Motivating student learning using a formative assessment journey

REVIEW ARTICLE

Motivating student learning using a formativeassessment journeyDarrell J. R. Evans,1 Paul Zeun2 and Robert A Stanier3

1Office of the Pro Vice-Chancellor (Learning and Teaching), Monash University, Melbourne, Australia2Brighton and Sussex Medical School, Sussex University, Brighton, UK3Information Services, University of Brighton, Brighton, UK

Abstract

Providing formative assessment opportunities has been recognised as a significant benefit to student learning.

The outcome of any formative assessment should be one that ultimately helps improve student learning

through familiarising students with the levels of learning required, informing them about gaps in their

learning and providing feedback to guide the direction of learning. This article provides an example of how

formative assessments can be developed into a formative assessment journey where a number of different

assessments can be offered to students during the course of a module of teaching, thus utilising a spaced-

education approach. As well as incorporating the specific drivers of formative assessment, we demonstrate how

approaches deemed to be stimulating, interactive and entertaining with the aim of maximising enthusiasm and

engagement can be incorporated. We provide an example of a mixed approach to evaluating elements of the

assessment journey that focuses student reaction, appraisal of qualitative and quantitative feedback from

student questionnaires, focus group analysis and teacher observations. Whilst it is not possible to determine a

quantifiable effect of the assessment journey on student learning, usage data and student feedback shows that

formative assessment can achieve high engagement and positive response to different assessments. Those

assessments incorporating an active learning element and a quiz-based approach appear to be particularly

popular. A spaced-education format encourages a building block approach to learning that is continuous in

nature rather than focussed on an intense period of study prior to summative examinations.

Key words: anatomy; feedback; formative assessment; quiz; spaced education; student learning.

Introduction

Formative assessment is designed to aid learning by gener-

ating feedback information that benefits students during

the learning process and leads to enhanced learning out-

comes. The provision of opportunities for formative assess-

ment has been recognised as a significant benefit to

student learning (Rolfe & McPherson, 1995; Black & Wiliam,

1998; Bierer et al. 2008; Carrillo-de-la-Pena et al. 2009). For-

mative assessments are usually systematic in approach, and

are designed to be available to students during a particular

period of study to provide motivation for learning. Whilst it

is generally agreed that the outcome of any formative

assessment should be one that ultimately helps improve

learning, it has been suggested that there should be focus

on three specific drivers when designing any formative

assessment: using a method to inform students of gaps in

their learning; familiarising students with the expectations

of summative assessments; and providing feedback that

guides the direction of student learning (Rolfe &McPherson,

1995; Krasne et al. 2006). Ideally and unlike summative

assessments, formative assessment should occur in a non-

threatening environment, be offered at a time that is

applicable to the students’ learning journey and be one

where the student takes an active part in the process

(Rolfe & McPherson, 1995; Harlen & James, 1997; Krasne

et al. 2006). The progress of students will only be

enhanced by formative assessment if they are able to use

the opportunities effectively and recognise where they

need to develop their learning or skills.

The retention of knowledge after the learning period is

essential so that the ‘graduate’ is able to use and rely on a

full understanding of that knowledge for use in their

chosen career (Sugand et al. 2010). This deeper learning is

Correspondence

Darrell J.R. Evans, Office of the Pro Vice-Chancellor, Monash Univer-

sity, PO Box 197, Caulfield East, Melbourne, Vic 3150, Australia.

T: #61 3 990 34489; E: [email protected]

Accepted for publication 21 August 2013

© 2013 Anatomical Society

J. Anat. (2013) doi: 10.1111/joa.12117

Journal of Anatomy

usually achieved when knowledge is not restricted to learn-

ing a collection of isolated facts, and is instead a result of

an active learning process being engaged and knowledge

being fully understood and retained in context by the

learner. Cognitive psychology research demonstrates that

understanding involves creating links, and this is accom-

plished through active participation of the learner and

being familiar with the material in question (Harlen &

James, 1997). It has been suggested that the incorporation

of formative assessment into the process will encourage

adoption of an active learning approach and therefore may

help achieve deeper learning (Rolfe & McPherson, 1995). In

addition, it has been recognised that retention of gained

knowledge is improved when educational encounters are

spaced and repeated over a defined period and students

are encouraged to apply ongoing learning and not a cram-

ming technique just before the final examinations (Krasne

et al. 2006; Kerfoot et al. 2007). Greater use of formative

assessment throughout the module or course therefore pro-

vides an ideal opportunity for encouraging a spaced

approach to learning.

