Assessing student course evaluation comments through the lens of cognitive load theory: Insights for best teaching practices
DOI:
https://doi.org/10.46542/pe.2026.261.116126Keywords:
Cognitive load theory, Faculty and course evaluation, Learning, Pharmacy student, TeachingAbstract
Background: Cognitive Load Theory (CLT) explains how memory processes affect learning and retention. In healthcare education, managing complex knowledge, skills, and behaviors can overwhelm learners, underscoring the need for instructional designs that balance cognitive demands. Faculty and course evaluation (FCE) comments offer qualitative insights into student perceptions of instructional effectiveness. This study applies CLT to analyse FCE comments and identify instructional practices that support effective learning.
Methods: Student FCE comments in a 3-year accelerated Doctor of Pharmacy (PharmD) programme (2019 – 2023) were anonymised, compiled into a text corpus, and analysed using a literature-derived CLT codebook. Three investigators conducted qualitative analysis to identify recurring cognitive load themes.
Results: Codes were categorised into extraneous, intrinsic, and germane load elements. The most frequent theme involved instructional practices increasing extraneous load (400 codes), reflecting unnecessary cognitive burden. Supportive and organised teaching practices were linked to reduced extraneous load (321 codes). Simplified explanations and real-life examples were associated with minimising intrinsic load. Interactive and inclusive methods were identified as enhancing germane load (20 codes).
Conclusion: Findings demonstrate how student experiences reflect CLT principles and offer guidance for improving instructional design. Applying CLT in healthcare education can foster more efficient, engaging, and meaningful learning environments.
References
Baddeley, A. (2012). Working memory: Theories, models, and controversies. Annual review of psychology, 63(1), 1‒29. https://doi.org/10.1146/annurev-psych-120710-100422
Baddeley, A. D., & Hitch, G. (1974). Working Memory. In G. H. Bower (Ed.), Psychology of learning and motivation (Vol. 8, pp. 47-89). Academic Press.
Bolkan, S., & Goodboy, A. K. (2020). Instruction, example order, and student learning: Reducing extraneous cognitive load by providing structure for elaborated examples. Communication Education, 69(3), 300‒316. https://doi.org/10.1080/03634523.2019.1701196
Camina, E., & Güell, F. (2017). The neuroanatomical, neurophysiological and psychological basis of memory: Current models and their origins. Frontiers in Pharmacology, 8, 438. https://doi.org/10.3389/fphar.2017.00438
Catrambone, R., & Yuasa, M. (2006). Acquisition of procedures: The effects of example elaborations and active learning exercises. Learning and Instruction, 16(2), 139‒153. https://doi.org/10.1016/j.learninstruc.2006.02.002
Choi, H.-H., Van Merriënboer, J. J., & Paas, F. (2014). Effects of the physical environment on cognitive load and learning: Towards a new model of cognitive load. Educational Psychology Review, 26, 225‒244. https://doi.org/10.1007/s10648-014-9262-6
Clark, J. (2008). PowerPoint and pedagogy: Maintaining student interest in university lectures. College Teaching, 56(1), 39‒44. https://doi.org/10.3200/CTCH.56.1.39-46
Cook, M. P. (2006). Visual representations in science education: The influence of prior knowledge and cognitive load theory on instructional design principles. Science Education, 90(6), 1073‒1091. https://doi.org/10.1002/sce.20164
Costley, J. (2021). How role-taking in a group-work setting affects the relationship between the amount of collaboration and germane cognitive load. International Journal of Educational Technology in Higher Education, 18(1), 24. https://doi.org/10.1186/s41239-021-00259-w
Costley, J., Gorbunova, A., Courtney, M., Chen, O., & Lange, C. (2024). Problem-solving support and instructional sequence: impact on cognitive load and student performance. European Journal of Psychology of Education, 39(3), 1817‒1840. https://doi.org/10.1007/s10212-023-00757-7
Costley, J., & Lange, C. (2018). The moderating effects of group work on the relationship between motivation and cognitive load. International Review of Research in Open and Distributed Learning, 19(1). https://doi.org/10.19173/irrodl.v19i1.3325
Cowan, N. (2010). The magical mystery four: How is working memory capacity limited, and why? Current Directions in Psychological Science, 19(1), 51‒57. https://doi.org/10.1177/0963721409359277
Cutting, M. F., & Saks, N. S. (2012). Twelve tips for utilising principles of learning to support medical education. Medical Teacher, 34(1), 20‒24. https://doi.org/10.3109/0142159X.2011.558143
Demetriadis, S. N., Papadopoulos, P. M., Stamelos, I. G., & Fischer, F. (2008). The effect of scaffolding students’ context-generating cognitive activity in technology-enhanced case-based learning. Computers & Education, 51(2), 939‒954. https://doi.org/10.1016/j.compedu.2007.09.012
Eggen, P. (2020). Information processing and human memory. Oxford Research Encyclopedia of Education. https://oxfordre.com/education/view/10.1093/acrefore/9780190264093.001.0001/acrefore-9780190264093-e-86
Feldon, D. F., Callan, G., Juth, S., & Jeong, S. (2019). Cognitive load as motivational cost. Educational Psychology Review, 31, 319‒337.
