Abstract
Cognitive Load Theory has emerged as an important approach to improving instruction in the health professions workplace, including patient handovers. At the same time, there is growing recognition that emotion influences learning through numerous cognitive processes including motivation, attention, working memory, and long-term memory. This study explores how emotion influences the cognitive load experienced by trainees performing patient handovers. From January to March 2019, 693 (38.7%) of 1807 residents and fellows from a 24-hospital health system in New York city completed a survey after performing a handover. Participants rated their emotional state and cognitive load. The survey included questions about features of the learner, task, and instructional environment. The authors used factor analysis to identify the core dimensions of emotion. Regression analyses explored the relationship between the emotion factors and cognitive load types. Two emotion dimensions were identified representing invigoration and tranquility. In regression analyses, higher levels of invigoration, tranquility, and their interaction were independently associated with lower intrinsic load and extraneous load. The interaction of invigoration and tranquility predicted lower germane load. The addition of the emotion variables to multivariate models including other predictors of cognitive load types significantly increased the amount of variance explained. The study provides a model for measuring emotions in workplace learning. Because emotion appears to have a significant influence on cognitive load types, instructional designers should consider strategies that help trainees regulate emotion in order to reduce cognitive load and improve learning and performance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abernathy, C., & Hamm, R. M. (1995). Surgical intuition : what it is and how to get it. Hanley & Belfus ; Distributed by Mosby.
Artino, A. R., Jr., Holmboe, E. S., & Durning, S. J. (2012). Control-value theory: using achievement emotions to improve understanding of motivation, learning, and performance in medical education: AMEE Guide No. 64. Medical Teacher, 34(3), e148-160. https://doi.org/10.3109/0142159x.2012.651515
Baddeley, A. (2012). Working memory: theories, models, and controversies. Annual Review of Psychology, 63, 1–29. https://doi.org/10.1146/annurev-psych-120710-100422
Balslev, T., Rasmussen, A. B., Skajaa, T., Nielsen, J. P., Muijtjens, A., De Grave, W., & Van Merriënboer, J. (2015). Combining bimodal presentation schemes and buzz groups improves clinical reasoning and learning at morning report. Medical Teacher, 37(8), 759–766. https://doi.org/10.3109/0142159x.2014.986445
Caverzagie, K. J., Cooney, T. G., Hemmer, P. A., & Berkowitz, L. (2015). The development of entrustable professional activities for internal medicine residency training: a report from the education redesign committee of the alliance for academic internal medicine. Academic Medicine, 90(4), 479–484. https://doi.org/10.1097/acm.0000000000000564
Choi, H.-H., van Merriënboer, J. J. G., & Paas, F. (2014). Effects of the physical environment on cognitive load and learning: Towards a new model of cognitive load. Educational Psychology Review, 26(2), 225–244. https://doi.org/10.1007/s10648-014-9262-6
Clore, G. L., & Palmer, J. (2009). Affective guidance of intelligent agents: How emotion controls cognition. Cognitive Systems Research, 10(1), 21–30. https://doi.org/10.1016/j.cogsys.2008.03.002
Cook, D. A., & Beckman, T. J. (2009). Does scale length matter? A comparison of nine- versus five-point rating scales for the mini-CEX. Advances in Health Sciences Education Theory Practicess, 14(5), 655–664. https://doi.org/10.1007/s10459-008-9147-x
Cowan, N. (2001). The magical number 4 in short-term memory: a reconsideration of mental storage capacity. Behavioral and Brain Sciences, 24(1), 87–114.
Crispim, A. C., Archer, A. B., & Cruz, R. (2014). Methodological issues about affect: a systematic review about assessment tests of affect. International Journal of Education and Social Science, 1(3), 118–226.
Custers, E. J. (2015). Thirty years of illness scripts: Theoretical origins and practical applications. Medical Teacher, 37(5), 457–462. https://doi.org/10.3109/0142159x.2014.956052
Dillman, D. A., Smyth, J. D., & Christian, L. M. (2008). Internet, phone, mail, and mixed-mode surveys: the tailored design method (3rd ed.). Wiley.
