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Working memory is limited: improving knowledge transfer by optimising simulation through cognitive load theory
  1. Michael Meguerdichian1,
  2. Katie Walker2,
  3. Komal Bajaj3
  1. 1Department of Emergency Medicine, Institute for Medical Simulation and Advanced Learning, Harlem Hospital Center, Columbia University, New York, New York, USA
  2. 2Institute for Medical Simulation and Advanced Learning, NYC Health + Hospital, Bronx, New York, USA
  3. 3Institute for Medical Simulation and Advanced Learning, NYC Health + Hospitals, Albert Einstein School of Medicine, Bronx, New York, USA
  1. Correspondence to Dr Michael Meguerdichian Harlem Hospital Center, Department of Emergency Medicine, 506 Malcolm X Blvd, New York, NY 10037; michael.meguerdichian{at}


This analysis explores how to optimise knowledge transfer in healthcare simulation by applying cognitive load theory to curriculum design and delivery for both novice and expert learners. This is particularly relevant for interprofessional learning which is team-based, as each participant comes to the simulation experience with different levels of expertise. Healthcare simulation can offer opportunities to create complex and dynamic experiences that replicate real clinical situations. Understanding Cognitive Load Theory can foster the acquisition of complex knowledge, skills and abilities required to deliver excellence in patient care without overwhelming a learner's ability to handle new materials due to working memory limitations. The 2 aspects of working memory that will be explored in this paper are intrinsic load and extrinsic load. These will be addressed in terms of the learner's level of expertise and how to consider these elements to enhance the learning environment in simulation scenario development and delivery. By applying the concepts of Cognitive Load Theory, this paper offers educators a method to tailor their curricula to navigate working memory and optimise the opportunity for knowledge transfer.

  • Cognitive Load
  • Curriculum Design
  • Simulation Education
  • Working Memory
  • Knowledge Transfer

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  • Contributors MM conceived the idea for the manuscript; MM, KW and KB contributed equally to drafting and revising the manuscript, and have approved the final version.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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