Neel Sharma: Lightening the learning load during junior doctor ward rounds

Educating newly qualified junior doctors to become masters of their trade is not easy. Hospital life is fast paced and typically acute. Rapid patient turnover as well as demands on senior doctors means that teaching time is often at a premium. Therefore, as educators we have the added pressure of ensuring that we sufficiently cover the curriculum without overloading trainees with information. Current evidence suggests that overloading trainees with too much information (more precisely termed cognitive load) can hinder optimum learning if it is done inappropriately. [1]

So what is meant by cognitive load? In brief it focuses on three areas:

Intrinsic load—the complexity of the information being learned.

Extraneous load—the way the information is presented.

Germane load—the processing of that information so that learning can truly occur.

How therefore can we ensure optimum cognitive load?

Intrinsic: educators can focus on chunking information, or staging, with movement from basic to more intense complexity. Learners may practice a particular aspect by themselves and then with peers.

Extraneous: here senior educators can offer learners problems completed either partially or fully. Alternatively, information can be provided using various media such as video or audio. The learner can also observe a particular skill before performing it for themselves. The educator can ensure that potential distractions are avoided such as mobile phone alerts or social media notifications.

Germane: information is presented in a randomised fashion, or the learner is exposed to a different patient demographic that they are not typically exposed to.

So how can this apply to the hospital setting? Here are three potential clinical case examples:

Acute coronary syndrome: Intrinsic: Educators can initially focus on delivering information regarding the importance of lifestyle factors such as diet, exercise, and avoiding alcohol and smoking, before moving on to the complexities of therapeutics such as anti-platelets, anti-hypertensives and cholesterol modifying agents alongside their side effects.

Upper GI bleed: Extraneous: educators can provide videos on the management of a GI bleed before patient consultation.

Shortness of breath: Germane: Educators can present details on an array of breathing difficulties (COPD, pneumonia, asthma etc) and then choose to mix up the order of presentation.

Recognising the importance of cognitive load theory is key in ensuring the development of the learner. As indicated earlier, in view of the short time constraints during hospital life, optimising the amount of information presented to trainees can ensure adequate educational gains.


1. Young et al. Cognitive load theory: implications for medical education. AMEE guide. Medical Teacher 36:5 371-384. 2015

2. Schumacher et al. Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. Acad Med. 2013; 88:1635-1645

Neel Sharma graduated from the University of Manchester and did his internal medicine training at The Royal London Hospital and Guy’s and St Thomas’ NHS Foundation Trust. Currently he is a gastroenterology trainee based in Singapore.

Competing interests: None declared.