The Effect of Technology-Enhanced Formative Assessment on Learning and Test Anxiety in Anatomy Education Among Medical Students: A Quasi-Experimental Study
Authors
-
Samira Latifi
Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
https://orcid.org/0009-0002-6452-8915
-
Haniye Mastour
Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; School of Medical Education and Learning Technologies, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
https://orcid.org/0000-0003-4893-0998
-
Reyhaneh Shafieian
Department of Anatomical Sciences and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
https://orcid.org/0000-0002-5057-9028
-
Maliheh Dadgar Moghaddam
Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
https://orcid.org/0000-0002-4797-8714
DOI:
https://doi.org/10.22100/ijhs.v12i5.1456Keywords:
Technology-enhanced assessment, Formative assessment, Anatomy education, Learning outcomes, Test anxietyAbstract
Background: Anatomy is crucial in medical education, but traditional teaching methods can overload students and increase test anxiety. Technology-enhanced formative assessment (TEFA) may improve learning and reduce anxiety. This study examines the effect of TEFA on learning outcomes and test anxiety in anatomy education for medical students.
Methods: This quasi-experimental study included 147 second-year medical students enrolled in a Head and Neck Anatomy course at Mashhad University of Medical Sciences, Iran. Students were allocated into intervention (n=78) and control (n=69) groups based on pre-existing class structures determined by institutional scheduling procedures. Learning outcomes were measured using midterm and final exam scores, and test anxiety was assessed using Sarason’s Test Anxiety Scale at three time points. Non-parametric statistical tests were applied for data analysis.
Results: Students in the TEFA group performed significantly better in both midterm and final examinations (P-value<0.001) compared to the control group. Although the intervention group exhibited lower levels of test anxiety, the differences were not statistically significant (P-value>0.05).
Conclusion: TEFA significantly improved learning outcomes in anatomy education but did not produce a statistically significant reduction in test anxiety. Integrating TEFA into medical curricula may enhance academic performance while requiring additional strategies to manage student anxiety.
References
St-Onge C. Embracing the next frontier in assessment. Canadian Medical Education Journal. 2025;16(2):1-5. doi: 10.36834/cmej.81477
Gupta S, Ojeh N, Sa B, Majumder MAA, Singh K, Adams OP. Use of an adaptive e-learning platform as a formative assessment tool in the cardiovascular system course component of an MBBS programme. Advances in Medical Education and Practice. 2020:989-996. doi: 10.2147/AMEP.S267834
Rashid S. Role of technology enhanced assessment in medical and dental education: A scoping review. Health Professions Education and Research. 2024;2 doi: 10.54844/hper.2024.0472
Velan GM, Jones P, McNeil HP, Kumar RK. Integrated online formative assessments in the biomedical sciences for medical students: benefits for learning. BMC Medical Education. 2008;8:52. doi: 10.1186/1472-6920-8-52
Hisham SHA, Hadie SNH, Kasim F, Shamsuddin SA. From crisis to opportunity: enhancing anatomy education in a post-COVID world: the Universiti Sains Malaysia experience. Korean Journal of Medical Education. 2024;36(4):435. doi: 10.3946/kjme.2024.315
Syed Abd Halim SA, Yusoff MSB, Yaman MN, Roslan NS, Tengku Muda TFM, Ramli RR, et al. The need to identify anatomy-related competencies in medical education. Anatomical Sciences Education. 2024;17(9):1659-1667. doi: 10.1002/ase.2515
