A Longitudinal Study of Student Feedback Integration in Medical Examination Development

Examinations are essential in assessing student learning in medical education. Ensuring the quality of exam questions is a highly challenging yet necessary task to assure that assessments are equitable, reliable, and aptly gauge student learning. The aim of this study was to investigate whether the incorporation of student feedback can enhance the quality of exam questions in the Renal and Urinary System course, offered to second-year medical students. Using a single-arm between-person survey-based design, we conducted an a priori power analysis to establish the sample size. The exam comprised 100 multiple-choice questions written by a panel of 31 instructors. A total of 125 medical students took the exam in 2021. Following the exam, student feedback was collected, resulting in the revision of 12 questions by two subject experts. In the following year, the revised questions were administered to a new cohort of 125 second-year medical students. We used Fisher's z-transformation to test the significance of differences in point-biserial correlations between the 2021 and 2022 cohorts. The results reveal that 66% of the revised exam questions exhibited significantly higher point-biserial correlations. This demonstrates the positive impact of involving students in the exam revision process. Their feedback enhances question clarity, relevance, alignment with learning objectives, and overall quality. In conclusion, student participation in exam evaluation and revision can improve the quality of exam questions. This approach capitalises on students experiences and feedback and complements the traditional approaches to ensure the quality of exam questions, benefiting both the institution and its learners.