Formative Assessment and Feedback in First-Year Nursing Anatomy Education: Student Perceptions and Association with Summative Examination Performance

Background: Formative assessment (FA) coupled with structured feedback is increasingly recognized as a means of supporting learning in human anatomy, a foundational yet challenging discipline for first-year nursing students. This study examined first-year nursing students’ perceptions of FA and feedback in theoretical and practical anatomy sessions and examined their association with performance in the summative examination, which incorporates both written and practical components. Performance comparison is exploratory and non-causal. Methods: This study combined a cross-sectional questionnaire survey of student perceptions with a single-group, sequential within-cohort (quasi-experimental) comparison of summative examination scores at the College of Medicine and Health Sciences, Arabian Gulf University (CMHS-AGU), Bahrain, during the 2024–2025 academic year. First-year nursing students received standard anatomy instruction without FA in semester one (Anatomy I) and the same instruction with a structured FA-and-feedback intervention in semester two (Anatomy II). A 21-item, 5-point Likert-scale questionnaire plus two open-ended questions was administered at the end of semester two; 226 students responded (response rate 90.4%). Summative marks from both semesters were available for 244 students who sat both examinations and were compared using paired-samples t-tests. Questionnaire reliability was assessed by Cronbach’s alpha and construct validity by exploratory factor analysis (EFA); subgroup differences by independent-samples t-tests, and open-ended responses by thematic analysis. Statistical significance was set at p < 0.05. Results: The questionnaire showed excellent internal consistency (Cronbach’s α = 0.93), and EFA supported a three-factor structure explaining 56.63% of the total variance. Student perceptions were strongly positive, with an overall satisfaction mean of 4.66 (±0.61). Mean summative marks were significantly higher in Anatomy II (with FA: 72.82 ± 16.24) than in Anatomy I (without FA: 71.78 ± 15.33; t = −2.43, p = 0.016), but the mean paired difference was approximately one percentage point (95% CI 0.20–1.88) and the effect size was small (Cohen’s d_z = 0.16), indicating limited educational significance. Perceptions did not differ significantly by gender, country of origin, or prior FA exposure; however, students from national high-school curricula reported higher satisfaction than those from international curricula (p = 0.041). Qualitative responses emphasized preparation for the Objective Structured Practical Examination (OSPE), improved conceptual understanding, and reduced exam anxiety, with requests for more questions, wider question formats, and dissemination of FA materials via the learning management system (LMS). Conclusions: Structured FA and feedback were positively perceived by first-year nursing students and were associated with a small, statistically significant difference in summative examination scores. Because the program was introduced for the entire cohort in the second semester, this association cannot be separated from semester-related progression, differences in course content, and increasing student experience. The findings support the acceptability and perceived educational value of FA in this setting. However, controlled, multi-institutional studies are needed before firm recommendations about its effect on examination performance can be made.