Papa V, Vaccarezza M. Teaching anatomy in the XXI century: new aspects and pitfalls. ScientificWorld Journal. 2013;2013:310348. doi: 10.1155/2013/310348
Ahmad K, Khaleeq T, Hanif U, Ahmad N. Addressing the failures of undergraduate anatomy education: Dissecting the issue and innovating a solution. Annals of Medicine and Surgery. 2021;61:81-84. doi: 10.1016/j.amsu.2020.12.024
Naidoo N, Akhras A, Banerjee Y. Confronting the Challenges of Anatomy Education in a Competency-Based Medical Curriculum During Normal and Unprecedented Times (COVID-19 Pandemic): Pedagogical Framework Development and Implementation. JMIR Medical Education. 2020;6(2):e21701. doi: 10.2196/21701
Chang Chan AY, Stapper CPM, Bleys R, van Leeuwen M, Ten Cate O. Are We Facing the End of Gross Anatomy Teaching as We Have Known It for Centuries? Advances in Medical Education and Practice. 2022;13:1243-1250. doi: 10.2147/AMEP.S378149
Turney BW. Anatomy in a modern medical curriculum. The Annals of The Royal College of Surgeons of England. 2007;89(2):104-107. doi: 10.1308/003588407X168244
Emadzadeh A, EidiBaygi H, Mohammadi S, Etezadpour M, Yavari M, Mastour H. Virtual Dissection: an Educational Technology to Enrich Medical Students' Learning Environment in Gastrointestinal Anatomy Course. Medical Science Educator. 2023;33(5):1175-1182. doi: 10.1007/s40670-023-01867-z
Lu DM, Hoang HB, Le TM, Huynh ST, Ngo PT, Bui ST, et al. Fabricating a low-cost 3D printed transparent temporal bone model for anatomy teaching in medical education. Medicine and Pharmacy Reports. 2025;9(2):232-240. doi: 10.32895/UMP.MPR.9.2.21
James J, Natarajan PS, Subramanian SP. Unveiling challenges in cadaveric dissection for medical education-a study of student perspectives. European Journal of Clinical and Experimental Medicine. 2024;22(1):102-106. doi: 10.15584/ejcem.2024.1.19
Bathla S. Digital Content on YouTube Channels: Boon or Bane to Anatomy Teaching and Learning. National Journal of Clinical Anatomy. 2024;13(1):48-51. doi: 10.4103/NJCA.NJCA_168_23
Wadi MM, Yusoff MSB, Rahim AFA, Lah NAZN. Assessment modalities that provoke test anxiety among medical students. Education in Medicine Journal. 2022;14(2):49-60. doi: 10.21315/eimj2022.14.2.4
Hameed KH, Channa TA, Khan AA, Khan S, Rana MS, Gayantri G, et al. Assessment of test anxiety and its correlation with academic performance among undergraduate students: Assessment of test anxiety. Pakistan Journal of Health Sciences. 2023;4(08):38-42. doi: 10.54393/pjhs.v4i08.970
Butt A, Ishaque A. Frequency of Anxiety During Exam/Assessments among Medical Students. Annals of Punjab Medical College. 2023;17(3):386-389. doi: 10.29054/apmc/2023.1380
Ata M, Irum S, Azam F, Shaheen A, Riyaz S, Ali H, et al. Gamifying Assessments in Medical Education: A Novel Approach to Tackling Test Anxiety in Medical Students. Proceedings. 2023;37(4):31-7. doi: 10.47489/szmc.v37i4.386
Saravanan C, Kingston R, Gin M. Is test anxiety a problem among medical students: a cross sectional study on outcome of test anxiety among medical students. International Journal of Psychological Studies. 2014;6(3):24. doi: 10.5539/ijps.v6n3p24
Anand S, Hemwani K, Ajmani S, Goothy SSK, Choudhary A. Assessment of depression, anxiety, stress, and cognitive parameters in medical students: A pilot study. Asian Journal of Medical Sciences. 2023;14(2):214-217. doi: 10.3126/ajms.v14i2.49269
Shaheen A, Azam F, Rabbani MW, Kazmi N. Correlation of computer-based test anxiety with medical students' performance before, during and after assessments. Pakistan Journal of Medical Sciences. 2022;38(3Part-I):476-480. doi: 10.12669/pjms.38.3.4989
Alhawari H, Alshelleh S, Alzoubi O, Khanfar AN, Akiely R, Abdallah B, et al. Comparison of baseline and test day cardiovascular parameters, anxiety scores and coffee consumption among medical students undergoing objective structured clinical examinations in Jordan. International Journal of General Medicine. 2023:4249-4256. doi: 10.2147/IJGM.S432157
