Assessment as Learning in Medical Education: Feasibility and Perceived Impact of Student-Generated Formative Assessments
Open accessPublished version of a preprint
Abstract
Background: Self-regulated learning (SRL) is gaining widespread recognition as a vital competency that is desirable to sustain lifelong learning, especially relevant to health professions education. Contemporary educational practices emphasize this aspect of undergraduate medical education through innovative designs of teaching and learning, such as the flipped classroom and team-based learning. Assessment practices are less commonly deployed to build capacity for SRL. Assessment as learning (AaL) can be a unique way of inculcating SRL by enabling active learning habits. It charges students to create formative assessments, reinforcing student-centered in-depth learning and critical thinking. Objective: This study aimed to explore, from the learners’ perspectives, the feasibility and perceived learning impact of student-generated formative assessments. Methods: This study relied on a convergent mixed methods approach. An educational intervention was deployed on a cohort of 54 students in the second year of a 6-year undergraduate medical program as part of a single-course curriculum. The AaL intervention engaged students in generating assessments using peer collaboration, tutor facilitation, and feedback. The outcomes of the intervention were measured through quantitative and qualitative data on student perceptions, which were collected through an anonymized web-based survey and in-person focus groups, respectively. Quantitative survey data were analyzed using SPSS (IBM), and qualitative inputs underwent thematic analysis. Results: The students’ overall score of agreement with the AaL educational intervention was 84%, which was strongly correlated with scores for ease and impact on a 5-point Likert-type scale. The themes that emerged from the qualitative analysis included prominent characteristics, immediate gains, and expected long-term benefits of engagement. The prominent characteristics included individuals’ engagement, effective interdependencies, novelty, and time requirements. The identified immediate gains highlighted increased motivation and acquisition of knowledge and skills. The expected long-term benefits included critical thinking, problem solving, and clinical reasoning. Conclusions: As a form of AaL, student-generated assessments were perceived as viable, constructive, and stimulating educational exercises by the student authors. In the short term, the activity provided students with a fun and challenging opportunity to dive deeply into the content, be creative in designing questions, and improve exam-taking skills. In the long term, students expected an enhancement of critical thinking and the inculcation of student-centered attributes of self-regulated lifelong learning and peer collaboration, which are vital to the practice of medicine.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
Seeking student feedback helps identify barriers to inclusion and promotes a culture of continuous improvement.
“This process helps identify barriers to inclusion and promotes a culture of continuous improvement [69].”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [69]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Self-efficacy: Toward a unifying theory of behavioral change
Bandura, A. (1977) · Psychological Review · doi:10.1037/0033-295x.84.2.191 · Cited by 43,925 · see citing works
Achieving integration in mixed methods designs-principles and practices
Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013) · Health Services Research · doi:10.1111/1475-6773.12117 · Cited by 5,772 · cited 2× · see citing works
“Therefore, meta-inferences were generated [14].”
MethodThematic analysis of qualitative data: AMEE Guide No. 131
Kiger, M. E., & Varpio, L. (2020) · Medical Teacher · doi:10.1080/0142159x.2020.1755030 · Cited by 3,787 · see citing works
A Review of Self-regulated Learning: Six Models and Four Directions for Research
Panadero, E. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00422 · Cited by 2,915 · cited 4× · see citing works
“This perceived weakness highlights the social regulation of learning, wherein the degree of achieved coregulation determines the enhancement of the ease and impact of learning on the individual and the group [2].”
BackgroundMethodInfluentialImplications for educational practice of the science of learning and development
Darling-Hammond, L., Flook, L., Cook-Harvey, C., Barron, B., & Osher, D. (2020) · Applied Developmental Science · doi:10.1080/10888691.2018.1537791 · Cited by 2,733 · cited 1× · see citing works
“The development of higher-order thinking is best achieved through inquiry and investigation, applying knowledge to new situations and problems, producing ideas and solutions, and collaborative problem solving [29].”
