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interleaving: the secret to handling random exam questions

train exam-style thinking by mixing topics. interleaving boosts efficiency and scores by improving discrimination and reducing false confidence from blocked study.

The Bottom Line

  • Blocked study trains recognition; exams demand discrimination and selection.
  • Interleaving forces you to pick the right framework under uncertainty.
  • Start interleaving after first exposure, then patch misses immediately.

The Concept

If you do Cardiology for seven days, every stem looks like Cardiology. You get fast, then fragile. Interleaving mixes topics so you practise the hardest skill: deciding what the question is before you would have forgotten. This increases desirable difficulty and produces exam-ready flexibility. The key is dosage: reduce needless complexity (extraneous load) while increasing useful processing (germane load).

Scientific Evidence

Interleaving has been shown to improve learning in many domains by strengthening discrimination between similar categories. Cognitive load theory explains why you should interleave once baseline schemas exist, not at zero familiarity.

Implementation Strategy

1

Phase 1: First exposure (brief, broad)

Do a broad sweep of the syllabus so you can recognise core diagnoses and management steps. This prevents interleaving from turning into random guessing.
2

Phase 2: Mixed blocks (exam simulation)

Do mixed blocks across systems (e.g., cardio + resp + renal + neuro + pharm). Keep the mix unpredictable rather than themed.
3

Phase 3: Discriminator logging

For each miss, write the single cue you missed (e.g., 'pleuritic pain + tachycardia + risk factor = PE pathway'). Review this list daily.
4

Phase 4: Patch then return to mixing

After each mixed block, patch only the top two recurring miss types (20 minutes). Then return to interleaving so learning generalises.
Practice

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SourceRead the original paper (PubMed)
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