The Wizard of OT

Reducing Cognitive Load in OT Education

9-25-24

Heather Kuhaneck

Managing cognitive load is crucial to ensure that students can effectively learn and retain complex information without becoming overwhelmed. This post explores the concept of cognitive load, its impact on learning, and practical strategies for OT educators to reduce cognitive load, enhancing student learning outcomes.

Cognitive Load Theory? What is Cognitive load?

Cognitive load theory (CLT) (Sweller, 1988;2011) is an instructional theory, used to generate experiments to compare methods of instructional design. CLT considers the workings of human cognitive architecture in the process of devising instructional activities. It is an evolutionary theory in that CLT assumes that knowledge is of two types- biologically primary knowledge (knowledge we have evolved to acquire) and biologically secondary knowledge (knowledge that is important for cultural reasons). Biologically primary knowledge includes the types of information we learn through interacting with our environment- such as learning to walk and learning to eat solid foods.  This is information crucial for our survival. Biologically secondary knowledge is the type we learn in school, from books or lectures.  It is not typically part of survival and it requires effort to learn (for example learning geometry, algebra, or latin).  The second type takes longer to acquire and relies heavily on working memory.

Cognitive load is the amount of mental effort required to process information and the amount of information that can be held in working memory at any given time. Working memory typically can process about 7 items of information at once, and can only hold it briefly unless it is rehearsed. (Think about how you try to recall a telephone number stated to you out loud).

CLT distinguishes between three types of cognitive load:

1. Intrinsic Load: The inherent difficulty of the material being learned. This load is influenced by the complexity of the information and the learner’s prior knowledge.
2. Extraneous Load: The cognitive load imposed by the way information is presented. This load can be reduced through effective instructional design.
3. Germane Load: The cognitive load dedicated to processing, understanding, and learning the material. This load is beneficial and should be optimized.

The literature from scientists studying CLT suggests that educators often unwittingly hinder learning by increasing the cognitive load on students. Some ways this may occur include:

1. Overloading Working Memory: Working memory has limited capacity (usually 4-7 items). Presenting too much new information at once, or using complex diagrams and texts, can overload students, making it difficult for them to process and retain information.
2. Unnecessary Complexity: If instructional materials are overly complex (e.g., dense text, unclear diagrams, or too much irrelevant detail), they add extraneous load. Simplifying materials and focusing on key concepts can reduce this.
3. Multitasking Demands: Asking students to listen, read, and write simultaneously (e.g., copying notes from a board while listening to a lecture) can increase cognitive load by splitting attention, reducing their ability to process the material effectively.
4. Lack of Guidance: When students are expected to discover concepts on their own without sufficient guidance (e.g., through pure inquiry-based learning), cognitive load increases. Structured, scaffolded learning with clear examples and guidance reduces extraneous load.
5. Non-Intuitive Visuals: Poorly designed visual aids can increase extraneous load. For instance, visuals that don’t match the accompanying explanation or are too complex can make it harder for students to connect information. Clear, well-labeled visuals reduce unnecessary effort.
6. Redundant Information: Presenting the same information in multiple formats (e.g., reading the same text that is displayed on a slide) can create redundant processing tasks, increasing cognitive load. Instead, use complementary materials that build on one another.
7. Ignoring Prior Knowledge: Instruction that fails to account for students’ existing knowledge can increase intrinsic load by presenting concepts that are either too advanced or too simple. Tailoring materials to students’ experience levels helps manage cognitive load.

Why Should Occupational Therapy Educators be Familiar with Cognitive Load and Attempt to Reduce It?

Reducing cognitive load is essential because excessive cognitive load can hinder learning, causing students to struggle with understanding and retaining information.  Many of the occupational therapy concepts and skills are already inherently complex.  Just because of this, much of the instruction in OT already has a high intrinsic load. By managing other aspects of cognitive load, educators can:

• Enhance comprehension and retention of material.
• Reduce student stress and frustration.
• Promote a deeper understanding of these complex concepts.

How to Reduce Cognitive Load for Students: Strategies for Education

Simplify Complex Information: Break down complex concepts into smaller, manageable chunks and present them sequentially.

• Chunking: Divide information into smaller, meaningful units. 
• Scaffolding: Provide support structures that gradually diminish as students become more proficient. For example, start with guided practice and move towards independence with tasks.
• Use Pre-training:  Teach complex information in two stages:  in the first stage, present the isolated basic concepts and then in the second stage, teach the knowledge needed for understanding relationships between concepts- as opposed to teaching everything all at once. Cognitive load may be reduced during learning of whole tasks that include inter-relationships, IF pre-training has been provided for basic necessary content (terminology, basic concepts).

Optimize Instructional Design: Use clear, concise, and well-organized instructional materials to reduce extraneous cognitive load.

• Multimedia: Apply multimedia learning principles, such as judicious use of both visual and auditory channels. For instance, diagrams along with verbal explanations may enhance understanding. (Visuals aid learning of concrete information in particular. For example, for learning basic anatomy, use pictures, diagrams, and anatomy coloring books). But be aware of the timing of the presentation of visuals so that students can focus on what is being said. If using digital animations, ensure animations do not overwhelm via engaging novice learners in whole tasks (see chunking above). Make sure animations either use only simple whole tasks or demonstrate parts of tasks individually.
• Minimize Redundancy: Avoid unnecessary repetition of information. Ensure that all instructional materials directly contribute to learning objectives.
• Allow control over pacing:  When possible, if using multimedia or animation, allow student control over the pace of the instruction. Allow pausing, rewind, etc.
• Methods of Provision: Spoken verbal explanations are generally better than written explanations, particularly when used in combination with pictures or diagrams. In simulations, feedback during or after the simulation and the presence of an instructor were associated with lower cognitive loads, but the use of simultaneous technology during the simulation was associated with higher cognitive loads. Repetition of the simulation decreased cognitive load.

