Cognitive load imposed by knobology may adversely affect learners' perception of utility in using ultrasonography to learn physical examination skills, but not anatomy

Anat Sci Educ. 2015 May-Jun;8(3):197-204. doi: 10.1002/ase.1467. Epub 2014 Jun 5.


Ultrasonography is increasingly used for teaching anatomy and physical examination skills but its effect on cognitive load is unknown. This study aimed to determine ultrasound's perceived utility for learning, and to investigate the effect of cognitive load on its perceived utility. Consenting first-year medical students (n = 137) completed ultrasound training that includes a didactic component and four ultrasound-guided anatomy and physical examination teaching sessions. Learners then completed a survey on comfort with physical examination techniques (three items; alpha = 0.77), perceived utility of ultrasound in learning (two items; alpha = 0.89), and cognitive load on ultrasound use [measured with a validated nine-point scale (10 items; alpha = 0.88)]. Learners found ultrasound useful for learning for both anatomy and physical examination (mean 4.2 ± 0.9 and 4.4 ± 0.8, respectively; where 1 = very useless and 5 = very useful). Principal components analysis on the cognitive load survey revealed two factors, "image interpretation" and "basic knobology," which accounted for 60.3% of total variance. Weighted factor scores were not associated with perceived utility in learning anatomy (beta = 0.01, P = 0.62 for "image interpretation" and beta = -0.04, P = 0.33 for "basic knobology"). However, factor score on "knobology" was inversely associated with perceived utility for learning physical examination (beta = -0.06; P = 0.03). While a basic introduction to ultrasound may suffice for teaching anatomy, more training may be required for teaching physical examination. Prior to teaching physical examination skills with ultrasonography, we recommend ensuring that learners have sufficient knobology skills.

Keywords: anatomical sciences education; cognitive load; gross anatomy course; gross anatomy education; medical skills; physical examination; ultrasonography; ultrasonography education; undergraduate medical education.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anatomy / education*
  • Clinical Competence
  • Cognition / physiology*
  • Curriculum
  • Data Interpretation, Statistical
  • Education, Medical / methods
  • Humans
  • Learning / physiology*
  • Physical Examination / methods*
  • Pilot Projects
  • Surveys and Questionnaires
  • Ultrasonography / psychology*
  • Visual Perception / physiology*