EEmotions, Cognitive Load and i
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Learning Outcomes During Simulator Training
Kristin Fraser University of Calgary RCPSC 2011 Simulation Summit
RCPSC 2011 Simulation Summit
• II do not have any affiliation (financial or do not have any affiliation (financial or
otherwise) with a commercial organization that may have a direct or indirect connection
that may have a direct or indirect connection to the content of my presentation(s) CHEST. 2011;139:376‐81
p < 0.001
0 001
p < 0.001
0 001
Learning gap
Learning
gap
(~1/3)
80
P errfo rm an ce (% )
70
Training scenario
60
50
No murmur
40
Aortic stenosis
30
Mitral regurgitation
20
10
0
Identifying correct
clinical findings
Diagnosing mitral
regurgitation
Audience Poll
Audience Poll
• Which
Which factor is most likely to contribute to factor is most likely to contribute to
successful learning from a simulation session: A) High emotions of participants
A)
High emotions of participants
B) Very difficult case content C) High ”Noise
C) High Noise to signal ratio
to signal ratio” of the scenario
of the scenario
D) Confederates giving partial answers
E) E
E) Easy :Low mental effort required
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t l ff t
i d
Emotions, Cognitive Load &Learning :
Why emotion?
h
i ?
Where were you Sept 11, 2001?
•Emotion triggers memory •Emotional activation is the goal of immersive simulation
•We
We learn from our mistakes learn from our mistakes
•BUT •Emotion also contributes to cognitive load Optimizing Learning Outcomes:
Manipulation
Consolidation
Retrieval
Cognitive Load Theory
Cognitive Load Theory
http://www.fsc.yorku.ca/york/istheory/
Emotion & Cognitive Load
Emotion & Cognitive Load
Emotion
http://www.fsc.yorku.ca/york/istheory
Study design
Study design
Training on chest pain with aortic stenosis (n = 81)
(
)
+Debriefing
Evaluation of emotion and cognitive load
Training on acute pulmonary embolus
+ Debriefingg
Evaluation of diagnostic performance on aortic stenosis
and mitral regurgitation 1 hour
Hypothesis
• Subjective rating of emotion is associated with subjective rating of cognitive load
• Subjective rating of cognitive load is associated with objective evaluation of performance
evaluation of performance
Measuring emotion
g
Measuring emotion
Measuring emotion
Tense
Nervous
St
Stressed
d
Upset
Sad
Depressed
g
Lethargic
Bored
Calm
Relaxed
S
Serene
Contented
Happy
Elated
Excited
Alert
Measuring Emotion Affect ratings following debriefing
Affect ratings following debriefing Tense
Nervous
Stressed
Upset
Sad
Depressed
p
Lethargic
Bored
-2
-1.5
Calm
Relaxed
Serene
Contented
Happy
Elated
Excited
Alert
1
2
3
4
5
6
7
8
-1
-0.5
0
0.5
1
1.5
2
Factor analysis
Factor analysis
Variable
Factor 1 Factor 2
Tense/Calm
0.90
Nervous/Relaxed
0 84
0.84
Stressed/Serene
0.87
Upset/Contented
0.65
Sad/Happy
0.74
Depressed/Elated
0.71
Lethargic/Excited
0.78
Bored/Alert
0.75
Measuring emotion
Measuring emotion
Weighted factors:
g
Tranquility = (0.38*calm)+(0.34*relaxed)+(0.35*serene)
Elation = (0.23*contented)+(0.27*happy)+(0.24*elated)+ (0 33*excited)+(0 34*alert)
(0.33*excited)+(0.34*alert)
Measuring emotion
Measuring emotion
Data reduction: Tranquility R2 for calm = 0.83
Elation R2 for happy + excited = 0.87
Measuring emotion
g
Tense
Calm } Tranquility Sad
Lethargic
Happy
Excited
} Elation Measuring cognitive load (
(or relative condition efficiency)
l i
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ffi i
)
Using the rating scale, please rate the amount of mental effort that was required to complete
this simulation scenario:
1
2
3
4
5
Very,
Very
very
small
Paas et al. Human Factors. 1993;35:737
6
7
8
9
Very,
Very
very
high
Results
Relationship between emotion and cognitive load:
Relationship between emotion and cognitive load:
Variable
Regression
coefficient
95% CI
p value
Tranquility
‐0.20
[‐0.32, ‐0.08]
0.001
Elation
0.14
[0.04, 0.25]
0.005
Relationship between cognitive load & odds of diagnostic success:
Variable
Odds ratio
95% CI
p value
Cognitive Load
0.27
[0.11, 0.67]
0.004
P ro b a b ility o f c o rre c t d ia g n o s is o n ttra in e d m u rm u r
.5
1
P ro b a b ility o f c o rre c t d ia g n o s is o n u n tra in e d m u rm u r
0
.5
1
0
Results
TRAINED MURMUR
3
4
5
6
Cognitive Load
7
NOVEL MURMUR
8
9
3
4
5
6
Cognitive Load
7
8
9
Measuring emotion
g
‐ Tranquility Elation Key Points
Key Points
 Simulation training does not have optimal learning outcomes l
d
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ll
 Activated emotion is associated with increasing cognitive load
Activated emotion is associated with increasing cognitive load
 Measurement of Emotion can be simplified to a 3 item scale
 Cognitive load has an negative association with performance
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Summary: Emotion & Cognitive Load
Summary: Emotion & Cognitive Load
Emotion
http://www.fsc.yorku.ca/york/istheory
Poll
• Which
Which factor is most likely to contribute to factor is most likely to contribute to
successful learning from a simulation session: A) High emotions of participants
A)
High emotions of participants
B) Very difficult case content C) High ”Noise
C) High Noise to signal ratio
to signal ratio” of the scenario
of the scenario
D) Confederates giving partial answers
E) E
E) Easy: Low mental effort required
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t l ff t
i d
Acknowledgements:
•
•
•
•
•
•
•
•
Bruce Wright MD
Kevin McLaughlin MD
Matthew Sobczek
Joann McIlwrick MD
Joann McIlwrick
Irene Ma MD Mike Paget
g
Janet Tworek
James Huffman MD