Fisher, D., & Frey, N. (2021). Better learning through structured teaching: A framework for the gradual release of responsibility. ASCD Publication. https://files.ascd.org/staticfiles/ascd/pdf/siteASCD/publications/books/Better-Learning-Through-Structured-Teaching-3ed-sample-chapters.pdf
Frisby, B. N., Sexton, B. T., Buckner, M. M., Beck, A.-C., & Kaufmann, R. (2018). Peers and instructors as sources of distraction from a cognitive load perspective. International Journal for the Scholarship of Teaching and Learning, 12(2), 6. https://digitalcommons.georgiasouthern.edu/cgi/viewcontent.cgi?article=1790&context=ij-sotl
Galanes, G. J., & Carmack, H. J. (2013). “He's really setting an example”: Student contributions to the learning environment. Communication Studies, 64(1), 49‒65. https://doi.org/10.1080/10510974.2012.731464
Gerjets, P., Scheiter, K., & Catrambone, R. (2006). Can learning from molar and modular worked examples be enhanced by providing instructional explanations and prompting self-explanations? Learning and Instruction, 16(2), 104‒121. https://doi.org/10.1016/j.learninstruc.2006.02.007
Ghanbari, S., Haghani, F., Barekatain, M., & Jamali, A. (2020). A systematised review of cognitive load theory in health sciences education and a perspective from cognitive neuroscience. Journal of Education and Health Promotion, 9. https://doi.org/10.4103/jehp.jehp_643_19
Gooding, H., Mann, K., & Armstrong, E. (2017). Twelve tips for applying the science of learning to health professions education. Medical Teacher, 39(1), 26‒31. https://doi.org/10.1080/0142159X.2016.1231913
Greenberg, K., & Zheng, R. (2023). Revisiting the debate on germane cognitive load versus germane resources. Journal of Cognitive Psychology, 35(3), 295‒314. https://doi.org/10.1080/20445911.2022.2159416
Hadie, S. N., Manan, H. A., Ismail, Z. I. M., Talip, S., & Rahim, A. F. A. (2018). Creating an engaging and stimulating anatomy lecture environment using the Cognitive Load Theory-based Lecture Model: Students' experiences. Journal of Taibah University Medical Sciences, 13(2), 162‒172. https://doi.org/10.1016/j.jtumed.2017.11.001
Islam, M. A., & Yang, Y. (2023). Establishing a culture of assessment in a new U.S. pharmacy school: Lessons learned. Health Professions Education, 9(4), Article 6. https://hpe.researchcommons.org/journal/vol9/iss4/6
Jordan, J., Wagner, J., Manthey, D. E., Wolff, M., Santen, S., & Cico, S. J. (2020). Optimising lectures from a cognitive load perspective. AEM Education and Training, 4(3), 306‒312. https://doi.org/10.1002/aet2.10389
Kalyuga, S. (2011). Cognitive load theory: How many types of load does it really need? Educational Psychology Review, 23, 1‒19. https://doi.org/10.1007/s10648-010-9150-7
Kassam, A., de Vries, I., Zabar, S., Durning, S. J., Holmboe, E., Hodges, B., . . ., & Kalet, A. (2024). The next era of assessment within medical education: Exploring intersections of context and implementation. Perspectives on Medical Education, 13(1), 496. https://doi.org/10.1007/s10648-010-9150-710.5334/pme.1128
Kawaguchi-Suzuki, M., Blakely, M. L., Childs-Kean, L. M., Devraj, R., Frenzel, J. E., Medina, M. S., . . . Franks, A. M. (2023). Guidance for qualitative research manuscripts in pharmacy education. American Journal of Pharmaceutical Education, 87(7), 100089. https://doi.org/10.1016/j.ajpe.2023.10008 9
Khuman, P. (2024). The impact of non-verbal communication in teaching: Enhancing educational effectiveness. A Global Journal of Humanities, 7, 89. https://www.gapbodhitaru.org/res/articles/(89-95)%20THE%20IMPACT%20OF%20NON-VERBAL%20COMMUNICATION%20IN%20TEACHING%20ENHANCING%20EDUCATIONAL%20EFFECTIVENESS.pdf
Kirschner, F., Paas, F., & Kirschner, P. A. (2009). A cognitive load approach to collaborative learning: United brains for complex tasks. Educational Psychology Review, 21, 31‒42. https://doi.org/10.1007/s10648-008-9095-2
