Teaching through their eyes: effects on optometry teachers' adaptivity and students' learning when teachers see students' gaze.

Adaptive teacher support fosters effective learning in one-to-one teaching sessions, which are a common way of learning complex visual tasks in the health sciences. Adaptive support is tailored to student needs, and this is difficult in complex visual tasks as visual problem-solving processes are covert and thus cannot be directly observed by the teacher. Eye-tracking apparatus can measure covert processes and make them visible in gaze displays: visualizations of where a student looks while executing a task. We investigate whether live dynamic gaze displays help teachers in being more adaptive to students' needs when teaching optical coherence tomography interpretation in one-to-one teaching sessions and whether this fosters learning. Forty-nine students and 10 teachers participated in a one-to-one teaching session in clinical optometry. In the control condition, teachers saw the learning task of the student and could discuss it with them, whereas in the gaze-display condition, teachers could additionally see where the student looked. After the 15-minute teaching session, a test was administered to examine achievement. Furthermore, students filled in the 'questionnaire on teacher support adaptivity', and teachers rated how adaptive their support was. Bayesian analyses provide some initial evidence that students did not experience support to be more adaptive in the gaze-display condition versus the control condition, nor were their post-test scores higher. Teachers rated their provided support as being more adaptive in the gaze-display versus the control condition. Further research could investigate if live dynamic gaze displays impact adaptive teaching when used over longer periods or with more teacher training.

The effects of gaze-display feedback on medical students' self-monitoring and learning in radiology.

Self-monitoring is essential for effectively regulating learning, but difficult in visual diagnostic tasks such as radiograph interpretation. Eye-tracking technology can visualize viewing behavior in gaze displays, thereby providing information about visual search and decision-making. We hypothesized that individually adaptive gaze-display feedback improves posttest performance and self-monitoring of medical students who learn to detect nodules in radiographs. We investigated the effects of: (1) Search displays, showing which part of the image was searched by the participant; and (2) Decision displays, showing which parts of the image received prolonged attention in 78 medical students. After a pretest and instruction, participants practiced identifying nodules in 16 cases under search-display, decision-display, or no feedback conditions (n = 26 per condition). A 10-case posttest, without feedback, was administered to assess learning outcomes. After each case, participants provided self-monitoring and confidence judgments. Afterward, participants reported on self-efficacy, perceived competence, feedback use, and perceived usefulness of the feedback. Bayesian analyses showed no benefits of gaze displays for post-test performance, monitoring accuracy (absolute difference between participants' estimated and their actual test performance), completeness of viewing behavior, self-efficacy, and perceived competence. Participants receiving search-displays reported greater feedback utilization than participants receiving decision-displays, and also found the feedback more useful when the gaze data displayed was precise and accurate. As the completeness of search was not related to posttest performance, search displays might not have been sufficiently informative to improve self-monitoring. Information from decision displays was rarely used to inform self-monitoring. Further research should address if and when gaze displays can support learning.

Teaching medical students to apply deliberate reflection.

PURPOSE: Deliberate reflection on initial diagnosis has been found to repair diagnostic errors. We investigated the effectiveness of teaching students to use deliberate reflection on future cases and whether their usage would depend on their perception of case difficulty. METHOD: One-hundred-nineteen medical students solved cases either with deliberate-reflection or without instructions to reflect. One week later, all participants solved six cases, each with two equally likely diagnoses, but some symptoms in the case were associated with only one of the diagnoses (discriminating features). Participants provided one diagnosis and subsequently wrote down everything they remembered from it. After the first three cases, they were told that the next three would be difficult cases. Reflection was measured by the proportion of discriminating features recalled (overall; related to their provided diagnosis; related to alternative diagnosis). RESULTS: The deliberate-reflection condition recalled more features for the alternative diagnosis than the control condition (p = .013) regardless of described difficulty. They also recalled more features related to their provided diagnosis on the first three cases (p = .004), but on the last three cases (described as difficult), there was no difference. CONCLUSION: Learning deliberate reflection helped students engage in more reflective reasoning when solving future cases.

Learning deliberate reflection in medical diagnosis: does learning-by-teaching help?

