Neonatologist Baylor College of Medicine Sugar Land, Texas, United States
Background: Since its introduction in 1987, the Neonatal Resuscitation Program (NRP) has contributed to a significant decrease in neonatal mortality and has evolved and grown but has increased in complexity and scope, with a concomitant increase in the cognitive load of content for learners. The burgeoning content includes instructions about actions to take during resuscitation, the sequence of these actions, and numeric information. According to cognitive load theory, the amount of information that short-term or working memory can handle effectively is limited. Exceeding this capacity leads to poor understanding, retention, and learning. There are three kinds of cognitive load: intrinsic (related to the instructional content); germane (related to the activities that the students do); and extraneous (everything else). Minimizing the load on working memory in these areas facilitates information processing and learning. We aimed to determine the amount of numeric information-a form of cognitive load-learners are expected to memorize in the NRP. Objective: We aimed to determine the amount of numeric information, a form of cognitive load, learners are expected to memorize in the NRP. Design/Methods: We reviewed the current 8th edition of the NRP textbook, and determined the number of distinct numerical elements present in the entire curriculum and per lesson. Numerical data were categorized based on the capacity of how each number was used in the context of neonatal resuscitation. Results: There were 106 items of numeric information included in the textbook. Of these, 7 (6.7%) were related to assessment (e.g., gestational age), 52 (49%) were related to action thresholds (e.g., starting positive pressure ventilation pressures based on gestational age), and 47 (44.3%) addressed the amount of therapeutic support provided (e.g., size of orogastric tube inserted or endotracheal tube size). The median (IQR) number of numeric items per lesson was 12.5 (1 -18.5). The highest number of numeric items was found in Lesson Two (40), followed by Lesson Five (33). The lowest number of numeric items were found on Lessons 11 and 12 (1). Three lessons had no numerical information presented.
Conclusion(s): There is a large amount of numeric information included in the NRP which constitutes a significant cognitive load on health professionals performing resuscitation. Future editions of the NRP should address methods to decrease this cognitive load. Incorporation of principles of human factors engineering may help decrease the numeric cognitive load for learners in the next edition of the NRP textbook.
