title: Cognitive load imposed by ultrasound-facilitated teaching does not adversely affect gross anatomy learning outcomes.
abstract: Ultrasonography is increasingly used in medical education, but its impact on learning outcomes is unclear. Adding ultrasound may facilitate learning, but may also potentially overwhelm novice learners. Based upon the framework of cognitive load theory, this study seeks to evaluate the relationship between cognitive load associated with using ultrasound and learning outcomes. The use of ultrasound was hypothesized to facilitate learning in anatomy for 161 novice first-year medical students. Using linear regression analyses, the relationship between reported cognitive load on using ultrasound and learning outcomes as measured by anatomy laboratory examination scores four weeks after ultrasound-guided anatomy training was evaluated in consenting students. Second anatomy examination scores of students who were taught anatomy with ultrasound were compared with historical controls (those not taught with ultrasound). Ultrasound's perceived utility for learning was measured on a five-point scale. Cognitive load on using ultrasound was measured on a nine-point scale. Primary outcome was the laboratory examination score (60 questions). Learners found ultrasound useful for learning. Weighted factor score on "image interpretation" was negatively, but insignificantly, associated with examination scores [F (1,135) = 0.28, beta = -0.22; P = 0.61]. Weighted factor score on "basic knobology" was positively and insignificantly associated with scores; [F (1,138) = 0.27, beta = 0.42; P = 0.60]. Cohorts exposed to ultrasound had significantly higher scores than historical controls (82.4% ± SD 8.6% vs. 78.8% ± 8.5%, Cohen's d = 0.41, P < 0.001). Using ultrasound to teach anatomy does not negatively impact learning and may improve learning outcomes. Anat Sci Educ 10: 144-151. © 2016 American Association of Anatomists.
authors.affiliation: Department of Cell Biology and Anatomy, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Jamniczky
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Darrel
authors.initials: D
authors.lastname: Cotton
authors.affiliation: Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Paget
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Qahir
authors.initials: Q
authors.lastname: Ramji
authors.affiliation: Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Lenz
authors.affiliation: Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: McLaughlin
authors.affiliation: Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Coderre
authors.affiliation: Undergraduate Medical Education Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.|Ward of the 21st Century (W21C), University of Calgary/Calgary Zone of Alberta Health Services, Calgary, Alberta, Canada.|Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Irene W Y
authors.initials: IW
authors.lastname: Ma
mesh_terms: D000416:Alberta; D000715:Anatomy / Q000193:education*; D003071:Cognition; D032882:Comprehension; D003196:Computer Graphics; D003194:Computer-Assisted Instruction; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D004522:Educational Status; D006801:Humans; D007858:Learning; D016014:Linear Models; D025341:Principal Component Analysis; D012577:Schools, Medical; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D013663:Teaching; D014463:Ultrasonography; D016526:Workload
keywords: cognitive load; gross anatomy education; medical education; ultrasound training; undergraduate medical education ultrasound education