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Context: Health professions trainees must acquire a vast amount of clinical knowledge and skills, and a deliberate instructional design approach is needed to provide trainees with effective learning strategies. One powerful yet counterintuitive strategy that facilitates long‐term learning is incorporating intentional difficulties during the learning process. Difficulties that require more effort from learners may impede short‐term learning but are ultimately beneficial for long‐term learning and are therefore termed Desirable Difficulties. Objectives: In this cross‐cutting edge paper, we describe the Desirable Difficulty effect from three theoretical perspectives originating in different fields, discuss common evidence‐based Desirable Difficulty strategies used in Health Professions Education and explore emerging research that could further optimise Desirable Difficulty‐enhanced learning for health professions trainees. Methods: We synthesise theory and research from psychology, cognitive science and Health Professions Education literatures to further the understanding and application of Desirable Difficulties. We introduce three theoretical perspectives that provide a comprehensive overview of the theoretical underpinnings of the Desirable Difficulty effect: the New Theory of Disuse, the Challenge Point Framework and Cognitive Load Theory. We then illustrate how three common Desirable Difficulty strategies in medical education research—retrieval practice, spaced practice and interleaved practice—can be understood through these theoretical lenses. Finally, we provide relevant examples from the literature and explore emerging research in this area. Conclusions: This paper summarises the theory and empirical research on Desirable Difficulties during the learning process, from explaining what they are and why they may be effective to how they have been applied in different contexts. We argue that providing educators and trainees with a comprehensive theoretical and applied understanding of Desirable Difficulty will promote deliberate instructional design decisions and lead to more effective learning. Synthesizing theories and frameworks from psychology and education, Nelson and Eliasz propose a unified understanding of the powerful "desirable difficulty" effect. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]