BackgroundLevitt, H. M., Bamberg, M., Creswell, J. W., Frost, D. M., Josselson, R., & Suárez-Orozco, C. (2018) · American Psychologist · doi:10.1037/amp0000151 · Cited by 2,286 · see citing works
Guetterman, T. C., Fetters, M. D., & Creswell, J. W. (2015) · The Annals of Family Medicine · doi:10.1370/afm.1865 · Cited by 1,740 · see citing works
Analysis of self-efficacy theory of behavioral change
Bandura, A., & Adams, N. E. (1977) · Cognitive Therapy and Research · doi:10.1007/bf01663995 · Cited by 1,338 · see citing works
Taylor, D. C. M., & Hamdy, H. (2013) · Medical Teacher · doi:10.3109/0142159x.2013.828153 · Cited by 1,176 · see citing works
Advances in medical education and practice: student perceptions of the flipped classroom
Ramnanan, C. J., & Pound, L. D. (2017) · Advances in Medical Education and Practice · doi:10.2147/amep.s109037 · Cited by 349 · see citing works
(2013) · Choice Reviews Online · doi:10.5860/choice.50-6461 · Cited by 277 · see citing works
Dann, R. (2014) · Assessment in Education Principles Policy and Practice · doi:10.1080/0969594x.2014.898128 · Cited by 276 · see citing works
Conceptual models to guide integration during analysis in convergent mixed methods studies
Moseholm, E., & Fetters, M. D. (2017) · Methodological Innovations · doi:10.1177/2059799117703118 · Cited by 273 · see citing works
Frameworks for learner assessment in medicine: AMEE Guide No. 78
Pangaro, L. N., & ten Cate, O. (2013) · Medical Teacher · doi:10.3109/0142159x.2013.788789 · Cited by 267 · see citing works
Towards a learning-oriented assessment to improve students’ learning—a critical review of literature
Zeng, W., Huang, F., Yu, L., & Chen, S. (2018) · Educational Assessment Evaluation and Accountability · doi:10.1007/s11092-018-9281-9 · Cited by 140 · see citing works
Amir‐Rad, F., Otaki, F., Baqain, Z. H., Zary, N., & Halabi, M. A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0246584 · Cited by 104 · see citing works
Self-citationBottomley, S., & Denny, P. (2011) · Biochemistry and Molecular Biology Education · doi:10.1002/bmb.20526 · Cited by 102 · see citing works
The predominant learning approaches of medical students
Chonkar, S. P., Ha, T., Chu, S. S. H., Ng, A. X., Lim, M. L. S., Ee, T. X., Ng, M. J., & Tan, K. H. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1122-5 · Cited by 89 · see citing works
Student perspectives on assessment: Experience in a competency-based portfolio system
Altahawi, F. F., Sisk, B. A., Poloskey, S. L., Hicks, C. W., & Dannefer, E. F. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.652243 · Cited by 80 · see citing works
Virtual Special Issue on “Integration in Mixed Methods Research”
Guetterman, T. C., Molina-Azorín, J. F., & Fetters, M. D. (2020) · Journal of Mixed Methods Research · doi:10.1177/1558689820956401 · Cited by 64 · see citing works
Medical students create multiple-choice questions for learning in pathology education: a pilot study
Grainger, R., Dai, W., Osborne, E., & Kenwright, D. N. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1312-1 · Cited by 62 · see citing works
Instagram for peer teaching: opportunity and challenge
Gulati, R. R., Reid, H., & Gill, M. (2020) · Education for Primary Care · doi:10.1080/14739879.2020.1811163 · Cited by 58 · see citing works
Harris, B. H. L., Walsh, J. L., Tayyaba, S., Harris, D. A., Wilson, D. J., & Smith, P. (2015) · Teaching and Learning in Medicine · doi:10.1080/10401334.2015.1011651 · Cited by 46 · see citing works
Alzaabi, S., Nasaif, M., Khamis, A. H., Otaki, F., Zary, N., & Mascarenhas, S. (2021) · JMIR Medical Education · doi:10.2196/25875 · Cited by 40 · see citing works
Self-citationMedical school 2.0: How we developed a student-generated question bank using small group learning
