Medical students carry a large academic load which could potentially contribute to poor sleep quality above and beyond that already experienced by modern society. In this global literature review of the medical students' sleep experience, we find that poor sleep is not only common among medical students, but its prevalence is also higher than in non-medical students and the general population. Several factors including medical students' attitudes, knowledge of sleep, and academic demands have been identified as causative factors, but other potential mechanisms are incompletely understood. A better understanding about the etiology of sleep problems in medical trainees is essential if we hope to improve the overall quality of medical students' lives, including their academic performance. Sleep self-awareness and general knowledge appear insufficient in many studied cohorts, so increasing education for students might be one beneficial intervention. We conclude that there is ample evidence for a high prevalence of the problem, and research in this area should now expand towards initiatives to improve general sleep education for medical students, identify students at risk, and target them with programs to improve sleep.

We found that increased invigoration and reduced tranquillity during simulation training were associated with increased cognitive load, and that the likelihood of correctly identifying a trained murmur declined with increasing cognitive load. Further studies are needed to evaluate the impact on performance of strategies to alter emotion and cognitive load during simulation training.

Simulation-based education (SBE) has emerged as an effective and important tool for medical educators, but research about how to optimize training with simulators is in its infancy. It is often difficult to generalize results from experiments on instructional design issues in simulation because of the heterogeneity of learner groups, teaching methods, and rapidly changing technologies. We have found that cognitive load theory is highly relevant to teaching in the simulation laboratory and a useful conceptual framework to reference when designing or researching simulation-based education. Herein, we briefly describe cognitive load theory, its grounding in our current understanding of cognitive architecture, and the evidence supporting it. We focus our discussion on a few well-established cognitive load effects with examples from simulation training and recommend some instructional applications with theoretical potential to improve learning outcomes.

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