and neutral). Experiment 2 used a modified paradigm, incorporating cognitive load manipulation, to investigate error rates, reaction times, N2, and P3 ERPs among 32 smokers facing social reward and neutral feedback under different cognitive loads (high and low). RESULTS: Smokers exhibit lower Nogo error rates with social reward feedback; higher error rates occur with smoking cues and high cognitive load; increased N2, P3 amplitudes under social reward versus neutral feedback; low cognitive load enhances P3 amplitude under social reward. CONCLUSION: Social reward improves smokers' inhibitory control, but this effect weakens with exposure to smoking cues; higher cognitive load further diminishes the enhancement of smokers' inhibitory control by social reward under smoking cues.

Food Safety Exam Phrasing for Food Service Employees.

In many jurisdictions, foodservice workers are required to obtain food handler certification via written examination before being able to work. This study investigated the effect of the readability, or the ease in which one can read and comprehend written text, of food handler exam questions on exam performance. It was hypothesized that the reduction in cognitive load by improving the readability of exam questions would lead to improved scores. Participants received training in personal hygiene and basic food safety and were tested on their knowledge using questions that were worded using the traditional phrasing and updated phrasing that has improved readability. The results indicate that improved readability had a significant difference in the personal hygiene section but not on the basic food safety section. These results are due, in part, to the types of cognitive load (intrinsic vs. extraneous) that are required to solve different types of problems.

Research on identification of flight cadets' cognitive load based on multi-source physiological data and CGAN-DBN model.

Modern aircraft cockpit system is highly information-intensive. Pilots often need to receive a large amount of information and make correct judgments and decisions in a short time. However, cognitive load can affect their ability to perceive, judge and make decisions accurately. Furthermore, the excessive cognitive load will induce incorrect operations and even lead to flight accidents. Accordingly, the research on cognitive load is crucial to reduce errors and even accidents caused by human factors. By using physiological acquisition systems such as eye movement, ECG, and respiration, multi-source physiological signals of flight cadets performing different flight tasks during the flight simulation experiment are obtained. Based on the characteristic indexes extracted from multi-source physiological data, the CGAN-DBN model is established by combining the conditional generative adversarial networks (CGAN) model with the deep belief network (DBN) model to identify the flight cadets' cognitive load. The research results show that the flight cadets' cognitive load identification based on the CGAN-DBN model established has high accuracy. And it can effectively identify the cognitive load of flight cadets. The research paper has important practical significance to reduce the flight accidents caused by the high cognitive load of pilots.

In our study, a highly accurate cognitive load identification model for flight cadets was established by using multi-source physiological data. Moreover, it provides a theoretical basis for identifying the cognitive load of pilots through wearable physiological devices. Our intent is to catalyse further research and technological development.

Alone but not isolated: social presence and cognitive load in learning with 360 virtual reality videos.

Introduction: This study aimed to identify any differences in social presence and cognitive load among three types of 360 virtual reality (VR)-based videos lectures. We hypothesized that social presence would be higher when interactions among peers are visible in a 360 VR video lectures while the cognitive load would be also increased. Methods: A total of 48 college students were randomly assigned to one of the three study groups to view an assigned 360 VR video lecture. The three groups were: (1) an instructor-only video viewing group, (2) a classroom lecture video viewing group, and (3) a classroom lecture and activity video viewing group. The video lectures were differently designed depending on the levels of peer visibility and the interactions between the instructor and peers. The participants watched one of the three types of assigned video lecture and subsequently completed two sets of questionnaires regarding social presence and cognitive load. A multivariate analysis of variance (MANOVA) was conducted with a planned contrast analysis for the type of video lectures. Results: We found that, contrary to the hypotheses, students in the group 1 (instructor-only video) showed higher social presence scores than students in the groups 2 and 3. However, no significant differences were found in the cognitive load scores. Discussion: The results show that 360 VR video lectures with an instructor-only are more effective at enhancing users' social presence than 360 VR video lectures with both the instructor and class-peers. We suggest creating 360 VR video lectures with the presence of the course instructor to offer learners the sense of actually participating in a lecture.

Multimodal data for behavioural authentication in Internet of Things environments.

Identifying humans based on their behavioural patterns represents an attractive basis for access control as such patterns appear naturally, do not require a focused effort from the user side, and do not impose the additional burden of memorising passwords. One means of capturing behavioural patterns is through passive sensors laid out in a target environment. Thanks to the proliferation of the Internet of Things (IoT), sensing devices are already embedded in our everyday surroundings and represent a rich source of multimodal data. Nevertheless, collecting such data for authentication research purposes is challenging, as it entails management and synchronisation of a range of sensing devices, design of diverse tasks that would evoke different behaviour patterns, storage and pre-processing of data arriving from multiple sources, and the execution of long-lasting user activities. Consequently, to the best of our knowledge, no publicly available datasets suitable for behaviour-based authentication research exist. In this brief article, we describe the first multimodal dataset for behavioural authentication research collected in a sensor-enabled IoT setting. The dataset comprises of high-frequency accelerometer, gyroscope, and force sensor data collected from an office-like environment. In addition, the dataset contains 3D point clouds collected with wireless radar and electroencephalogram (EEG) readings from a wireless EEG cap worn by the study participants. Within the environment, 54 volunteers conducted 6 different tasks that were constructed to elicit different behaviours and different cognitive load levels, resulting in a total of 16 h of multimodal data. The richness of the dataset comprising 5 different sensing modalities, a variability of tasks including keyboard typing, hand gesturing, walking, and other activities, opens a range of opportunities for research in behaviour-based authentication, but also the understanding of the role of different tasks and cognitive load levels on human behaviour.

