Cognitive overload during the COVID‐19 pandemic: A student’s response to Sewell et al

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Editor – The ongoing COVID‐19 pandemic has severely disrupted both health care and clinical teaching across the world. Although lockdown restrictions are now being eased in many places, allowing medical students to return to their clinical teaching posts, there is still anxiety with reference to learning in such an unusual context. As a final‐year medical student, I became intrigued when reading Sewell et al’s ¹ article on identifying cognitive overload among learners and wondered how their findings might be translated to help students during the COVID‐19 pandemic.

Although the majority of medical students prefer to ‘return’ to clinical placements, we should also consider the concerns felt by the other one‐third of trainees. ² Those who do not want to return have offered reasons such as ‘I don’t want to be a possible vector of infection’ and ‘[I want to] reduce possible risk to patients’, and have described a perceived risk to themselves. ² With regard to cognitive load theory, it seems important to question if such feelings of anxiety might place extraneous load on students and thereby impair their ability to learn even if they do return. ³ Some will be reticent about voicing their worries as a result of concerns about stigmatisation, ⁴ which will make the recognition of cognitive cues indicating cognitive overload (the focus of Sewell et al’s work ¹ ) critical in helping educators intervene early.

Sewell et al sorted indicators of cognitive overload into four categories: reduced performance (the most common manifestation); non‐verbal cues (eg, facial expressions, tearfulness); verbal utterances (eg, sighs), and interpersonal interactions (eg, lack of responsiveness). ¹ Although some cues may appear vague, when they are noticed it would take fairly little effort to ask students how they are coping with current circumstances. Doing so can have considerable benefit as support from co‐workers can improve well‐being and reduce negative emotions related to the work environment. ⁵ Creating a more welcoming atmosphere and encouraging increased student participation in duties with the rest of the medical team may itself alleviate the anxiety students face with regard to COVID‐19 and thereby improve both our learning experience and our learning.

The educational response from medical schools to the pandemic has been commendable, with strong efforts being made to maintain clinical teaching through remote learning. Unfortunately, this cannot replace integrated learning within the context of clinical placements. As students re‐enter these settings, the indicators highlighted by Sewell et al ¹ can help to identify those who are feeling anxiety, thereby enabling the provision of extra support to help them integrate and succeed in training for their own roles as future doctors despite the current pandemic.