Cognitive load in clinical training: a scoping review of factors and strategies linked to well‑being, retention, and performance

Background: Cognitive load is the mental effort required to perform a task due to demands on working memory storage and information processing. In clinical training, the cognitive load can be high due to the task complexity. Applying cognitive load management strategies may help educators support trainees’ well-being, retention, and performance. Limited research exists on the translating cognitive load management strategies with practical recommendations for enhancing clinical trainees' retention, well-being, and performance. Objectives: This scoping review aims to identify cognitive load factors and management strategies that can be used to improve trainees’ well-being, retention, and performance in clinical training and practice. Methods: We investigated the impacts of different cognitive load factors and management strategies on trainees’ well-being, retention, and performance, through a scoping review with narrative synthesis. No meta-analysis was planned. We followed PRISMA-ScR for search and screening. Databases (Embase, MEDLINE, Web of Science, CINAHL) searched 18-19 February 2025; Google Scholar and hand‑searches updated 27 February 2026. Results: We identified 8,395 records (Embase 110; Medline 124; Web of Science 188; CINAHL 66; Google Scholar and hand searches 7,907). After deduplication, screening and full-text review, 125 studies were included. Cognitive load management strategies were clustered here as (i) optimising intrinsic load via task segmentation and part-task/step-up sequencing; (ii) minimising extraneous load via de-cluttering, supportive environments and clear and concise instructions; (iii) optimising germane load via structured feedback, worked examples, and appropriately staged simulation. Conclusions: Cognitive load management strategies and institutional support may be important for trainee retention, well-being, and performance in clinical training. By using evidence-based strategies, healthcare systems may help trainees better manage cognitive load and improve learning and performance.