Teaching Matters

Presentation 7 FR2

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Teaching Matters 2018 | Presentation Details | 2018


Designing low-fidelity simulation: A cognitive load theory approach


Richard Say, School of Health Science
Vasiliki Betihavas, University of Sydney
Denis Visentin, School of Health Science
Susannah Minutillo, Australian Technical and Management College


Excellent teaching happens by design

Presentation Type



Flexible Learning Space 2




This project evaluated a low-fidelity simulation workshop that taught nursing students how to assess and manage deteriorating patients. Cognitive load theory (CLT), which uses an understanding of brain architecture for effective educational design (Sweller, 2003), informed the design of the workshop.

Many nurses are underprepared to manage patients who are deteriorating (Purling & King, 2012) and simulation is frequently used to improve skills in this area (Fisher & King, 2013). However, literature favours the reporting of high-fidelity simulation over more cost-effective, low-fidelity approaches. Managing the deteriorating patient is a complex task with high intrinsic load. Since working memory is very limited, minimising the extraneous load that is superfluous to the task improves learning of new tasks (the intrinsic load). Hence, a CLT informed low-fidelity approach may enhance learning for nursing students (Fraser, et al., 2015).

Fourteen second-year nursing students attended a one-day program utilising CLT informed simulation designed to minimise extraneous cognitive load, with n = 13 completing evaluations. A single arm pre-post evaluation of students’ confidence in managing the deteriorating patient was performed. Post-intervention, students improved their mean overall confidence from 2.98 (0.19) to 4.47 (0.12) on a 5-point scale (mean diff = 1.49, p< 0.001). Confidence increased significantly in all seven areas of managing deteriorating patients, demonstrating the importance of CLT informed low-fidelity simulation for learning new and complex tasks in undergraduate nursing programs.

This presentation is for educators who are interested in low-cost simulation for skill development. An exploration of the effectiveness of low-fidelity simulation is discussed, including the application of CLT to simulation.


Sweller, J. (2003). Evolution of human cognitive architecture, in The psychology of learning and motivation: Advances in research and theory, B.H. Ross, Editor. Elsevier Science: New York, US. p. 215-266.

Purling, A. and King, L. (2012). A literature review: graduate nurses' preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23-24): p. 3451-3465.

Fisher, D. and King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient. Journal of Advanced Nursing, 2013. 69(11): p. 2375-2388.

Fraser, K.L., Ayres, P. and Sweller, J. (2015). Cognitive load theory for the design of medical simulations. Simulation in Healthcare. 10(5): p. 295-307.

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