Incorporating an active experience into the formative

assessment format used is important, and research suggests

that students prefer approaches that are stimulating, moti-

vating and entertaining because they encourage their

involvement (Harlen & James, 1997; Hudson & Bristow,

2006). The use of games can be used as an educational

intervention to achieve these goals, and such strategies

may help promote longer-term knowledge retention and

the learning of key cognitive skills (Akl et al. 2010). A wide

variety of games has been used as formative assessments

in subjects such as physiology, biochemistry and pharma-

cology, and approaches have included board games,

puzzles and activities based on television game shows

(Moy et al. 2000; Willmott, 2001; Howard et al. 2002;

Zakaryan et al. 2005; Hudson & Bristow, 2006; Shah et al.

2010). In each case students appear to have reacted

positively to each intervention, and results suggests that

the students’ learning process might be enhanced using

such approaches.

Formative assessment opportunities have been used in

many areas of medical training, and are seen by some as

an expected provision by medical schools to ensure stu-

dents are able to track progress and therefore reach speci-

fied competencies (Bierer et al. 2008). For the opportunity

of formative assessment to be maximized, it must there-

fore feature as a built-in component of a planned curricu-

lum (Rushton, 2005). In the anatomy arena formative

assessment has been used for many years, although has

increasingly become a defined and integrated part of the

approach used in gross anatomy, histology and embryol-

ogy (McBride & Prayson, 2008; Rizzolo et al. 2010; Evans,

2011). Here we present a formative assessment journey

where a number of different assessments can be offered

to students during the course of a module or unit of

teaching, thus utilising a spaced-education approach. In

this example from Brighton and Sussex Medical School

(BSMS), assessments included those of differing content,

format and release, and were made available to all stu-

dents taking the module. A specific focus was given to

activity and quiz-based approaches with the aim of maxi-

mising enthusiasm and engagement. We demonstrate how

a mixed approach to evaluation that focusses on aspects

including evaluation of the server logs from the Learning

Management System (LMS), appraisal of qualitative and

quantitative feedback from student questionnaires, focus

group analysis and teacher observations can be used to

examine the use of and student reaction to formative

assessment.

Creating an assessment journey

A collection of nine formative assessments in anatomy was

designed and introduced into each of the system-based

modules at BSMS. The system-based modules make up the

basis of the first 2 years of the medical programme, and are

designed to combine both scientific and clinical knowledge

and skills in an integrated manner. Anatomy features as an

interwoven element throughout each of the system-based

modules, and is delivered using a multi-faceted approach

that includes dissection (Evans & Watt, 2005; Evans & Cuffe,

2009). Individual elements of assessment were designed to

have a different focus both in terms of content and

approach using an interactive element where possible.

Whilst content was directed towards anatomical knowl-

edge, each assessment included functional and clinical rele-

vance and reference to other elements of the module to

enhance an integrated approach. In each case the assess-

ments were targeted at different stages during the running

of the modules to create a formative assessment journey,

whereby specific assessments were released at defined

times during the 10 weeks of each module. All students

were introduced to the concept of formative vs. summative

assessments in order to reduce any confusion (Anziani et al.

2008).

Table 1 provides a summary of the formative assessments

released in each module, and includes the time of release,

the mode of delivery, and details of when students receive

answers and feedback. Assessments were not all originally

produced at the same time, and it took a period of 3 years

to put the full assessment journey together. Analysis was

made, however, for students that had access to all assess-

ments.

• A ‘Who wants to be an Anatomist’ quiz approach was

used in each lecture in order to break up the session,

to take account of students’ total concentration and

to see how they were responding to the material

being presented. A question would appear at different

times during the presentation with four possible

answers to which a colour was assigned. Students were


Formative assessment journey, D. J. R. Evans et al.2

each provided with a collection of cards of the same

four colours as an automated audience response sys-

tems (ARS) was not available, and when prompted

were asked to show the lecturer the colour of their

chosen answer. The lecturer was able to receive an

immediate response of student performance and pro-

vide feedback to students.