Duffy, M. C., Lajoie, S., & Lachapelle, K. (2016). Measuring emotions in medical education: methodological and technological advances within authentic medical learning environments. In S. Bridges, L. K. Chan, & C. E. Hmelo-Silver (Eds.), Educational technologies in medical and health sciences education (pp. 181–213). Springer.
Duffy, M. C., Lajoie, S. P., Pekrun, R., & Lachapelle, K. (2020). Emotions in medical education: Examining the validity of the Medical Emotion Scale (MES) across authentic medical learning environments. Learning and Instruction, 70, 101150. https://doi.org/10.1016/j.learninstruc.2018.07.001
Dyrbye, L., & Shanafelt, T. (2016). A narrative review on burnout experienced by medical students and residents. Medical Education, 50(1), 132–149. https://doi.org/10.1111/medu.12927
Dyrbye, L. N., West, C. P., Satele, D., Boone, S., Tan, L., Sloan, J., & Shanafelt, T. D. (2014). Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Academic Medicine, 89(3), 443–451. https://doi.org/10.1097/acm.0000000000000134
Ekkekakis, P. (2013). The measurement of affect, mood, and emotion: A guide for health-behavioral research. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511820724
Ericsson, K. A. (2015). Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Academic Medicine, 90(11), 1471–1486. https://doi.org/10.1097/acm.0000000000000939
Estrada, C. A., Isen, A. M., & Young, M. J. (1994). Positive affect improves creative problem solving and influences reported source of practice satisfaction in physicians. Motivation and Emotion, 18(4), 285–299. https://doi.org/10.1007/BF02856470
Estrada, C. A., Isen, A. M., & Young, M. J. (1997). Positive affect facilitates integration of information and decreases anchoring in reasoning among physicians. Organizational Behavior and Human Decision Processes, 72(1), 117–135. https://doi.org/10.1006/obhd.1997.2734
Feldman Barrett, L., & Russell, J. A. (1998). Independence and bipolarity in the structure of current affect. Journal of Personality and Social Psychology, 74(4), 967–984. https://doi.org/10.1037/0022-3514.74.4.967
Feldon, D. F. (2007). Cognitive Load and Classroom Teaching: The Double-Edged Sword of Automaticity. Educational Psychologist, 42(3), 123–137. https://doi.org/10.1080/00461520701416173
Fraser, K., Huffman, J., Ma, I., Sobczak, M., McIlwrick, J., Wright, B., & McLaughlin, K. (2014). The emotional and cognitive impact of unexpected simulated patient death: a randomized controlled trial. Chest, 145(5), 958–963. https://doi.org/10.1378/chest.13-0987
Fraser, K., Ma, I., Teteris, E., Baxter, H., Wright, B., & McLaughlin, K. (2012). Emotion, cognitive load and learning outcomes during simulation training. Medical Education, 46(11), 1055–1062. https://doi.org/10.1111/j.1365-2923.2012.04355.x
Fraser, K., & McLaughlin, K. (2019). Temporal pattern of emotions and cognitive load during simulation training and debriefing. Medical Teacher, 41(2), 184–189. https://doi.org/10.1080/0142159x.2018.1459531
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J0urnal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Homer, B. D., Plass, J. L., Rose, M. C., MacNamara, A. P., Pawar, S., & Ober, T. M. (2019). Activating adolescents’ “hot” executive functions in a digital game to train cognitive skills: The effects of age and prior abilities. Cognitive Development, 49, 20–32. https://doi.org/10.1016/j.cogdev.2018.11.005
Hooper, D., Coughlan, J., & Mullen, M. (2008). Structural equation modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods, 6(1), 53–60.