Predicting cognitive load with EEG using Riemannian geometry-based features.

Objective. We show that electroencephalography (EEG)-based cognitive load (CL) prediction using Riemannian geometry features outperforms existing models. The performance is estimated using Riemannian Procrustes Analysis (RPA) with a test set of subjects unseen during training.Approach. Performance is evaluated by using the Minimum Distance to Riemannian Mean model trained on CL classification. The baseline performance is established using spatial covariance matrices of the signal as features. Various novel features are explored and analyzed in depth, including spatial covariance and correlation matrices computed on the EEG signal and its first-order derivative. Furthermore, each RPA step effect on the performance is investigated, and the generalization performance of RPA is compared against a few different generalization methods.Main results. Performances are greatly improved by using the spatial covariance matrix of the first-order derivative of the signal as features. Furthermore, this work highlights both the importance and efficiency of RPA for CL prediction: it achieves good generalizability with little amounts of calibration data and largely outperforms all the comparison methods.Significance. CL prediction using RPA for generalizability across subjects is an approach worth exploring further, especially for real-world applications where calibration time is limited. Furthermore, the feature exploration uncovers new, promising features that can be used and further experimented within any Riemannian geometry setting.

Does a Video-Based and 3D Animation Hybrid Learning System Improve Teaching Outcomes in Orthopedic Surgery? A Randomized Controlled Trial.

OBJECTIVE: This study aims to evaluate the instructional efficacy of a 3D Surgical Training System (3DSTS), which combines real surgical footage with high-definition 3D animations, against conventional surgical videos and textbooks in the context of orthopedic proximal humerus fracture surgeries. DESIGN: Before the experiment, 89 participants completed a pre-educational knowledge assessment. They were then randomized into 3 groups: the 3DSTS group (n = 30), the surgical video (SV) group (n = 29), and the textbook group (n = 30). After their respective teaching courses, all participants took a posteducational assessment and completed a perceived cognitive load test. The 3DSTS group also filled out a satisfaction survey. Once all assessments were finished, the SV and textbook groups were introduced to the 3DSTS course and subsequently completed a satisfaction survey. All statistical analyses were executed using IBM SPSS version 24 (IBM Corp., Armonk, NY). For data fitting normal distribution, we employed one-way analysis of variance (one-way ANOVA) and Tukey HSD tests, whereas, for non-normally distributed data, we used Kruskal-Wallis H tests and Dunn's tests. The significance level for all tests was set at p < 0.05. SETTING: Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China. PARTICIPANTS: About 89 doctors who undergoing standardized residents training. RESULT: The initial assessment scores among the three groups were comparable, showing no significant statistical difference. Post-education revealed a marked difference in the scores, with the 3DSTS group outperforming both the SV and textbook groups. Specifically, the 3DSTS group exhibited statistically greater improvement in areas such as procedural steps, and specialized surgical techniques compared to the SV and textbook groups. During the 3DSTS teaching process, participants reported the least perceived cognitive load and expressed strong satisfaction, highlighting that the instructional materials are well-prepared, and considering this teaching method superior and more innovative than previous courses they had encountered. CONCLUSION: The 3D Surgical Training System, integrating real videos with 3D animations, significantly enhances orthopedic surgery education over conventional methods, providing improved comprehension, lower cognitive load, and standardized learning outcomes. Its efficacy and high participant satisfaction underscore its potential for broader adoption in surgical disciplines. This study is registered with ClinicalTrials. gov ID: ChiCTR2300074730.

Debriefer cognitive load during Traditional Reflective Debriefing vs. Rapid Cycle Deliberate Practice interdisciplinary team training.

BACKGROUND: Cognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD. METHODS: This study was part of a large-scale, interdisciplinary team training program at Children's Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups. RESULTS: For all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (- 0.8, p = 0.004 and - 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p < 0.001). For RCDP, perceived performance success increased post-debriefing (+ 3.6, p < 0.001), time demands decreased (- 1.0, p = 0.04), and frustration decreased (- 2.0, p < 0.001). Comparing TRD directly to RCDP, perceived performance success was greater in RCDP than TRD (3.6 vs. 2.4, p = 0.04). Main facilitators had lower effort and mental demand in RCDP and greater perceived success (p < 0.001). CONCLUSION: RCDP had greater perceived success than TRD for debriefers. Main facilitators also report reduced effort and baseline mental demand in RCDP. For less experienced debriefers, newer simulation programs, or large team training sessions such as our study, RCDP may be a less mentally demanding debriefing methodology for facilitators.

Exploring the responses of preclinical medical students and professors to flipped learning for the development of clinical reasoning.

PURPOSE: This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation. METHODS: The study was conducted at a medical school in Korea, where the "clinical reasoning method" course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students' experiences in more detail. RESULTS: In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning. CONCLUSION: The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.