Frequent Low-Stakes Formative Testing as a Mechanism to Reduce Academic Anxiety Among Second-Year Medical Students: A Narrative Review

Muad Fahmi Yousef¹, Musaab Fahmi Yousef², Mohammed Tareq Yousef³

Keywords: Medical students, academic anxiety, low-stakes testing, formative assessment, retrieval practice, well-being

DOI: 10.63475/yjm.v5i2.0460

DOI URL: https://doi.org/10.63475/yjm.v5i2.0460

Publish Date: 05-08-2026

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Pages: 258 - 263

Views: 1

Downloads: 5

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Author Affiliation:

1 Medical Student, Medipol University, Istanbul, Turkey
2 Medical Student, University of Jordan, School of Medicine, Amman, Jordan
3 Medical Student, Emirate International University, Faculty of Medicine and Health Sciences, Sana’a, Yemen

Abstract

Academic anxiety is highly prevalent among medical students and is particularly pronounced during the second year of undergraduate medical education, when increasing curricular complexity and frequent high-stakes examinations may adversely affect learning, psychological well-being, and academic performance. Frequent low-stakes formative testing has emerged as a promising educational strategy that promotes continuous learning while potentially reducing assessment-related anxiety. This narrative review examines the current evidence regarding the effectiveness of frequent low-stakes formative assessment in alleviating academic anxiety among second-year medical students and explores the psychological and educational mechanisms underlying its benefits. Relevant peer-reviewed literature published between 2005 and 2024 was identified through searches of PubMed, Scopus, Web of Science, and Google Scholar, focusing on formative assessment, retrieval practice, educational psychology, test anxiety, and medical student well-being. The available evidence indicates that regular low-stakes assessments improve knowledge retention while reducing anxiety through multiple complementary mechanisms, including increased familiarity with examination conditions, enhanced retrieval practice, improved metacognitive awareness, strengthened self-efficacy, reduced fear of failure, normalization of assessment, and timely formative feedback. However, the current evidence is limited by methodological heterogeneity, reliance on self-reported anxiety measures, predominantly observational study designs, and limited data specifically involving second-year medical students. Excessive assessment frequency and poor-quality feedback may also diminish the psychological benefits of formative testing. Overall, frequent low-stakes formative assessment represents an evidence-informed approach that can enhance both learning and student wellbeing when thoughtfully integrated into medical curricula. Future multicenter longitudinal and randomized studies are needed to establish optimal implementation strategies and evaluate sustained effects on academic anxiety, resilience, and educational outcomes.

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