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/ .

Load effect of visual working memory on distractor interference: An investigation with two replication experiments.

Konstantinou et al. (Experiment 1B; Attention, Perception, & Psychophysics, 76, 1985-1997, 2014) reported that an increase in visual short-term memory (VSTM) load reduced distractor interference in the flanker task. Yao et al. (Experiment 3; Attention, Perception, & Psychophysics, 82, 3291-3313, 2020) replicated the design of Konstantinou et al.'s experiment and showed that the VSTM load did not modulate the distractor interference effect, contradicting the original findings. However, it is unknown whether differences in task-design between the two experiments contributed to the inconsistent results. Therefore, we first replicated the original two studies with Experiment 1 (N = 54) and Experiment 2 (N = 54) and performed a statistical comparison between the data from these two experiments. In a third experiment (N = 28), we incorporated articulatory suppression into the design to exclude possible effects of verbalization. According to the ANOVA analyses, the VSTM load did not change the level of distractor interference in all three experiments, indicating that differences in task design alone do not explain the inconsistency.

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.

Harnessing open science practices to teach ecology and evolutionary biology using interactive tutorials.

Open science skills are increasingly important for a career in ecology and evolutionary biology (EEB) as efforts to make data and analyses publicly available continue to become more commonplace. While learning core concepts in EEB, students are also expected to gain skills in conducting open science to prepare for future careers. Core open science skills like programming, data sharing, and practices that promote reproducibility can be taught to undergraduate students alongside core concepts in EEB. Yet, these skills are not always taught in biology undergraduate programs, and a major challenge in developing open science skills and learning EEB concepts simultaneously is the high cognitive load associated with learning multiple disparate concepts at the same time. One solution is to provide students with easily digestible, scaffolded, pre-formatted code in the form of vignettes and interactive tutorials. Here, we present six open source teaching tutorials for undergraduate students in EEB. These tutorials teach fundamental ecological concepts, data literacy, programming (using R software), and analysis skills using publicly available datasets while introducing students to open science concepts and tools. Spanning a variety of EEB topics and skill levels, these tutorials serve as examples and resources for educators to integrate open science tools, programming, and data literacy into teaching EEB at the undergraduate level.

Identifying and Exploring the Cognitive Nature of Threshold Concepts in Pharmacology to Improve Medical Students' Learning.

Phenomenon: Pharmacology is a fundamental healthcare discipline, but it can be difficult and counterintuitive for learners to learn. Navigation toward understanding pharmacology can be troublesome, but once the threshold to comprehension is crossed, learners can experience a transformative shift in their ways of thinking and practicing. We conducted an in-depth examination of threshold concepts within pharmacology, aiming to identify and prioritize their learning to improve the medical curriculum and enhance medical treatment and patient safety. Approach: We carried out a consensus generation process using the Nominal Group Technique (NGT) to identify potential threshold concepts in pharmacology. Participant groups of pharmacology experts and medical students considered, identified, reviewed, and ranked potential pharmacology threshold concepts within their own group. Then, using a logical, step-by-step approach, we combined the final ranked data from these multiple NGT sessions. We further analyzed these data using an abductive analysis approach; data were coded, categorized, reorganized, and conceptually mapped after critical evaluation. Conceptual themes were established corresponding to different phases of cognitive schema development. Findings: Six comprehensive conceptual themes were identified: Drug Mechanism of Action; Pharmacotherapeutics; Pharmacokinetics; Drug Receptor Interactions; Drug Terminology and Nomenclature; and Signaling Pathways. These concepts align with many of the key attributes of threshold concepts (e.g., troublesome, integrative and transformative). The cognitive schematic themes generated were (i) acquisition-troublesome; (ii) acquisition-transformative; (iii) automation-troublesome; (iv) automation-transformative. Insights: Transformative learning involves different stages of cognitive schema evolution, including acquisition, elaboration, and automation, and is influenced by both the inherent challenges of the concepts and limitations of human cognition. The high interactivity of these troublesome concepts challenge schema acquisition and automation. Troublesome concepts underpinning procedures or skills, while not easily explained by cognitive rules, can lead to slow, awkward, error-prone performance, creating additional barriers for practice. Integrating concepts into a coherent structure leads to the irreversible assimilation of knowledge and the transferability of both knowledge and skills, influencing learners' epistemological transitions and ontological transformations at theoretical and professional levels. Further work on designing instructional models around assisting and automating schemas around identified troublesome knowledge, while addressing the impact of cognitive load, has the potential to promote transformational learning.

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.

Reasoning More Efficiently with Primary Knowledge Despite Extraneous Cognitive Load.

