Dawn Mangine

    A phrase that we keep encountering as we research and write about simulation is “cognitive load.”

    For students, cognitive load means the point at which there is so much information, they are no longer learning. In layperson terms, cognitive load means TMI – too much information! Our brains are only capable of absorbing so much at a time.

    For instructors, cognitive load comes into play when it is time to debrief. Simulation instructors are tasked with multiple duties in a short time frame, including observing and assessing participants, structuring the debrief to facilitate meaningful discussion, and providing psychological safety for students while fostering open and honest feedback.

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    Cognitive Load Theory (CLT) is a theory about how people learn, derived from the current understanding of the limits of human cognition. CLT asserts that learning can only happen when there is “adequate room in working memory for processing of new information so that it can be stored in long-term memory.” Since many simulation instructors are themselves learners, effective debriefing can be challenging if working memory is overwhelmed.

    Three Types of Working Memory Loads

    CLT breaks working memory down into three types:

    • Intrinsic load: The interaction between expertise of the learner and complexity of the information to be learned. Intrinsic load is dependent on prior experience and how many elements of the problem need to be compared at once.
    • Extraneous load: Mental load of elements not relevant for learning, often described as anything in the learning environment that distracts from the actual learning point.
    • Germane load: Cognitive activities undertaken for intentional learning – in other words, an increase on the working memory beyond task performance that improves learning rather than detracts from it.

    Debriefing is a complex task comprised of many activities and tasks that can overwhelm the mental workload of the facilitator, especially if the facilitator in simulation training is learning as well.

    • Intrinsic load depends on the expertise and knowledge of the instructor, the engagement of the students, and the nature of the simulation.
    • Extraneous load in simulation can include extra tasks taken on by the facilitator (such as taking notes or tracking time); the challenge of co-facilitation, which requires clear communication and pre-set boundaries; and reactions from the learners, who may focus on details that are not part of the debriefing goals.
    • Germane load is the way the facilitator will incorporate past outcomes into current lessons by remembering what was effective and what was not effective, even as the debriefing in happening.

    Proactive Strategies for Managing Cognitive Load

    Instructors can manage intrinsic load by:

    1. Matching debriefing difficulty to the skill level of the instructor
    2. Aligning number and content of objectives to learning experience
    3. Inviting expert speakers to facilitate the simulation or providing supplemental materials to students
    4. Engaging in learner-centered debriefing strategies, which allows students with expertise to lead reflection
    5. Providing a template or framework for the debrief, which reduces the burden of decision-making on the instructor

    Managing the extraneous load requires the facilitator to anticipate the learner experience. To offset unsatisfied students, the instructor can take the following steps:

    1. Clearly communicate expectations and logistics of the simulation
    2. Explain the “fiction contract” – the agreement between the creator of the simulation (the facilitator) and those who participate in the simulation (the learners)
    3. Establish psychological safety

    Instructors should also proactively minimize distractions and, if using a co-facilitator for the benefit of pooled expertise, conducting a pre-brief to explicitly define tasks and responsibilities.

    Finally, germane load is optimized when debriefing instructors are motivated, and faculty development enables a supportive environment for self-reflection, peer coaching, and expert feedback.

    Do you experience cognitive load? How do you manage it as part of simulation debriefing?


    Fraser, Kristin L., et al. “Cognitive Load Theory for debriefing simulation: implications for faculty development,” Advances in Simulation, Biomedical Central.