• A wordsearch puzzle was released on the LMS after

each lecture, and contained 10 words that the lecturer

felt were important to the lecture topic and with

which the students should become familiar and be

able to define.

• The dissection checklists appeared in the dissection

notes along with a number of clinical and observa-

tional questions. The checklists covered the main

learning outcomes of the session, and were used by

each table to check student knowledge in a group

environment and provide immediate feedback. Simple

PowerPoint quizzes containing a selection of different

question formats were released to students via the

LMS at the end of every 2-week teaching period. The

quiz included image annotation, multiple choice and

short-answer questions. Answers were time-released

for the following week.

• A self-assessment quiz was released in the second half

of each module, it was held in a presentation format

for all students in the lecture theatre. Students were

asked to write down their individual answers to a

range of questions. Following the quiz, students went

through their answers in a group tutorial environment

with demonstrators.

• Spotter tests using specimens, models and images were

incorporated into the dissection review sessions in the

anatomy laboratory. The definitive answers were

released 1 day after the session on the LMS.

• The ‘A Question of Anatomy’ revision/review quiz was

developed as a screencast and delivered online. The

quiz was loosely based on a UK television programme

called ‘A Question of Sport’ and used a number of dif-

ferent quiz rounds with varying formats. The screen-

cast lasted for approximately 15 min without breaks,

but could be paused at any point. The screencast

approach allowed students to have multiple attempts,

and for the lecturer to provide immediate feedback

and include supplementary questions.

• The anatomy viva was delivered as a group activity

where the students from each dissecting table were

asked a serious of oral questions using specimens and

models. Students were each asked individual questions

to test their knowledge and understanding. Unlike all

the other assessments, an element of a summative

approach was included in the vivas with students

required to reach a satisfactory standard before being

‘signed-off’ by the examiner.

• The final element of the assessment journey was the

online picture quiz, which students could access on an

individual basis at any time. On entering the quiz, stu-

dents were presented with a set of six randomly cho-

sen anatomical images from a large database of

multiple choice and true/false answer image-based

questions. Whilst students would get a single attempt

at each question, they could access a new set of six

randomly chosen questions as many times as they

wished. Ongoing total scores were made available to

the student and also presented as part of a league

table to all students.

Table 1 Details of each assessment type used in the formative assessment journey.

Assessment Release time (Module is 10 weeks) Mode/location of delivery Answers/feedback

‘Who Wants to be an

Anatomist?’

During each lecture (weeks 1–7) Interactive coloured card quiz,

lecture theatre

Immediate

Anatomical wordsearch At the end of each lecture (weeks 1–7) Puzzle, managed learning

environment

One week after

release

Dissection session

checklist

At the end of each dissection session (weeks

1–7)

Checklist and questions, anatomy

laboratory

Immediate

‘Anatomy Quiz of the

Week’

At the end of each 2-week period of

anatomy teaching (weeks 2, 4, 6, 8)

PowerPoint-based quiz, managed

learning environment

One week after

release

Anatomy self-

assessment quiz

Week 6 PowerPoint-based quiz, lecture

theatre and tutorial rooms

Immediate

Anatomy spotter test Week 7 Anatomical specimens/models,

anatomy laboratory

One day after

dissection session

‘A Question of

Anatomy’ Revision quiz

Week 8 Screencast quiz, managed learning

environment

Immediate

Anatomy viva Week 8/9 Oral assessment, anatomy

laboratory

Immediate and

result 1 day later

Online picture quiz Week 7–10 (new questions added each week) Interactive online quiz, managed

learning environment

Immediate (plus

league table)


Formative assessment journey, D. J. R. Evans et al. 3

Student reaction to a formative assessmentjourney

A mixed analysis approach was adopted to assess student

usage and reaction to the implementation of the formative

assessment journey, and focussed on both qualitative and

quantitative data retrieval for one first-year and one sec-

ond-year module. Data were collected from the LMS server

logs, teacher observations, a focus group and feedback

questionnaires.

