Table 1
Cognitive Load Inventory for Handoffs (CLI4H)
|
Type of cognitive load |
Items |
Anchors for 0–10 Scale | |
|---|---|---|---|
|
0 |
10 | ||
|
Intrinsic load |
Please rate the COMPLEXITY of the patient in this handoff |
NOT at all complex |
Extremely complex |
|
Please rate the ACUTENESS of the patient in this handoff |
Not at all acute |
Highly acute | |
|
Please rate the AMOUNT OF CLINICAL INFORMATION that needed to be communicated during this handoff |
Low amount of clinical information |
High amount of clinical information | |
|
Please rate the CLINICAL DECISIONS that will have to be made after this handoff |
Not at all complex |
Highly complex, possibly depending on multiple pieces of interacting information. | |
|
Extraneous load |
Please rate how well you understood the HANDOFF PROTOCOL that was used |
Not at all |
Completely |
|
Please rate the ACCESSIBILITY of all the different information that needed to be communicated |
Highly fragmented and difficulty to organize |
Readily accessible and easy to organize | |
|
Please rate how much MENTAL EFFORT you invested to UNDERSTAND the TERMINOLOGY used in the handoff |
Extremely low |
Extremely high | |
|
Please rate how DISTRACTED you were during the handoff |
Not at all |
Very much | |
|
Germane load |
Please rate how much this handoff improved YOUR UNDERSTANDING of how to perform a handoff? |
Not at all |
Very much |
Table 2
Results of exploratory factor analysis of all items
|
Item |
N |
Mean |
SD |
Skewness |
Kurtosis |
Loading factor 1a |
Loading factor 2a |
Loading factor 3a |
|---|---|---|---|---|---|---|---|---|
|
Intrinsic load: complexity |
86 |
5.581 |
1.8261 |
− 0.168 |
− 0.343 |
0.532 |
− 0.077 |
0.429 |
|
Intrinsic load: acuity |
86 |
7.221 |
1.7634 |
− 0.498 |
0.226 |
0.552 |
0.032 |
0.053 |
|
Intrinsic load: amount of clinical information |
85 |
6.31 |
1.746 |
− 0.127 |
− 0.375 |
0.741 |
0.184 |
0.085 |
|
Intrinsic load: complexity of clinical decisions |
86 |
6.186 |
2.3137 |
− 0.775 |
0.299 |
0.750 |
0.310 |
− 0.011 |
|
Extraneous load: protocol |
86 |
5.372 |
2.8944 |
− 0.575 |
− 0.757 |
0.042 |
0.827 |
− 0.225 |
|
Extraneous load: accessibility of information |
86 |
5.093 |
2.3992 |
− 0.567 |
− 0.064 |
0.104 |
0.318 |
0.080 |
|
Extraneous load: terminology |
86 |
5.314 |
2.5449 |
− 0.401 |
− 0.285 |
0.127 |
0.127 |
0.733 |
|
Extraneous Load: distraction |
85 |
2.52 |
2.767 |
1.059 |
0.127 |
− 0.308 |
− 0.176 |
0.290 |
|
Germane Load: understanding |
85 |
4.08 |
2.803 |
− 0.035 |
− 1.034 |
0.133 |
0.764 |
0.083 |
aExtraction method: Principal axis factoring. Rotation method: Varimax with Kaiser normalization.
Table 3
Factor loadings for final model
|
Item |
Factor | |
|---|---|---|
|
Intrinsic Load |
Germane Load | |
|
Intrinsic load: complexity |
0.50 |
0.08 |
|
Intrinsic load: acuity |
0.65 |
− 0.08 |
|
Intrinsic load: amount of clinical information |
0.69 |
0.33 |
|
Intrinsic load: complexity of clinical decisions |
0.73 |
0.30 |
|
Germane load: understanding |
0.09 |
0.78 |
Extraction method: principal axis factoring, Rotation method: Varimax with Kaiser normalization.
Table 4
Relationship of cognitive load factors to other variables
|
Variable |
Intrinsic load factora |
Germane load factorb |
|
Paas single item measure of overall cognitive load |
Pearson correlation coefficient 0.310 (N = 86, P = 0.004) |
Pearson correlation coefficient 0.110 (N = 85, P = 0.32) |
|
Student self-assessment of handoff’s success |
Pearson correlation coefficient 0.129 (N = 85, P = 0.24) |
Pearson correlation coefficient 0.303 (N = 85, P = 0.005) |
|
Performance rating by standardized resident |
Pearson correlation coefficient − 0.140 (N = 85, P = 0.20) |
Pearson correlation coefficient 0.107 (N = 84, P = 0.33) |
|
Lowc versus highd handoff experience |
T-test Low (N = 52): M = 26.3 (SD = 5.3) High (N = 34): M = 23.6 (SD = 6.3) P = 0.036 |
T-test Low (N = 52): M = 4.6 (SD = 2.4) High (N = 33): M = 3.3 (SD = 3.2) P = 0.03 |
aSum of four contributing factors—range 0–40.
bValue of one contributing factor—range 0–10.
cLow = prior experience with less than 5 handoffs.
dHigh = prior experience with 5 or more handoffs.