Kolfschoten, G. L., & Brazier, F. M. (2013). Cognitive load in collaboration: Convergence. Group Decision and Negotiation, 22, 975‒996. https://doi.org/10.1007/s10726-012-9322-6
Leppink, J., & Duvivier, R. (2016). Twelve tips for medical curriculum design from a cognitive load theory perspective. Medical Teacher, 38(7), 669‒674. https://doi.org/10.3109/0142159X.2015.1132829
Leppink, J., Paas, F., Van der Vleuten, C. P., Van Gog, T., & Van Merriënboer, J. J. (2013). Development of an instrument for measuring different types of cognitive load. Behavior Research Methods, 45, 1058‒1072. https://doi.org/10.3758/s13428-013-0334-1
Leppink, J., & van den Heuvel, A. (2015). The evolution of cognitive load theory and its application to medical education. Perspectives on Medical Education, 4, 119‒127. https://doi.org/10.1007/s40037-015-0192-x
Loftus, G. R., & Loftus, E. F. (2019). Human memory: The processing of information. Psychology Press.
MacPhail, C., Khoza, N., Abler, L., & Ranganathan, M. (2016). Process guidelines for establishing intercoder reliability in qualitative studies. Qualitative Research, 16(2), 198–212. https://doi.org/10.1177/1468794115577012
Martin, A. J., & Evans, P. (2019). Load reduction instruction (LRI): 14Sequencing explicit instruction and guided discovery to enhance students’ motivation, engagement, learning, and achievement Advances in Cognitive Load Theory (pp. 15-29). Routledge.
Mayer, R. E. (2002). Rote versus meaningful learning. Theory into Practice, 41(4), 226‒232. https://doi.org/10.1207/s15430421tip4104_4
Moreno, R. (Ed.). (2010). Cognitive load theory: Historical development and relation to other theories. In J. L. Plass, R. Moreno, & R. Brünken (Eds.), Cognitive load theory (pp. 9–28). Cambridge University Press. https://doi.org/10.1017/CBO9780511844744.003
Myers, S. A., Goldman, Z. W., Ball, H., Carton, S. T., Atkinson, J., Tindage, M. F., & Anderson, A. O. (2015). Assessing college student use of anti-citizenship classroom behavior: Types, reasons, and association with learning outcomes. Communication Teacher, 29(4), 234‒251. https://doi.org/10.1080/17404622.2015.1064984
Olmos-Vega, F. M., Stalmeijer, R. E., Varpio, L., & Kahlke, R. (2023). A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Medical Teacher, 45(3), 241–251. https://doi.org/10.1080/0142159X.2022.2057287
Ouwehand, K., Lespiau, F., Tricot, A., & Paas, F. (2025). Cognitive Load Theory: Emerging trends and innovations. Education Sciences, 15(4), 458. https://doi.org/10.3390/educsci15040458
Paas, F., & Ayres, P. (2014). Cognitive load theory: A broader view on the role of memory in learning and education. Educational Psychology Review, 26, 191‒195. https://psycnet.apa.org/doi/10.1007/s10648-014-9263-5
Paas, F., Renkl, A., & Sweller, J. (2004). Cognitive load theory: Instructional implications of the interaction between information structures and cognitive architecture. Instructional science, 32, 1-8. https://doi.org/10.1023/B:TRUC.0000021806.17516.d0
Paas, F., & Sweller, J. (2014). In R. E. Mayer (Ed.), The Cambridge handbook of multimedia learning (2nd ed., pp. 27–42). Cambridge University Press. https://doi.org/10.1017/CBO9781139547369.004
Papadopoulos, P. M., Demetriadis, S. N., Stamelos, I. G., & Tsoukalas, I. A. (2009). Prompting students’ context-generating cognitive activity in ill-structured domains: Does the prompting mode affect learning? Educational Technology Research and Development, 57, 193‒210. https://psycnet.apa.org/doi/10.1007/s11423-008-9105-6
Pollock, E., Chandler, P., & Sweller, J. (2002). Assimilating complex information. Learning and instruction, 12(1), 61‒86. https://psycnet.apa.org/doi/10.1016/S0959-4752(01)00016-0