Horwitz, L. I., Moin, T., Krumholz, H. M., Wang, L., & Bradley, E. H. (2008). Consequences of inadequate sign-out for patient care. Archives of Internal Medicine, 168(16), 1755–1760. https://doi.org/10.1001/archinte.168.16.1755
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
Isen, A. M., Rosenzweig, A. S., & Young, M. J. (1991). The influence of positive affect on clinical problem solving. Medical Decision Making, 11(3), 221–227. https://doi.org/10.1177/0272989x9101100313
Johnson, J. K., & Arora, V. M. (2016). Can we talk? The art (and science) of handoff conversation. BMJ Quality and Saftey, 25(2), 63–65. https://doi.org/10.1136/bmjqs-2015-004666
Kensinger, E. A. (2009). Remembering the Details: Effects of Emotion. Emotion Review : Journal of the International Society for Research on Emotion, 1(2), 99–113. https://doi.org/10.1177/1754073908100432
Kyriazos, T. (2018). Applied Psychometrics: The 3-Faced Construct Validation Methods, a Routine for Evaluating a Factor Structure. Psychology (savannah, Ga.), 9, 2044–2072. https://doi.org/10.4236/psych.2018.98117
Lane-Fall, M. B., Davis, J. J., Clapp, J. T., Myers, J. S., & Riesenberg, L. A. (2018). What every graduating resident needs to know about quality improvement and patient safety: a content analysis of 26 Sets of ACGME milestones. Academic Medicine, 93(6), 904–910. https://doi.org/10.1097/acm.0000000000002039
Lebares, C. C., Coaston, T. N., Delucchi, K. L., Guvva, E. V., Shen, W. T., Staffaroni, A. M., Kramer, J. H., Epel, E. S., Hecht, F. M., Ascher, N. L., Harris, H. W., & Cole, S. W. (2020). Enhanced stress resilience training in surgeons: iterative adaptation and biopsychosocial effects in 2 small randomized trials. Annals of Surgery. https://doi.org/10.1097/sla.0000000000004145
Lebares, C. C., Guvva, E. V., Desai, A., Herschberger, A., Ascher, N. L., Harris, H. W., & O’Sullivan, P. (2020). Key factors for implementing mindfulness-based burnout interventions in surgery. American Journal of Surgery, 219(2), 328–334. https://doi.org/10.1016/j.amjsurg.2019.10.025
Lebares, C. C., Guvva, E. V., Olaru, M., Sugrue, L. P., Staffaroni, A. M., Delucchi, K. L., Kramer, J. H., Ascher, N. L., & Harris, H. W. (2019). Efficacy of mindfulness-based cognitive training in surgery: additional analysis of the mindful surgeon pilot randomized clinical trial. JAMA Network Open, 2(5), e194108. https://doi.org/10.1001/jamanetworkopen.2019.4108
Lebares, C. C., Hershberger, A. O., Guvva, E. V., Desai, A., Mitchell, J., Shen, W., Reilly, L. M., Delucchi, K. L., O’Sullivan, P. S., Ascher, N. L., & Harris, H. W. (2018). Feasibility of Formal Mindfulness-Based Stress-Resilience Training Among Surgery Interns: A Randomized Clinical Trial. JAMA Surgery, 153(10), e182734. https://doi.org/10.1001/jamasurg.2018.2734
LeBlanc, V. R. (2009). The effects of acute stress on performance: implications for health professions education. Academic Medicine, 84(10 Suppl), S25-33. https://doi.org/10.1097/ACM.0b013e3181b37b8f
LeBlanc, V. R., McConnell, M. M., & Monteiro, S. D. (2015). Predictable chaos: a review of the effects of emotions on attention, memory and decision making. Advance Health Science Education Theory Practices, 20(1), 265–282. https://doi.org/10.1007/s10459-014-9516-6
