Evaluating the Efficacy of Formative MCQs on Student Learning Outcomes in Cardiovascular System Biochemistry

Abstract

Medical students often have problems with the application of abstract biochemical concepts to clinical practice, and this problem is especially evident in complex modules such as cardiovascular system biochemistry. Formative multiple-choice questions (MCQs) have shown promise in bridging this gap; however, limited research exists on their integration into cardiovascular biochemistry curricula. This study aimed to evaluate the efficacy of weekly formative MCQs on student engagement, self-assessment, critical thinking, and exam preparedness in a cardiovascular biochemistry module. A prospective, single-cohort educational study was conducted during a 7 week cardiovascular biochemistry module at University Geomedi, Tbilisi, Georgia. Participants were 120 second year medical students who completed weekly formative MCQs designed to emphasise clinical application across seven topics. After the module and final examination, students completed an anonymous 12 item questionnaire comprising 10 quantitative Likert-scale items and two open ended questions. The response rate was 100%. Mean scores were high across all domains: engagement (4.77/5), learning and self assessment (4.66/5), critical thinking (4.58/5), exam preparedness (4.43/5), and overall satisfaction (4.52/5). The highest "Strongly Agree" ratings were obtained for engagement (Question 1, 85.8%), knowledge gap identification (Question 3, 81.7%), and motivation to attend seminars (Question 2, 71.7%). Disagreement rates were minimal (0–2.5% across items). Qualitative thematic analysis revealed four dominant advantages: self assessment and knowledge gap identification, readiness for exams, clinical reasoning and application, and engagement with active participation. Minor challenges included requests for more clinically complex questions, occasional time constraints, and public participation anxiety for a small number of students. This study demonstrates that weekly formative MCQs in cardiovascular biochemistry are highly accepted by medical students and perceived to enhance engagement, self directed learning, clinical reasoning, and exam preparedness while reducing exam anxiety. Future research should correlate MCQ performance with final exam scores and assess long term knowledge retention.