Geary's evolutionary approach in educational psychology differentiates between primary (low cognitive costs and motivational advantage) and secondary knowledge (high cognitive costs and no motivational benefit). Although these features have been well demonstrated in previous work, the underlying mechanisms remain unclear. To investigate it, in a reasoning task, the present study varies (i) the content of the problems (primary knowledge vs. secondary; e.g., food vs. grammar rules), (ii) the intrinsic cognitive load (conflict or non-conflict syllogism, the former requiring more cognitive resources to be properly processed than the latter) and (iii) the extraneous cognitive load (via a Dot Memory Task with three modalities: low, medium and high cognitive load). Analyses assessed the influence of these variables on performance, problem solving speed and perceived cognitive load. Results confirmed the positive impact of primary knowledge on efficiency, particularly when intrinsic cognitive load was high. Surprisingly, the extraneous cognitive load did not influence the performance in secondary knowledge content but that in primary knowledge content: the higher the additional load was, the better the performance was, only for primary knowledge and especially for syllogisms with high intrinsic load. Findings support evolutionary theory as secondary knowledge would overload cognitive resources, preventing participants from allocating sufficient resources to solve problems. Primary knowledge would allow participants to process the additional load and to increase their performance despite this. This study also raises the hypothesis that a minimum cognitive load is necessary for participants to be invested in the task.

Collaborative robots can augment human cognition in regret-sensitive tasks.

Despite theoretical benefits of collaborative robots, disappointing outcomes are well documented by clinical studies, spanning rehabilitation, prostheses, and surgery. Cognitive load theory provides a possible explanation for why humans in the real world are not realizing the benefits of collaborative robots: high cognitive loads may be impeding human performance. Measuring cognitive availability using an electrocardiogram, we ask 25 participants to complete a virtual-reality task alongside an invisible agent that determines optimal performance by iteratively updating the Bellman equation. Three robots assist by providing environmental information relevant to task performance. By enabling the robots to act more autonomously-managing more of their own behavior with fewer instructions from the human-here we show that robots can augment participants' cognitive availability and decision-making. The way in which robots describe and achieve their objective can improve the human's cognitive ability to reason about the task and contribute to human-robot collaboration outcomes. Augmenting human cognition provides a path to improve the efficacy of collaborative robots. By demonstrating how robots can improve human cognition, this work paves the way for improving the cognitive capabilities of first responders, manufacturing workers, surgeons, and other future users of collaborative autonomy systems.

The Influence of Manipulating and Accentuating Task-Irrelevant Information on Learning Efficiency: Insights for Cognitive Load Theory.

The paper endorses Cognitive Load Theory and offers insights into the characterization of the mechanisms underlying extraneous cognitive load and their impact on basic learning. Students were asked to learn associations between eight base-code words and eight digits, based on an example, and to rapidly apply their new knowledge in a test section. Two groups of 60 university students participated in two experiments. The study was implemented as two distinct experiments, one using color names (e.g., blue, yellow) and the other using color-related word concepts (e.g., sky, banana) for stimulation. Each experiment had two conditions that manipulated the location and salience of task-irrelevant color information (extraneous cognitive load) and its congruity with the digits' corresponding base-code words. Findings indicated extraneous cognitive load has the potential to both sustain and undermine learning processes by varying the overall cognitive load, with gains and costs in learning efficiency resulting from essentially different processing scenarios.

Evaluating an obstetrics and gynecology teaching program for medical students incorporating simulation-based education underpinned by cognitive load theory.

Although there have been previous publications on curriculum innovations in teaching O&G to medical students, especially utilizing simulation-based education, there have been none, as far as we know, incorporating and evaluating the outcomes using cognitive load theory. The aim of this article was to describe the introduction, implementation, and evaluation of an innovative teaching program in O&G, incorporating simulation-based education, underpinned by cognitive load theory. Cognitive load is defined as the amount of information a working memory can hold at any one time and incorporates three types of cognitive load-intrinsic, extraneous, and germane. To optimize learning, educators are encouraged to manage intrinsic cognitive load, minimize extraneous cognitive load, and promote germane cognitive load. In these sessions, students were encouraged to prepare in advance of each session with recommended reading materials; to limit intrinsic cognitive load and promote germane cognitive load, faculty were advised ahead of each session to manage intrinsic cognitive load, an open-book MCQ practice session aimed to reduce anxiety, promote psychological safety, and minimize extraneous cognitive load. For the simulation sessions, the faculty initially demonstrated the role-play situation or clinical skill first, to manage intrinsic cognitive load and reduce extraneous cognitive load. The results of the evaluation showed that the students perceived that they invested relatively low mental effort in understanding the topics, theories, concepts, and definitions discussed during the sessions. There was a low extraneous cognitive load. Measures of germane cognitive load or self-perceived learning were high. The primary message is that we believe this teaching program is a model that other medical schools globally might want to consider adopting, to evaluate and justify innovations in the teaching of O&G to medical students. The secondary message is that evaluation of innovations to teaching and facilitation of learning using cognitive load theory is one way to contribute to the high-quality training of competent future healthcare workers required to provide the highest standard of care to women who are crucial to the overall health and wellbeing of a nation.

