gms | German Medical Science

Introduction: Summative assessments are powerful drivers of student learning; their effect on learning outcome is largely moderated by their impact on learning behaviour. In contrast to this, formative assessments help students to identify potential areas of improvement. However, recent research suggests that formative assessments may also enhance knowledge acquisition by inducing specific learning processes on the subconscious level. This qualitative study aimed at identifying evidence of this phenomenon (also termed ‘direct testing effect’) in medical students using formative assessments to train higher-order cognitive skills.

Methods: In winter 2013/14, fourth-year medical students participated in a randomised trial on the effectiveness of formative key feature (KF) questions versus a reading assignment. After the final exam, students shared their views on how these E-learning sessions had impacted on their learning outcome in three focus group discussions. Content analysis was conducted by two different researchers.

Results: Student comments referred to four distinct themes: comparison between KF questions and reading assignments / learning processes / implementation / future developments. Compared to reading assignments, students perceived KF questions as motivating due to their being directly related to clinical practice. They also felt that KF questions enhanced knowledge retention by forcing them to actively produce an answer rather than simply reproducing factual knowledge. The feedback provided with correct answers was also valued highly by students. While the software used was deemed suboptimal, there were numerous positive comments on implementation within the context of the undergraduate curriculum. Students felt that clinical cases helped them draw connections between different areas of internal medicine.

Discussion/conclusion: These qualitative data support the hypothesis that formative KF assessments enhance learning outcome by promoting learning processes [1], [2], [3], [4].