Multimedia Learning for Healthcare Education

How to design multimedia learning experiences that minimize cognitive load.

Today more than ever the modern educator has access to a variety of multimedia technology, ranging from text-based formats (ie., this blog), to images, graphics, and audio for slide shows and podcasts, as well as animations and videos. All of which can be easily accessed and streamed from one's laptop, tablet, or smartphone. With so many options, it can sometimes be difficult to know if the multimedia we've selected actually enhances student learning, or if it further burdens the experience, leaving the student drowning with cognitive overload. In this post, we'll discuss some tips and tricks to avoid cognitive overload using multimedia, based on Richard Mayer's Cognitive Theory of Multimedia Learning.

The primary purpose of instruction is to increase the amount of knowledge encoded into long-term memory that can be accessed or retrieved at a later time (Mayer & Mayer, 2005). The Cognitive Theory of Multimedia Learning (CTML) proposed by Dr. Richard Mayer, suggests that the cognitive processing of information by the learner is enhanced when both verbal and pictorial representations of information are used in combination to generate understanding (Mayer & Fiorella, p. 148, 2021).

Going forward we'll discuss some of the contributing factors leading to cognitive overload, and possible solutions. The first type of cognitive load is referred to as extraneous cognitive load. Put simply, this refers to nonessential or irrelevant content that ultimately detracts from our short-term memory's ability to process information. For example, if we were planning a learning event to teach nurses how to remove sutures, and I decided to spice it up with some videos of graphic wounds, this would be considered nonessential content for learning the skill of suture removal. As such, the entertaining videos only contribute by adding extraneous cognitive load for the learners. CTML emphasizes the very limited capacity of working memory in processing information that can ultimately be coded for long-term memory.

So what then is the intrinsic cognitive load or what CTML refers to as essential processing? Here intrinsic cognitive load or essential processing refers to the inherent complexity or difficulty associated with the learning content. Previously, we attempted to remove all extraneous cognitive load to improve working memory and facilitate the coding of information into long-term memory. However, the intrinsic load is an essential component of the learning event. Therefore, it need not be eliminated, but rather managed to better facilitate the cognitive processing of complex learning content.

CTML simply recognizes that we have limited working memory capacity, and can quickly become overloaded, which impedes the acquisition of new knowledge into our long-term memory. It is believed that our working memory processes information through two channels; one for visual information and the other for verbal information. A fundamental premise of CTML is that the use of words and pictures is better than words alone (Mayer & Fiorella p.155, 2021). In the following section, I will highlight a couple of examples from CTML to consider when making your next learning event.

As mentioned previously, our working memory has a limited storage capacity, therefore it is important to remove any extraneous material that does not enhance the learning experience, and adds a cognitive burden to the student's ability to process information. One such example is what is referred to as the Redundancy principle. It is often tempting to reinforce concepts by presenting information that is simultaneously provided in both a written and verbal form. However, it is believed this only interferes with cognitive processing. For example, presenting your slide notes on screen for your learners, as you read them aloud. This places a significant burden on the auditory component of our working memory. Instead, a better option might be a pictorial representation with narration, this balances incoming information between both the auditory and visual inputs.

Another common example of creating extraneous cognitive load for learners is the principle of Spatial Contiguity. In the example below, the top images are presented but the relevant verbal information is separated from its depiction into a key on the right. Instead, spatial contiguity suggests that people learn better when words and pictures are presented near each other (Gretch, 2018). Thus, the bottom example in this image would be the preferred method.

Redundancy and Spatial Contiguity are just two examples of processes that should be considered in reducing extrinsic cognitive load. Next, we'll look at a couple of examples for managing the intrinsic cognitive load.

Imagine we are to create a learning experience for new nurses to be competent in suture removal. The complexity of the skill may result in a high intrinsic cognitive load for the nurses. Thus, it would be important to manage this information in such a way to facilitate processing it from working memory and into long-term memory.

While creating your suture removal learning event for your nursing students, it may be beneficial to pre-teach some content prior to the actual learning experience. Pre-teaching is when a portion of the learning content such as vocabulary or skills is delivered before the main lesson and is reinforced with spaced repetition over time (Lovell et. al, 2020) By off-loading some of the learning content ahead of time, students are less likely to become overwhelmed by the intrinsic cognitive load of the skill during the actual learning event. For example, introducing vocabulary terms such as dehiscence will lessen the student's cognitive burden.

Another technique for managing intrinsic cognitive load or essential processing is the Segmenting Principle. Segmentation attempts to break up information into bite-sized chunks, especially for learners with a low prior knowledge level (Lovell et. al, 2020). Thus, instead of providing one continuous learning event, it would be advantageous to break apart the skill into its constituent parts to reduce intrinsic load and foster long-term knowledge acquisition. In the case of our nursing students learning how to remove sutures; we might start by reviewing the indications of suture removal, followed by what equipment or instruments are necessary, then progressing to learning the common types of sutures or staples that require removal, such as interrupted, continuous, or mattress sutures. Of course, this patient intervention also requires patient education regarding topics such as signs & symptoms of wound infection or dehiscence, and home care instructions. Segmenting this information into part vs. whole sequencing affords the novice learner the ability to practice and acquire the skill without overwhelming the essential processing of new information.

The principle of Signaling or Cueing is frequently used in instructional design to guide the learner's attention to essential material that will facilitate the organization and integration of information ( Mayer & Fiorella p. 221, 2021). However, the use of signaling may be audience specific, such as the case with novice or expert learners. In the simple example below, the suture, steristrip, and wound edges are labeled to direct the learner's attention and reduce the need for them to scan and search for content.

In today's digital age, cinematic quality multimedia can produce videos, images, text, and animations that both enthrall and entertain learners. However, multimedia can also be distracting, isolating, expensive, and easily overwhelm the essential processing of new information. Before you create your next multimedia learning experience, keep sight of your learning event's goals and objectives. By utilizing a few of the guiding principles from the Cognitive Theory of Multimedia Learning, you'll be better prepared to eliminate extraneous processing, as well as manage the essential processing of information to facilitate the acquisition of new knowledge into long-term memory.

Test Your Knowledge

Grech. (2018). The application of the Mayer multimedia learning theory to medical.

Powerpoint slide show presentations. Journal of Visual Communications in Medicine, 41(1),

36-41. https://doi.org10.1080/174553054.2017.1408400

Lovell, Caviglioli, O., & Sweller, J. (2020). Sweller's cognitive load theory in action. John Catt

Educational, Limited.

Mayer, R., & Fiorella, L. (Eds.). (2021). The Cambridge handbook of multimedia learning. (3rd

ed., Cambridge Handbooks in Psychology). Cambridge: Cambridge University Press.

doi:10.1017/9781108894333

Mayer, R., & Mayer, R.E. (Eds.). (2005). The Cambridge handbook of multimedia learning.

Cambridge university press.