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Background: Simulation-based educations’ prevalence within clinical neuroscience is on the rise, however investigation into what environment is most conducive to optimizing learning performance is limited. We aimed to determine whether training a simple-to-complex (progressive) sequence would result in superior learning compared to complex-to-simple (mixed) or complex-only sequences. Methods: A three-arm, prospective, randomised experiment was conducted to determine the effects on novice learner LP performance and cognitive load during learning and a very complex simulated reality assessment test 9-11 days later. Results: During learning, sterility breaches decreased linearly over time (p<.01) with no group differences, and accuracy was higher in the progressive group compared to complex-only (p<.01) and trended in the mixed group (p<.09). Across the learning phase cognitive load increased in the progressive group (p<.01) and decreased across the mixed group (p<.01). At assessment, there were no group differences in number of sterility breaches (p=.66), needle passes (p=.68) or cognitive load (p=.25). Conclusions: Contrary to our hypothesis, equivocal assessment performance was found across groups. Our results suggest that successive progression in complexity of simulation does not increase novice learner outcomes. Further, a “one-size fits all” approach to simulated environment complexity in clinical neurosciences education may be warranted given equivocal learning and less resources necessary.
