In this episode, emergency physician and cognitive load researcher Dr. Adam Szulewski explores how cognitive load affects clinical reasoning and performance in busy practices. He explains how limited working memory, interruptions, fatigue, and information overload can influence decision-making and shares practical strategies to help clinicians manage these demands.
In this episode, emergency physician and cognitive load researcher Dr. Adam Szulewski explores how cognitive load affects clinical reasoning and performance in busy practices. He explains how limited working memory, interruptions, fatigue, and information overload can influence decision-making and shares practical strategies to help clinicians manage these demands.
Dr. Szulewski discusses approaches such as pre-briefing, mental simulation, pausing to recap and reprioritize, and using checklists and cognitive aids appropriately. The conversation also looks at how electronic health records can add unnecessary cognitive burden and why recognizing cognitive load can help clinicians create more space to think clearly.
Guest: Dr. Adam Szulewski
Host: Dr. Chris Morrow, Associate Dean, UBC CPD
Producer: Julia Donahue
Music: "“Flight of the Starbird” by Andrei and Mike Diaconu of Cosmic Mansions
Episode Timestamps
00:00 — Introduction and what cognitive load means
01:58 — Intrinsic, extraneous and germane cognitive load
04:17 — Translating cognitive load theory into clinical medicine
06:02 — Interruptions, competing priorities and busy clinical practice
08:42 — Working memory, expertise and mental schemas
12:22 — Expert vs. novice attention: the ruptured AAA simulation example
15:47 — Fast and slow thinking, cognitive error and knowing when to slow down
18:40 — Pre-briefing and mental simulation before high-stakes care
21:46 — Applying structure and preparation in primary care
22:16 — The medical pause: recapping, slowing down and reprioritizing
25:22 — Checklists, cognitive aids and when they help
27:24 — Research on cognitive load in clinical practice and CanMEDS
31:40 — Electronic health records, extraneous load and the potential role of AI
Resources:
Szulewski A, Howes D, van Merriënboer JJG, Sweller J. From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine. Academic Medicine. 2021;96(1):24–30.
https://academic.oup.com/academicmedicine/article-abstract/96/1/24/8346681
Young M, Szulewski A, Anderson R, Gomez-Garibello C, Thoma B, Monteiro S. Clinical Reasoning in CanMEDS 2025. Canadian Medical Education Journal. 2023;14(1):58–62.
https://journalhosting.ucalgary.ca/index.php/cmej/article/view/75843
Kahneman D. Thinking, Fast and Slow.
https://www.penguinrandomhouse.com/books/89308/thinking-fast-and-slow-by-daniel-kahneman/
Lee JY, Donkers J, Jarodzka H, Sellenraad G, van Merriënboer JJG. Different effects of pausing on cognitive load in a medical simulation game. Computers in Human Behaviour. 2020;110:106385.
https://www.sciencedirect.com/science/article/pii/S0747563220301382
Lee JY, et al. The medical pause: Importance, processes and training. Medical Education. 2021.
https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.14529
KeyLIME+ Podcast. Adam discusses KeyLIME+ near the end of the episode as a medical education podcast focused on the stories and practical implications behind research and policy.
https://keylimepodcast.libsyn.com/