Cognitive Load Theory-Informed Curriculum Design in Health Sciences Education

Cognitive Load Theory-Informed Curriculum Design in Health Sciences Education: Comparison

Please note this is a comparison between Version 2 by Abigail Zou and Version 1 by Kritika Rana.

Cognitive load theory-informed curriculum design in health sciences education refers to the purposeful organisation of teaching strategies and learning materials based on the principles of Cognitive Load Theory (CLT), a framework developed by John Sweller in the late 1980s. CLT is grounded in cognitive psychology and recognises that the working memory has a limited capacity for processing new information. It identifies three types of cognitive load: intrinsic load, which refers to the inherent complexity of the material being learned; extraneous load, which results from ineffective instructional design or irrelevant information; and germane load, which reflects the mental effort directed toward understanding, integrating, and organising information into long-term memory. In health sciences education, students frequently engage with tasks that require the simultaneous processing of multiple interacting elements, placing high demands on working memory at specific points in time. This includes foundational biomedical sciences such as anatomy, physiology, and pathophysiology extending to applied clinical skills, diagnostic reasoning under uncertainty, health service management within complex systems, and ethically grounded decision-making. Without thoughtful instructional design, learners may be overwhelmed by excessive information and cognitive demands, which can hinder understanding, retention, and performance. Applying CLT-informed strategies, educators can reduce unnecessary cognitive burden, sequence learning activities to align with learners’ cognitive capacity, and promote deeper learning. This approach supports more effective knowledge acquisition and transfer and is particularly valuable in content dense academic environments such as medicine, nursing, allied health education, public health and health service management education. Therefore, integrating CLT-informed principles into curriculum design can help optimise learning experiences and support the development of competent health professionals.

cognitive load theory
intrinsic load
extraneous load
germane load
schema formation
health sciences education
curriculum design
instructional design
learning efficiency

Cognitive Load Theory (CLT) emerged in the late 1980s from the work of Australian educational psychologist John Sweller, who sought to understand why some instructional approaches were more effective than others in facilitating meaningful learning ^[1]. CLT was grounded in earlier developments in cognitive science, particularly theories of memory and information processing that gained prominence during the mid-twentieth century. The conceptual roots of CLT can be traced to George Miller’s influential 1956 paper, which suggested that the capacity of working memory is limited to approximately seven units of information ^[2]. This was later developed by Nelson Cowan, who argued that working memory could manage about four interacting elements rather than discrete items at any given time, depending on the individual and the context ^[3].

Throughout the 1960s and 1970s, educational theorists increasingly shifted their attention from behaviourist models of learning to cognitive frameworks that emphasised the mental processes underpinning understanding and skill development. In this context, CLT represented a significant theoretical advancement by articulating how instructional design interacts with the cognitive architecture of learners. Sweller and his colleagues demonstrated that learners often struggle not because the material is inherently difficult, but because the way in which information is presented can exceed the processing limits of working memory [4,5,6]^[4][5][6]. In a series of experimental studies, the authors showed that students who were provided with worked examples, which provided step-by-step guidance for solving problems, performed better on problem-solving tasks than those who were left to discover solutions independently ^[7].

CLT distinguishes among three types of cognitive load ^[8]. Intrinsic load refers to the inherent complexity of the content and is shaped by the degree of interaction among elements that must be understood simultaneously. Extraneous load results from suboptimal instructional design that distracts from learning objectives, such as disorganised layouts or irrelevant information. Germane load, on the other hand, refers to the cognitive resources allocated to schema construction and automation in long-term memory. Schemas are mental structures stored in long-term memory that organise knowledge and allow efficient retrieval and automation of complex information during problem-solving. There is some debate to the distinctiveness of germane load within both intrinsic/extraneous load with some authors suggesting it should not be treated as fully separable from intrinsic/extraneous load rather considered as the allocation of remaining working-memory resources to learning ^[8]. At the level of individual learning tasks, CLT is concerned with how information is processed in working memory during instruction. Cognitive overload occurs when the number of interacting elements within a specific task exceeds working memory capacity, even when this involves only a small number of elements (e.g., more than four interacting components).

Importantly, cognitive load is influenced not only by content complexity and instructional design but also by the mode and structure of learning. Online or hybrid learning environments can impose additional extraneous load if technological platforms, virtual interfaces, or poorly integrated multimedia disrupt attention. Conversely, they can reduce load when designed to scaffold understanding through interactive modules, simulations, or just-in-time resources ^[9]. At a program level, structural features such as curriculum sequencing and pacing may influence the distribution of cognitive demands across learning experiences. However, CLT is primarily a theory of moment-to-moment cognitive processing, and therefore such macro-level considerations should be interpreted as indirect influences on task-level cognitive load rather than cumulative “load over time”. Without well-designed support structures that respect cognitive limitations, students may experience reduced comprehension, inefficient knowledge retention, and impaired clinical performance. Aligning educational strategies with CLT, instructors and curriculum designers can better manage cognitive load and foster deeper learning ^[10]. Techniques informed by CLT include segmenting content into manageable units, integrating visual and verbal information, eliminating redundant materials, and providing scaffolding that gradually shifts cognitive responsibility to the learner ^[11]. Through these strategies, educators can support the development of expertise and improve long-term educational outcomes.

