title: Measuring cognitive load: mixed results from a handover simulation for medical students.
abstract: BACKGROUND
  The application of cognitive load theory to workplace-based activities such as patient handovers is hindered by the absence of a measure of the different load types. This exploratory study tests a method for measuring cognitive load during handovers.
  
  
  METHODS
  The authors developed the Cognitive Load Inventory for Handoffs (CLI4H) with items for intrinsic, extraneous, and germane load. Medical students completed the measure after participating in a simulated handover. Exploratory factor and correlation analyses were performed to collect evidence for validity.
  
  
  RESULTS
  Results yielded a two-factor solution for intrinsic and germane load that explained 50 % of the variance. The extraneous load items performed poorly and were removed from the model. The score for intrinsic load correlated with the Paas Cognitive Load scale (r = 0.31, p = 0.004) and was lower for students with more prior handover training (p = 0.036). Intrinsic load did not, however, correlate with performance. Germane load did not correlate with the Paas Cognitive Load scale but did correlate as expected with performance (r = 0.30, p = 0.005) and was lower for those students with more prior handover training (p = 0.03).
  
  
  CONCLUSIONS
  The CLI4H yielded mixed results with some evidence for validity of the score from the intrinsic load items. The extraneous load items performed poorly and the use of only a single item for germane load limits conclusions. The instrument requires further development and testing. Study results and limitations provide guidance to future efforts to measure cognitive load during workplace-based activities, such as handovers.
authors.affiliation: Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine, Zucker Hillside Hospital, Glen Oaks, NY, USA. Jyoung9@nshs.edu.
authors.forename: John Q
authors.initials: JQ
authors.lastname: Young
authors.affiliation: Department of Medicine, UCSF School of Medicine, San Francisco, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Irby
authors.affiliation: Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Maria-Louise
authors.initials: ML
authors.lastname: Barilla-LaBarca
authors.affiliation: Center for Research & Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Olle
authors.initials: O
authors.lastname: Ten Cate
authors.affiliation: Research and Development in Medical Education, UCSF School of Medicine, San Francisco, USA.
authors.forename: Patricia S
authors.initials: PS
authors.lastname: O'Sullivan
keywords: Cognitive Load; Cognitive Load Theory; Handover; Measurement; Validity