Student usage

Server log data from the LMS were retrieved for each of

those assessments that had an online element, for example

‘Anatomy Quiz of the Week’ or the downloading of results

of the spotter test. Data for each assessment were focussed

on the total number of downloads; the number of students

within a cohort downloading or attempting the assessment;

and the maximum number of downloads made by an indi-

vidual student. Four separate items of analysis were chosen,

with each focussing on different aspects of the student

usage (Table 2). The number of downloads for each ele-

ment differed substantially, with some assessments such as

the wordsearches receiving relatively few downloads (e.g.

23 for one wordsearch in the first-year module), whilst oth-

ers received a much higher level (e.g. 270 for the second-

year spotter test results). This was largely reflected in the

total number of students downloading each assessment,

which ranged from 13% to 77% of the total cohort.

Although the average number of repeated downloads per

participating student averaged only 1 in each case, some

students downloaded a particular assessment up to 11

times. For the online picture quiz, student usage data were

recorded based on numbers of questions answered in the

quiz collectively by the student cohort and by individual

students. The quizzes were released for 3 weeks prior to the

summative examination, and a total of 39 704 and 12 795

questions were answered by first- and second-year students,

respectively. First-year students recorded a total of 85%

correct answers in their quiz, and second-year students

recorded 74% correct answers. The maximum number of

questions attempted by an individual student in each quiz

was 2765 for the first-year module and 689 for the second-

year module, with an average of 272 and 127 attempts per

student in each respective year group. The proportion of

students attempting the quiz was 94% for first-year stu-

dents and 75% for second-year students.

Student reaction

First- and second-year student feedback was collected for

formative assessments via questions contained in the formal

end-of-module anonymous questionnaires. Any open com-

ments made about anatomy and the assessment in particu-

lar were noted and categorised into common themes. One-

hundred and forty-four first-year students (97% of student

cohort) and 127 second-year students (96% of student

cohort) responded to the questionnaire. All students were

given the opportunity to contribute to open-ended com-

ments under two categories: best aspect of the module;

and aspects requiring improvement. A total of 134 (first

year) and 102 (second year) separate comments attributed

to the anatomy component were made in the ‘best aspect’

section, and included remarks related to the overall teach-

ing quality, the subject area, lecture content and staff. Of

the anatomy comments, 37 (first year) and 17 (second year)

individual comments were made specifically about the for-

mative assessments offered and are categorised in Table 3.

There were no first-year comments about anatomy in the

Table 2 Student usage data retrieved from LMS server logs for online formative assessments. Figures in brackets represent the number of

students as a percentage of the year cohort.

Assessment

Average number of

downloads per type of

assessment

Average number of

students downloading

each assessment

Average number of

downloads per student

Maximum number of

downloads for one

student

1st year

module

2nd year

module

1st year

module

2nd year

module

1st year

module

2nd year

module

1st year

module

2nd year

module

Anatomical wordsearch 23 41 20 (13%) 33 (25%) 1 1 1 1

‘Anatomy Quiz of the

Week’

133 122 74 (50%) 69 (52%) 1 1 7 6

Anatomy spotter test 144 270 77 (52%) 97 (73%) 1 1 4 11

‘A Question of Anatomy’

Revision quiz

177 112 114 (77%) 68 (52%) 1 1 4 6

For the wordsearch and quiz of the week assessments, the results presented are a typical example of each of these types of assess-

ments as there were multiple wordsearches and quizzes of the week released during the module.

LMS, learning management system.



‘aspects requiring improvement’ section of the question-

naire, but nine separate comments were made about the

anatomy component from the second-year students, and of

these two were attributed to the formative assessments

(Table 3).

Quantitative evaluation using a five-point Likert scale was

also made of whether first-year students found the ‘Ques-

tion of Anatomy’ quiz of high quality and as a useful ele-

ment in their learning. A total of 140 students (94% of

student cohort) completed this section of the questionnaire,

and indicated that they rated the usefulness of the material

covered as an average of 4.4 and the difficulty and chal-

lenge of the material tested at 4.1. Students also gave a

high rating for the interest and enjoyment of the quiz with

an average score of 4.5.

