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The literature supports the Inverted\n                      <jats:italic>U<\/jats:italic>\n                      \u2010shape Hypothesis, suggesting that the ideal challenge level for learning is neither too easy nor too difficult. However, this optimal point depends on the type of training and response modality and may vary across domains, necessitating thorough examination before implementing adaptive learning procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to investigate the influence of training difficulty on the learning outcomes of French medical students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from a national educational platform, we explored the influence of the mean question difficulty encountered during training, relative to individual student ability, on the learning outcomes of medical students across diverse medical specialties. Importantly, the mean difficulty level varied randomly between students on this platform, mirroring a quasi\u2010experimental design and enabling a thorough exploration of these effects. We first employed the Elo rating system to estimate the difficulty of platform questions and the evolution of students' abilities. A linear mixed\u2010effects model was then used, with final exam performance as the main outcome and mean relative question difficulty during training (linear and quadratic terms) as the main predictor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and Conclusions<\/jats:title>\n                    <jats:p>\n                      Results showed a significant negative quadratic effect of mean relative difficulty on the final exam performance, revealing optimal difficulty levels for each medical specialty. Additionally, the analysis demonstrated that students with high abilities displayed a more pronounced inverted\n                      <jats:italic>U<\/jats:italic>\n                      \u2010shaped relationship between training difficulty and final exam scores. This study advances our understanding of optimal training difficulty in the complex realm of medical education, by emphasising the need to acknowledge variability across medical specialties and student abilities.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcal.70172","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T06:44:53Z","timestamp":1765521893000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigating the Influence of Training Difficulty on the Learning Outcomes of Medical Students"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8733-7367","authenticated-orcid":false,"given":"Erva Nihan","family":"Kandemir","sequence":"first","affiliation":[{"name":"Laboratoire De Sciences Cognitives et Psycholinguistique, D\u00e9partement D'etudes Cognitives Ecole Normale Sup\u00e9rieure, CNRS, PSL University  Paris France"}]},{"given":"Jill\u2010J\u00eann","family":"Vie","sequence":"additional","affiliation":[{"name":"Soda Team  Palaiseau France"}]},{"given":"Adam","family":"Sanchez\u2010Ayte","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Numerique en Sant\u00e9 et Sport (UNESS)  Inria, LIG France"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0803-358X","authenticated-orcid":false,"given":"Olivier","family":"Palombi","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Grenoble Alpes, Grenoble, INP, CNRS  Saint\u2010Martin\u2010d'H\u00e8res France"}]},{"given":"Franck","family":"Ramus","sequence":"additional","affiliation":[{"name":"Laboratoire De Sciences Cognitives et Psycholinguistique, D\u00e9partement D'etudes Cognitives, Ecole Normale Sup\u00e9rieure EHESS, CNRS, PSL University  Paris France"}]}],"member":"311","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","unstructured":"Abdi S. 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