Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.


College of Health Care Sciences - Physical Therapy Department

First Advisor

Shari Rone-Adams

Date of original Performance / Presentation


Publication Date / Copyright Date



Nova Southeastern University


While the body of evidence supporting the use of simulation-based learning in the education of health professionals is growing, howor why simulation-based learning works is not yet understood. There is a clear need for evidence, grounded in contemporary educational theory, to clarify the features of simulation instructional design that optimize learning outcomes and efficiency in health care professional students.

Cognitive Load Theory (CLT) is a theoretical framework focused on a learner’s working memory capacity. One principle of CLT is example based learning. While this principle has been applied in both traditional classroom and laboratory settings, and has shown positive performance and learning outcomes, example based learning has not yet been applied to the simulation setting. This study had two main objectives: to explore if the example-based learning principle could successfully be applied to the simulation learning environment, and to establish response process validation evidence for a tool designed to measure types of cognitive load.

Fifty-eight novice students from nursing, podiatric medicine, physician assistant, physical and occupational therapy programs participated in a blinded randomized control study. The dependent variable was the simulation brief. Participants were randomly assigned to either a traditional brief or a facilitated tutored problem brief. Performance outcomes were measured with verbal communications skill presented in the Introduction, Situation, Background, Assessment, Recommendation (I-SBAR) format. Response process evidence was collected from cognitive interviews of 11 students.

Results indicate participation in a tutored problem brief led to statistically significant differences at t(52)=-3.259, p=.002 in verbal communication performance compared to students who participated in a traditional brief. Effect size for this comparison was d=(6.06-4.61)/1.63 = .89 (95% CI 0.32-1.44). Response process evidence demonstrated that additional factors unique to the simulationlearning environment should be accounted for when measuring cognitive load in simulation based learning (SBL).

This study suggests that example based learning principles can be successfully applied to SBL and result in positive performance outcomes for health professions students. Additionally, measures of cognitive load do not appear to capture all contribution toload imposed by the simulation environment.


Physical Therapy


Health and environmental sciences, Education, Cognitive load theory, Example-base learning, Health professions education, Interprofessional communication, Simulation based learning

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