Are Baseline Learning Approaches Associated with Cognitive Load, and Do They Moderate the Cognitive Effects of Contextual Vertical Integration? A Prespecified Secondary Analysis of the CONVINCED-OG Trial

Introduction

Effective clinical teaching depends on managing cognitive load. Contextual vertical integration (CVI), which interweaves basic-science mechanisms with clinical content within a teaching session, was associated with lower self-reported Intrinsic Cognitive Load (ICL) and Extraneous Cognitive Load (ECL) scores and higher self-reported Germane Cognitive Load (GCL) scores in the CONVINCED-OG cluster-randomized crossover trial. Whether baseline deep and surface learning approaches are associated with cognitive load, or moderate CVI’s benefits, is unknown. This prespecified secondary analysis addressed both questions. Materials & Methods: The dataset comprised 103 third-year MBBS students (824 student-topic observations) taught eight core obstetrics and gynecology topics across two teaching hospitals, each topic delivered under CVI-enabled and non-integrated conditions in a topic-level crossover. Baseline deep and surface learning approaches were measured once using the Revised Two-Factor Study Process Questionnaire; ICL, ECL and GCL were self-reported after each session using the Cognitive Load Questionnaire. For each outcome, two linear mixed-effects models were fitted with random intercepts for participant and cluster-period: a main-effects model, and an interaction model adding condition-by-approach interaction terms.