title: Thrive or overload? The effect of task complexity on novices' simulation-based learning.
abstract: BACKGROUND
  Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded.
  
  
  OBJECTIVE
  In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training.
  
  
  METHODS
  Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures.
  
  
  RESULTS
  In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80).
  
  
  CONCLUSIONS
  Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.
authors: Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.|Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada.
authors: Faizal A
authors: FA
authors: Haji
authors: Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|SickKids Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Jeffrey J H
authors: JJ
authors: Cheung
authors: Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Nicole
authors: N
authors: Woods
authors: Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Glenn
authors: G
authors: Regehr
authors: Division of Clinical Neurological Sciences, Faculty of Medicine, Western University, London, Ontario, Canada.
authors: Sandrine
authors: S
authors: de Ribaupierre
authors: Division of Emergency Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
authors: Adam
authors: A
authors: Dubrowski
mesh_terms: D002983:Clinical Competence; D003071:Cognition; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D055815:Young Adult