Contextual Vertical Integration Optimizes the Cognitive Load Profile of Undergraduate Clinical Obstetrics and Gynecology Learners: Evidence from the CONVINCED-OG Cluster-Randomized Crossover Trial

Mohammed Ismail-Khan,1,2 Dominic A Blake,1 Mona MI Abdalla,3 Porfyrios Korompelis1 1Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK; 2Department of Physiology & Medical Education, Shadan Institute of Medical Sciences, Hyderabad, India; 3Department of Human Biology, School of Medicine, International Medical University, Kuala Lumpur, MalaysiaCorrespondence: Mohammed Ismail-Khan, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, NE9 6SX, UK, Email Ismail.khan11@nhs.netBackground: The disjunction between basic sciences and clinical teaching impairs knowledge retention and application. Contextual vertical integration (CVI) embeds basic-science explanations within clinical instruction and may optimize cognitive load by lowering intrinsic cognitive load (ICL) and extraneous cognitive load (ECL), which impede learning and enhance germane cognitive load (GCL) that facilitates learning. The Contextual Vertical Integration in Clinical Education in Obstetrics and Gynecology (CONVINCED-OG) trial evaluates the role of CVI in optimizing the cognitive load.Methods: This cluster-randomized crossover study involved three year-3 undergraduate medical student cohorts from Newcastle University at two teaching units. Each cohort was taught eight topics (four obstetrics, four gynecology). A computer-generated Latin-square schedule assigned two cohorts to CVI and one to standard teaching for each topic, then rotated the pattern, so every cohort received four CVI and four standard sessions. The same teacher delivered all sessions with identical materials at both sites, with students remaining unaware of their randomization status. Perceived cognitive loads (ICL, ECL and GCL) were self-reported using the validated Klepsch’s Cognitive Load Questionnaire. Topic-level differences (integrated vs standard) were analyzed with independent t-tests and pooled within-student differences were assessed with paired t-tests.Results: Across all eight topics, CVI reduced ICL and ECL, alongside significantly increasing GCL (except one topic where ICL differences were insignificant). Pooled within-subject analyses corroborated these findings, demonstrating consistent cognitive load optimisation with CVI.Conclusion: By demonstrating the role of CVI in optimizing cognitive load across diverse topics within undergraduate clinical obstetrics and gynecology education, CONVINCED-OG trial supports the adoption of CVI in clinical teaching.Keywords: basic sciences, medical education, schema, intrinsic cognitive load, extraneous cognitive load, germane cognitive load