title: Cumulative assessment: strategic choices to influence students' study effort.
abstract: BACKGROUND
  It has been asserted that assessment can and should be used to drive students' learning. In the current study, we present a cumulative assessment program in which test planning, repeated testing and compensation are combined in order to influence study effort. The program is aimed at helping initially low-scoring students improve their performance during a module, without impairing initially high-scoring students' performance. We used performance as a proxy for study effort and investigated whether the program worked as intended.
  
  
  METHODS
  We analysed students' test scores in two second-year (n = 494 and n = 436) and two third-year modules (n = 383 and n = 345) in which cumulative assessment was applied. We used t-tests to compare the change in test scores of initially low-scoring students with that of initially high-scoring students between the first and second subtest and again between the combined first and second subtest and the third subtest. During the interpretation of the outcomes we took regression to the mean and test difficulty into account.
  
  
  RESULTS
  Between the first and the second subtest in all four modules, the scores of initially low-scoring students increased more than the scores of initially high-scoring students decreased. Between subtests two and three, we found a similar effect in one module, no significant effect in two modules and the opposite effect in another module.
  
  
  CONCLUSIONS
  The results between the first two subtests suggest that cumulative assessment may positively influence students' study effort. The inconsistent outcomes between subtests two and three may be caused by differences in perceived imminence, impact and workload between the third subtest and the first two. Cumulative assessment may serve as an example of how several evidence-based assessment principles can be integrated into a program for the benefit of student learning.
authors.affiliation: Center for Research and Innovation in Medical Education, University of Groningen and University Medical Center Groningen, Ant, Deusinglaan 1, FC40, 9713, AV Groningen, The Netherlands. w.kerdijk@umcg.nl.
authors.forename: Wouter
authors.initials: W
authors.lastname: Kerdijk
authors.forename: René A
authors.initials: RA
authors.lastname: Tio
authors.forename: B Florentine
authors.initials: BF
authors.lastname: Mulder
authors.forename: Janke
authors.initials: J
authors.lastname: Cohen-Schotanus
mesh_terms: D004501:Education, Medical / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D006801:Humans; D015397:Program Evaluation; D013337:Students, Medical / Q000523:psychology*