LeDoux, J. E., & Brown, R. (2017). A higher-order theory of emotional consciousness. Proceedings of the National Academy of Sciences, 114(10), E2016–E2025. https://doi.org/10.1073/pnas.1619316114
Leppink, J., Paas, F., van Gog, T., van der Vleuten, C. P. M., & van Merrienboer, J. J. G. (2014). Effects of pairs of problems and examples on task performance and different types of cognitive load. Learning and Instruction, 30, 32–42. https://doi.org/10.1016/j.learninstruc.2013.12.001
Levine, L. J., & Burgess, S. L. (1997). Beyond general arousal: Effects of specific emotions on memory. Social Cognition, 15(3), 157–181. https://doi.org/10.1521/soco.1997.15.3.157
Lomis, K., Amiel, J. M., Ryan, M. S., Esposito, K., Green, M., Stagnaro-Green, A., Bull, J., & Mejicano, G. C. (2017). Implementing an entrustable professional activities framework in undergraduate medical education: early lessons from the aamc core entrustable professional activities for entering residency pilot. Academic Medicine, 92(6), 765–770. https://doi.org/10.1097/acm.0000000000001543
Mauss, I. B., & Robinson, M. D. (2009). Measures of emotion: A review. Cognition and Emotion, 23(2), 209–237. https://doi.org/10.1080/02699930802204677
Mayer, R. E., & Moreno, R. (2003). Nine ways to reduce cognitive load in multimedia learning. Educational Psychologist, 38(1), 43–52. https://doi.org/10.1207/S15326985EP3801_6
McNaughton, N. (2013). Discourse(s) of emotion within medical education: the ever-present absence. Medical Education, 47(1), 71–79. https://doi.org/10.1111/j.1365-2923.2012.04329.x
Merz, E. L., Malcarne, V. L., Roesch, S. C., Ko, C. M., Emerson, M., Roma, V. G., & Sadler, G. R. (2013). Psychometric properties of positive and negative affect schedule (PANAS) original and short forms in an African American community sample. Journal of Affective Disorders, 151(3), 942–949. https://doi.org/10.1016/j.jad.2013.08.011
Merz, E. L., & Roesch, S. C. (2011). Modeling trait and state variation using multilevel factor analysis with PANAS daily diary data. Journal of Research in Personality, 45(1), 2–9. https://doi.org/10.1016/j.jrp.2010.11.003
Moreno, R. (2010). Cognitive load theory: more food for thought. Instructional Science, 38(2), 135–141. https://doi.org/10.1007/s11251-009-9122-9
Moreno, R., & Mayer, R. (2007). Interactive Multimodal Learning Environments. Educational Psychology Review, 19(3), 309–326. https://doi.org/10.1007/s10648-007-9047-2
Niedenthal, P. M., & Setterlund, M. B. (1994). Emotion congruence in perception. Personality and Social Psychology Bulletin, 20(4), 401–411. https://doi.org/10.1177/0146167294204007
Paas, F. G., Van Merrienboer, J. J., & Adam, J. J. (1994). Measurement of cognitive load in instructional research. Perceptual and Motor Skills, 79(1 Pt 2), 419–430.
Park, B., Plass, J. L., & Brünken, R. (2014). Cognitive and affective processes in multimedia learning. Learning and Instruction, 29, 125–127. https://doi.org/10.1016/j.learninstruc.2013.05.005
Pekrun, R., Goetz, T., Titz, W., & Perry, R. P. (2002). Academic emotions in students’ self-regulated learning and achievement: a program of qualitative and quantitative research. Educational Psychologist, 37(2), 91–105. https://doi.org/10.1207/S15326985EP3702_4
Pekrun, R., & Perry, R. P. (2014). Control-value theory of achievement emotions. In International handbook of emotions in education. (pp. 120–141). Routledge/Taylor & Francis Group.
