Cognitive load amongst emergency care students during simulation-based education: Findings from the Cognitive Load Assessment Scales–Simulation instrument

Background: Cognitive load (CL) is the demand placed on the working memory during various tasks. Cognitive load influences students’ ability to process information during simulation-based education. Limited evidence exists on CL amongst emergency care students in South Africa. Aim: To measure the CL Emergency Care Practitioner (ECP) students experience during a teaching simulation. Setting: A cross-sectional, quantitative pilot study was conducted with final-year ECP students at a South African University. Methods: Participants completed the validated Cognitive Load Assessment Scales–Simulation immediately after a homogeneous, high-fidelity teaching simulation. Mean scores for intrinsic load (IL), extraneous load (EL), germane load (GL) and overall CL were calculated. Internal consistency of each CL component was assessed using Cronbach’s alpha. Results: Eighteen students completed the survey (response rate: 86%). Mean scores were IL = 4.72, EL = 3.49, GL = 7.03 and overall CL = 5.08. Reliability analysis demonstrated acceptable internal consistency for EL (α = 0.847) and GL (α = 0.754), while IL showed low reliability (α = 0.458). Germane load was the dominant contributor to CL, indicating substantial mental effort directed towards processing and integrating learning during the simulation. Conclusion: Emergency Care Practitioner students reported moderate overall CL, with high GL suggesting strong engagement in meaningful learning. These findings highlight the importance of clear instructional design and structured cognitive support within emergency care simulations. Contribution: Understanding how emergency care students experience CL can guide educators in refining simulation design, reducing unnecessary cognitive burden and enhancing readiness for complex clinical practice.