Task Complexity and Cognitive Load in Simulation-based Education: A Randomized Trial

Marie-Laurence Tremblay*, Jan-Joost Rethans, Diana Dolmans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Downloads (Pure)


CONTEXT: When designing simulation for novices, educators aim to design tasks and environments that are complex enough to promote learning, but not too complex to compromise task performance and cause cognitive overload.

OBJECTIVE: To determine the impact of modulating task and environment complexity on novices' performance and cognitive load during simulation.

METHODS: Second-year pharmacy students (N=162) were randomly assigned to one of four conditions (2x2 factorial design) in simulation: simple task in simple environment, complex task in simple environment, simple task in complex environment, and complex task in complex environment. Using video recordings, two raters assessed students' performance during the simulation. We measured intrinsic (ICL) and extraneous cognitive load (ECL) with questionnaires after the task, and tested knowledge after task and debriefing.

RESULTS: Mean performance scores in simple environment were 28.2/32 (SD=3.8) for simple task and 25.8 (SD=4.2) for complex task. In complex environment, mean performance scores were 24.6 (SD=5.2) for simple task and 25.6/32 (SD=5.3) for complex task. We found significant interaction effects between task and environment complexity for performance. In simple environment, mean ICL scores were 4.2 (SD=2.2) for simple task and 5.7 (SD=1.5) for complex task. In complex environment, mean ICL scores were 4.9/10 (SD=1.8) for simple task and 5.1/10 (SD=1.9) for complex task. There was a main effect of task complexity on ICL. For ECL, we found neither an interaction effect nor main effects of task and environment complexity. There was a main effect of task complexity on knowledge test after task and main effects of both task and environment complexity on knowledge after debriefing.

CONCLUSION: Performance was good and cognitive load remained reasonable in all conditions, which suggests that, despite increased complexity, students seemed to strategically manage their own cognitive load and learn from the simulations. Our findings also indicate that environmental complexity contributes to ICL.

Original languageEnglish
Pages (from-to)161-169
Number of pages9
JournalMedical Education
Issue number2
Early online date23 Sept 2022
Publication statusPublished - Feb 2023

Cite this