• Mark Guadagnoli, Marie-Paule Morin, and Adam Dubrowski.
• Motor Behaviour Laboratory, Department of Kinesiology and Nutrition, University of Nevada, Las Vegas, Nevada 89154-3034, USA. mark@triadconsultinginc.com
• Med Educ. 2012 May 1; 46 (5): 447-53.

ObjectivesThe current paper describes a model of learning that has been used to produce efficient learning, thus yielding greater retention of information and superior performance under stress. In this paper, the model is applied to the learning of technical skills.StructureAfter a brief review of the learning-performance paradox and other relevant literature from the field of movement science, the benefits of challenge and adversity for learning are discussed in the context of a framework for learning known as the challenge point framework (CPF). The framework is based on laboratory and field studies of methods that have been shown to consistently enhance learning, and is used to model and generate insight into the relationships between practice protocols and the learning that results from them.ApplicationThe practical application of the CPF to simulation-based medical education and training is described. Firstly, a simple conceptual model that utilises three key elements to adjust the functional difficulty of the tasks to be learned is outlined. Secondly, a number of assessment strategies that may be necessary to ensure that the trainee remains in the optimal learning zone are proposed. Thirdly, a practical example is used to demonstrate how to utilise this conceptual model to design simulation environments suitable for teaching an endotracheal intubation task to beginners and more advanced trainees.© Blackwell Publishing Ltd 2012.

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