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.

**研究背景**：虚拟患者（virtual patients, VPs）由于自身复杂度较高，或与其他教学方法的适配序列不当，可能会引发较高的认知负荷（cognitive load），进而阻碍学习效果。
**研究目的**：探究三种结合讲座的虚拟患者应用方式的教学有效性。
**研究方法**：本次研究纳入连续两批共183名学生中的171名，使其参与讲座与虚拟患者学习环节。其中一组先完成讲座环节，随后开展协作演绎式（collaborative deductive）虚拟患者学习活动；另外两组均同步参与讲座环节与独立虚拟患者学习活动，一组在讲座之后开展独立演绎式（independent deductive）学习，另一组则在讲座之前开展独立归纳式（independent inductive）学习。所有组别均接受书面知识获取测试（knowledge acquisition test）、知识保持测试（knowledge retention test），以及基于两款全新虚拟患者的迁移测试（transfer test）；所有参与者均填写了认知负荷问卷，该问卷用于评估内在认知负荷（intrinsic cognitive load）、外在认知负荷（extraneous cognitive load）与关联认知负荷（germane cognitive load）。本研究使用R统计程序（R statistical program）对认知负荷与学习效率开展混合效应分析（mixed effect analysis）。
**研究结果**：独立归纳组（independent inductive）的内在认知负荷与外在认知负荷均为最高，而协作演绎组（collaborative deductive）的内在认知负荷与外在认知负荷则为最低。此外，对比结果显示，协作演绎组的学习效率显著高于另外两组——即其学习表现更优且认知负荷更低。
**研究结论**：在本次测试的教学方法中，讲座后开展协作演绎式虚拟患者学习是最为高效的教学方式：相较于在讲座前或讲座后开展独立虚拟患者学习，该方式可在降低认知负荷的同时，实现更优的学习效果与知识迁移能力。