Relating cognitive load theory to medical education, how can this theory be applied in lesson planning? We must only use this one theory to describe how we can apply the theory behind this process in medical education lesson planning. For example, if we were to teach the student on the ECG tracing of the heart in a 3 hour session, how would we used cognitive load theory to best plan this lesson?This should include a brief history of CLT, details of the theory, how it has evolved medical education and how it can be used to plan a lesson on teaching the ECG (heart tracing).This essay is primarily focused on teaching undergraduate medical students the ECG (http://www.practicalclinicalskills.com/ecg-interpretation.aspx). Using cognitive load theory to plan a lesson (justifying each section of the lesson plan using cognitive load theory). Please include as many references as possible.This is for a masters level report.In accordance with BrainMass standards this is not a hand in ready essay but only guidelines. Step 1
Cognitive load theory provides a framework that enables instructional designers to control the condition of learning within instructional materials. The theory can be applied to plan a lesson on teaching the ECG. The Cognitive load theory provides empirically based guidelines the help medical instructors designing heart tracing or ECG to focus learner attention towards relevant materials, increasing relevant cognitive load. Step 2
Cognitive load refers to the total amount of mental effort being used in the working memory. The cognitive load theory was developed from the study of problem solving by John Sweller in 1980s. According to the theory, instructional design can be used to reduce cognitive load in learners. The theory differentiates cognitive load into three types, intrinsic, extraneous, and germane. The history of cognitive load theory begins with the beginning of Cognitive Science in 1950s and the work of G A Miller. Miller suggested that our working memory has inbuilt limits. In 1970s, Simon and Chase used the term chunk to describe the organization of information by individuals in short-term memory. In 1980s the cognitive load theory was developed by John Sweller. According to him, instructional planning should develop instructional materials that do not involve problem solving. He suggested the development of instructional materials that had worked examples and goal free problems. During the 1990, the cognitive load theory was applied to several contexts such as the completion problem effect, modality effect, split attention effect, and expertise reversal effect (a). Cognitive load theory says that intrinsic cognitive load is the inherent level of difficulty associated with a specific instructional topic. Medical instruction also has an inherent difficulty associated with it. Extraneous cognitive load is generated by the manner in which information is presented to learners and can be controlled by instructional designers. In medical education, extrinsic load is attributed to the design of instructional materials. For example, an ECG change can be described verbally but it is far faster to show the change of ECG in the form of a chart. It takes relatively less effort to see the change on a chart. Germane cognitive load is the load that is devoted to the processing, construction, and automation of schemas (b). Cognitive load theory suggests that extrinsic and germane loads can be manipulated by instructional designs. The point is that cognitive load researchers seek ways to redesign instruction to redirect what would be extraneous load to now germane load. The theory when applied to ECG instruction means that extraneous load can be reduced by the use of goal-free tasks, worked examples, and completion tasks by integrating different sources of information. ECG (heart tracing) instruction can be enhanced by using multiple modalities, and reducing redundancies. Intrinsic load in ECG (heart tracing) instruction can be managed by simple to complex ordering of learning tasks and working from low to high fidelity environments. In ECG (heart tracing) instruction, germane load can be optimized by increasing variability over tasks, applying contextual interference and evoking self-explanation. Cognitive load theory says that learning happens best under conditions that are aligned with human cognitive architecture. The point is that learning requires a change in the schematic structures of long term memory and is shown by performance that moves from awkward, error-prone, tardy and difficulty to smooth and effortless. As the learner becomes more familiar with the subject, the cognitive characteristics related to the subject matter are changed so that it can be handled more efficiently by working memory. In instructions for ECG (heart tracing), the role of cognitive load theory is to use techniques that reduce working memory load to enable changes in the long term memory related to schema acquisition (c). The most important aspect of ECG (heart tracing) lesson will be to ensure that the information given is not only better understood by the learner but they are also able to retain that information for future use. Applying the fundamentals of Cognitive load theory in the lesson for ECG (heart tracing) is essential so that the learners get the most from the ECG lesson. Step 3
The following is the lesson plan for ECG (heart tracing).
Class Objectives:
To give an introduction to ECG (heart tracing);
To provide training for interpretation of ECG (heart tracing);
To provide drills for Arrhythmia;Relationship to Course Objectives:
This training is required for reviewing the electrophysiology of the heart as it relates to ECG. The training is also essential to understand the characteristics of a normal ECG. The student must be able to understand the characteristics of a normal ECG, he must know how to record an ECG on a human being, and know the common errors in ECG recording. The student must be able to identify 40 types of common ECG tracings. Finally, the student must be able to identify arrhythmia tracings from ECG practice strip. Anticipatory Set:
How can you use ECG (heart tracing) to indicate abnormal conditions?Introduction:
The introduction will inform the students that they will be provided an introduction to ECG (heart tracing), ECG interpretation techniques, and arrhythmia identification. Procedures:
The procedures used to deliver the material will use goal free tasks, worked examples, partial solutions, use visual and spoken information, and self-contained instruction. Also the tasks will be graded from simple tasks to complex tasks. Tasks with similar surface features will be replaced with tasks that differ from one another on dimensions on which tasks differ from one another on all dimensions. There will be completion tasks that will contain prompts that ask learners to self explain the given information. Conclusion:
The lesson will succeed in ECG (heart tracing) training, ECG (heart tracing) interpretation, and arrhythmia drills. Step 4
The first section of the lesson will be introduction to ECG (heart tracing). During this section, the students will be involved in a discussion where they will have to answer questions:
Please describe the ways in which the electrophysiology of heart is related to the ECG.
Please explain the characteristics of a normal ECG
Which illnesses can be identified by using an ECG?
