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Residents have limited time and much to learn. Mounting evidence shows that Desirable Difficulty (DD) learning strategies can ease that imbalance, but few studies have specifically studied combinations of these strategies. We tested two different combinations of DD strategies: a double combination of distributed practice and retrieval practice and a triple combination additionally including interleaved practice. We compared residents’ annual In-Training Exam (ITE) scores and graduates’ board certification performance between both DD curricula and a historical baseline. Average ITE scores rose from 149.06 in the historical baseline to 160.04 under the combined DD curricula (p < 0.001). Average ITE scores fell from 162.50 under the double combination to 155.11 under the triple combination (p = 0.03). There were no significant changes in graduates’ board performance between any of the curricula. These results add to the evidence that DD strategies can enhance residents’ learning. The drop in ITE scores under the triple DD combination may suggest that it pushed learners past beneficial desirable difficulty into detrimental overwhelming difficulty. Further research should apply this framework in larger and more diverse settings to clarify how these DD strategies can be optimally used to enhance residents’ learning.

Two studies were conducted to examine the effects of learner-adapted practice on the self-efficacy beliefs, acquisition and retention of a motor task. Through a discovery process all participants learned to perform several keypress patterns, with the goal of completing each sequence as fast and accurate as possible. The first experiment had learners practice the keypress sequences in one of two adaptive schedules, which utilized either a ‘WinSwitch’ or ‘WinRepeat’ task switching algorithm, or follow a pre-determined order of tasks (two yoked-control groups). The purpose of this experiment was to determine if adaptive schedules were effective because they were tailored to a learner’s performance characteristics or due to the nature of the contextual interference employed by the switching algorithm when the 'winning' criterion was satisfied. To examine the psychological factors involved in adaptive practice, the second experiment had all groups practice in a ‘WinSwitch Adaptive’ schedule and manipulated the social-comparative feedback that was provided (positive, negative or control). Together these studies revealed that the effectiveness of adaptive schedules may not necessarily be due to the fact that they are tailored to a learner's performance characteristics. They also suggest that learning is facilitated by a switching algorithm that involves some blocked practice towards the beginning and mostly random practice towards the end of acquisition (WinRepeat schedule). However, providing positive social-comparative feedback can override the negative effects of the opposite schedule (WinSwitch) and result in more effective learning and increases in self-efficacy beliefs. These findings are discussed in reference to contextual interference effects and the self-efficacy framework. Master of Science in Kinesiology