Kimberly M Vella1,2, Andrew K Hall2, Jeroen J G van Merrienboer3, Wilma M Hopman4, Adam Szulewski5. 1. Faculty of Health Sciences Queen's University Kingston ON Canada. 2. Department of Emergency Medicine Queen's University Kingston ON Canada. 3. Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences Maastricht University ER Maastricht The Netherlands. 4. Kingston General Hospital Research Institute Department of Public Health Sciences Queen's University Kingston ON Canada. 5. Departments of Emergency Medicine & Psychology Queen's University Kingston Canada.
Abstract
BACKGROUND: Emergency physicians often experience a high cognitive load (CL) due to the inherent nature of working in acute care settings. CL has traditionally been measured in educational studies but has not been well studied in the clinical environment. METHODS: Emergency medicine attending physicians and residents working in an academic urgent care center completed psychometric questionnaires while on shift to measure overall CL, intrinsic cognitive load (ICL), extraneous cognitive load (ECL), and acute stress. Data regarding the patient load, patient acuity, and the number of patients in the waiting room were also collected. Correlational analysis and simple linear regression were used to evaluate predictors of CL on shift. RESULTS: Forty-two questionnaires were completed (26 by attending physicians, 16 by residents). Attending physicians carried a significantly higher patient load compared to residents (p < 0.001). No differences in mean overall CL, ICL, ECL, and acute stress were observed between attending physicians and residents. Bivariate analysis demonstrated associations between ICL, ECL, acute stress, and overall CL in attending physicians. In residents, acute stress was the only variable associated with overall CL and the number of high-acuity patients was associated with ICL. CONCLUSIONS: Factors influencing reported CL during clinical work are different between attending emergency physicians and residents. Further study to appreciate the impact of these differences is required and may help educators elucidate strategies to better manage CL, thereby improving clinical performance and potentially improving patient care.
BACKGROUND: Emergency physicians often experience a high cognitive load (CL) due to the inherent nature of working in acute care settings. CL has traditionally been measured in educational studies but has not been well studied in the clinical environment. METHODS: Emergency medicine attending physicians and residents working in an academic urgent care center completed psychometric questionnaires while on shift to measure overall CL, intrinsic cognitive load (ICL), extraneous cognitive load (ECL), and acute stress. Data regarding the patient load, patient acuity, and the number of patients in the waiting room were also collected. Correlational analysis and simple linear regression were used to evaluate predictors of CL on shift. RESULTS: Forty-two questionnaires were completed (26 by attending physicians, 16 by residents). Attending physicians carried a significantly higher patient load compared to residents (p < 0.001). No differences in mean overall CL, ICL, ECL, and acute stress were observed between attending physicians and residents. Bivariate analysis demonstrated associations between ICL, ECL, acute stress, and overall CL in attending physicians. In residents, acute stress was the only variable associated with overall CL and the number of high-acuity patients was associated with ICL. CONCLUSIONS: Factors influencing reported CL during clinical work are different between attending emergency physicians and residents. Further study to appreciate the impact of these differences is required and may help educators elucidate strategies to better manage CL, thereby improving clinical performance and potentially improving patient care.
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