Pessoa, L. (2008). On the relationship between emotion and cognition. Nature Reviews Neuroscience, 9(2), 148–158. https://doi.org/10.1038/nrn2317
Piquette, D., Tarshis, J., Sinuff, T., Fowler, R. A., Pinto, R., & Leblanc, V. R. (2014). Impact of acute stress on resident performance during simulated resuscitation episodes: a prospective randomized cross-over study. Teaching and Learning in Medicine, 26(1), 9–16. https://doi.org/10.1080/10401334.2014.859932
Plass, J. L., Homer, B. D., MacNamara, A., Ober, T., Rose, M. C., Pawar, S., Hovey, C. M., & Olsen, A. (2020). Emotional design for digital games for learning: The effect of expression, color, shape, and dimensionality on the affective quality of game characters. Learning and Instruction, 70, 101194. https://doi.org/10.1016/j.learninstruc.2019.01.005
Plass, J. L., & Kalyuga, S. (2019). Four Ways of Considering Emotion in Cognitive Load Theory. Educational Psychology Review, 31(2), 339–359. https://doi.org/10.1007/s10648-019-09473-5
Plass, J. L., & Kaplan, U. (2016). Emotional design in digital media for learning. In Emotions, technology, design, and learning. (pp. 131–161). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-801856-9.00007-4
Posner, J., Russell, J. A., & Peterson, B. S. (2005). The circumplex model of affect: an integrative approach to affective neuroscience, cognitive development, and psychopathology. Development and Psychopathology, 17(3), 715–734. https://doi.org/10.1017/s0954579405050340
Pucher, P. H., Johnston, M. J., Aggarwal, R., Arora, S., & Darzi, A. (2015). Effectiveness of interventions to improve patient handover in surgery: A systematic review. Surgery, 158(1), 85–95. https://doi.org/10.1016/j.surg.2015.02.017
Richards, A., French, C. C., Calder, A. J., Webb, B., Fox, R., & Young, A. W. (2002). Anxiety-related bias in the classification of emotionally ambiguous facial expressions. Emotion, 2(3), 273–287. https://doi.org/10.1037/1528-3542.2.3.273
Riesenberg, L. A., Leitzsch, J., Massucci, J. L., Jaeger, J., Rosenfeld, J. C., Patow, C., Padmore, J. S., & Karpovich, K. P. (2009). Residents’ and attending physicians’ handoffs: a systematic review of the literature. Academic Medicine, 84(12), 1775–1787. https://doi.org/10.1097/ACM.0b013e3181bf51a6
Russell, J. A. (2003). Core affect and the psychological construction of emotion. Psychological Review, 110(1), 145–172. https://doi.org/10.1037/0033-295x.110.1.145
Russell, J. A., & Barrett, L. F. (1999). Core affect, prototypical emotional episodes, and other things called emotion: Dissecting the elephant. Journal of Personality and Social Psychology, 76(5), 805–819. https://doi.org/10.1037/0022-3514.76.5.805
Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: classic definitions and new directions. Contemporary Educational Psychology, 25(1), 54–67. https://doi.org/10.1006/ceps.1999.1020
Salehi, B., Cordero, M. I., & Sandi, C. (2010). Learning under stress: the inverted-U-shape function revisited. Learning and Memory, 17(10), 522–530. https://doi.org/10.1101/lm.1914110
Scherer, K. R. (2005). What are emotions? And how can they be measured? Social Science Information, 44(4), 695–729. https://doi.org/10.1177/0539018405058216
Schlairet, M. C., Schlairet, T. J., Sauls, D. H., & Bellflowers, L. (2015). Cognitive load, emotion, and performance in high-fidelity simulation among beginning nursing students: a pilot study. Journal of Nursing Education, 54(3 Suppl), S5-11. https://doi.org/10.3928/01484834-20150218-10
Schmidt, H. G., & Boshuizen, H. P. (1993). On acquiring expertise in medicine. Educational Psychology Review, 5(3), 205–221. https://doi.org/10.1007/BF01323044