The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions.

OBJECTIVE: This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. METHODS: A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. RESULTS: Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. CONCLUSION: In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

Optimising listening skills: Analysing the effectiveness of a blended model with a top-down approach through cognitive load theory.

The ability to listen is critical in the task of language learning. Although listening has the least pedagogical attention, the growing emphasis on communication and language proficiency makes listening skills prominent in the language classroom. This paper aims to analyse the effectiveness of the Blended model to improve teaching listening skills, by instigating a top-down approach through Cognitive Load Theory. The top-down approach aids the students with the background knowledge of the audio with information like context, situation, phrases, etc. The blended model enables the teacher to facilitate students through the technological platform to process their listening input. A questionnaire was adopted for data collection and a semi-structured interview was performed from 60 samples from prefinal year Engineering students selected through purposive sampling techniques and grouped as experimental N = 30 and control N = 30 groups. The experimental group was trained with a top-down approach with the support of LMS. The control group was provided with the same listening material but taught in the conventional method. The purpose of this study is to show the statistically significant impact of employing technology inside the language classroom to teach listening skills. Findings showed that samples in the experimental group could identify the relevant and non-relevant information from the audio, conceptualise the audio content and predict the information beforehand. The difficulties that the students and teachers faced and the remedial measures to overcome them are also discussed. The following objectives were established for the study through mixed methods of enhancing listening skills through Cognitive Load Theory (CLT). •To explore the effect of intervention through a top-down approach with the support of technology (LMS) on enhancing the listening skills of the students.•How the blending of synchronous and asynchronous and a top-down approach develops the predicting skills of the students during the listening comprehension exercises.•To adapt procedures involved in enhancing the self-paced learning efficacy and reducing listening anxiety in ESL learners.

High variability in learning materials benefits children's pattern practice.

Concrete materials (e.g., pictures, objects) are believed to be helpful with learning, but not in all circumstances. Variability in these materials (i.e., using different materials vs. the same materials) could be an important factor. We compared how variability in concrete images influenced children's learning about repeating patterns (e.g., ABBABBABB). A total of 87 children aged 4 to 6 years from the United States (75% White; 44% female) completed an experiment via Zoom in which they received brief pattern training. Children were randomly assigned into Low, Medium, and High Variability training conditions, which differed in terms of whether the same materials were used over and over or they varied in their perceptual features. Children in the Low Variability condition performed better at the beginning of training, but this trend ultimately reversed. Children in the High Variability condition performed best by the end of training and on the posttest. Using variable materials may allow children to extract common structures across instances.

Tracking the water storage and runoff variations in the Paraná basin via GNSS measurements.

The Paraná basin is the second largest river basin in South America and provides abundant water resources globally. However, current research lacks hydrological investigation of the region. The vertical crustal deformation recorded by the Global Navigation Satellite System (GNSS) can be used to accurately estimate regional-scale terrestrial water storage (TWS). Therefore, we utilized the daily vertical displacement time series data at 102 GNSS stations to recover the water storage variations in the Paraná basin from 2013 to 2020. To recognize primary spatiotemporal features of TWS changes, we applied the principal component analysis (PCA) method in the inversion strategy. Results indicate that the TWS variations inferred from GNSS generally align in spatiotemporal patterns with estimates from both the Gravity Recovery and Climate Experiment (GRACE) and the Global Land Data Assimilation System (GLDAS). However, some discrepancies are evident at local scales. The TWS changes derived from both GNSS and GRACE exhibited generally larger magnitude of oscillations than those estimated by GLDAS, while the GRACE results neglected the evident seasonal oscillation of the water mass in the southeast of the basin. Given the challenge of capturing large-scale runoff variations through in-situ observations, we innovatively applied GNSS and water budget closure method to provide a novel runoff estimate for the Paraná basin. The GNSS-inferred runoff exhibited a strong correlation (correlation coefficient of 0.72) with in-situ observations. Overall, our study fills the critical knowledge gap in geodesy-based hydrological investigation in the Paraná basin. We aim to highlight the immense potential of GNSS for hydrological parameter estimation and provide valuable reference data for regional hydrological research and for water resources management.