Hammer CM, Scholz M, Bischofsberger L, Hammer A, Kleinsasser B, Paulsen F, et al. Positive effects of medical hypnosis on test anxiety in first year medical students. Innovations in Education and Teaching International. 2022;59(4):472-482. doi: 10.1080/14703297.2021.1886971
Encandela J, Gibson C, Angoff N, Leydon G, Green M. Characteristics of test anxiety among medical students and congruence of strategies to address it. Medical Education Online. 2014;19:25211. doi: 10.3402/meo.v19.25211
Huang HW, Mills DJ, Tiangco JANZ. Inquiry-based Learning Approaches Supported by Technology-enhanced Formative Assessment in Flipped EFL Writing. Proceedings - 2024 5th International Conference on Computer Science, Engineering, and Education, CSEE 2024, 45-50. doi: 10.1109/CSEE63195.2024.00017
Lakhtakia R, Otaki F, Alsuwaidi L, Zary N. Assessment as learning in medical education: feasibility and perceived impact of student-generated formative assessments. JMIR Medical Education. 2022;8(3):e35820. doi: 10.2196/35820
Smirnova A, Barone MA, Zabar S, Kalet A. Introducing the Next Era in Assessment. Perspectives on Medical Education. 2025;14(1):1-8. doi: 10.5334/pme.1551
Haruna-Cooper L, Rashid MA. GPT-4: the future of artificial intelligence in medical school assessments. Journal of the Royal Society of Medicine. 2023;116(6):218-219. doi: 10.1177/01410768231181251
Taufiqulloh T, Nindya MA, Rosdiana I. Technology-enhanced formative assessment: unraveling indonesian efl learners' voices. English review: Journal of English Education. 2023;11(3):981-990. doi: 10.25134/erjee.v11i3.9076
Luthfiyyah R, Aisyah A, Sulistyo GH. Technology-enhanced formative assessment in higher education: A voice from Indonesian EFL teachers. EduLite: Journal of English Education, Literature and Culture. 2021;6(1):42-54. doi: 10.30659/e.6.1.42-54
Choi-Lundberg D. Technology-Enhanced Learning in Medical Education Collection: Latest Developments. MedEdPublish (2016). 2023;13:219. doi: 10.12688/mep.19856.1
Mdlalose N, Ramaila S, Ramnarain U. Using Kahoot! as a formative assessment tool in science teacher education. International Journal of Higher Education. 2022;11(2):43-51. doi: 10.5430/ijhe.v11n2p43
Saeed Alharbi A, Meccawy Z. Introducing Socrative as a tool for formative assessment in Saudi EFL classrooms. Arab World English Journal (AWEJ). 2020;11(3):372-384. doi: 10.24093/awej/vol11no3.23
Gubbiyappa KS, Barua A, Das B, Murthy CV, Baloch HZ. Effectiveness of flipped classroom with Poll Everywhere as a teaching-learning method for pharmacy students. Indian Journal of Pharmacology. 2016;48(Suppl 1):S41. doi: 10.4103/0253-7613.193313
Pramudita RF, Rahmanita M, Wardani PA, Farhan M, Binarkaheni S. Students' Perception in Using ProProfs Online Quizzes as an Assessment Tool in English Classroom. Journal of Language, Communication, and Tourism. 2023;2(1):29-37. doi: 10.25047/jlct.v2i1.4495
Mattei MD, Ennis E. Continuous, Real-Time Assessment of Every Student's Progress in the Flipped Higher Education Classroom Using Nearpod. Journal of Learning in Higher Education. 2014;10(1):1-7.
Andriani R, Mellyzar M, Lukman IR, Muttakin M, Pasaribu AI, Fadli MR. A Review of Digital Assessment in Education: Tools, Feature, and Effectiveness. 2024:0023-0023.
Díaz-Sainz G, Pérez G, Gómez-Coma L, Ortiz-Martínez VM, Domínguez-Ramos A, Ibañez R, et al. Mobile learning in chemical engineering: An outlook based on case studies. Education for Chemical Engineers. 2021;35:132-145. doi: 10.1016/j.ece.2021.01.013
Sarason IG. Test anxiety, cognitive interference, and performance. Aptitude, learning, and instruction. Routledge; 2021:131-142.
