Cognitive Load in the Clinical Workplace: Integrating Emotion, Stress, and Motivation in Authentic Health Professions Learning Environments

Cognitive Load Theory (CLT) is a foundational framework in health professions education, rooted in the cognitive science of human memory. It encompasses working memory, long-term schema formation, and learning through practice and retrieval. CLT distinguishes intrinsic from extraneous load, with germane processing driving schema construction and automation. Yet most CLT research is conducted in controlled settings such as simulation labs and classrooms. In contrast, the clinical workplace - trauma units, emergency departments, Intensive Care Units, operating rooms, labour wards, and dental settings demands that novice learners transfer fragile schemas into action under uncertainty, time pressure, distraction, and emotional stress. This alone causes a challenge in achieving competencies. Affective variables such as emotion, acute stress, and motivation interact with cognitive load and shape what is encoded, retrieved, and consolidated. This intersection is underexplored, methodologically demanding, and educationally consequential.

Therefore, this Research Topic seeks to advance an integrated, workplace-grounded science of cognitive learning in real, high-acuity care across the health professions. It aims to consolidate emerging evidence on how cognitive load interacts with emotion, stress, and motivation during authentic patient care, and to surface measurement strategies suited to complex clinical environments. It also aspires to stimulate cross-disciplinary dialogue among educators in medicine, nursing, paramedicine, pharmacy, dentistry, respiratory therapy, and allied health. The Topic spans the full clinical learner spectrum (students, residents, fellows, and new staff) to understand how these factors affect learning. By drawing CLT into dialogue with the broader cognitive science of learning, this Topic surfaces mechanisms, not just outcomes. The collection will inform instructional design, supervision, and assessment that prepare learners for the cognitive demands of unscripted, high-intensity clinical work.

We invite Original Research, Systematic Reviews (including scoping reviews), Reviews and Mini Reviews, Brief Research Reports, Methods, Community Case Studies, Perspectives, Opinions, and Hypothesis and Theory papers, with submissions that follow the relevant EQUATOR-network reporting guidelines. Qualitative and mixed-methods designs are particularly encouraged for their ability to illuminate learners’ inner experiences during real, high-stakes care. We explicitly welcome submissions from low- and middle-income country settings and from non-physician health professions.

Particular areas of interest include, but are not limited to, the following aspects of education and training across all health professions:

• Measurement and validation of cognitive load in real clinical settings, including subjective scales (NASA-TLX, Paas), eye-tracking, pupillometry, heart-rate variability, EEG, and multimodal triangulation.
• Interaction of cognitive load with emotion, acute stress, and motivation during, for example, trauma resuscitation, cardiac arrest, deteriorating-patient response, time-critical procedures, and on-call work.
• Transfer studies comparing simulation with authentic clinical environments.
• Multidisciplinary and interprofessional learner perspectives across medicine, nursing, paramedicine, pharmacy, dentistry, respiratory therapy, physical therapy, and allied health.
• Supervisor- and team-level cognitive load and their downstream effects on the learner.
• Application of cognitive science principles, including retrieval practice, spaced learning, interleaving, and worked-example studies, to authentic clinical learning across the health professions.
• Theory-building linking CLT with the control-value theory of academic emotions, self-determination theory, and the transactional model of stress.
• Implications for workplace-based assessment, supervision frameworks, and curriculum design.
• Cognitive load differences between preclinical labs, simulation labs, training, and real patient care.
• The relationship between cognitive load, physical and mental ability, and clinical errors.

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• General Commentary
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Clinical Trial
• Community Case Study
• Curriculum, Instruction, and Pedagogy
• Data Report
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Policy and Practice Reviews
• Policy Brief
• Review
• Study Protocol
• Systematic Review
• Technology and Code

Keywords: cognitive load, workplace-based learning, health professions education, emotion, stress, clinical performance, motivation, mixed methods, clinical settings, simulation-to-clinical transfer, interprofessional education

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.