Effect of repeated/spaced formative assessments on medical school final exam performance
Open accessAbstract
Formative assessments, especially if spaced, encourage effective study habits such as retesting. The individual and combined effect of weekly formative assessments and cumulative assessments on final exam performance was studied. Methods: Students were placed into 6 groups by weekly formative assessment performance and practice exam utilization/ performance. Students who scored below the median on weekly assessments comprised groups 1/3/5. Groups 2/4/6 scored above the median. Groups 1/2 did not use the practice exam. Groups 3/4 scored below the median on the practice exam while Groups 5/6 scored above. Multiple comparisons were made using ANCOVA. Results: Adjusted analysis showed weekly assessment and practice exam performance had a significant relationship with final exam performance (F[7,145]¼18.765, po0.0005). Groups 2/4/6 performed better on the final exam than groups 1/3/5 respectively (1v2, 80.8% vs 88.0%, po0.0005 || 3v4, 83.4% vs 88.6%, po0.0005 || 5v6, 84.1% vs 90.1%, po0.0005). Group 1 performed worse than group 3 (80.8% vs 83.4%, p¼0.072) and group 5 (80.8% vs 84.1%, p¼0.047). Discussion: Performance on weekly formative assessments was predictive of final exam scores. Struggling medical students will benefit from extra cumulative practice exams while students who are excelling do not need extra practice
AI snapshot
Written from the paper’s full text.
TL;DR
In first-year medical students at UCLA, performance on weekly formative assessments and an optional cumulative practice exam was significantly associated with final exam performance after controlling for GPA and MCAT. Students above the median on weekly assessments scored higher on finals, and among lower-performing students, taking the practice exam was associated with higher final scores.
Key findings
- After accounting for MCAT and GPA, weekly formative assessments and practice exam performance still had a significant effect on final exam performance (F[7,145] = 18.77, p < 0.0005).
- Students above the median on weekly assessments outperformed their below-median counterparts: Group 1 vs 2, 80.8% vs 88.0%, p < 0.0005; Group 3 vs 4, 83.4% vs 88.6%, p < 0.0005; Group 5 vs 6, 84.1% vs 90.1%, p < 0.0005.
- Among students below the median on weekly assessments, Group 1 (no practice exam) scored lower than Group 5 (above-median practice exam), 80.78% vs 84.15%, p = 0.047; the difference versus Group 3 (below-median practice exam) was 80.78% vs 83.44%, p = 0.072.
- There was no statistical difference between Groups 2, 4, and 6 in final exam performance even though Group 2 did not take a practice exam. Pearson correlations with final exam performance were 0.58 for weekly quiz, 0.36 for practice final, 0.59 for MCAT, and 0.50 for GPA (all p < 0.0005 except GPA and MCAT as reported).
Methods
- Observational study of 153 first-year medical students at David Geffen School of Medicine at UCLA during the first preclinical block; from 178 students, those taking only one or two practice exam parts were excluded, leaving 153 who took all three parts or none.
- Students were divided into six groups by weekly formative assessment performance (below vs above median) and practice exam status (none, below median, above median): Groups 1/3/5 below median weekly; Groups 2/4/6 above median weekly; Groups 1/2 no practice exam; Groups 3/4 below median practice exam; Groups 5/6 above median practice exam.
- Analysis used ANCOVA with GPA and MCAT z-scores as covariates, Fisher’s LSD post hoc pairwise comparisons, and alpha = 0.05.
Limitations
- The paper states the study was only done at DGSOM, so conclusions cannot necessarily be extrapolated to all medical schools; there was no randomly selected control group that did not do weekly assessments; students were encouraged but not forced to take assessments closed-book by themselves; and the study assumes behavior based on performance without knowing if that is true for every individual.
- Evident from the text: the study is observational and non-randomized, with students self-selecting into practice exam use, and it evaluates only the first block, so causal claims about practice exams or weekly assessments are not established.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 12 cited sources checked · 0 supported · 0 flagged
- Findingown data
MCAT score correlated with final exam performance (r=0.59, p<0.0005).
“Pearson correlation for MCAT score or undergraduate GPA to final exam performance was 0.59 (p o 0.0005) and 0.50 (p o 0.0005).”
Quote in the paperNot a substantial claim - Findingown data
Group 6 had the highest average final exam score among the six groups.
“Group 6, which consisted of students who scored highest on the weekly assessments and practice exam, had the highest final exam average out of all other groups.”