Deliberate reflection has been found to foster diagnostic accuracy on complex cases or under circumstances that tend to induce cognitive bias. However, it is unclear whether the procedure can also be learned and thereby autonomously applied when diagnosing future cases without instructions to reflect. We investigated whether general practice residents would learn the deliberate reflection procedure through 'learning-by-teaching' and apply it to diagnose new cases. The study was a two-phase experiment. In the learning phase, 56 general-practice residents were randomly assigned to one of two conditions. They either (1) studied examples of deliberate reflection and then explained the procedure to a fictitious peer on video; or (2) solved cases without reflection (control). In the test phase, one to three weeks later, all participants diagnosed new cases while thinking aloud. The analysis of the test phase showed no significant differences between the conditions on any of the outcome measures (diagnostic accuracy, p = .263; time to diagnose, p = .598; mental effort ratings, p = .544; confidence ratings, p = .710; proportion of contradiction units (i.e. measure of deliberate reflection), p = .544). In contrast to findings on learning-by-teaching from other domains, teaching deliberate reflection to a fictitious peer, did not increase reflective reasoning when diagnosing future cases. Potential explanations that future research might address are that either residents in the experimental condition did not apply the learned deliberate reflection procedure in the test phase, or residents in the control condition also engaged in reflection.

Improving medical residents' self-assessment of their diagnostic accuracy: does feedback help?

When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate diagnostic calibration, diagnostic errors or overtesting can occur. A previous study showed that physicians' diagnostic calibration for easy cases improved, after they received feedback on their previous diagnoses. We investigated whether diagnostic calibration would also improve from this feedback when cases were more difficult. Sixty-nine general-practice residents were randomly assigned to one of two conditions. In the feedback condition, they diagnosed a case, rated their confidence in their diagnosis, their invested mental effort, and case complexity, and then were shown the correct diagnosis (feedback). This was repeated for 12 cases. Participants in the control condition did the same without receiving feedback. We analysed calibration in terms of (1) absolute accuracy (absolute difference between diagnostic accuracy and confidence), and (2) bias (confidence minus diagnostic calibration). There was no difference between the conditions in the measurements of calibration (absolute accuracy, p = .204; bias, p = .176). Post-hoc analyses showed that on correctly diagnosed cases (on which participants are either accurate or underconfident), calibration in the feedback condition was less accurate than in the control condition, p = .013. This study shows that feedback on diagnostic performance did not improve physicians' calibration for more difficult cases. One explanation could be that participants were confronted with their mistakes and thereafter lowered their confidence ratings even if cases were diagnosed correctly. This shows how difficult it is to improve diagnostic calibration, which is important to prevent diagnostic errors or maltreatment.

Co-thought gesturing supports more complex problem solving in subjects with lower visual working-memory capacity.

During silent problem solving, hand gestures arise that have no communicative intent. The role of such co-thought gestures in cognition has been understudied in cognitive research as compared to co-speech gestures. We investigated whether gesticulation during silent problem solving supported subsequent performance in a Tower of Hanoi problem-solving task, in relation to visual working-memory capacity and task complexity. Seventy-six participants were assigned to either an instructed gesture condition or a condition that allowed them to gesture, but without explicit instructions to do so. This resulted in three gesture groups: (1) non-gesturing; (2) spontaneous gesturing; (3) instructed gesturing. In line with the embedded/extended cognition perspective on gesture, gesturing benefited complex problem-solving performance for participants with a lower visual working-memory capacity, but not for participants with a lower spatial working-memory capacity.

Fostering novice students' diagnostic ability: the value of guiding deliberate reflection.

BACKGROUND: Deliberate reflection when practising the diagnosis of clinical cases has been shown to develop medical students' diagnostic competence. Adding guidance by cueing reflection or providing modelling of reflection increased the benefits of reflection for advanced (Years 5-6) students. The present study investigated whether we could replicate and extend these findings by comparing the effects of free, cued and modelled reflection on novice students' diagnostic competence. METHODS: A total of 80 third-year medical students participated in a two-phase experiment. In the learning phase, students diagnosed nine clinical cases under one of three conditions: free reflection; cued reflection, and modelled reflection. Two weeks later, all students diagnosed four new examples of the diseases studied in the learning phase and four cases of non-studied related diseases ('adjacent diseases'). The main outcome measurements were diagnostic accuracy scores (range 0-1) on studied and adjacent diseases. RESULTS: For studied diseases, there was a significant effect of experimental condition on diagnostic accuracy (p < 0.02), with the cued-reflection group (mean = 0.58, standard deviation [SD] = 0.23) performing significantly better than the free-reflection group (mean = 0.41, SD = 0.20; p < 0.02). The cued-reflection and modelled-reflection groups (mean = 0.54, SD = 0.22) did not differ in diagnostic accuracy (p > 0.05), nor did the modelled-reflection group perform better than the free-reflection group (p > 0.05). For adjacent diseases, the three groups scored extremely low, without significant differences in performance (p > 0.05). Cued reflection and free reflection were rated as requiring similar effort (p > 0.05) and both were more demanding than studying examples of reflection (both p < 0.001) in the learning phase. CONCLUSIONS: Simply cueing novice students' reflection to focus it on relevant diseases was sufficient to increase diagnostic performance relative to reflection without any guidance. Cued reflection and studying examples of reflection appear to be equally useful approaches for teaching clinical diagnosis to novice students. Students found studying examples of reflection required less effort but cued reflection will certainly demand much less investment from teachers.

Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53.

AIM: Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear. METHOD: To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks. RESULT: Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found distractions and other aspects of workplace environments as contributing to extraneous load. Studies outside the health professions documented similar findings to those within the health professions, supporting relevance of CLT to workplace learning. CONCLUSION: The authors discuss implications for workplace teaching, curricular design, learning environment, and metacognition. To advance workplace learning, the authors suggest future CLT research should address higher-level questions and integrate other learning frameworks.

Fostering clinical reasoning in physiotherapy: comparing the effects of concept map study and concept map completion after example study in novice and advanced learners.

BACKGROUND: Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners. METHODS: Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples. RESULTS: Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners' prior ability and learning condition on conceptual knowledge but not on near and far transfer performance. CONCLUSIONS: Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.

Are gesture and speech mismatches produced by an integrated gesture-speech system? A more dynamically embodied perspective is needed for understanding gesture-related learning.

We observe a tension in the target article as it stresses an integrated gesture-speech system that can nevertheless consist of contradictory representational states, which are reflected by mismatches in gesture and speech or sign. Beyond problems of coherence, this prevents furthering our understanding of gesture-related learning. As a possible antidote, we invite a more dynamically embodied perspective to the stage.

Reverse inference of memory retrieval processes underlying metacognitive monitoring of learning using multivariate pattern analysis.

Monitoring of learning is only accurate at some time after learning. It is thought that immediate monitoring is based on working memory, whereas later monitoring requires re-activation of stored items, yielding accurate judgements. Such interpretations are difficult to test because they require reverse inference, which presupposes specificity of brain activity for the hidden cognitive processes. We investigated whether multivariate pattern classification can provide this specificity. We used a word recall task to create single trial examples of immediate and long term retrieval and trained a learning algorithm to discriminate them. Next, participants performed a similar task involving monitoring instead of recall. The recall-trained classifier recognized the retrieval patterns underlying immediate and long term monitoring and classified delayed monitoring examples as long-term retrieval. This result demonstrates the feasibility of decoding cognitive processes, instead of their content.

Compensatory effects of pointing and predictive cueing on age-related declines in visuospatial working memory.

In this study, we investigated whether the visuospatial working memory performance of young and older adults would improve if they used a multimodal as compared with a unimodal encoding strategy, and whether or not visual cues would add to this effect. In Experiment 1, participants were presented with trials consisting of an array of squares and an array of circles. They were instructed to point at one type of figure (multimodal encoding strategy) and only to observe the other (unimodal encoding strategy). After each trial, an immediate location recognition test of one of the two arrays followed. In Experiment 2, the same task was used, but a cue was provided, either before or after the encoding phase, indicating which of the two arrays would be tested. Our results showed that a multimodal, as compared with a unimodal, encoding strategy improved visuospatial working memory performance in both young and older adults (Exp. 1), and that adding visual cues to the multimodal but not to the unimodal encoding strategy improved older adults' performance up to the level of young adults (Exp. 2). In both age groups, cueing after encoding led to higher performance in the multimodal than in the unimodal condition when the second array was tested. However, cueing before encoding led to higher performance in the multimodal than in the unimodal condition when the first array of the figure sequence was tested. These results suggest that pointing together with predictive cueing can have beneficial effects on visuospatial working memory, which is especially important for older adults.

Effects of pointing compared with naming and observing during encoding on item and source memory in young and older adults.

