Curriculum-Integrated MRI Simulation Across Successive Cohorts: A Quasi-experimental Curriculum-Development Study of Cognitive Load and Instructional Efficiency.

RATIONALE AND OBJECTIVES: Clinical magnetic resonance imaging (MRI) training is constrained by scanner access, MR-safety requirements, service pressures, and limited opportunities for deliberate practice. Simulation can provide repeatable practice, but evidence from radiography education remains heterogeneous and often relies on reaction-level outcomes. This study aims to describe the design, implementation, and evaluation of a curriculum-integrated MRI simulation program using Kern's six-step model and cognitive load theory, while examining patterns in learner outcomes across successive cohorts. MATERIALS AND METHODS: This single-institution educational-scholarship study included 40 undergraduate radiography students in three successive, independent cohorts (n = 14, 13, and 13) enrolled in a 204-hour MRI clerkship. Forty hours (20%) were redesigned around a high-functional-fidelity simulator, and the program was iteratively refined between cohorts. Outcomes included satisfaction, final examination performance, perceived mental effort, Paas-van Merriënboer instructional efficiency, metacognitive awareness, faculty perceptions, and post-graduation perceived transfer. Because cohorts were independent, no within-person repeated-measures factor was present; outcome patterns were therefore interpreted as between-cohort descriptive comparisons, with baseline equivalence assessed by one-way analysis of variance. RESULTS: Mean course-satisfaction scores rose from 3.89 ± 0.91 to 4.14 ± 0.72; mean mental effort fell from 4.07 ± 1.18 to 3.53 ± 0.92; final examination means increased from 17.55 ± 1.83 to 18.34 ± 0.91 out of 20; instructional-efficiency means rose from 1.06 ± 1.90 to 2.11 ± 1.60; and metacognitive-awareness means rose from 3.51 ± 0.49 to 4.03 ± 0.62. Faculty-domain means ranged from 3.20 to 3.47 on a 5-point scale. Pairwise contrasts for mental effort and instructional efficiency did not remain significant after correction. Transfer outcomes were based on self-reports and should be interpreted with caution. CONCLUSION: Across successive cohorts, we observed a consistent direction of improvement in course satisfaction, examination scores, instructional efficiency, and metacognitive awareness, alongside reduced mental effort. Simulation should complement, rather than replace, supervised MRI exposure, particularly for patient positioning, coil handling, in-room safety checks, and other tactile or psychomotor competencies.