The Impact of an Exam “Safety Net” Program in a Pre-Clinical “Foundations” Course on Test Scores, and Students’ Perception of the Learning Environment

Introduction: Since the first high-stakes exams of medical school can promote anxiety and impede assessment for learning, it is important to evaluate programs designed to address these issues. We studied the impact of an exam “safety net” program (SNP), which enabled low-scoring students to raise their score via a learning exercise, on class-wide exam performance and the student’s perception of assessment for learning and wellness. Methods: A SNP was implemented in the AY22–23 and AY23–24 Foundations course for our two summative mid-term exams. The SNP was not offered for the comprehensive final exam. We compared class-wide aggregated non-adjusted Foundations exam data from the AY21–22 class (no intervention) to the intervention classes. The SNP’s impact on students’ perception of assessment and the learning environment was analyzed via anonymous surveys and two focus groups. Results: Non-adjusted mean scores on Foundations mid-term and final exams for classes with the SNP were slightly higher than the AY21–22 class. Low-scoring students who participated in the SNP learning exercise exhibited an increase in scores on subsequent Foundations exams greater than the class as a whole. Students perceived the SNP to be associated with mastery learning, study strategy experimentation, a low-anxiety introduction to the testing process, and collaborative learning among students and faculty. Discussion: The impact of remediation on struggling students has been well-studied. Less attention has been paid to the class-wide impact of SNPs on the learning environment. Our SNP was associated with favorable student perceptions of the learning environment in the transition to medical school, without compromising performance on exam-based knowledge metrics.