Sewell, J. L., Boscardin, C. K., Young, J. Q., ten Cate, O., & O’Sullivan, P. S. (2016). Measuring cognitive load during procedural skills training with colonoscopy as an exemplar. Medical Education, 50(6), 682–692. https://doi.org/10.1111/medu.12965
Sewell, J. L., Boscardin, C. K., Young, J. Q., Ten Cate, O., & O’Sullivan, P. S. (2017). Learner, Patient, and Supervisor Features Are Associated With Different Types of Cognitive Load During Procedural Skills Training: Implications for Teaching and Instructional Design. Academic Medicine, 92(11), 1622–1631. https://doi.org/10.1097/acm.0000000000001690
Sewell, J. L., Maggio, L. A., Ten Cate, O., van Gog, T., Young, J. Q., & O’Sullivan, P. S. (2019). Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53. Medical Teacher, 41(3), 256–270. https://doi.org/10.1080/0142159x.2018.1505034
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., Noble, E. L., Tse, L. L., Dalal, A. K., Keohane, C. A., Lipsitz, S. R., Rothschild, J. M., Wien, M. F., Yoon, C. S., Zigmont, K. R., Wilson, K. M., O’Toole, J. K., Solan, L. G., Aylor, M., … Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803–1812. https://doi.org/10.1056/NEJMsa1405556
Stovel, R. G., Ginsburg, S., Stroud, L., Cavalcanti, R. B., & Devine, L. A. (2018). Incentives for recruiting trainee participants in medical education research. Medical Teacher, 40(2), 181–187. https://doi.org/10.1080/0142159x.2017.1395402
Sullivan, G. M., & Artino, A. R. (2013). Analyzing and interpreting data from likert-type scales. Journal of Graduate Medical Education, 5(4), 541–542. https://doi.org/10.4300/jgme-5-4-18
Sweller, J. (1988). Cognitive load during problem solving: Effects on learning. Cognitive Science, 12(2), 257–285.
Sweller, J., Ayres, P. L., & Kalyuga, S. (2011). Cognitive load theory. Springer. Publisher description http://www.loc.gov/catdir/enhancements/fy1316/2011922376-d.html
Sweller, J., & van Merrienboer, J. J. G. (2013). Cognitive load theory and instructional design for medical education. In K. Walsh (Ed.), The Oxford Textbook of Medical Education (pp. 74–85). Oxford University Press.
Sweller, J., van Merriënboer, J. J. G., & Paas, F. (2019). Cognitive architecture and instructional design: 20 Years Later. Educational Psychology Review, 31(2), 261–292. https://doi.org/10.1007/s10648-019-09465-5
Sweller, J., van Merrienboer, J. J. G., & Paas, F. G. W. C. (1998). Cognitive architecture and instructional design. Educational Psychology Review, 10(3), 251–296.
Szulewski, A., Howes, D., van Merriënboer, J. J. G., & Sweller, J. (2020). From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine. Academic Medicine. https://doi.org/10.1097/acm.0000000000003524
ten Cate, O., & Young, J. Q. (2012). The patient handover as an entrustable professional activity: adding meaning in teaching and practice. BMJ Quality and Saftey, 21(Suppl 1), i9-12. https://doi.org/10.1136/bmjqs-2012-001213
Thompson, E. R. (2007). Development and Validation of an Internationally Reliable Short-Form of the Positive and Negative Affect Schedule (PANAS). Journal of Cross-Cultural Psychology, 38(2), 227–242. https://doi.org/10.1177/0022022106297301
Tremblay, M. L., Lafleur, A., Leppink, J., & Dolmans, D. H. (2017). The simulated clinical environment: cognitive and emotional impact among undergraduates. Medical Teacher, 39(2), 181–187. https://doi.org/10.1080/0142159x.2016.1246710
Tuccitto, D. E., Giacobbi, P. R., & Leite, W. L. (2010). The internal structure of positive and negative affect: A confirmatory factor analysis of the PANAS. Educational and Psychological Measurement, 70(1), 125–141. https://doi.org/10.1177/0013164409344522
