ArticleBMC medical education2023
Using cognitive load theory to evaluate and improve preparatory materials and study time for the flipped classroom.
Article in BMC medical education, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- DeepSeek-assisted problem-based learning for glaucoma education in an undergraduate ophthalmology clerkship: a randomized educational pilot study.Scientific reports · 2026Trial
- AI-ding peer feedback: a randomized study of self-generated vs. ai-assisted peer feedback.BMC medical education · 2025Trial
- Teaching a single manual therapy technique at a time reduces cognitive load in physiotherapy students: a randomized controlled educational study.BMC medical education · 2025Trial
- A structured teaching module for postoperative follow-up in urology residency training: development and evaluation of an IMDB-based educational tool.BMC medical education · 2026Article
- Transforming surgical ward rounds: constructivist pedagogy, structured models, and intelligent technologies.Frontiers in medicine · 2026Review
- Impact of a hybrid flipped classroom and case-based learning model on learning outcomes and competency development inFrontiers in medicine · 2026Article
- Effectiveness of a flipped classroom combined with case-based learning in the clinical training of pediatric interns: a randomized controlled study.Frontiers in medicine · 2026Article
- The Application of Flipped Classroom Integrated with ChatGPT in Improving Graduate Education on Choroidal Melanoma.Journal of cancer education : the official journal of the American Association for Cancer Education · 2025Article
- Timing, Tools, and Thinking: H5P-Driven Engagement in Flipped Veterinary Education.Veterinary sciences · 2025Article
- Training for the future of the genetic counseling profession: Exploring the assessment and adaptation of graduate programs' didactic curriculum.Journal of genetic counseling · 2025Article
- Reducing Nurses' Barriers to Reporting Adverse Events Using a WeChat-Based Cognitive Load Training Platform: An Open-Label, Randomized Controlled Trial.Risk management and healthcare policy · 2025Article
- Impact of integrating paper-based pulmonary function test case group discussions into flipped classroom on residents' COPD grading assessment competency.Frontiers in medicine · 2025Article
- Effective and Engaging Active Learning in the Medical School Classroom: Lessons from Case-Based Collaborative Learning.Journal of medical education and curricular developmentArticle
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPreclinical medical education is content-dense and time-constrained. Flipped classroom approaches promote durable learning, but challenges with unsatisfactory student preparation and high workload remain. Cognitive load theory defines instructional design as "efficient" if learners can master the presented concepts without cognitive overload. We created a PReparatory Evaluation Process (PREP) to systematically assess and measure improvement in the cognitive-load efficiency of preparatory materials and impact on study time (time-efficiency).
methodsWe conducted this study in a flipped, multidisciplinary course for ~ 170 first year students at Harvard Medical School using a naturalistic post-test design. For each flipped session (n = 97), we assessed cognitive load and preparatory study time by administering a 3-item PREP survey embedded within a short subject-matter quiz students completed before class. Over three years (2017-2019), we evaluated cognitive load- and time- based efficiency to guide iterative revisions of the materials by content experts. The ability of PREP to detect changes to the instructional design (sensitivity) was validated through a manual audit of the materials.
resultsThe average survey response rate was ≥ 94%. Content expertise was not required to interpret PREP data. Initially students did not necessarily allocate the most study time to the most difficult content. Over time, the iterative changes in instructional design increased the cognitive load- and time-based efficiency of preparatory materials with large effect sizes (p < .01). Furthermore, this increased the overall alignment of cognitive load with study time: students allocated more time to difficult content away from more familiar, less difficult content without increasing workload overall.
conclusionsCognitive load and time constraints are important parameters to consider when designing curricula. The PREP process is learner-centered, grounded in educational theory, and works independently of content knowledge. It can provide rich and actionable insights into instructional design of flipped classes not captured by traditional satisfaction-based evaluations.
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