Research showed that source memory functioning declines with ageing. Evidence suggests that encoding visual stimuli with manual pointing in addition to visual observation can have a positive effect on spatial memory compared with visual observation only. The present study investigated whether pointing at picture locations during encoding would lead to better spatial source memory than naming (Experiment 1) and visual observation only (Experiment 2) in young and older adults. Experiment 3 investigated whether response modality during the test phase would influence spatial source memory performance. Experiments 1 and 2 supported the hypothesis that pointing during encoding led to better source memory for picture locations than naming or observation only. Young adults outperformed older adults on the source memory but not the item memory task in both Experiments 1 and 2. In Experiments 1 and 2, participants manually responded in the test phase. Experiment 3 showed that if participants had to verbally respond in the test phase, the positive effect of pointing compared with naming during encoding disappeared. The results suggest that pointing at picture locations during encoding can enhance spatial source memory in both young and older adults, but only if the response modality is congruent in the test phase.

Gesturing during mental problem solving reduces eye movements, especially for individuals with lower visual working memory capacity.

Non-communicative hand gestures have been found to benefit problem-solving performance. These gestures seem to compensate for limited internal cognitive capacities, such as visual working memory capacity. Yet, it is not clear how gestures might perform this cognitive function. One hypothesis is that gesturing is a means to spatially index mental simulations, thereby reducing the need for visually projecting the mental simulation onto the visual presentation of the task. If that hypothesis is correct, less eye movements should be made when participants gesture during problem solving than when they do not gesture. We therefore used mobile eye tracking to investigate the effect of co-thought gesturing and visual working memory capacity on eye movements during mental solving of the Tower of Hanoi problem. Results revealed that gesturing indeed reduced the number of eye movements (lower saccade counts), especially for participants with a relatively lower visual working memory capacity. Subsequent problem-solving performance was not affected by having (not) gestured during the mental solving phase. The current findings suggest that our understanding of gestures in problem solving could be improved by taking into account eye movements during gesturing.

The role of sleep timing in children's observational learning.

Acquisition of information can be facilitated through different learning strategies, classically associated with either declarative or procedural memory modalities. The consolidation of the acquired information has been positively associated with sleep. In addition, subsequent performance was better when acquisition was quickly followed by sleep, rather than daytime wakefulness. Prior studies with adults have indicated the viability of the alternative learning strategy of observational learning for motor skill acquisition, as well as the importance of sleep and sleep timing. However, relatively little research has been dedicated to studying the importance of sleep for the consolidation of procedural memory in children. Therefore, this study investigated whether children could encode procedural information through observational learning, and whether sleep timing could affect subsequent consolidation and performance. School-aged children aged 9-12years (N=86, 43% male, Mage=10.64years, SD=.85) were trained on a procedural fingertapping task through observation, either in the morning or evening; creating immediate wake and immediate sleep groups, respectively. Performance was evaluated the subsequent evening or morning on either a congruent or incongruent task version. Observation and task execution was conducted using an online interface, allowing for remote participation. Performance of the immediate wake group was lower for a congruent version, expressed by a higher error rate, opposed to an incongruent version; an effect not observed in the immediate sleep group. This finding showed that observational learning did not improve performance in children. Yet, immediate sleep prevented performance reduction on the previously observed task. These results support a benefit of sleep in observational learning in children, but in a way different from that seen in adults, where sleep enhanced performance after learning by observation.

Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge.

BACKGROUND: Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning. METHODS: Ninety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps. RESULTS: Pre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P < .001) in the concept map study condition (68.8 ± 21.8%) compared to the concept map completion (52.8 ± 17.0%) and self-explanation (52.2 ± 21.7%) conditions. Post-test problem-solving performance was higher (P < .05) in the self-explanation (63.2 ± 16.0%) condition compared to the concept map study (53.3 ± 16.4%) and concept map completion (51.0 ± 13.6%) conditions. Students in the self-explanation condition also invested less mental effort in the post-test. CONCLUSIONS: Studying model concept maps led to greater conceptual knowledge, whereas self-explanation led to higher transfer performance. Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection.

Effects of free, cued and modelled reflection on medical students' diagnostic competence.

