Purpose
Self-regulated learning (SRL) is a process where learners actively set goals, select strategies, monitor progress, reflect, and adjust their approach. Retrieval practice, formative feedback, and peer instruction enhances learning and retention. Building on these principles, we implemented a primarily student-written formative question bank (Q-bank) to supplement our Fundamentals of Medicine course. We hypothesized that a voluntary, gamified Q-bank would promote engagement, encourage SRL behaviors, and improve academic performance.

Methods
Senior students developed questions and explanations with faculty review. Daily questions, released via a digital platform, promoted SRL by allowing students to monitor progress, identify knowledge gaps, refine learning strategies, and choose when and how to engage with questions. Gamified features, including badges and leaderboards, fostered motivation and engagement. We used ANOVA to compare mean exam scores (K%) across 2022, 2023, and 2024. We also analyzed the correlation between q-bank accuracy and block K%.

Results
Participation increased after the first-course block then remained stable for the remaining three blocks (mean 92%). 87% of students completed more than 50% of the questions; 77% completed all questions with a mean question accuracy of 78%. Mean K% was significantly higher in 2024 compared to 2022 (p=.024) and 2023 (p=.026). Although question accuracy was positively correlated with exam scores, the strength of the correlation decreased across course blocks (R ² = 0.38, 0.31, 0.27, 0.21). The Q-bank received the highest ratings of all course components on end-of-course evaluations.

Conclusion
High engagement and course evaluations suggest students value the Q-bank. The decreasing correlation between Q-bank accuracy and K% may suggest that students shifted from using the Q-bank to assess exam readiness to using it as a learning tool. While multiple factors influence academic performance including cohort effects and potential adjustments to performance criteria, a voluntary, gamified Q-bank can foster self-regulated learning and appears to offer academic benefits. Post-course mixed-methods analyses will provide deeper insights into Q-bank usage patterns.