title: Cognitive Load and Self-Determination Theories Applied to E-Learning: Impact on Students' Participation and Academic Performance.
abstract: BACKGROUND
  Emergency clerkships expose students to a stressful environment that require multiple tasks, which may have a direct impact on cognitive load and motivation for learning. To address this challenge, Cognitive Load Theory and Self Determination Theory provided the conceptual frameworks to the development of a Moodle-based online Emergency Medicine course, inspired by real clinical cases.
  
  
  METHODS
  Three consecutive classes (2013-2015) of sixth-year medical students (n = 304) participated in the course, during a curricular and essentially practical emergency rotation. "Virtual Rounds" provided weekly virtual patients in narrative format and meaningful schemata to chief complaints, in order to simulate real rounds at Emergency Unit. Additional activities such as Extreme Decisions, Emergency Quiz and Electrocardiographic challenge offered different views of emergency care. Authors assessed student´s participation and its correlation with their academic performance. A survey evaluated students´ opinions. Students graduating in 2015 answered an online questionnaire to investigate cognitive load and motivation.
  
  
  RESULTS
  Each student produced 1965 pageviews and spent 72 hours logged on. Although Clinical Emergency rotation has two months long, students accessed the online course during an average of 5.3 months. Virtual Rounds was the most accessed activity, and there was positive correlations between the number of hours logged on the platform and final grades on Emergency Medicine. Over 90% of students felt an improvement in their clinical reasoning and considered themselves better prepared for rendering Emergency care. Considering a Likert scale from 1 (minimum load) to 7 (maximum load), the scores for total cognitive load were 4.79±2.2 for Virtual Rounds and 5.56±1.96 for real medical rounds(p<0,01).
  
  
  CONCLUSIONS
  A real-world inspired online course, based on cognitive and motivational conceptual frameworks, seems to be a strong tool to engage students in learning. It may support them to manage the cognitive challenges involved in clinical care and increase their motivation for learning.
authors.affiliation: Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Tiago
authors.initials: T
authors.lastname: de Araujo Guerra Grangeia
authors.affiliation: Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: de Jorge
authors.affiliation: Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Franci
authors.affiliation: Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Thiago
authors.initials: T
authors.lastname: Martins Santos
authors.affiliation: Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Maria Silvia
authors.initials: MS
authors.lastname: Vellutini Setubal
authors.affiliation: Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Schweller
authors.affiliation: Department of Internal Medicine, Division of Emergency Medicine, Faculty of Medical Sciences at State University of Campinas (Unicamp), São Paulo, Brazil.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: de Carvalho-Filho
mesh_terms: D000328:Adult; D003071:Cognition / Q000502:physiology*; D004504:Education, Medical, Undergraduate; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D012649:Self Concept; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires