Novel hybrid exam introduces new medical students to collaborative learning and board style questions 2306372

Introduction 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. Funding Source This project was supported by the ITLE Healthcare Education Grant Award (HEGA) awarded to Dr. Cusick, and by a CNUCOM intramural grant awarded to Dr. Gerriets.