Exploring Implications of Context Specificity and Cognitive Load in Residents

Context specificity (CS) refers to the variability in clinical reasoning across different presentations of the same diagnosis. Cognitive load (CL) refers to limitations in working memory that may impact clinicians’ clinical reasoning. CL might be one of the factors that lead to CS. Although CL during clinical reasoning would be expected to be higher in internal medicine residents, CL’s effect on CS in residents has not been studied. Methods: Internal medicine residents watched a series of three cases portrayed on videos. Following each case, participants filled out a post-encounter form and completed a validated measure of CL. Results: Fourteen residents completed all three cases. Across cases, self-reported CL was relatively high and there were small to moderate correlations between CL and performance in clinical reasoning (r’s = .43, -.33, -.23). In terms of changing CL across cases, the correlations between change in CL and change in total performance were statistically significantly only in moving from case 1 to case 2 (r = -.54, p =.05). Discussion and Conclusion: Residents self-reported measurements of CL were relatively high across cases. However, higher CL was not consistently associated with poorer performance. We did observe the expected associations when looking at case-to-case change in CL. This relationship warrants further study.