Replacing the cumulative final with multiple low-stakes assessments: a teaching method designed to enhance long-term retention

There is evidence that test anxiety can hinder learning 1 and that intense studying at the end of a semester is not conducive to long-term knowledge acquisition 2. In traditional physiology courses, students have long been assessed through cumulative exams at the end of the semester. We hypothesized that replacing a large cumulative exam with weekly quizzes, would increase student learning by increasing active recall and engagement with the material throughout the semester and reducing stress surrounding final exams. In a graduate-level Neurophysiology course, student learning was assessed through weekly quizzes comprising 10 multiple-choice questions that reviewed material covered the previous week. Students dropped their lowest two quiz scores and in total the scores contributed 50% of their course grade. In one semester of the course a cumulative final quiz was also administered, worth 10% of the grade. The remainder of the student assessment in the course was through primary research literature analysis and discussion, in addition to student presentations. Following the course, students were surveyed and the quiz performances were assessed. Across three years 75% of students reported that the class format worked well for them. In survey narrative comments a number of students described being very happy with the weekly quizzes helping them to stay on track with their studying. A number of students also cited reductions in stress as a result of the quiz format. One additional finding that students reported and that teaching faculty also observed, was that this regular assessment structure encouraged them to study throughout the semester and stay up to date with the material. One advantage of students being up to date throughout the semester was that it ensured a background understanding of content, which helped prepare them for subsequent topics and engage more with the material in class. Over three years the average score in the weekly quizzes was 86% +/- 6. In the cohort of students that received the cumulative final the average score was 83% +/- 5.71. This data suggests there was no significant learning loss between the weekly quizzes and final cumulative quiz taken at the end of the semester. In summary we conclude that weekly quizzes are effective in ensuring students are studying throughout the semester. We intend to continue to assess the impact on learning that periodic low-stakes quizzes with and without a cumulative final have on long-term physiology knowledge acquisition and retention. 1. Nora Alshareef et al. Med Educ Online. 2025 May 17;30(1):25051772. Eugène J F M Custers. Adv Health Sci Educ Theory Pract. 2010 Mar;15(1):109-128 This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.