European Journal of Cardiovascular Medicine

The rapid advancements in medicine have profoundly shaped the evolution of medical education (1). To optimize learning efficiency, teaching and learning activities must be tailored to support all learners (2). The adage "assessment drives student learning" highlights the critical role of assessments in guiding student progress. Caroline Gipps describes formative assessment as the process of appraising, judging, or evaluating students' work to shape and enhance their competence (3,4). Understanding effective study habits is crucial in medical education, as recognizing habits associated with progress early on can help students reach their full potential and achieve proficiency (5).

Today’s medical education landscape often places considerable stress on mediocre students during internal and final examinations. Introducing weekend exams serves a dual purpose: acting as a formative assessment and alleviating the burden of the syllabus during major exams. Additionally, segregating students into batches based on weekend exam performance and conducting targeted study hours allows for customized teaching methods that address each student's unique needs.

This study aims to evaluate the effectiveness of using evaluation-based segregation of students and the implementation of diverse teaching methods during study hours. By focusing more clearly on individual learning needs, this approach strives to enhance the educational experience and ultimately create better-prepared Indian Medical Graduates.

Program Structure and Implementation:

The weekend examination program was designed to simulate the university examination pattern while providing regular assessment opportunities. Over one academic year, 150 second-year MBBS students and 20 faculty members participated in this initiative. The program operated on a monthly rotation covering all three major second-year subjects (likely Pathology, Pharmacology, and Microbiology based on the standard MBBS curriculum). Each weekend, one subject was examined, ensuring students were tested monthly in each subject.

This approach aligns with recommendations in the National Medical Commission (NMC) guidelines, which specify that "there shall be no less than three internal assessment examinations in each Para-clinical subject" in a professional year. The weekend format provided additional assessment opportunities beyond the minimum requirements.

Student Stratification and Batch Formation:

Based on their performance in these weekend examinations, students were strategically divided into four performance-based batches:

1. D Batch (Distinction): Students scoring above 75%, representing top performers
2. C Batch (Clever): Students scoring between 65% and 75%, forming the largest group
3. B Batch (Better): Students scoring between 55% and 65%, representing those with moderate performance
4. A Batch (Average): Students scoring below 55%, typically including slower learners

This stratification allowed for targeted interventions based on student needs, similar to the principles of competency-based medical education (CBME) that emphasize ongoing assessment and feedback. The dynamic nature of batch assignments meant students could move between batches based on their performance in different subjects, experiencing varied peer groups and teaching approaches.

Study Sessions and Teaching Methods:

Each batch attended weekly one-hour study sessions specifically designed to address their learning needs. These sessions functioned as a form of structured formative assessment, providing students with ongoing feedback about their progress. The approach incorporated elements of problem-based learning, which has been recognized as an effective small-group teaching methodology in medical education.

For higher-performing batches (C and D), sessions focused on advanced topics and competitive preparation, while for lower-performing batches (A and B), sessions emphasized essential concepts and fundamentals. This tailored approach aligns with educational theories suggesting that feedback should be specific to learner goals and adapt to individual needs.

Feedback Collection Mechanism:

A standardized questionnaire was used to collect feedback from both students and teachers about the program's effectiveness. This systematic feedback collection allowed for continuous improvement of the study program and ensured that both stakeholder perspectives were considered. The approach mirrors best practices in medical education assessment, where continuous monitoring of competencies and program evaluation is essential.

Table 1. Distribution of students in percentage after weekend exams

Student Performance Trends

The implementation of the weekend examination program demonstrated measurable improvements in student performance. Data collected throughout the year showed a significant shift of students from A and B batches (lower performance) to C and D batches (higher performance). This upward mobility indicates the effectiveness of the program in enhancing academic achievement.

The program's impact was particularly notable among initially poor performers, with a substantial number of students from the A batch progressing to B and C batches over time. This suggests that the regular assessment and targeted study sessions were especially beneficial for students who were struggling with the traditional curriculum structure.

Consistency in Performance

While there was a positive trend in overall performance, the data also revealed interesting patterns regarding consistency. Although the number of students in the A batch increased at certain points, these fluctuations indicated that consistency remained a challenge for some students. This highlights the importance of sustained intervention and support, especially for students at risk of falling behind.

The dynamic nature of batch assignments—allowing students to be in different performance groups for different subjects—acknowledged the reality that students may have varying strengths across different disciplines. This approach provided a more nuanced understanding of student performance compared to traditional assessment methods.

Stakeholder Perspectives

Student Feedback and Experiences

Students across all performance levels reported benefits from the program, though their experiences varied based on their academic standing:

1. Top Performers (D Batch) reported:

• Increased competitive attitude and motivation
• Sustained drive to excel, particularly when temporarily moved to a lower batch
• Enhanced preparation for university examinations

2. Moderate and Lower Performers (A, B, and C Batches) reported:

• Reduced perceived syllabus burden during final examinations
• Increased interest in subject matter
• Boosted confidence in their ability to pass examinations
• Decreased stress and anxiety about assessments
•  

Overall, students reported significant psychological benefits, including decreased stress levels and increased engagement with their studies. The program appears to have created a more supportive learning environment that encouraged ongoing preparation rather than last-minute cramming before major examinations.

