Presented By: Munder Zagaar, Baylor College of Medicine
Co-Authors: Peter Boedeker, Baylor College of Medicine
Sandra Haudek, Baylor College of Medicine

Purpose
To optimize learning for pre-clinical medical students, our institution introduced a two-part summative assessment strategy. The present study details student exam performance, perceptions of the assessment strategy, and study approaches between each exam.  

Methods
In the 4-week Foundations of Medicine course, 223 MS1 students engaged in weekly two-part assessments, featuring morning (AM) and afternoon (PM) exams with 35-40 unique multiple-choice questions tagged to objectives. Individualized feedback on missed objectives post-AM exam facilitated remediation during a 4-hour gap before the PM exam.  A post-course survey, given to all MS1 students, collected data on study strategies between exams and the perceived impact of two-part assessments on learning. 

Results 
Students exhibited significant improvement (p < 0.001) in the first three Friday assessments, with average score increases of 4.93, 5.06, and 10.86 from AM to PM sessions. However, there was no significant change in the fourth and final Friday assessment. 99 students (44.8%) responded to the survey. Regarding study time utilization between exams, discussion with peers was most common, followed by independent study and group study sessions. Concerning assessment format preferences, 27% favored a more targeted PM assessment over taking another comprehensive assessment, while only 4% preferred having high-stakes summative exams. Additionally, 82% agreed they were more confident in the PM exam, and respondents indicated that the assessment format allowed them to prioritize mastering content (90%), enhanced comprehension (74%), and pinpointed areas for improvement or strengths (78%).  

Conclusions
The two-part assessment strategy was favored over other formats, with learners utilizing the 4-hour break for a combination of collaborative learning and independent study. This approach facilitated focused learning while reducing exam-related stress. The results endorse the ongoing use of this strategy locally, and other institutions are encouraged to explore its implementation for their learners.