Health professions educators are increasingly encouraged to implement desirable difficulties in their instruction, such as interleaved practice. In practical context, however, there is limited empirical evidence regarding the (meta)cognitive benefits of desirable difficulties, and interleaved practice in particular, posing a challenge to theoretical propositions. In this quasi-experimental field study, we examined the effectiveness of interleaved practice in auscultation training for second-year nursing students, with a focus on their learning outcomes and relative monitoring accuracy. Over 3 weeks, we measured participants' immediate and delayed-test scores, monitoring accuracy, and metacognitive knowledge of blocked and interleaved practice. Results revealed that interleaved practice yielded better auscultation performance than blocked practice. Regarding metacognitive accuracy, however, we found no statistically significant benefit of interleaving. Many students were unaware of the learning benefits of interleaved practice and found it more effortful than blocking. Our findings indicate that interleaved practice is a viable instructional method that can be utilized in authentic environments.

Background
In higher education, students often avoid desirably difficult learning strategies, such as interleaved practice, thereby limiting their learning outcomes.

Aim
We studied why students (under)utilize interleaved practice and whether an intervention that combines theory- and experience-based support can improve their immediate and delayed strategy decisions.

Sample
Higher education students (N = 120) from the Prolific participant pool were recruited.

Methods
They were randomized into four conditions: Theory-based support, experience-based support, full-treatment, and no support. The theory-based support was refutations that challenged students’ erroneous beliefs about learning strategies and warned them about inaccurate monitoring of effort and learning. The experience-based support was metacognitive prompts in the form of visual feedback. This visual prompt showed students the development of their perceived effort and learning across time.

Results
Pre-intervention use of interleaved practice was 18%. Students experienced more effort and low learning, at least initially, when using interleaved practice, although actual learning was enhanced. Full-treatment and refutations increased the use of interleaved practice significantly more compared to the other conditions: From 24% to 88% and from 20% to 70%, respectively. Yet, refutations were the necessary and sufficient condition for this improvement.

Conclusion
Refutations and visual prompts form a strong strategy intervention that improves the self-regulated use of interleaved practice in immediate and delayed-transfer learning tasks. But, refutations are the key ingredient for this improvement.

During category learning, students struggle to create an optimal study order: They often study one category at a time (i.e., blocked practice) instead of alternating between different categories (i.e., interleaved practice). Several interventions to improve self-study of categorical learning have been proposed, but these interventions have only been tested in learning tasks where students did not create the study order themselves. Instead, they decided which type of study order to follow. This pre-registered experiment examined whether an intervention that combines refutations and metacognitive prompts can enhance students’ engagement in interleaved practice, specifically when they organize the learning materials themselves. Ninety-one undergraduate students were randomized into the intervention and control condition and learned visual categories. Prior to the intervention, students used more blocked practice. After the intervention, the use of interleaved practice significantly increased in both immediate and delayed-transfer tasks. More interleaved practice was associated with better classification performance. Our findings indicate that refutations and metacognitive prompts form a strong intervention that corrects students’ erroneous beliefs and increases their engagement in interleaved practice.

Desirable difficulties are learning conditions that are often experienced as effortful, but have a positive effect on learning results and transfer of knowledge and skills (Bjork & Bjork, 2011; Bjork, 1994). Learners often do not appreciate the beneficial effects of desirable difficulties, and the negative experiences of high effort and perceived low learning make them resistant to engage in desirable difficulties (Biwer et al., 2020a). This ultimately limits learning outcomes and academic achievement. With the increasing emphasis on self-regulation in education, characterized by higher learner agency and abundant choices in what, when, and how to study, the field of educational psychology is in need of theoretical and empirically testable assumptions that improve self-regulation in desirably difficult learning conditions with the aim to foster self-regulation abilities, learning outcomes, and academic achievement. Here, we present a framework that describes how to support self-regulation of effort when engaging in desirable difficulties: the “Start and Stick to Desirable Difficulties (S2D2)” framework. The framework builds on the Effort Monitoring and Regulation model (de Bruin et al., 2020). The aim of this framework is (1) to describe evidence for the central role of perceived effort and perceived learning in (dis)engagement in desirable difficulties, and (2) to review evidence on, and provide an agenda for research to improve learners’ self-regulated use of desirable difficulties to help them start and persist when learning feels tough, but is actually effective.