Qiao, Y. Q., Shen, J., Liang, X., Ding, S., Chen, F. Y., Shao, L., . . . Ran, Z. H. (2014). Using cognitive theory to facilitate medical education. BMC Medical Education, 14, 79. https://doi.org/10.1186/1472-6920-14-79
Rajesh, R., & Reena, M. (2015). A review on worksystem interactions in a technology enabled class room. International Journal of Technology Enhanced Learning, 7(2), 99‒115. https://doi.org/10.1504/IJTEL.2015.072026
Schindler, L., & Burkholder Jr, G. J. (2014). Instructional design and facilitation approaches that promote critical thinking in asynchronous online discussions: A review of the literature. Higher Learning Research Communications, 4(4), 11‒29. https://files.eric.ed.gov/fulltext/EJ1133209.pdf
Siregar, T. (2024). Differentiated instruction from the perspective of Cognitive Load Theory. https://www.researchgate.net/publication/383001031_Differentiated_Instruction_from_the_Perspective_of_Cognitive_Load_Theory
Sweller, J. (2010). Element interactivity and intrinsic, extraneous, and germane cognitive load. Educational Psychology Review, 22, 123‒138. https://doi.org/10.1007/s10648-010-9128-5
Sweller, J., Ayres, P., Kalyuga, S. (2011). The expertise reversal effect. In: Cognitive Load Theory. Explorations in the Learning Sciences, Instructional Systems and Performance Technologies, vol 1. Springer, New York. https://doi.org/10.1007/978-1-4419-8126-4_12
Sweller, J., & Van Merrienboer, J. J. (2013). Instructional design for medical education. In Kieran Walsh (ed.), Oxford Textbook of Medical Education. Oxford Academic. https://doi.org/10.1093/med/9780199652679.003.0007
Sweller, J., Van Merrienboer, J. J., & Paas, F. (2019). Cognitive architecture and instructional design: 20 years later. Educational Psychology Review, 31, 261‒292. https://doi.org/10.1023/A:1022193728205
Sweller, J., Van Merrienboer, J. J., & Paas, F. G. (1998). Cognitive architecture and instructional design. Educational Psychology Review, 10, 251‒296. https://doi.org/10.1023/A:1022193728205
Ten Cate, O., & Durning, S. (2007). Peer teaching in medical education: twelve reasons to move from theory to practice. Medical teacher, 29(6), 591‒599. https://doi.org/10.1080/01421590701606799
Tyng, C. M., Amin, H. U., Saad, M. N., & Malik, A. S. (2017). The influences of emotion on learning and memory. Frontiers in Psychology, 8, 235933. https://doi.org/10.3389/fpsyg.2017.01454
Van Merrienboer, J. J., & Sweller, J. (2005). Cognitive load theory and complex learning: Recent developments and future directions. Educational Psychology Review, 17, 147‒177. https://doi.org/10.1007/s10648-005-3951-0
Van Merriënboer, J. J., & Sweller, J. (2010). Cognitive load theory in health professional education: design principles and strategies. Medical education, 44(1), 85‒93. https://doi.org/10.1111/j.1365-2923.2009.03498.x
Van Merriënboer, J. J., & Kirschner, P. A. (2017). Ten steps to complex learning: A systematic approach to four-component instructional design. Routledge.
Wang, S., Tripathy, S. P., & Öğmen, H. (2022). Capacity and allocation across sensory and short-term Memories. Vision, 6(1), 15. https://doi.org/10.3390/vision6010015
Widmaier, E., Raff, H., & Strang, K. T. (2022). Vander's human physiology. McGraw-Hill US Higher Ed USE.
Woo, J.-C. (2014). Digital game-based learning supports student motivation, cognitive success, and performance outcomes. Journal of Educational Technology & Society, 17(3), 291‒307. https://www.jstor.org/stable/jeductechsoci.17.3.291
Young, J. Q., Van Merrienboer, J., Durning, S., & Ten Cate, O. (2014). Cognitive load theory: Implications for medical education: AMEE Guide No. 86. Medical teacher, 36(5), 371‒384. https://doi.org/10.3109/0142159X.2014.889290
Zhong, L. (2024). Investigating learning efficiency and mental efficiency in a personalised role-playing-game environment. Interactive Learning Environments, 32(6), 2713‒2724. https://doi.org/10.1080/10494820.2022.2157840