van Merriënboer, J. J. G., & Sweller, J. (2010). Cognitive load theory in health professional education: Design principles and strategies. Medical Education, 44(1), 85–93.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063
Weigl, M., Heinrich, M., Keil, J., Wermelt, J. Z., Bergmann, F., Hubertus, J., & Hoffmann, F. (2020). Team performance during postsurgical patient handovers in paediatric care. European Journal of Pediatrics, 179(4), 587–596. https://doi.org/10.1007/s00431-019-03547-w
Woods, C. M., & Edwards, M. C. (2011). 6–Factor analysis and related methods. In C. R. Rao, J. P. Miller, & D. C. Rao (Eds.), Essential statistical methods for medical statistics (pp. 174–201). Elsevier. https://doi.org/10.1007/s00431-019-03547-w
Yerkes, R. M., & Dodson, J. D. (1908). The Relation of strength of stimulus to rapidity of habit formation. Journal of Comparative Neurology and Psychology, 18, 459–482. https://doi.org/10.1002/cne.920180503
Yik, M., Russell, J. A., & Steiger, J. H. (2011). A 12-point circumplex structure of core affect. Emotion, 11(4), 705–731. https://doi.org/10.1037/a0023980
Young, J. Q., Boscardin, C. K., van Dijk, S. M., Abdullah, R., Irby, D. M., Sewell, J. L., Ten Cate, O., & O’Sullivan, P. S. (2016). Performance of a cognitive load inventory during simulated handoffs: Evidence for validity. SAGE Open Med, 4, 2050312116682254. https://doi.org/10.1177/2050312116682254
Young, J. Q., Hasser, C., Hung, E. K., Kusz, M., O’Sullivan, P. S., Stewart, C., Weiss, A., & Williams, N. (2018). Developing end-of-training entrustable professional activities for psychiatry: results and methodological lessons. Academic Medicine, 93(7), 1048–1054. https://doi.org/10.1097/acm.0000000000002058
Young, J. Q., Irby, D. M., Barilla-LaBarca, M. L., Ten Cate, O., & O’Sullivan, P. S. (2016). Measuring cognitive load: mixed results from a handover simulation for medical students. Perspect Medical Education, 5(1), 24–32. https://doi.org/10.1007/s40037-015-0240-6
Young, J. Q., John, M., Thakker, K., Friedman, K., Sugarman, R., Sewell, J. L., & O’Sullivan, P. S. (2020). Evidence for Validity for the Cognitive Load Inventory for Handoffs. Medical Education. https://doi.org/10.1111/medu.14292
Young, J. Q., & Sewell, J. L. (2015). Applying cognitive load theory to medical education: construct and measurement challenges. Perspect Medical Education, 4(3), 107–109. https://doi.org/10.1007/s40037-015-0193-9
Young, J. Q., Ten Cate, O., O’Sullivan, P. S., & Irby, D. M. (2016). Unpacking the complexity of patient handoffs through the lens of cognitive load theory. Teaching and Learning in Medicine, 28(1), 88–96. https://doi.org/10.1080/10401334.2015.1107491
Young, J. Q., Thakker, K., John, M., Friedman, K., Sugarman, R., Sewell, J. L., & O’Sullivan, P. S. (2021). Features of the learner, task, and instructional environment that predict cognitive load types during patient handoffs: implications for instruction. Applied Cognitive Psychology. https://doi.org/10.1002/acp.3803
Young, J. Q., Van Merrienboer, J., Durning, S., & Ten Cate, O. (2014). Cognitive load thewory: implications for medical education: AMEE Guide No. 8. Medical Teacher, 36(5), 371–384. https://doi.org/10.3109/0142159x.2014.889290
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Rights and permissions
About this article
Cite this article
Young, J.Q., Thakker, K., John, M. et al. Exploring the relationship between emotion and cognitive load types during patient handovers. Adv in Health Sci Educ 26, 1463–1489 (2021). https://doi.org/10.1007/s10459-021-10053-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-021-10053-y