Analysis of student reaction was also assessed using a

small focus group approach, to which four volunteer stu-

dents from year 1 were recruited in response to an open

e-mail invitation. The focus group methodology was

included as we wanted to explore the question of formative

assessment in relation to learning styles, the approach used

to teach anatomy and to capitalise on group interactions. A

student facilitator was used for the focus group to help

ensure no bias was given to the questions and discussion

topics raised and responses recorded. The format of the

focus group was semi-structured, with prompts ensuring

that student views were appropriately explored. This

approach was used to help keep the discussion reasonably

focussed, whilst allowing views to be freely expressed.

Notes (agreed by the student group) were taken by the

facilitator during the discussion and used for further analy-

sis. The focus group highlighted that formative assessment

opportunities helped ‘consolidate their knowledge’ by link-

ing particular concepts and information learned in a teach-

ing session. Students commented that they ‘like to know

what you need to know and to what level’, and formative

assessments helped them gauge this more clearly. When

asked, not all students in the group were aware that they

had been through a formative assessment journey, but

recognised the benefit of releasing assessments at different

times. They felt such an approach helped reinforce their

learning in a continuous way and not just during the revi-

sion/review period. Students felt it was important that for-

mative assessments were ‘not an absolute requirement’,

and that they could choose what to use and when. When

asked about individual resources, the students commented

that ‘different students find different formative assessments

more useful than others’. Students were aware that they

have different learning styles and used the example that

whilst for some a wordsearch puzzle might be effective, for

others it was less so as it was not particularly active in

approach. The ‘Who wants to be an Anatomist’ quiz was

highlighted as a way of maintaining interest and attention

during lectures. The group members felt it gave them ‘more

of an incentive to listen’, allowed them to follow the thread

of the lecture and was done in a non-threatening way so as

not to embarrass particular students who did not know the

answer to the question. The immediate feedback allowed

them to re-examine a concept they may have been strug-

gling to grasp or identify gaps in their knowledge. This was

also true of the dissection checklists that the students in the

group valued as these allowed them to test each other and

identify and correct areas they had not been clear on

before leaving the laboratory. The quizzes of the week,

whilst popular, were not always accessed by this group of

students as they felt they needed time to direct towards

other non-anatomical areas of learning in the module and

not spend all their time on one subject. Some commented

that they thought the quizzes could have covered other

material delivered in that week of learning and not just

anatomy and delivered as a ‘unified quiz’. The group all

used the revision/review quiz and online picture quiz as

they felt it was a good way to review material, with one

student commenting that it helped ‘check my progress and

highlight what I didn’t know’. Students thought it was a

fun and interactive approach and gave variation to their

learning. In each case students felt that whilst the feedback

given for each question was useful it could have been

expanded.

Teacher observation

For those assessments that were not delivered online and

where no LMS data could therefore be retrieved, such

as in the lecture ‘Who wants to be an Anatomist’ quiz

and the anatomy self-assessment quiz, qualitative teacher

observations on student engagement (including atten-

dance, discussion and interaction) were recorded through

informal interviews. In the case of the delivery of the ‘Who

wants to be an Anatomist’ quiz, the lead teacher reported

that all students appeared to participate by raising the

Table 3 Details of qualitative student comments attributed to the for-

mative assessments obtained from the end-of module questionnaire.

Categorization of student comments

Number of

comments

First

year

Second

year

Best aspects

Having formative assessment in anatomy 11 8

Aided in lecture interaction 10 -

Needed for other disciplines 9 6

Variety of assessment types 6 3

Viva 1 –

Aspects requiring improvement

Questions were not always representative

of summative assessments

– 1

Viva should be placed earlier in the cycle – 1



coloured card enthusiastically suggesting positive engage-

ment. A total of two–four questions were delivered in the

space of a 50-min lecture. It was noted that a minority of

students were initially rather hesitant in providing answers

to the questions; however, this appeared to improve as

the module progressed and students became used to the

quiz approach. The dissection checklists were used by both

tutors and students to check knowledge and understand-

ing of the main learning outcomes at the end of each dis-

section session. These appeared to work well, with most

students reported to have responded and interacted well.

