Incentivized formative quiz engagement and assessment performance: a multiple-campus observational study of student response profiles

Abstract

Foundational basic science courses in early health sciences curricula are characterized by high conceptual density, complex disciplinary content, and large student enrollments. In this demanding environment, students frequently rely on superficial rote memorization rather than deep conceptual understanding, compromising the overarching curricular goal of establishing robust scientific foundations for subsequent clinical training. The pedagogical strategy implemented in this study consisted of an instructional framework combining weekly curated short instructional videos with asynchronous, incentivized online formative quizzes, designed to provide students with opportunities to identify conceptual gaps and perform active retrieval practice. Utilizing a multi-campus, observational quasi-experimental design across two consecutive cohorts of first-year dental students ( N  = 771), the association between active quiz completion (Responders) and raw summative examination performance was analyzed. Active participation in the strategy was significantly and positively associated with raw summative examination scores across all evaluation periods (Cohen's d  = 0.37–0.77), with continuous milestone completion accounting for 14.1% of the total variance in overall semester performance ( η 2  = 0.1409). Additionally, a concept-matched anchor-question design aligned with Bloom's revised taxonomy was implemented ( N  = 412) to explore whether active participation was associated with item-level performance on higher-order questions, operationalized into categorical response profiles (Null, Basic, and Deep). Although small effect sizes were observed (Cramer's V  = 0.10–0.11), item-level response profile distributions between Responders and Non-responders did not reach statistical significance following False Discovery Rate adjustment ( p adj >.25). The instructional design described here provides an adaptable, operationally scalable formative framework for large-enrollment health science courses. Prospective and longitudinal studies will be valuable to further investigate the relationship between continuous formative scaffolding and both long-term knowledge retention and higher-order analytical performance.