Designing a Clinical Clerkship Program with the 4C/ID Model / 医学教育

Clinical clerkships in medical school requires an educational approach that integrates medical students into the medical team and progressively assigns medical tasks to them based on their competencies. However, it is challenging for supervisors to delegate tasks to medical students gradually while considering medical safety. This paper outlines the design of an emergency department clinical clerkship program based on the Four Component Instructional Design (4C/ID) model. This model enables students to learn complex task performance skills in stages while developing a schema, considering the cognitive load involved in learning complex tasks. The 4C/ID model is anticipated to be an effective instructional design for constructing clinical clerkship programs.

The Effects of Emotional Labor on Work Strain and Nonwork Strain Among Dancers: A Person-Centered Approach.

Introduction: Emotional labor is an important research area, but four key gaps remain regarding outcomes of nonwork strains, explanatory frameworks beyond the conservation of resources theory, adoption of person-centered approaches, and subjects of performers. Methods: By surveying 183 Chinese dance students, we employed cluster analysis to examine the adoption of emotional labor strategies (ie, surface acting, deep acting, and expression of naturally felt emotions) and to explore the outcomes on work strain (ie, emotional exhaustion and reduced flow experience) and nonwork strain (ie, depression and anxiety) with introducing the allostatic load theory as an analytical basis. Results: Four types of emotional workers were identified, namely, flexible regulators (33.33%), authentic regulators (15.85%), display rules compliers (39.34%), and non-regulators (11.48%). Authentic regulators had the lowest emotional exhaustion. Non-regulators had the lowest flow. No differences emerged in depression or anxiety across clusters. Discussion: Findings partially align with past research showing risks of surface acting in terms of emotional exhaustion. However, all three strategies enhanced flow states. Moreover, dancers' work strains did not extend to psychological problems, unlike other professions. Possible explanations include training in emotional regulation and flow states in performing. Practical implications exist for training emotional regulation and fostering flow at work.

Cognitive Ergonomics: A Review of Interventions for Outpatient Practice.

Doctoring is difficult mental work, involving many cognitively demanding processes such as diagnosing, decision-making, parallel processing, communicating, and managing the emotions of others. According to cognitive load theory (CLT), working memory is a limited cognitive resource that can support a finite amount of cognitive load. While the intrinsic cognitive load is the innate load associated with a task, the extraneous load is generated by inefficiency or suboptimal work conditions. Causes of extraneous cognitive load in healthcare include inefficiency, distractions, interruptions, multitasking, stress, poor communication, conflict, and incivility. High levels of cognitive load are associated with impaired function and an increased risk of burnout among physicians. Cognitive ergonomics is the branch of human factors and ergonomics (HFE) focused on supporting the cognitive processes of individuals within a system. In health care, where the cognitive burden on physicians is high, cognitive ergonomics can establish practices and systems that decrease extraneous cognitive load and support pertinent cognitive processes. In this review, we present cognitive ergonomics as a useful framework for conceptualizing an oft-overlooked dimension of labor and apply theory to practice by summarizing evidence-based cognitive ergonomics interventions for outpatient care settings. Our proposed interventions are structured within four general recommendations: 1. minimize distractions, interruptions, and multitasking; 2. optimize the use of the electronic health record (EHR); 3. optimize the use of health information systems (HIS); and 4. support good communication and teamwork. Best practices in cognitive ergonomics can benefit patients, minimize practice inefficiency, and support physician career longevity.

The influence of peripheral information on a proactive process during multitasking.

The aim of this study was to examine whether peripheral information facilitates proactive processes during multitasking. For this purpose, peripheral information was presented regularly during multitasking and its effects on the performance of a tracking task (main task: reactive process) and a discrimination task (sub-task: proactive process) were examined. Experiment 1 presented peripheral information (white circles) in the same sensory modality (visual) as the information used for multitasking and the number of circle presentations was manipulated. In Experiment 2, a pure tone (auditory) was presented as peripheral information. We found that, in both experiments, the difficulty of the tracking task influenced discrimination performance, showing that as the difficulty of the tracking task (reactive process) increased, more cognitive resources were consumed in the tracking task, resulting in a decrease in cognitive resources available for the discrimination task (proactive process). In addition, regular presentation of peripheral information facilitated discrimination task performance in both experiments. Interestingly, this peripheral information also facilitated the tracking task performance (reactive process) even if the tracking task was difficult. Moreover, this promoting effect of the peripheral information occurred regardless of the sensory modality. This study revealed that processing of peripheral information facilitates the proactive process even if more cognitive resources are consumed, and that this facilitating effect does not conflict with multitasking and provides a margin of cognitive resources and also facilitates the reactive process. Our results provide evidence of how peripheral information and cognitive resources are used during multitasking.