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In medical education, the use of flipped classrooms is on the increase. The complex, interdependent active- and social learning activities often built into the 'in-class' phase of this new approach may, however, cause cognitive overload, impeding learning. Computer-supported collaborative learning could play a role in reducing such cognitive load. The current study investigated how four constituent factors of 'in-class' scenarios for 'flipped' classrooms affect the intrinsic, germane and extraneous cognitive load for students. After participating in a computer-supported 'in-class' scenario for a radiology training course that combined face-to-face individual activities, small-group work and class-wide activities, undergraduate medical students ( n  = 135) completed a questionnaire rating the cognitive load perceived. Computer support comprised a program for radiology assessment and a learning dashboard that captured and visualized the assessment results. Total intrinsic load, germane load, and extraneous load (EL) were calculated from the results obtained. The 'high' intrinsic load, 'high' germane load, and 'low' EL indicate that the computer-supported 'in-class' scenario was cognitively challenging but that sufficient mental effort could be spent on task performance and learning. We attribute the successful management of the cognitive load imposed by this complex in-class scenario to the specially designed learning dashboard.

Aim: To examine how collaborative diagramming affects discussion and knowledge construction when learning complex basic science topics in medical education, including its effectiveness in the reformulation phase of problem-based learning., Methods: Opinions and perceptions of students (n = 70) and tutors (n = 4) who used collaborative diagramming in tutorial groups were collected with a questionnaire and focus group discussions. A framework derived from the analysis of discourse in computer-supported collaborative leaning was used to construct the questionnaire. Video observations were used during the focus group discussions., Results: Both students and tutors felt that collaborative diagramming positively affected discussion and knowledge construction. Students particularly appreciated that diagrams helped them to structure knowledge, to develop an overview of topics, and stimulated them to find relationships between topics. Tutors emphasized that diagramming increased interaction and enhanced the focus and detail of the discussion. Favourable conditions were the following: working with a shared whiteboard, using a diagram format that facilitated distribution, and applying half filled-in diagrams for non-content expert tutors and\or for heterogeneous groups with low achieving students., Conclusion: The empirical findings in this study support the findings of earlier more descriptive studies that diagramming in a collaborative setting is valuable for learning complex knowledge in medicine.