Quote in the paperNot a substantial claim - Findingown data
Group 1 (low weekly assessment, no practice exam) scored lower on the final exam than Group 5 (low weekly assessment, high practice exam): 80.8% vs 84.1%, p=0.047.
“Group 1 performed worse than group 3 (80.8%vs 83.4%, p ¼0.072) and group 5 (80.8% vs 84.1%, p¼ 0.047).”
- Also stated in: § 3. Results · plain
“Out of the groups that scored below the median on the weekly assessments, Group 1 (no practice exam) did not perform as well as group 3 which scored below median on practice exam (80.78% vs 83.44%, p ¼ 0.072) and group 5 which scored above median on practice exam (80.78% to 84.15%, p ¼ 0.047).”
Quote in the paperSubstantial claim - Also stated in: § 3. Results · plain
- Findingown data
Undergraduate GPA correlated with final exam performance (r=0.50, p<0.0005).
“Pearson correlation for MCAT score or undergraduate GPA to final exam performance was 0.59 (p o 0.0005) and 0.50 (p o 0.0005).”
Quote in the paperNot a substantial claim - Findingown data
Group 6 (high weekly assessment, high practice exam) scored higher on the final exam than Group 5 (low weekly assessment, high practice exam): 90.1% vs 84.1%, p<0.0005.
“Groups 2/4/6 performed better on the final exam than groups 1/3/5 respectively (1v2, 80.8% vs 88.0%, p o 0.0005 || 3v4, 83.4% vs 88.6%, p o0.0005 || 5v6, 84.1% vs 90.1%, p o 0.0005).”
Quote in the paperSubstantial claim
- Findingown data
Group 1 had the lowest average final exam score among the six groups.
“Group 1 (19% of the study population), which consisted of students who scored below the median on weekly assessments and did not take the optional practice test had the lowest average score on the final exam.”
Quote in the paperNot a substantial claim - Findingown data
Group 4 (high weekly assessment, low practice exam) scored higher on the final exam than Group 3 (low weekly assessment, low practice exam): 88.6% vs 83.4%, p<0.0005.
“Groups 2/4/6 performed better on the final exam than groups 1/3/5 respectively (1v2, 80.8% vs 88.0%, p o 0.0005 || 3v4, 83.4% vs 88.6%, p o0.0005 || 5v6, 84.1% vs 90.1%, p o 0.0005).”
Quote in the paperSubstantial claim - Findingown data
Group 2 (high weekly assessment, no practice exam) scored higher on the final exam than Group 1 (low weekly assessment, no practice exam): 88.0% vs 80.8%, p<0.0005.
“Groups 2/4/6 performed better on the final exam than groups 1/3/5 respectively (1v2, 80.8% vs 88.0%, p o 0.0005 || 3v4, 83.4% vs 88.6%, p o0.0005 || 5v6, 84.1% vs 90.1%, p o 0.0005).”
Quote in the paperSubstantial claim - Findingown data
After accounting for MCAT score and GPA, weekly formative assessment and practice exam performance had a statistically significant relationship with final exam performance (F[7,145]=18.77, p<0.0005).
“Adjusted analysis showed weekly assessment and practice exam performance had a significant relationship with final exam performance (F[7,145] ¼18.765, p o 0.0005).”
- Also stated in: § 3. Results · plain
“After accounting for MCAT score and GPA, analysis of the 6 groups showed that the practice exam and weekly formative assessments still had a significant effect on final exam performance (F 7 ,145] ¼ 18.77, p o 0.0005).”
Quote in the paperSubstantial claim - Also stated in: § 3. Results · plain
- Findingown data
Group 1 (low weekly assessment, no practice exam) scored lower on the final exam than Group 3 (low weekly assessment, low practice exam): 80.8% vs 83.4%, p=0.072.
“Group 1 performed worse than group 3 (80.8%vs 83.4%, p ¼0.072) and group 5 (80.8% vs 84.1%, p¼ 0.047).”
- Also stated in: § 3. Results · plain
“Out of the groups that scored below the median on the weekly assessments, Group 1 (no practice exam) did not perform as well as group 3 which scored below median on practice exam (80.78% vs 83.44%, p ¼ 0.072) and group 5 which scored above median on practice exam (80.78% to 84.15%, p ¼ 0.047).”