CONTEXT: Structured reflection while practising the diagnosing of cases has been shown to improve medical students' learning of clinical diagnosis. The present study investigated whether additional instructional guidance increases the benefits of reflection by comparing the effects of free, cued and modelled reflection on learning. METHODS: Fifty-eight Year 5 and 57 Year 6 medical students participated in a three-phase experiment. During the learning phase, participants diagnosed eight clinical cases under different experimental conditions: free reflection; cued reflection, and modelled reflection. In an immediate test and a delayed test administered 1 week later, they diagnosed new sets of eight different cases, four of which presented diseases they had studied during the learning phase. Learning was measured according to diagnostic accuracy on the cases that involved the four diseases that appeared in all phases. RESULTS: Repeated-measures analysis of variance (anova) of mean scores for diagnostic accuracy (range: 0-1) showed a significant main effect of experimental condition (p < 0.001), year of training (p = 0.013), and performance moment (p = 0.003), without significant interaction effects. Overall, the modelled reflection group and the cued reflection group did not differ in performance (p = 1.00), but both outperformed the free reflection group (p < 0.001 for both comparisons). Overall performance increased in the delayed test relative to the immediate test (p = 0.004) and to the learning phase (p = 0.03), but did not differ in the latter two phases. Both Year 6 and Year 5 students rated studying examples of reflection as less effortful than either cued or free reflection in the learning phase (p < 0.001 for all comparisons). CONCLUSIONS: Students apparently learn more with less effort by studying correct structured reflection while practising the diagnosing of cases than by reflecting without any instructional guidance. Examples of reflection and cued reflection were more beneficial for learning than free reflection and may represent a useful instructional strategy for clinical teaching.

When left is not right: handedness effects on learning object-manipulation words using pictures with left- or right-handed first-person perspectives.

According to the body-specificity hypothesis, hearing action words creates body-specific mental simulations of the actions. Handedness should, therefore, affect mental simulations. Given that pictures of actions also evoke mental simulations and often accompany words to be learned, would pictures that mismatch the mental simulation of words negatively affect learning? We investigated effects of pictures with a left-handed, right-handed, or bimanual perspective on left- and right-handers' learning of object-manipulation words in an artificial language. Right-handers recalled fewer definitions of words learned with a corresponding left-handed-perspective picture than with a right-handed-perspective picture. For left-handers, there was no effect of perspective. These findings suggest that mismatches between pictures and mental simulations evoked by hearing action words can negatively affect right-handers' learning. Left-handers, who encounter the right-handed perspective frequently, could presumably overcome the lack of motor experience with visual experience and, therefore, not be influenced by picture perspective.

Effects of modelling examples in complex procedural skills training: a randomised study.

CONTEXT: Learning complex procedural skills, such as bronchoscopy, through simulation training, imposes a high cognitive load on novices. Example-based learning has been shown to be an effective way to reduce cognitive load and enhance learning outcomes. Prior research has shown that modelling examples, in which a human model demonstrates the skill to a learner, were effective for learning basic surgical skills. However, principles derived from simple skills training do not necessarily generalise to more complex skills. Therefore, the present study examined the effectiveness of integrating modelling examples into simulation training for a more complex procedural skill - bronchoscopy. Moreover, this study extended previous simulation studies by using a physical demonstration rather than video-based modelling examples. METHODS: Forty-eight medical students were randomised into a modelling group and a control group. They all practised on eight bronchoscopy simulation cases individually, followed by standardised feedback from an instructor. Additionally, the modelling group watched three modelling examples of the simulated bronchoscopy, performed by the instructor. These modelling examples were interspersed between cases. Assessments were carried out at pre-, post- and 3-week retention tests with simulator-measured performance metrics. The primary outcome measure was the percentage of segments entered/minute. Other measures were wall collisions, red-out, the percentage of segments entered and the time to completion. Group differences were examined using repeated measures analysis of variance (anova). RESULTS: A clear learning curve was observed for both groups, but as hypothesised, the modelling group outperformed the control group on all parameters except the percentage of segments entered on the post-test and retained this superiority at the retention test. For the primary outcome measure, the percentage of segments entered/minute, the modelling group achieved a 46% higher score at the post-test and a 43% higher score at the retention test. CONCLUSIONS: The present study shows, that integrating modelling examples into the curriculum of bronchoscopy simulation training optimises the role of the instructor and enhances novices' learning outcomes, presumably by optimising cognitive load during training.

Development of an instrument for measuring different types of cognitive load.

According to cognitive load theory, instructions can impose three types of cognitive load on the learner: intrinsic load, extraneous load, and germane load. Proper measurement of the different types of cognitive load can help us understand why the effectiveness and efficiency of learning environments may differ as a function of instructional formats and learner characteristics. In this article, we present a ten-item instrument for the measurement of the three types of cognitive load. Principal component analysis on data from a lecture in statistics for PhD students (n = 56) in psychology and health sciences revealed a three-component solution, consistent with the types of load that the different items were intended to measure. This solution was confirmed by a confirmatory factor analysis of data from three lectures in statistics for different cohorts of bachelor students in the social and health sciences (ns = 171, 136, and 148), and received further support from a randomized experiment with university freshmen in the health sciences (n = 58).