Gooi, A. C. C., & Sommerfeld, C. S. (2014) · Medical Teacher · doi:10.3109/0142159x.2014.970624 · Cited by 39 · see citing works
Gamified E-learning in medical terminology: the TERMInator tool
Seidlein, A., Bettin, H., Franikowski, P., & Salloch, S. (2020) · BMC Medical Education · doi:10.1186/s12909-020-02204-3 · Cited by 32 · see citing works
Otaki, F., Zaher, S., du Plessis, S. S., Lakhtakia, R., Zary, N., & Inuwa, I. M. (2021) · PLoS ONE · doi:10.1371/journal.pone.0253662 · Cited by 31 · see citing works
Self-citationStudent‐written single‐best answer questions predict performance in finals
Walsh, J. L., Harris, B. H. L., Tayyaba, S., Harris, D. A., & Smith, P. (2015) · The Clinical Teacher · doi:10.1111/tct.12445 · Cited by 24 · see citing works
Association Between Dental Student‐Developed Exam Questions and Learning at Higher Cognitive Levels
González‐Cabezas, C., Anderson, O. S., Wright, M. C., et al. (2015) · Journal of Dental Education · doi:10.1002/j.0022-0337.2015.79.11.tb06025.x · Cited by 24 · see citing works
Wagener, S., Möltner, A., Tımbıl, S., Gornostayeva, M., Schultz, J., Brüstle, P., Mohr, D., Beken, A. V., Better, J., Fries, M., et al. (2015) · Europe PMC (PubMed Central) · doi:10.3205/zma000988 · Cited by 20 · see citing works
Question-Based Collaborative Learning for Constructive Curricular Alignment
Wynn-Lawrence, L. S., Bala, L., Fletcher, R. J., et al. (2021) · Advances in Medical Education and Practice · doi:10.2147/amep.s280972 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [1]Edmondson DR Boyer SL Artis AB Self-directed learning: a meta-analytic review of adult learning constructs Int J Educ Res 2012 7 1 40 8
- [9]Rodríguez-Gómez GI Ibarra-Sáiz MS Peris-Ortiz M Lindahl JM Assessment as learning and empowerment: towards sustainable learning in higher education Sustainable Learning in Higher Education: Developing Competencies for the Global Marketplace 2015 Cham, Switzerland Springer 1 20
Cited by
Sorted by citations
Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189
Lipnevich, A. A., Mattern, K., & Feddock, C. (2026) · Medical Teacher · doi:10.1080/0142159x.2025.2569623 · Cited by 37 · see citing works
Lin, Y., Luo, Z., Ye, Z., Zhong, N., Zhao, L., Zhang, L., Li, X., Chen, Z., & Chen, Y. (2025) · JMIR Medical Education · doi:10.2196/71125 · Cited by 31 · see citing works
“Simultaneously, the focus on core competencies (such as clinical reasoning and problem-solving) emphasized in teaching methods must be integrated into new assessment dimensions [167], driving teaching methods to evolve from mere knowledge transmission to competency development.”
- Authors
- Lakhtakia, R., Otaki, F., Alsuwaidi, L., & Zary, N.
- Affiliations
- Mohammed Bin Rashid University of Medicine and Health Sciences (AE)
- Corresponding author
- Lakhtakia, Ritu
- Venue
- JMIR Medical Education
- Publisher
- JMIR Publications Inc.
- Published
- 2022-07-22
- Volume
- 8
- Issue
- 3
- Pages
- e35820
- ISSN
- 2369-3762 (ISSN-L)
- PMC
- PMC9356338
- OpenAlex
- W4285319758
- Cited by
- 38
- References
- 32
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 9 · 2023: 6 · 2021: 1
- FWCI
- 6.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Medical Education (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- 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
- Social Sciences › Psychology › Developmental and Educational Psychology › Innovative Teaching and Learning Methods
- Keywords
- assessment as learning, formative assessment, student self-regulation, medical students, peer collaboration, student perceptions, critical thinking, clinical reasoning, student-centered learning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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 ›
Are you an author, or do you see a problem with this page? Request a review