Please describe a normal ECG.
Kindly say what errors occur in ECG recordingAn electrocardiogram is the graphical record produced by an electrocardiograph that records the electrical activity of the heart over time. The justification of the questions asked is that it applies the goal free principle of Cognitive load theory. The conventional tasks of asking questions such as define an ECG (heart tracing) or list the seven characteristics of ECG are replaced with goal free questions. These questions have the potential of decreasing extraneous load.
The first section will also have an exercise in which two ECGs, one normal and a second abnormal will be interpreted in a solution. The solution will say which ECG is normal and which is abnormal. The students will each be given a copy of the ECGs and solution. The students will be asked to give reasons why they feel the ECG is normal and the other is abnormal. The students will also be allowed to differ from the solution. They may disagree with the answers and may give a different explanation. The justification of this exercise is worked example principle (d). According to cognitive load theory, extraneous load is reduced when students are asked to criticize an answer than having them independently answer which ECG is normal and which is not normal This section will take about forty five minutes. Step 5
During the second section that is expected to last seventy-five minutes, ECG (heart tracing) interpretation will be presented to students. The steps of interpretation are rhythm, rate, P wave, PR Interval, QRS Interval, T Wave, QT interval, and ST Segment. The students will each be given a task in which an incomplete description of each step of interpreting the ECG (heart tracing) will be provided. There will either be a blank left in the description or the student will be required to add a word or two at the end of the description. Some examples are:
The ECG paper speed is normally ____ mm/sec.
Vertically, the ECG graph measures the ____ of a given wave or deflection.
QT Interval represents _______ and re-polarization of ventricles.
The ST segment is that flat, ______ section of the ECG between the end of the S wave and the beginning of the T wave.
The QRS complex is ____ than the P wave. It consists of ____ wave components.
The justification from the Cognitive load theory is the completion principle. If a completion task is given to students, the extraneous load is reduced so that the germane cognitive load is maximized. The medical students have to observe statements importantly related to interpreting ECG, they only answer part of the answers. They are not required to write the full definition of ST segment or QT intervals. The second part of the second section will have slide presentation which will show strips of ECG along with short descriptions of the step. The description will be written on the slide and will point to the exact meaning on the ECG strip on the slide. There will be one slide for each of the eight steps of ECG (heart tracing) interpretation. There will be one slide each for rhythm, rate, P wave and so on. The justification from Cognitive load theory is the use of split attention principle. Multiple sources of information, which are distributed in either space or time, are eliminated and one integrated source of information is provided to the students. The slides will provide description and use of each step with arrows showing the step on a strip of ECG. The justification will be that the students will get information for each step exactly when they see the ECG strip on the screen. This reduces extrinsic cognitive load. The third part of the second section will have five ECG strips presented one at a time on the slide projector. The instructor will verbally interpret those slides. The Cognitive load theory justification for this step is that it replaces a written explanatory text with another source of visual information with spoken explanatory text. This step is supported by the modality principle of the Cognitive load theory. The students are given a spoken explanation about each strip being presented to them. Step 6
The third section is expected to last sixty minutes:Abnormal rhythms of the patients heart are called arrhythmia. It is abnormally slow or fast heart rate or an irregular cardiac rhythm. During the first part of the third section the students are required to learn the parts of ECG tracking. These are called P,Q, R, S, T and U. The student will be shown a video on which each of these parts are shown visually. There will also be a slide on which each of the parts will be marked.
From the Cognitive load theory, extraneous cognitive load is decreased by replacing multiple sources of information with one that is self-contained. Both the video and the static slide are self-contained. The students can understand them on their own, no explanation is required. There will be no verbal or written explanation required. This will increase germane cognitive load. During the second part of this section, the students will be provided with a total of 12 ECG strips. The student will be required to mark the arrhythmia categories. There will be two strips from each of the categories namely atrial, junctional, ventricular, heart-blocks, and sudden arrhythmic death syndrome. Since every student will be given different types of ECG strips, all arrhythmia categories will be covered during this lesson. Cognitive load theory justification for this exercise is that a series of tasks with similar surface features is replaced with a series of tasks that differ from one another on each dimension. When giving the ECG strips to students care will be taken that there are two strips each from each arrhythmia category. This satisfies the variability principle and helps optimize germane load. During the third part of this section, there will be a total of fifteen strips presented one by one on a slide and the students will be required to identify the arrhythmia category of each prompt. The students may differ with each other and they have to explain the causes of their difference. The justification of this exercise from Cognitive load theory is the self-explanatory principle. The worked examples or completion tasks are replaced with slides containing prompts asking students to self-explain the given information. This part of the third section is based on the self explanation principle of the Cognitive load theory. References:(a) Cognitive Load Theory: Studies in Modality and Redundancy, Wayne Michael Leahy, University of New South Wales, 2000
(b) Efficiency in Learning: Evidence-Based Guidelines to Manage Cognitive Load, Ruth C. Clark, Frank Nguyen, John Sweller, John Wiley & Sons, 2011
(c) Cognitive Load Theory, John Sweller, Paul Ayres, Slava Kalyuga, Springer Science & Business Media, 2011
(d) Cognitive Load Theory, Jan L. Plass, Roxana Moreno, Roland Brünken, Cambridge University Press, 2010Other References:
Joanne Oud, (2009) Guidelines for effective online instruction using multimedia screencasts, Reference Services Review, Vol. 37 Iss: 2, pp.164 – 177
Päivi Tynjälä, Päivi Häkkinen, (2005) E‐learning at work: theoretical underpinnings and pedagogical challenges, Journal of Workplace Learning, Vol. 17 Iss: 5/6, pp.318 – 336




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