Teacher Observations and Insights

Faculty members identified several advantages to the program:

1. Enhanced Student-Teacher Interaction: The smaller batch sizes and focused study sessions facilitated more meaningful interactions between faculty and students.
2. Individualized Attention: Teachers were able to provide more focused attention to each student's needs.
3. Adaptive Teaching Methods: Faculty could tailor their teaching approaches based on batch performance levels, allowing for more effective knowledge transfer.
4. Continuous Evaluation Platform: The program provided a structured mechanism for ongoing assessment rather than relying solely on periodic formal examinations.
5. Gradual CBME Sensitization: The approach helped sensitize students to competency-based medical education principles, which are becoming increasingly important in modern medical education.

However, teachers also noted several challenges:

1. Increased Workload: The program required significant additional effort in preparing weekend examination papers.
2. Evaluation Burden: Grading and providing feedback on monthly examinations added to faculty responsibilities.
3. Extended Working Hours: Since study sessions had to be conducted outside normal teaching schedules to comply with university guidelines, faculty experienced longer working days.

Appropriate assessment methods help students understand the focal points of the course and curriculum, thereby improving their confidence, enthusiasm, and creativity in learning [20]. This goal of deeper learning is usually achieved when knowledge is not restricted to isolated facts but is the result of an active learning process, where knowledge is fully understood and retained in context by the learner [6]. A previous study analyzed that medical students prefer individual feedback, which is very effective [7].

In this study, 71.3% of students became aware of their strengths and weaknesses in the concerned topics. McMillan and Hearn also observed that formative assessment encourages self-assessment, a process where students monitor and evaluate their thinking to improve their understanding [8]. Bruce and Chappuis considered self-reflection and goal setting as key aspects of self-assessment. With time and training, students become more responsible for evaluating how close they are to the learning target, identifying areas for improvement, and selecting learning strategies to achieve their goals [9, 10]. In their study they supported weekend learning as a powerful tool for students, similar results were found in our study.

A high percentage of students (86%) were satisfied with the formative assessment and wanted the process to continue in subsequent years. Many studies support this evidence, showing that students value quality feedback, which is identified as an important indicator of effective teaching [11, 12, 13]. Formative assessment can significantly enhance students' progress if they use these opportunities effectively and realize the need to develop their learning skills [14].

All faculty members (100%) agreed that the teacher-student relationship has improved with formative assessment specially through weekend assessments. Bloom’s Theory of Mastery Learning also states that formative assessment promotes student learning goals and helps develop the ideal teacher-student relationship, which is crucial for successful teaching and learning [15]. Previous studies have described that corrective or reinforcing feedback is essential in medical education, helping to promote learning and ensuring that standards are met [16]. In our study we found weekend learning as an effective tool for students, our results were also similar with the published studies.

Students must be motivated to use their knowledge to analyze, compare, and evaluate what they have learned rather than simply relying on rote memorization. This type of fortified learning lays the foundation for alternative types of assessment to measure academic benefits [17]. Providing students with a foundation in constructivism in the classroom may help support this type of teaching and learning process [18]. All faculty members supported the concept of formative assessment and favoured incorporating this process for future batches.

Future Directions and Recommendations

Based on the findings of this study, several recommendations can be made for medical education programs considering similar initiatives:

1. Integration with Curriculum: Weekend examinations should be formally integrated into the curriculum structure rather than added as an extra component.
2. Faculty Development: Training faculty in effective feedback methods could enhance the educational impact of the program.
3. Technology Integration: Utilizing online assessment platforms could reduce the workload associated with paper setting and evaluation.
4. Balanced Batch System: While performance-based grouping showed benefits, ensuring a supportive atmosphere that celebrates improvement rather than just achievement is crucial.
5. Long-term Outcome Assessment: Future studies should examine whether improved performance in weekend examinations translates to better outcomes in university examinations and clinical competence.

The structured weekend examination program represents a promising approach to enhancing medical education in the challenging second year of MBBS studies. By combining regular assessment opportunities with targeted study sessions, the program demonstrated significant improvements in student performance and engagement. Despite the additional workload for faculty, the educational benefits appear to justify the investment of time and resources.

The success of this approach highlights the importance of continuous assessment and feedback in medical education. As medical institutions continue to transition toward competency-based curricula, programs that provide regular, structured assessment opportunities with targeted interventions may play an increasingly important role in preparing competent, confident medical professionals. The principles demonstrated in this study could be adapted to different contexts and stages of medical education to enhance learning outcomes and student experiences.

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