Quote in the paperSubstantial claim - Also stated in: § 3. Results · plain
- Findingown data
Students who scored below the median on weekly assessments scored at most 84% on the final exam.
“Students who scored above the median on the weekly assessments did not score lower than 88% on the final exam while students who scored below the median did not score higher than 84%.”
Quote in the paperSubstantial claim - Findingown data
There was no statistically significant difference in final exam performance between Groups 2, 4, and 6.
“There was no statistical difference between groups 2, 4, and 6 in final exam performance even though group 2 did not take a practice exam.”
Quote in the paperSubstantial claim - Findingown data
Students who scored above the median on weekly assessments scored at least 88% on the final exam.
“Students who scored above the median on the weekly assessments did not score lower than 88% on the final exam while students who scored below the median did not score higher than 84%.”
Quote in the paperSubstantial claim - Interpretationown data
Students who are excelling (scoring above the median on weekly assessments) do not need extra practice exams.
“Struggling medical students will benefit from extra cumulative practice exams while students who are excelling do not need extra practice.”
- Also stated in: § 4. Discussion · hedged
“The lack of statistically significant difference between Groups 2, 4 and 6 suggest that the practice exam is not as beneficial to those who are learning well throughout the block because they do not necessarily need the extra practice or feedback.”
Quote in the paperSubstantial claim - Also stated in: § 4. Discussion · hedged
- Interpretationown data
Struggling medical students (those scoring below the median on weekly assessments) benefit from extra cumulative practice exams.
“Struggling medical students will benefit from extra cumulative practice exams while students who are excelling do not need extra practice.”
- Also stated in: § 4. Discussion · hedged
“Our results advocate that these students would benefit from an extra cumulative formative assessment such.”
Quote in the paperSubstantial claim - Also stated in: § 4. Discussion · hedged
- Interpretationown data
Performance on weekly formative assessments was predictive of final exam scores.
“Performance on weekly formative assessments was predictive of final exam scores.”
- Also stated in: § 4. Discussion · boosted
“In our study, weekly formative assessments were highly predictive of final exam performance.”
Quote in the paperSubstantial claim - Also stated in: § 4. Discussion · boosted
- Premisecitation
Students who space out their studying rather than cramming have better long-term performance.
“Research has shown that students who space out their studying rather than cramming have better long-term performance likely due to enhanced retention from multiple exposures 14 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Kornell, 2009, Optimising learning using flashcards: spacing is more effective than cramming, Applied Cognitive Psychology source
Not checked in the free run.
- Premisecitation
Randomized controlled trials demonstrate that repeated testing promotes better retention of information than repeated studying (the testing effect).
“For example, randomized controlled trials demonstrate that repeated testing promotes better retention of information than repeated studying, a phenomenon known as the testing effect.3,4”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Larsen, 2008, Test-enhanced learning in medical education, Medical Education source
Not checked in the free run.
- cites [4] Larsen, 2009, Repeated testing improves long-term retention relative to repeated study: a randomised controlled trial, Medical Education source
Not checked in the free run.
- Interpretationown data
Regardless of how the student took the weekly formative assessments and practice exam, the study still shows their influence on final exam performance.
“Nevertheless, regardless of how the student took the weekly formative assessments and practice exam, our study still shows their influence on final exam performance.”
Quote in the paperSubstantial claim - Premisecitation
If a student becomes extrinsically motivated, he or she is more likely to have a superficial approach to studying.
“If a student becomes extrinsically motivated, simply wanting higher exam scores or avoiding punishment from superiors, rather than intrinsically motivated, engaging in tasks because the individual finds them challenging, interesting and enjoyable, then he or she is more likely to have a superficial approach to studying 20 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [20] Moneta, 2009, Coping as a mediator of the relationships between trait intrinsic and extrinsic motivation and approaches to studying during academic exam preparation, Personality and Individual Differences source
Not checked in the free run.
- Interpretationreasoning
Weekly formative assessments serve as a good way to monitor a student's study progress throughout a block.
“Our study suggests that weekly formative assessments serve as a good way to monitor a student's study progress throughout a block.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Students' study behaviors (e.g., spacing, cramming) can be inferred from their performance on weekly assessments.
- Interpretationreasoning
The study's conclusions cannot necessarily be extrapolated to all medical schools because it was only conducted at DGSOM.
“First, the study was only done at DGSOM, meaning our conclusions cannot necessarily be extrapolated to all medical schools.”
