My brain is full!

Far side

This t-shirt admittedly is one of my very favorite Far Side cartoons, and is an idea that has occurred to me more than once.  It impacts how we function in our responsibilities, and it definitely impacts how we learn.

“Cognitive load” is a tricky thing. It influences our working memory, or how we process information.  Although many of us would like to believe that our working memory is both broad and durable, the truth is that it can’t contain more than 4-5 items in it at one time, and that the items there last at most for 10 seconds. That sounds suspiciously like a Twitter feed, doesn’t it?

Most importantly, working memory is impacted by the complexity of information or the complexity of tasks that we are trying to manage in any given moment. In surgical education, we feel this as a learner when we’re trying to perform a skill that is new to us and we are distracted with a question, a page, or just something noisy happening in the corner of the room. Interns, if you find that you suddenly stop what you’re doing while suturing a wound when the attending asks you a question…well, it’s pretty normal.  Suturing isn’t something that you’ve likely automated at this stage of your career.  The distraction of the question, particularly if the question contains somewhat complicated information, can easily result in you needing to hit the “pause” button- which is easier to do with the suturing than it is with the question you’re being asked by a 3rd party. Even those of us with more experience still have certain operations or parts of cases when we’ll ask to not have any disturbances unless they are life and death; as an example, anytime I am grafting a pediatric hand, I make a request to not be disturbed unless it’s completely necessary. Anyone who has put a skin graft (or many skin grafts) on a hand of an 18-month-old understands how complex and intricate that is, and why even with experience we don’t necessarily have the brain “space” to be disturbed.

The other interesting bit about cognitive load relates to multitasking, which we are essentially being asked to do in the above scenario.  If you are suturing, you’re likely to pick up speed as you go along because you are repeating the task. However, if you are interrupted by a question while you are suturing, you have two options:

  1. Respond to the question while suturing, or multitasking (unlikely for a novice), or
  2. Choose to focus on suturing by ignoring the question, or choose to focus on the question by stopping suturing.

If either choice in option 2 occurs, the switching between tasks makes you slower at both tasks.  Essentially, there is a cost to switching between activities.  This difference may be so small as to almost be imperceptible, but it is real.

As educators, what can we do to help our learners manage cognitive load and not exceed their brain bandwidth (or become frustrated by trying to do too many complicated things at one time)?

  • Try to integrate information sources when learners are acquiring new data
  • Reinforce using multiple modalities without being redundant
  • “Chunk” the content- give learners a schema for organizing information (this is an advantage that the expert has over the novice is that we have schemas to help us retrieve complex information efficiently)
  • Remember that learners come at different levels, and organize information appropriately
  • Take out the frills- it’s a distraction from the key material!

Our job? It really boils down to figuring out how to create an environment that will support learners doing their job- even if there is a bit of stress added to that system.