title: Influence of learner knowledge and case complexity on handover accuracy and cognitive load: results from a simulation study.
abstract: BACKGROUND
  The handover represents a high-risk event in which errors are common and lead to patient harm. A better understanding of the cognitive mechanisms of handover errors is essential to improving handover education and practice.
  
  
  OBJECTIVE
  This paper reports on an experiment conducted to study the effects of learner knowledge, case complexity (i.e. cases with or without a clear diagnosis) and their interaction on handover accuracy and cognitive load.
  
  
  METHODS
  Participants were 52 Dutch medical students in Years 2 and 6. The experiment employed a repeated-measures design with two explanatory variables: case complexity (simple or complex) as the within-subject variable, and learner knowledge (as indicated by illness script maturity) as the between-subject covariate. The dependent variables were handover accuracy and cognitive load. Each participant performed a total of four simulated handovers involving two simple cases and two complex cases.
  
  
  RESULTS
  Higher illness script maturity predicted increased handover accuracy (p < 0.001) and lower cognitive load (p = 0.007). Case complexity did not independently affect either outcome. For handover accuracy, there was no interaction between case complexity and illness script maturity. For cognitive load, there was an interaction effect between illness script maturity and case complexity, indicating that more mature illness scripts reduced cognitive load less in complex cases than in simple cases.
  
  
  CONCLUSIONS
  Students with more mature illness scripts performed more accurate handovers and experienced lower cognitive load. For cognitive load, these effects were more pronounced in simple than complex cases. If replicated, these findings suggest that handover curricula and protocols should provide support that varies according to the knowledge of the trainee.
authors: Department of Psychiatry, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA.
authors: John Q
authors: JQ
authors: Young
authors: Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Savannah M
authors: SM
authors: van Dijk
authors: Research and Development of Medical Education, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors: Patricia S
authors: PS
authors: O'Sullivan
authors: Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Eugene J
authors: EJ
authors: Custers
authors: Research and Development of Medical Education, School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors: David M
authors: DM
authors: Irby
authors: Centre for Research and Development of Education, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: Olle
authors: O
authors: Ten Cate
mesh_terms: D003071:Cognition; D003142:Communication; D004504:Education, Medical, Undergraduate; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007858:Learning; D009426:Netherlands; D062209:Patient Handoff / Q000706:statistics & numerical data*; D011582:Psychological Theory; D000066908:Simulation Training; D013337:Students, Medical