Students tend to avoid effective but effortful study strategies. One potential explanation could be that high-effort experiences may not give students an immediate feeling of learning, which may affect their perceptions of the strategy’s effectiveness and their willingness to use it. In two experiments, we investigated the role of mental effort in students’ considerations about a typically effortful and effective strategy (interleaved study) versus a typically less effortful and less effective strategy (blocked study), and investigated the effect of individual feedback about students’ study experiences and learning outcomes on their considerations. Participants learned painting styles using both blocked and interleaved studying (within-subjects, Experiment 1, N = 150) or either blocked or interleaved studying (between-subjects, Experiment 2, N = 299), and reported their study experiences and considerations before, during, and after studying. Both experiments confirmed prior research that students reported higher effort investment and made lower judgments of learning during interleaved than during blocked studying. Furthermore, effort was negatively related to students’ judgments of learning and (via these judgments) to the perceived effectiveness of the strategy and their willingness to use it. Interestingly, these relations were stronger in Experiment 1 than in Experiment 2, suggesting that effort might become a more influential cue when students can directly compare experiences with two strategies. Feedback positively affected students’ considerations about interleaved studying, yet not to the extent that they considered it more effective and desirable than blocked studying. Our results provide evidence that students use effort as a cue for their study strategy decisions.

In higher education, many students make poor learning strategy decisions. This, in part, results from the counterintuitive nature of effective learning strategies: they enhance long-term learning but also cost high initial effort and appear to not improve learning (immediately). This mixed-method study investigated how students make learning strategy decisions in category learning, and whether students can be supported to make effective strategy decisions through a metacognitive prompt, designed to support accurate monitoring of effort and learning. Participants (N = 150) studied painting styles through blocked and interleaved practice, rated their perceived effort and perceived learning across time, and chose between either blocked or interleaved practice. Half of the participants (N = 74) were provided with a metacognitive prompt that showed them how their subjective experiences per strategy changed across time and required them to relate these experiences to the efficacy of learning strategies. Results indicated that subjective experiences with interleaved practice improved across time: students’ perceived learning increased as their perceived effort decreased. Mediation analysis revealed that the increased feeling of learning increased the likelihood to select interleaved practice. The percentage of students who chose interleaved practice increased from 13 to 40%. Students’ learning strategy decisions, however, did not benefit from the metacognitive prompt. Qualitative results revealed that students initially had inaccurate beliefs about the efficacy of learning strategies, but on-task experiences overrode the influence of prior beliefs in learning strategy decisions. This study suggests that repeated monitoring of effort and learning have the potential to improve the use of interleaved practice.

The original version of this article unfortunately contained a mistake. The presentation of Fig. 1 was incorrect as it misses an arrow from “High-Cognition” to “Support” and misses two numbers next to the arrow displayed just to the right of “High-Cognition”.

The present study investigated the extent to which 18 dyads in 5th and 6th grade, who experienced low levels of social challenge, differed from 12 dyads who experience high levels of social challenge in terms of the quality of their written assignment, as well as the frequency and sequential pattern of their cognitive, metacognitive, relational, and off-task activities during a collaborative hypermedia assignment. Sequential analyses were performed by means of process mining with a fuzzy miner algorithm. Results showed that assignment quality was higher for low social challenge dyads. In addition, these more successful dyads showed more cognitive processing activities, more high-cognition, and fewer off-task activities. In terms of their process models, low and high challenge dyads showed marked differences. More specifically, high social challenge dyads showed a vicious cycle of social challenges and off-task behaviors, whereas low social challenge dyads engaged in high-cognition. In addition, for low challenge dyads, but not high challenge dyads, the various metacognitive activities were closely connected to each other. These findings indicate that social challenges not only affect assignment quality, but also fundamentally affect the overall learning process.