A recent study involving laparoscopic training, suggests that novices learn best from simplified practice during initial skills acquisition because it allows them to deal with future task complexity better than when being faced with complex image orientation. These findings are consistent with cognitive load theory, which emphasizes the limitations of the working memory when learning new tasks. Optimal learning occurs when the cognitive load of a new task is within the limits of the learner's working memory and when instructional features that do not contribute to learning are eliminated. Basic knobology (operating the ultrasound machine controls) and image interpretation represent significant sources of cognitive load for ultrasound novices and the acquisition of images should therefore be as simple as possible to avoid exceeding the working memory of the learner.