Medical Student, MS2 California Northstate University, College of Medicine San Diego, California, United States
Disclosure(s):
Lyndsey Hightower: No financial relationships to disclose
Introduction/Rationale: NBME (National Board of Medical Examiners)–style questions underpin medical school exams, yet opportunities for collaborative engagement with content is limited by disclosure policies. Two-stage ungraded hybrid exams—completed individually and then in small groups—may improve reasoning, clarify misconceptions, and reduce anxiety around vignette-based items, especially in immunology. This study evaluated how a hybrid exam influenced first-year medical students’ (MS1s) learning experiences and readiness for a graded summative exam.
Methods: This longitudinal study surveyed MS1s at baseline, after the hybrid exam, and after the summative exam using Likert-scale items assessing confidence, strategies, anxiety, belonging, and collaboration. Identical items enabled longitudinal comparisons, and Wilcoxon signed-rank tests analyzed change scores.
Results: At baseline, confidence with NBME-style questions (M = 3.39, n = 80) and multistep vignettes (M = 3.13) was modest, while anxiety (M = 5.24) and intimidation (M = 5.15) were elevated. After the hybrid exam, clarity improved (M = 5.03, n = 65), understanding increased (M = 5.26), peer support strengthened (M = 5.58), and anxiety decreased (M = 4.92). Following the summative exam, students applied hybrid-exam strategies (M = 5.29, n = 56), felt better prepared (M = 5.54), and showed improved understanding (M = 5.07) and confidence (M = 5.23). Longitudinal analyses revealed significant gains in study strategies (median Δ = +2.5), materials knowledge (Δ = +3), time management (Δ = +1), belonging (Δ = +1), and composite preparedness (median Δ = +2.17), all p < .001.
Conclusion: A hybrid NBME-style exam may aid MS1s’ transition into board-style reasoning by improving clarity, understanding, and exam approach. Early exposure to NBME material—particularly in immunology—may strengthen test-taking strategies and reduce exam stress. Future work should assess whether these gains translate to objective outcomes and if the model can be tested at other medical schools.
