Background
Flipped classroom models rely on student motivation and accountability for pre-class preparation. At our medical school, the curriculum requires students to complete prework (short videos and/or readings) before attending active learning sessions. Although optional self-assessment quizzes (SAQs) are provided to reinforce accountability, completion rates drop significantly over the first year, raising concerns about their effectiveness without formal incentives.

Methods
We piloted a graded SAQ intervention in a second-semester, five-week Cardiovascular Pulmonary (CVP) unit. Each correctly answered SAQ question submitted before its corresponding session contributed 0.01% toward the student’s semester grade, up to a maximum of 1% within the pass/fail structure. We compared SAQ and prework video completion rates between academic years 2023-24 (pre-intervention, N=51) and 2024-25 (intervention, N=52). Engagement was measured by quiz completion and video view metrics. Exam performance was calculated using identical questions administered in both years. Other first-year units without incentives served as additional controls.

Results
In the CVP unit, SAQ completion increased from 15% to 87%. Video engagement increased by ~40% in total views and minutes watched. The number of “highly engaged” students (those completing nearly all of 23 videos) tripled from 7 (14%) to 21 (40%). The average exam score improved by 1.7 percentage points (from 87.7% to 89.3%, P<0.05). In contrast, SAQ completion in other units remained unchanged, and exam scores were either the same or declined.

Conclusion
A minimal grade incentive led to substantial improvements in SAQ completion and prework engagement in a flipped classroom setting. These findings suggest that small incentives can meaningfully influence student behavior and may contribute to improved exam performance. Further analysis, including that of student feedback, is underway to inform future curricular strategies.