Tutors found that the checklists were particularly useful in

identifying those areas requiring clarification or more

cadaveric dissection. Many students also used the checklists

as an aide memoir during their dissection sessions to

ensure they were covering the objectives of the session.

This was even more notable in the review/revision sessions

held towards the end of the module where students

reviewed all the material covered in the sessions and had

access to the checklists. The self-assessment quiz was well

attended by the students in both the lecture element and

subsequent feedback tutorial (approximately 95%). Tutors

reported that the feedback sessions were interactive and

students appeared positively engaged, with most students

regularly proffering answers to questions. Informal feed-

back from the students suggested they approached the quiz

in one of two ways, with some students actively revising

their knowledge beforehand and other students testing

their current level of knowledge and determining how

much extra learning was necessary to achieve a suitable

standard. The viva was a compulsory element and delivered

as a group activity. Students demonstrated professional

behaviour during the assessment, and the assessors gauged

the level of performance as very high for most students.

A total of seven second-year students (5%) were judged not

to have achieved the standard of knowledge and under-

standing required, and they were given a subsequent addi-

tional opportunity at a later date, and all students were

able to be ‘signed’ off at this stage. All first-year students

were ‘signed’ off after their first viva attempt.

The effect of an assessment journey onstudent learning activity

A formative assessment journey was designed and intro-

duced in anatomy to examine the effect of a variety of dif-

ferent assessment modes released and available to students

at defined stages during the course of the module on stu-

dent learning activity. Overall the analysis of the data col-

lected demonstrated that formative assessments were well

used by students, although the reasons for utilising each

assessment and the numbers of students using each assess-

ment were different.

A spaced-education approach was used for introducing

each of the formative assessments, and each was released

at different stages during the module to allow a building

block approach to learning to be supported and meant

each assessment included only the material that had already

been covered or alluded to at that stage of the module,

thus not alienating students by testing on unseen material.

It has been argued that knowledge retention is improved

when educational encounters are spaced and repeated over

time (Krasne et al. 2006; Kerfoot et al. 2007). Interestingly

students in the focus group did not appear to recognise

that they had been through a formative assessment jour-

ney, although they thought such an approach was benefi-

cial and would help reinforce their learning in a continuous

way, which is in line with student feedback from other

studies (Bierer et al. 2008). To improve the perception of

the journey, all students are now given an overview of the

assessment journey at the start of the module and provided

with an illustrative map showing the types of assessment

and when they are available.

An active approach was built into the design of many of

the assessments to encourage participation and to enhance

the way students experiment with their learning. Data from

the LMS server logs show that some assessments were used

more than others, with those that required a more active

approach such as the ‘A Question of Anatomy’ revision quiz.

The results of the online picture quiz, which combined the

most active elements, demonstrate this trend further with

extremely high participation rates recorded especially by

first-year students. In contrast, the wordsearch puzzles were

used less widely, and this might be because this was a less

active assessment type or that this approach does not reflect

the types of questions used in the summative assessment

and therefore is perceived as less useful. Rolfe & McPherson

(1995) suggest that when an active learning approach is

used in assessment design, deeper learning is encouraged. It

is unclear whether the introduction of a formative assess-

ment journey using active formats has helped develop a

deeper approach to learning in our students, and this can

only be judged at a later date when students are required

to use the knowledge and understanding gained in subse-

quent modules and when on particular clinical rotations.