Huynh HP, Sramek KN, Sifuentes KA, Lilley MK, Bautista EM. Keep Calm and Be Humble: Can Intellectual Humility Predict Test Anxiety? Psychological Reports. 2023;126(6):2963-2978. doi: 10.1177/00332941221103524
Sarason, IG. Introduction to the Study of Test Anxiety. In I. G. Sarason (Ed.), Test Anxiety: Theory, Research, and Applications (pp. 3-14). (1980). Hillsdale, NJ: Lawrence Erlbaum Associates.
Woldeab D, Brothen T. 21st century assessment: Online proctoring, test anxiety, and student performance. International Journal of E-Learning and Distance Education/Revue internationale du e-learning et la formation à distance 2019;34(1).
Mousavi F, Pakzad Z, Safdari M. The Role of Electronic Testing on Reducing Studentsʼ Test Anxiety. Instruction and Evaluation. 2017;10(39): 135-149.
Yazdani F. Test anxiety and academic performance in female nursing students. Quarterly Journal of Nursing Management. 2012;1(1):47-58.
Sirianansopa K. Evaluating students' learning achievements using the formative assessment technique: a retrospective study. BMC Medical Education. 2024;24(1):1373. doi: 10.1186/s12909-024-06347-5
Veena CN, Fathima FN, Nandan TM, Bhat I, Kumar MP. Crossword Puzzle as an Effective Formative Assessment Tool in Physiology-From Trial for Implementation in Competency-Based Medical Education. Medical Journal of Dr DY Patil Vidyapeeth. 2025;18(2):277-281. doi: 10.4103/mjdrdypu.mjdrdypu_291_24
Donkin R, Rasmussen R. Student Perception and the Effectiveness of Kahoot!: A Scoping Review in Histology, Anatomy, and Medical Education. Anatomical Sciences Education. 2021;14(5):572-585. doi: 10.1002/ase.2094
Ismail MA, Ahmad A, Mohammad JA, Fakri N, Nor MZM, Pa MNM. Using Kahoot! as a formative assessment tool in medical education: a phenomenological study. BMC Medical Education. 2019;19(1):230. doi: 10.1186/s12909-019-1658-z
Garza MC, Olivan S, Monleón E, Cisneros AI, García-Barrios A, Ochoa I, et al. Performance in Kahoot! activities as predictive of exam performance. BMC Medical Education. 2023;23(1):413. doi: 10.1186/s12909-023-04379-x
Quek FF. Revolutionising Anatomy Education: The Current Role of Digital Technologies in Enhancing Anatomy Learning for Undergraduate Medical Students. Cureus 2024;16(12):e75919. doi: 10.7759/cureus.75919
Panchbudhe S, Shaikh S, Swami H, Kadam CY, Padalkar R, Shivkar RR, et al. Efficacy of Google Form-based MCQ tests for formative assessment in medical biochemistry education. Journal of Education and Health Promotion. 2024;13(1):92. doi: 10.4103/jehp.jehp_981_23
Miltykh I, Kafarov ES, Covantsev S, Dadashev AS, Skarlis AA, Zenin OK. A new dimension in medical education: Virtual reality in anatomy during COVID-19 pandemic. Clinical Anatomy. 2023;36(7):1007-1015. doi: 10.1002/ca.24098
Minouei MA, Omid A, Mirzaie A, Mahdavifard H, Rahimi A. Effectiveness of virtual reality on medical students' academic achievement in anatomy: systematic review. BMC Medical Education. 2024;24(1):1407. doi: 10.1186/s12909-024-06402-1
Mastour H, Moodi Ghalibaf A, Niroumand S. Remote Online Test Anxiety during the Coronavirus Disease 2019 Crisis: A Cross-Sectional Study among Medical Students. Iranian Red Crescent Medical Journal (IRCMJ). 2022;24(3):e1645.