Quote in the paperNot a substantial claim - Premisecitation
Practice in retrieving information from memory enhances future recall.
“Practice in retrieving information from memory seems to enhance future recall significantly 17,18 .”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [17] Karpicke, 2008, The critical importance of retrieval for learning, Science source
Not checked in the free run.
- cites [18] Kornell, 2009, Unsuccessful retrieval attempts enhance subsequent learning, Journal of Experimental Psychology: Learning, Memory, and Cognition
Not checked in the free run.
- Premisecitation
GPA and MCAT strongly account for the variance in test performance in medical school.
“GPA and MCAT are known to strongly account for the variance in test performance in medical school 12 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12] Ferguson, 2002, Factors associated with success in medical school: systematic review of the literature, Bmj source
Not checked in the free run.
- Interpretationown data
Students who scored below the median on weekly assessments are at higher risk for failing final exams.
“Regardless of the reason for their lower scores, our study proposes that these students are at higher risk for failing final exams.”
Quote in the paperSubstantial claim - Study design and conductown data
The study did not have a randomly selected control group that does not do weekly assessments throughout the block.
“Second, we did not have a randomly selected control group that does not do weekly assessments throughout the block.”
Quote in the paperSubstantial claim
- The quote only partly states this claim. 1
- May combine two claims. 2
- Classified as probably not a substantial claim. 6
The quote only partly states this claim.
Findingown dataPractice exam score correlated with final exam performance (r=0.36, p<0.0005).
“Pearson correlation for practice exam to final exam performance was 0.36 (p o 0.0005).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataThe difference in GPA and MCAT between students who scored lower than the median and students who scored higher than the median on weekly formative assessments was statistically significant (p<0.0005 for both).
“The difference in GPA and MCAT between students who scored lower than the median and students who scored higher than the median on the weekly formative assessments was statistically significant (p o 0.0005 for both).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenStudents chose to utilize the weekly assessments as they wished despite being encouraged to take them closed book by themselves.
“Another limitation was that even though students were encouraged to take the weekly assessments closed book by themselves, ultimately students chose to utilize the assessments as they wished.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA survey of 254 medical students in two medical schools found that 62.5% crammed for exams.
“A survey of 254 medical students in two different medical schools revealed that 62.5% of students crammed for exams, only 17% would prepare a list of probable questions and answers before exams, and only 47.8% of students maintained a daily schedule of study hours. 2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Vu, 1983, How medical students learn, Academic Medicine source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationGPA and MCAT are good predictors for medical school GPA and USMLE scores, with MCAT often being the better predictor.
“They are good predictors for medical school GPA and USMLE scores with the MCAT often being the better predictor 13 .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Julian, 2005, Validity of the Medical College Admission Test for predicting medical school performance, Academic Medicine source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOnly 17% of surveyed medical students would prepare a list of probable questions and answers before exams.
“A survey of 254 medical students in two different medical schools revealed that 62.5% of students crammed for exams, only 17% would prepare a list of probable questions and answers before exams, and only 47.8% of students maintained a daily schedule of study hours. 2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Vu, 1983, How medical students learn, Academic Medicine source
Not checked in the free run.
Probably not a substantial claim: may not pass S1 (asserted), S2 (checkable).
PremisecitationThe structure and frequency of examinations in a medical school curriculum may inhibit even the most self-confident and independent student from learning his own way.
“But this strategy may backfire, according to Neame and Powis, because the structure and frequency of examinations in the a medical school curriculum “may inhibit even the most self-confident and independent student from learning his own way” 19 .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [19] Neame, 1981, Toward independent learning: curricular design for assisting students to learn how to learn, Academic Medicine source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationOnly 47.8% of surveyed medical students maintained a daily schedule of study hours.
“A survey of 254 medical students in two different medical schools revealed that 62.5% of students crammed for exams, only 17% would prepare a list of probable questions and answers before exams, and only 47.8% of students maintained a daily schedule of study hours. 2”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2] Vu, 1983, How medical students learn, Academic Medicine source
Not checked in the free run.
The authors state this as an assumption.
Students' study behaviors (e.g., spacing, cramming) can be inferred from their performance on weekly assessments.
“Lastly, our study assumes behavior based on performance but we don't necessarily know if that is the truth for every individual.”
The paper relies on this without support.
At the first block, the medical school has not influenced the students' uses and beliefs about studying.