Enhance Visual and Spatial Organization: Use visual aids and spatial organization to help students process and retain information more effectively.

• Graphic Organizers: Utilize mind maps, flowcharts, and diagrams to visually represent information. For example, use a flowchart to outline the steps in the OT process. Using concept mapping as a pre-training tool may be particularly effective.
• Consistent Layouts: Maintain a consistent and organized layout in instructional materials to help students focus on the content rather than the format.  Make it easy for students to find what they need to attend to.

Promote Active Learning; Engage students in active learning to enhance germane cognitive load and deepen understanding.

• Interactive Activities: Incorporate activities such as case studies, simulations, and problem-based learning. For instance, use role-playing to practice clinical scenarios.
• Collaborative Learning: Facilitate group work and discussions to encourage peer-to-peer learning and diverse perspectives.

Use Advance Organizers: Provide students with advance organizers to give them a framework for understanding new information.

• Concept Maps: Use concept maps to outline the key points of a lecture or reading. For example, provide a concept map showing the relationships between different types of occupational assessments.
• Pre-Reading Questions: Offer guiding questions before a lecture or reading assignment to help students focus on important concepts.

Consider the environment and student self-regulation: More recent work on student learning has considered the physical environment in relation to cognitive load. For example, the cognitive load of a learning task may be influenced by a noisy or quiet environment. Similarly, cognitive load and self-regulation lines of research have recently been synthesized to demonstrate the importance of one’s ability to self-regulate during learning tasks of various cognitive loads. 

Activate prior knowledge: Help students to see/notice connections between prior learning and new concepts to build on what they already know.

• Opening question: Post a question of the day at the beginning of class and allow the first 1-3 minutes for students to answer the question. The question should activate prior knowledge that students will need for the new lesson.
• Anticipation guides: Create a brief pre-assessment (ungraded) to activate prior knowledge about a topic. Often these are T/F type questions to be answered quickly. To use this strategy, write about 4-5 thought-provoking statements and create a column to the right with Agree/Disagree, or T/F. (You may consider adding space for a Why?). At the end of the unit of content, have students revisit these and adjust their responses as needed. 
• KWL charts: Ask students to document what they know, want to know, and have already learned related to a topic. 
• Making a prediction or forecast: Ask students to predict an answer or what will happen, based on information they already know. After the lesson, revisit to see if their responses have changed.
• Case problem solving:  Provide a case that is just a bit harder than what students have been able to manage thus far and ask them to predict what they would do, based on what they already know.  Revisit the case again after the new content has been provided and have them discuss how their answers have changed..

Summary

Reducing cognitive load is essential for enhancing student learning in OT education. By simplifying complex information, optimizing instructional design, enhancing visual and spatial organization, promoting active learning, and using advance organizers, OT educators can create an effective learning environment that supports student success. These strategies help ensure that students can process and retain the information they need to become competent and confident occupational therapists.

References

Choi, H. H., Van Merriënboer, J. J., & Paas, F. (2014). Effects of the physical environment on cognitive load and learning: Towards a new model of cognitive load. Educational psychology review, 26, 225-244.

Ginns, P. (2005). Meta-analysis of the modality effect. Learning and instruction, 15(4), 313-331.

Kaye, M. (2020). Multimedia pretraining to teach complex content in Occupational Therapy education. The American Journal of Occupational Therapy, 74(6), 7406205080p1-7406205080p9.

Khalil, M. K., Paas, F., Johnson, T. E., & Payer, A. F. (2005). Interactive and dynamic visualizations in teaching and learning of anatomy: a cognitive load perspective. The Anatomical Record Part B: The New Anatomist: An Official Publication of the American Association of Anatomists, 286(1), 8-14.

Lapierre, A., Arbour, C., Maheu-Cadotte, M.-A., Vinette, B., Fontaine, G., & Lavoie, P. (2022). Association between Clinical Simulation Design Features and Novice Healthcare Professionals’ Cognitive Load: A Systematic Review and Meta-Analysis. Simulation & Gaming, 53(5), 538-563. https://doi.org/10.1177/10468781221120599

Paas, F., Renkl, A., & Sweller, J. (2003). Cognitive load theory and instructional design: Recent developments. Educational Psychologist, 38(1), 1-4.

Pociask, F. D., DiZazzo-Miller, R., & Samuel, P. S. (2013). Reducing cognitive load while teaching complex instruction to occupational therapy students. The American Journal of Occupational Therapy, 67(5), e92-e99.

Sweller, J. (1988). Cognitive Load during Problem Solving: Effects on Learning. Cognitive Science, 12, p.257-285. 

Sweller, J. (2011). Cognitive load theory. Psychology of Learning and Motivation; 55, Mestre, JP, Ross, BH, Eds, 37-76. 

Van Merrienboer, J. J., & Sweller, J. (2005). Cognitive load theory and complex learning: Recent developments and future directions. Educational psychology review, 17, 147-177.

Wouters, P., Paas, F., & van Merriënboer, J. J. G. (2008). How to Optimize Learning From Animated Models: A Review of Guidelines Based on Cognitive Load. Review of Educational Research, 78(3), 645-675. https://doi.org/10.3102/0034654308320320

Additional resources

Click to access Cognitive-Load-Theory.pdf