Collaborative use of virtual patients after a lecture enhances learning with minimal investment of cognitive load

<b>Background:</b> The use of virtual patients (VPs), due to their high complexity and/or inappropriate sequencing with other instructional methods, might cause a high cognitive load, which hampers learning. <b>Aim:</b> To investigate the efficiency of instructional methods that involved three different applications of VPs combined with lectures. <b>Method:</b> From two consecutive batches, 171 out of 183 students have participated in lecture and VPs sessions. One group received a lecture session followed by a collaborative VPs learning activity (collaborative deductive). The other two groups received a lecture session and an independent VP learning activity, which either followed the lecture session (independent deductive) or preceded it (independent inductive). All groups were administrated written knowledge acquisition and retention tests as well as transfer tests using two new VPs. All participants completed a cognitive load questionnaire, which measured intrinsic, extraneous and germane load. Mixed effect analysis of cognitive load and efficiency using the R statistical program was performed. <b>Results:</b> The highest intrinsic and extraneous load was found in the independent inductive group, while the lowest intrinsic and extraneous load was seen in the collaborative deductive group. Furthermore, comparisons showed a significantly higher efficiency, that is, higher performance in combination with lower cognitive load, for the collaborative deductive group than for the other two groups. <b>Conclusion:</b> Collaborative use of VPs after a lecture is the most efficient instructional method, of those tested, as it leads to better learning and transfer combined with lower cognitive load, when compared with independent use of VPs, either before or after the lecture.

<b>研究背景：</b> 虚拟患者（Virtual Patients，VPs）因自身复杂度较高，且与其他教学方法的实施顺序搭配不当，可能引发较高的认知负荷，进而阻碍学习效果。<b>研究目的：</b> 探讨结合三种不同虚拟患者应用形式与授课的教学方法的有效性。<b>研究方法：</b> 本研究纳入连续两批次的学生，183名学生中有171名参与了授课与虚拟患者学习环节。其中一组先接受授课环节，随后开展协作式虚拟患者学习活动（协作演绎组）；另外两组则先接受授课环节，再开展独立式虚拟患者学习活动（独立演绎组），或先开展独立式虚拟患者学习活动再进行授课（独立归纳组）。所有组别均接受了书面知识获取测试、保持测试，以及使用两个全新虚拟患者完成的迁移测试。所有参与者均完成了一份认知负荷问卷，用于测量内在认知负荷、外在认知负荷与关联认知负荷。本研究采用R统计软件对认知负荷与教学效率进行混合效应分析。<b>研究结果：</b> 独立归纳组的内在与外在认知负荷均为最高，而协作演绎组的内在与外在认知负荷均为最低。此外，对比结果显示，协作演绎组的教学效率显著更高，即兼具更高的学习表现与更低的认知负荷，优于另外两组。<b>研究结论：</b> 在所测试的教学方法中，授课后开展协作式虚拟患者学习是最为高效的教学方式：相较于在授课前或授课后开展独立式虚拟患者学习，该方式可实现更优的学习效果与知识迁移效果，同时伴随更低的认知负荷。