An investigation of preclinical medical students' preference for summative or formative assessment for physiology learning

Both summative and formative assessments are known to facilitate student learning and understanding and help students to identify areas of weakness. However, few studies have investigated students' preference for either summative or formative eval-uations, particularly in the area of preclinical medicine. The current study addresses this deficit by surveying 137 first-year gradu-ate entry to medicine (GEM) preclinical medical students from 2 consecutive years (2018-2019 and 2019-2020), for their thoughts on the 6 summative (i.e., for a small percentage of marks), proctored and the 5 informal, formative (i.e., no marks avail-able) continuous assessments in physiology that they encountered in semesters 1 and 2, respectively. Our survey revealed that between 75 and 90% of students felt that both evaluation formats were roughly equally useful (i.e., selecting options, "agree" or "strongly agree") both for providing feedback about their understanding of physiology and for identifying deficits in their physiol-ogy knowledge. However, although a significantly larger number of students felt that summative evaluations motivated them to study more than the formative evaluations (P = 0.006), overall, more students favored formative over summative assessments. Notably, however, GEM students from nonbiomedical backgrounds were significantly more in favor of summative assessments than those from either biomedical backgrounds (P = 0.003) or the whole GEM survey cohort (P = 0.01). The implications of these findings will be discussed, with suggestions as to how the student views outlined here might be facilitated within an academic program to maximize both student learning as well as their motivation to study and keep up with taught material. NEW & NOTEWORTHY Although several studies have investigated the relative effectiveness of regular summative versus forma-tive assessments as tools to facilitate student learning and understanding, ours is the first to explicitly solicit students' views on, and preferences for, either regular formative or summative assessment in preclinical medicine. We demonstrate that, overall, stu-dents preferred formative-to summative-type assessments, due to the immediacy of feedback, but also that summative tests incentivized them to study and keep up with material more.