In this episode, emergency physician and cognitive load researcher Dr. Adam Szulewski explores how cognitive load affects clinical reasoning and performance in busy practices. He explains how limited working memory, interruptions, fatigue, and information overload can influence decision-making and shares practical strategies to help clinicians manage these demands. Dr. Szulewski discusses approaches such as pre-briefing, mental simulation, pausing to recap and reprioritize, and using checklists and cognitive aids appropriately. The conversation also looks at how electronic health records can add unnecessary cognitive burden and why recognizing cognitive load can help clinicians create more space to think clearly. Guest: Dr. Adam SzulewskiHost: Dr. Chris Morrow, Associate Dean, UBC CPDProducer: Julia DonahueMusic: "“Flight of the Starbird” by Andrei and Mike Diaconu of Cosmic Mansions Episode Timestamps00:00 — Introduction and what cognitive load means01:58 — Intrinsic, extraneous and germane cognitive load04:17 — Translating cognitive load theory into clinical medicine06:02 — Interruptions, competing priorities and busy clinical practice08:42 — Working memory, expertise and mental schemas12:22 — Expert vs. novice attention: the ruptured AAA simulation example15:47 — Fast and slow thinking, cognitive error and knowing when to slow down18:40 — Pre-briefing and mental simulation before high-stakes care21:46 — Applying structure and preparation in primary care22:16 — The medical pause: recapping, slowing down and reprioritizing25:22 — Checklists, cognitive aids and when they help27:24 — Research on cognitive load in clinical practice and CanMEDS31:40 — Electronic health records, extraneous load and the potential role of AI Resources:Szulewski A, Howes D, van Merriënboer JJG, Sweller J. From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine. Academic Medicine. 2021;96(1):24–30.https://academic.oup.com/academicmedicine/article-abstract/96/1/24/8346681Young M, Szulewski A, Anderson R, Gomez-Garibello C, Thoma B, Monteiro S. Clinical Reasoning in CanMEDS 2025. Canadian Medical Education Journal. 2023;14(1):58–62.https://journalhosting.ucalgary.ca/index.php/cmej/article/view/75843Kahneman D. Thinking, Fast and Slow.https://www.penguinrandomhouse.com/books/89308/thinking-fast-and-slow-by-daniel-kahneman/Lee JY, Donkers J, Jarodzka H, Sellenraad G, van Merriënboer JJG. Different effects of pausing on cognitive load in a medical simulation game. Computers in Human Behaviour. 2020;110:106385.https://www.sciencedirect.com/science/article/pii/S0747563220301382Lee JY, et al. The medical pause: Importance, processes and training. Medical Education. 2021.https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.14529KeyLIME+ Podcast. Adam discusses KeyLIME+ near the end of the episode as a medical education podcast focused on the stories and practical implications behind research and policy.https://keylimepodcast.libsyn.com/ The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day. We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here. All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited. © UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.