Table 4.

The Basic Four application of cognitive load theory principles to optimize germane load.

Principle	The Basic Four application
Introduce contextual interference via random ordering of tasks	Disorders covered in lecture and their corresponding clinical cases are presented in different orders. Weekly clinical problem-solving sessions using The Basic Four are cumulative, including both recent and previously learned concepts.
Employ the variability principle	Cases featuring similar clinical presentations but different underlying causes are intermixed.
Encourage self-explanation	Students are asked to justify their answers to The Basic Four questions based on relevant neuroanatomy and pathophysiology principles.
Encourage imagination	Students are encouraged to write their own clinical cases and formulate answers to The Basic Four questions. Well-written questions are incorporated into the neuroscience course for subsequent use by other students.