“The first block was chosen because at this point, the medical school has not influenced the students' uses and beliefs about studying.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Researchers utilized high-impact standardized assessments, such as the USMLE Step 1 and institutional final exams, to measure long-term knowledge retention.
“Researchers utilized high-impact standardized assessments, such as the USMLE Step 1 and institutional final exams, to measure long-term knowledge retention (Azim et al., 2025;Burel et al., 2025;Chang & Wimmers, 2017;Gilbert et al., 2023;Ward & Vengrin, 2024).”
From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Chang & Wimmers, 2017
Section 2.1 (page unavailable) says the researchers evaluated performance on the medical school's first-block final exam, supporting the institutional-final-exam part. It does not say they used USMLE Step 1 as an outcome or measured long-term retention; Section 2.3 mentions USMLE scores only when discussing predictors of medical-school performance. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSeveral studies demonstrated that providing immediate feedback-whether expert-written or AI-generated-during spaced retrieval sessions significantly improved clinical reasoning and reduced academic stress.
“Several studies demonstrated that providing immediate feedback-whether expert-written or AI-generated-during spaced retrieval sessions significantly improved clinical reasoning and reduced academic stress (Chang & Wimmers, 2017;Çiçek et al., 2025).”
From Systematic Review of the Effectiveness of Neurodidactic Spaced Learning Strategies in Long-Term Memory (2026) · cites this paper as Chang & Wimmers, 2017
The Introduction (page unavailable) discusses feedback from spaced, repeated formative assessments, and the Abstract reports a significant relationship between assessment performance and final-exam scores. The paper does not establish that immediate expert-written or AI-generated feedback improved clinical reasoning or reduced academic stress; those outcomes were not reported. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Group 6 final-exam mean differs between abstract and table
MinorThe abstract reports Group 6's final-exam mean as 90.1%, whereas Table 1 gives 90.01%, which rounds to 90.0% at one decimal place.
“5v6, 84.1% vs 90.1%, p o 0.0005”
“| 6 | 27 0.66 | 0.61 | High | High | 90.01 | 88.56 | 91.46 |”
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The promise and perils of self-regulated study
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Unsuccessful retrieval attempts enhance subsequent learning.
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“But if medical students want to perform well on an upcoming test and want to have good long-term retention for future board exams and clinical practice, they should space their studying 8,15 .”
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Why Testing Improves Memory: Mediator Effectiveness Hypothesis
Pyc, M. A., & Rawson, K. A. (2010) · Science · doi:10.1126/science.1191465 · Cited by 371 · see citing works
Optimising learning using flashcards: Spacing is more effective than cramming
Kornell, N. (2009) · Applied Cognitive Psychology · doi:10.1002/acp.1537 · Cited by 350 · see citing works
Validity of the Medical College Admission Test for predicting medical school performance
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Background
Flagged first, then by citations
Cited by
Sorted by citations
Shahedi, F., Ahmadi, J., Sharifi, T., Seyedhasani, S. N., Abdollahi, M., Shaabani, N., & Sarmadi, M. (2020) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_753_19 · Cited by 5 · see citing works
Silva Sánchez, M., Lainez Quinde, G. A., & Zambrano Vélez, W. A. (2026) · Education Sciences · doi:10.3390/educsci16060962
“Researchers utilized high-impact standardized assessments, such as the USMLE Step 1 and institutional final exams, to measure long-term knowledge retention (Azim et al., 2025; Burel et al., 2025; Chang & Wimmers, 2017; Gilbert et al., 2023; Ward & Vengrin, 2024).”
Influential
- Authors
- Chang, E. K., & Wimmers, P. F.
- Affiliations
- University of California, Los Angeles (US)
- Corresponding author
- Chang, Edward K.
- Venue
- Health Professions Education
- Published
- 2017-06
- Volume
- 3
- Issue
- 1
- Pages
- 32-37
- ISSN
- 2452-3011 (ISSN-L)
- OpenAlex
- W2517372235
- Semantic Scholar
- 794a4f5f4383fa4c3f98e41f8531c8df10179b21
- Cited by
- 33
- References
- 22
- Citations by year
- 2025: 3 · 2024: 10 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 4
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Health Professions Education (publishedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Social Sciences › Education › Student Assessment and Feedback
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- formative assessment, medical students, final exam performance, practice tests, cumulative assessment, weekly assessment, retesting, study habits
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Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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