In health sciences education, these principles are particularly relevant, as learners frequently engage with tasks that require the simultaneous processing of multiple interacting elements. When these demands exceed working memory capacity, cognitive overload may occur, leading to suboptimal learning outcomes. Under such conditions, students are more likely to adopt surface learning strategies, such as rote memorisation, rather than developing deeper conceptual understanding required for clinical reasoning and application [12,13]^[12][13]. Cognitive overload has also been associated with increased psychological strain, including burnout and reduced motivation, which can negatively impact academic performance and retention [14,15]^[14][15]. Instructional strategies designed to manage cognitive load, such as spaced learning and retrieval practice, can improve knowledge acquisition and retention in health sciences education [16,17]^[16][17]. These findings underscore the importance of aligning teaching approaches with cognitive principles to optimise learning and support student wellbeing.

CLT continues to inform instructional practice across a wide range of disciplines. In the context of health sciences education, its application holds particular promise for addressing the challenges of information overload, enhancing knowledge transfer, and improving student performance in all academic, management and clinical settings ^[18]. This paper aims to explore how CLT has evolved and been applied in health sciences education, with a focus on identifying instructional strategies that manage cognitive load effectively. This study seeks to synthesise empirical and theoretical insights on the consequences of cognitive overload, highlight evidence-informed teaching practices, and outline future directions for integrating CLT principles into curriculum design to enhance learning efficiency and clinical competence in medical and allied health training.

References

Knowles, M.S. The Modern Practice of Adult Education: From Pedagogy to Andragogy. Available online: https://colllearning.info/wp-content/uploads/2019/03/The-Modern-Practice-of-Adult-Education.pdf (accessed on 17 April 2026).
Miller, G.A. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Psychol. Rev. 1956, 63, 81.
Cowan, N. Evolving conceptions of memory storage, selective attention, and their mutual constraints within the human information-processing system. Psychol. Bull. 1988, 104, 163–191.
Chandler, P.; Sweller, J. Cognitive load theory and the format of instruction. Cogn. Instr. 1991, 8, 293–332.
Paas, F.; Renkl, A.; Sweller, J. Cognitive load theory: Instructional implications of the interaction between information structures and cognitive architecture. Instr. Sci. 2004, 32, 1–8.
Sweller, J. Cognitive load theory, learning difficulty, and instructional design. Learn. Instr. 1994, 4, 295–312.
Sweller, J.; Cooper, G.A. The Use of Worked Examples as a Substitute for Problem Solving in Learning Algebra. Cogn. Instr. 1985, 2, 59–89.
Kalyuga, S. Cognitive Load Theory: How Many Types of Load Does It Really Need? Educ. Psychol. Rev. 2011, 23, 1–19.
Yin, P.; Sun, T. The impact of system interaction quality on learning outcomes in online virtual experiment teaching: The mediating role of extraneous cognitive load. Front. Psychol. 2025, 16, 1739300.
Sortwell, A.; Gkintoni, E.; Díaz-García, J.; Ellerton, P.; Ferraz, R.; Hine, G. Beyond Cognitive Load Theory: Why Learning Needs More than Memory Management. Brain Sci. 2026, 16, 109.
Si, J. Using cognitive load theory to tailor clinical reasoning training for preclinical medical students. BMC Med. Educ. 2024, 24, 1185.
van Merriënboer, J.J.; Sweller, J. Cognitive load theory in health professional education: Design principles and strategies. Med. Educ. 2010, 44, 85–93.
Norman, G.R.; Schmidt, H.G. Effectiveness of problem-based learning curricula: Theory, practice and paper darts. Med. Educ. 2000, 34, 721–728.
Qin, Z.; Yang, G.; Lin, Z.; Ning, Y.; Chen, X.; Zhang, H.; Un In Wong, C. The impact of academic burnout on academic achievement: A moderated chain mediation effect from the Stimulus-Organism-Response perspective. Front. Psychol. 2025, 16, 1559330.
Chong, L.Z.; Foo, L.K.; Chua, S.L. Student Burnout: A Review on Factors Contributing to Burnout Across Different Student Populations. Behav. Sci. 2025, 15, 170.
Khalafi, A.; Fallah, Z.; Sharif-Nia, H. The effect of spaced learning on the learning outcome and retention of nurse anesthesia students: A randomized-controlled study. BMC Med. Educ. 2024, 24, 322.
Deng, F.; Gluckstein, J.A.; Larsen, D.P. Student-directed retrieval practice is a predictor of medical licensing examination performance. Perspect. Med. Educ. 2015, 4, 308–313.
Ghanbari, S.; Haghani, F.; Barekatain, M.; Jamali, A. A systematized review of cognitive load theory in health sciences education and a perspective from cognitive neuroscience. J. Educ. Health Promot. 2020, 9, 176.

References

Quick Survey