It has been reported that students use a range of differ-

ent resources in their learning and in preparation for their

examinations (Ozolins et al. 2008). The formative assess-

ment journey was designed to incorporate a variety of dif-

ferent assessment types so that students would not get

overly used to just one type of assessment, and so that all

students would hopefully be able to find an assessment

that they felt was useful in their learning. Usage data dem-

onstrated that a large percentage of students used many if

not all the assessments on offer, although they utilised

some assessment types more than others. Students in the

focus group commented that it was important that they

could choose what to use and when, and this suited the

various learning styles different students have. Some

students suggested that if similar assessments could be



made available in other module themes or combined into

the anatomy assessments this would provide a more

rounded progress report for them and could utilise their

time more effectively. Student feedback demonstrated that

the online revision quiz and picture quiz were the most

popular assessments, and this was attributed in part to the

fun nature of the quizzes. Other studies also suggest that

students prefer approaches that are stimulating, motivating

and entertaining because they encourage their involvement

(Harlen & James, 1997; Hudson & Bristow, 2006). In addi-

tion, incorporation of fun into the learning process can help

reduce the stress and anxiety some students have about

assessment and help them to deal with the overwhelming

feeling that there is too much to learn (Allery, 2004; Ballon

& Silver, 2004; Zhang et al. 2011). One reason might be that

activities such as quizzes and puzzles are often associated as

being a recreational activity (Shah et al. 2010).

Teacher observations demonstrated that the ‘Who wants

to be an Anatomist’ quiz approach worked well in the

lecture sessions with high levels of participation. Students

reported that this quiz approach maintained interest

and attention during the lectures. This lecture-based quiz

approach has been used widely for many years, with

Harden reporting the use of audience response cards in lec-

tures several decades ago, and showed that it helped main-

tain student interest and enabled a student to self-assess

their understanding (Harden, 1968). The use of coloured

card and similar approaches has been largely superseded by

the introduction of automated ARS, which have also been

shown to enhance attention and enthusiasm in learners

(Miller et al. 2003; Latessa & Mouw, 2005; Alexander et al.

2009). The current study demonstrates, however, that the

coloured card system is still an appropriate method to use

and one that is highly valued by students. Whilst it is recog-

nised that the coloured card approach is more limited than

using ARS clickers, it does provide an opportunity for spon-

taneous questions to be introduced if gaps in understand-

ing are identified during the session, and unlike ARS it is

not subject to technical difficulties, is fully transportable

and the cost is minimal.

Immediacy of feedback appears to be appreciated by the

students and noted as an attribute for some of the assess-

ments used in the formative assessment journey, such as the

self-assessment quiz, anatomy viva and for the dissection

checklists. Students noted the checklists as particularly valu-

able as they allowed them to identify and correct areas

immediately (through their own investigation or with help

from a demonstrator) and before leaving the anatomy

laboratory. Checklists have been shown to also increase

practical examination scores and dissection quality (Hofer

et al. 2011). It is also recognised that students benefit

from not always being provided with answers immediately,

and a number of assessments can be used that encour-

age students to find out answers for themselves after the

assessment.

Concluding remarks

The development of a formative assessment journey in

anatomy provides a programme of different assessments

that can help ensure students find a format to engage

with and to act as an effective learning support resource.

Assessments are designed to incorporate the drivers of

highlighting gaps in student learning, giving indication to

the level of knowledge required, and to provide useful

feedback (Rolfe & McPherson, 1995; Krasne et al. 2006).

Presenting formative assessment using a temporal journey

format encourages a continuous and staged approach to

learning rather than an intense period of study just prior

to summative assessments. Whilst it was not possible to

determine a quantifiable effect of the assessment journey

on student learning, the overall engagement with the ele-

ments of the assessment journey suggests that students

reacted positively to the inclusion of each resource. To

ensure that active participation continues in the future,

however, it will be important to enhance assessment jour-

neys by involving students with the development of the

resources.

Acknowledgements

The authors would like to thank Tim Vincent for helping

with the technical aspects of some of the online materials,

Tracy Cuffe for some of the quiz design, and Alison Bryson

for help with the text. The authors are also grateful to

the students who took part in the focus group and com-

pleted anonymous questionnaires. Ethical approval was not

required for this study, and the anonymity of the partici-

pants in data collection through informal questioning,

questionnaires and the focus group was guaranteed.

Author contributions

DJRE: concept and design of the formative assessments, the

construction of the assessment journey, literature search,

data collection and analysis, and manuscript preparation.

PZ: literature search, focus group facilitation and analysis,

manuscript preparation. RAS: technical construction of the

online picture quiz, data collection and analysis, and manu-

script preparation.

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Motivating student learning using a formative assessment journey