Rajanayagam B, Manikandan S, Anand N, Selvaraj S. Prevalence of anxiety depression and stress among first year medical students in Tamilnadu. Bioinformation. 2023;19(5):649. doi: 10.6026/97320630019649
Ortadeveci A, Ermez MN, Oz S, Ozden H. A survey study on distance anatomy education: challenges unique to anatomy. Surgical and Radiologic Anatomy. 2022;44(1):41-47. doi: 10.1007/s00276-021-02772-z
Salman A, Qureshi AS, Umar Z, Riaz M, Usman M, Zulfiqar S, et al. Effects of COVID‐19 pandemic on anatomy education of medical and dental students of Pakistan; a reality check. Surgical and Radiologic Anatomy. 2022;44(11):1495-1500. doi: 10.1007/s00276-022-03034-2
Khasawneh RR. Anatomy Education of Medical Students During the COVID 19 Pandemic. International Journal of Morphology. 2021;39(5):1264-1269. doi: 10.4067/S0717-95022021000501264
Ali AH, Imam M, Abdelradi FE, Zidan A, Hamed M, Taha S, et al. Student-Centered Anatomy Learning Survey: Insights from the First-Year Medical Students. Journal of Behavioral Health. 2024;13(4):1-6. doi: 10.33425/2832-4579/24075
Neureiter D, Klieser E, Neumayer B, Winkelmann P, Urbas R, Kiesslich T. Feasibility of Kahoot! as a Real-Time Assessment Tool in (Histo-)pathology Classroom Teaching. Advances in Medical Education and Practice. 2020;11:695-705. doi: 10.2147/AMEP.S264821
Sadiq N, Fatima SH, Shabnam N, Rauf A. Empowering health professions educators: enhancing curriculum delivery through customized e-tutorial training on fundamental digital tools. Frontiers in Medicine. 2024;11:1342654. doi: 10.3389/fmed.2024.1342654
Goubar T, Larach J, Hindmarch J, Bownes S, Sinha S. A pragmatic approach to effective anatomy teaching and learning to medical students: a ten-year experience using evidence-based principles. MedEdPublish (2016). 2021;10:147. doi: 10.15694/mep.2021.000147.1
Otaki F, Gholami M, Fawad I, Akbar A, Banerjee Y. Students' Perception of Formative Assessment as an Instructional Tool in Competency-Based Medical Education: Proposal for a Proof-of-Concept Study. JMIR Research Protocols. 2023;12:e41626. doi: 10.2196/41626
Al-Hor M, Almahdi H, Al-Theyab M, Mustafa AG, Seed Ahmed M, Zaqout S. Exploring student perceptions on virtual reality in anatomy education: insights on enjoyment, effectiveness, and preferences. BMC Medical Education. 2024;24(1):1405. doi: 10.1186/s12909-024-06370-6
Agostini D, Lazareva A, Picasso F. Advancements in technology-enhanced assessment in tertiary education. Australasian Journal of Educational Technology. 2024;40(4):1-7. doi: 10.14742/ajet.10122
Erkan GN. Advancing Medical Assessment Skills in Dental Education: Technology-Enhanced Active Learning With Peer Role-Play Versus Real Patient Practice. Journal of Dental Education. 2025;89(9):1319-1330. doi: 10.1002/jdd.13866
Hahn H, Kropp P, Kirschstein T, Rücker G, Müller-Hilke B. Test anxiety in medical school is unrelated to academic performance but correlates with an effort/reward imbalance. PLoS One. 2017;12(2):e0171220. doi: 10.1371/journal.pone.0171220
Roy SK, Majumdar S, Mukherjee M, Paul A. Assessment of Examination Related Anxiety among Students in a Medical College at Kolkata, India: A Cross-sectional Study. Journal of Clinical and Diagnostic Research. 2022;16(10):40-3. doi: 10.7860/JCDR/2022/58219.17079
Published
Issue
Section
License
The Copyright Form should be downloaded and signed by corresponding author in the fourth step "upload supplementary files" during submission process.
After acceptance, copyright form should be downloaded and signed by all authors one by one ( "summery --> supp. file" part and click on "add a supplementary file" link).
