An exploratory study of cognitive load in diagnosing patient conditions.

OBJECTIVE To determine whether the ways in which information is presented to physicians will improve their ability to respond in a timely and accurate manner to acute care needs. The forms of the presentation compared traditional textual, chart and graph representations with equivalent symbolic language representations. To test this objective, our investigation involved two studies of interpreting patient conditions using two forms of information representation. The first assessed the level of cognitive effort (the outcome variable is known as cognitive load), and the second assessed the time and accuracy outcome variables. PARTICIPANTS Our investigation consisted of two studies, the first study involved 3rd and 4th year medical students, and the second study involved three board certified physicians who worked in an intensive care unit of a metropolitan hospital. DESIGN The first study utilized an all-within-subject design with repeated measures, where pretests were utilized as control covariate for prior learning and individual differences. The second study utilized a random sampling of records analyzed by two physicians and qualitatively evaluated by board-certified intensivists. RESULTS The first study indicated that the cognitive load to interpret the symbolic representation was less than those presented in the more traditional textual, chart and graphic form. The second study suggests that experienced physicians may react in a more timely fashion with at least the same accuracy when the symbolic language was used than with traditional charts and graphs. CONCLUSIONS The ways in which information is presented to physicians may affect the quality of acute care, such as in intensive, critical and emergency care units. When information can be presented in symbolic form, it may be cognitively processed more efficiently than when it is presented in the usual textual and chart form, potentially lowering errors in diagnosis and increasing the responsiveness to patient conditions.

[1]  R. Remington,et al.  The role of input and output modality pairings in dual-task performance: Evidence for content-dependent central interference , 2006, Cognitive Psychology.

[2]  Michael F. Morris Kiviat graphs: conventions and "figures of merit" , 1974, PERV.

[3]  G. Cruccu,et al.  Star-like display of EEG spectral values. , 1980, Electroencephalography and clinical neurophysiology.

[4]  K B Bennett,et al.  Graphical Displays: Implications for Divided Attention, Focused Attention, and Problem Solving , 1992, Human factors.

[5]  Herbert A. Simon,et al.  Why a Diagram is (Sometimes) Worth Ten Thousand Words , 1987, Cogn. Sci..

[6]  L. Jacoby A process dissociation framework: Separating automatic from intentional uses of memory , 1991 .

[7]  F. Paas,et al.  Cognitive Load Measurement as a Means to Advance Cognitive Load Theory , 2003 .

[8]  A. Stephanides,et al.  Philosophy in a New Key: A Study in the Symbolism of Reason, Rite, and Art , 1948 .

[9]  G E Legge,et al.  Efficiency of graphical perception , 1991, Perception & psychophysics.

[10]  R N Fleischman,et al.  Modeling the Cognitive Content of Displays , 1989, Human factors.

[11]  Demaris A. Montgomery,et al.  Human Sensitivity to Variability Information in Detection Decisions , 1999, Hum. Factors.

[12]  George R. S. Weir,et al.  Human Computer Interaction and Complex Systems , 1991 .

[13]  Noam Chomsky Human Language and Other Semiotic Systems , 1979 .

[14]  Herbert A. Simon,et al.  Why a Diagram is (Sometimes) Worth Ten Thousand Words , 1987 .

[15]  James J. Thomas,et al.  Visualizing the non-visual: spatial analysis and interaction with information from text documents , 1995, Proceedings of Visualization 1995 Conference.

[16]  Walter Schneider,et al.  Controlled and automatic human information processing: II. Perceptual learning, automatic attending and a general theory. , 1977 .

[17]  R. Shiffrin,et al.  Controlled and automatic human information processing: I , 1977 .

[18]  Kenneth W. Kolence,et al.  Software unit profiles & Kiviat figures , 1973, PERV.

[19]  N. Cowan The magical number 4 in short-term memory: A reconsideration of mental storage capacity , 2001, Behavioral and Brain Sciences.

[20]  Aaron B. Hoffman,et al.  Thirty-something categorization results explained: selective attention, eyetracking, and models of category learning. , 2005, Journal of experimental psychology. Learning, memory, and cognition.

[21]  Paul Kline,et al.  Validation of the AGARD STRES Battery of Performance Tests , 1996, Hum. Factors.

[22]  Kim J. Vicente,et al.  Coping with Human Errors through System Design: Implications for Ecological Interface Design , 1989, Int. J. Man Mach. Stud..

[23]  Herman Chernoff,et al.  The Use of Faces to Represent Points in k- Dimensional Space Graphically , 1973 .

[24]  A. Baddeley,et al.  The Psychology of Learning and Motivation , 1974 .

[25]  John Duncan,et al.  Effect of Template Complexity on Visual Search and Dual-Task Performance , 2005, Psychological science.

[26]  M. D’Esposito Working memory. , 2008, Handbook of clinical neurology.

[27]  M. Posner Chronometric explorations of mind , 1978 .

[28]  F. Paas,et al.  Cognitive Load Theory and Instructional Design: Recent Developments , 2003 .

[29]  John R. Goodall,et al.  A user-centered look at glyph-based security visualization , 2005, IEEE Workshop on Visualization for Computer Security, 2005. (VizSEC 05)..

[30]  Linda L. Lohr Creating Graphics for Learning and Performance: Lessons in Visual Literacy , 2002 .

[31]  Alfred Bork,et al.  Multimedia in Learning , 2001 .

[32]  R. Mayer,et al.  Multimedia Learning: The Promise of Multimedia Learning , 2001 .

[33]  John Sweller,et al.  Cognitive Load During Problem Solving: Effects on Learning , 1988, Cogn. Sci..

[34]  H Kondo,et al.  A computer system applying the face method to represent multiphasic tests. , 1987, Medical informatics = Medecine et informatique.

[35]  T. M. Barnhardt,et al.  Number of solutions effects in stem decision: Support for the distinction between identification and production processes in priming , 2005, Memory.

[36]  Ben Shneiderman,et al.  Readings in information visualization - using vision to think , 1999 .

[37]  D. Leutner,et al.  Assessment of cognitive load in multimedia learning using dual-task methodology. , 2002, Experimental psychology.