Promoting self-regulated learning: using online question bank testing system to improve the efficiency of regular quizzes

Abstract

Background

Anatomy is regarded as the basic course of medical science. It has the characteristic of a large number of contents, which makes it difficult for students and requires medical students to develop great self-learning ability. Chinese medical students are typically accustomed to passively receiving knowledge. This study aims to utilize the Wen Juan Xing (WJX) platform for in-class quizzes to explore its impact on the learning outcomes of medical students in anatomy courses and to cultivate their self-directed learning habits.

Methods

The experimental group consisted of 369 undergraduate students from the 2018 cohort of the Clinical Medicine program at Zhongshan School of Medicine, Sun Yat-sen University. The control group comprised 386 students from the 2017 cohort. During the Systematic Anatomy course for the 2018 cohort, five WJX in-class quizzes were conducted, averaging one every 3–4 weeks. The quiz scores contributed to the overall course assessment (accounting for 30%). An online questionnaire survey was administered to all 2018 cohort students enrolled in the Systematic Anatomy course to gather their subjective evaluations of the WJX quizzes.

Results

The final exam average score of the 2018 cohort (75.79 ± 13.81) was significantly higher than that of the 2017 cohort (67.52 ± 17.15). The passing rate (88%) was also significantly higher than that of the 2017 cohort (74%). Questionnaire results indicated that over 95% of students held a positive attitude towards the WJX quizzes, believing they improved their self-learning abilities. More than 90% of students reported that the quizzes helped them develop more suitable study plans and cultivate better learning habits. Students widely agreed that the WJX quizzes encouraged regular review, reduced end-of-term exam preparation pressure, and enhanced learning motivation.

Conclusion

WJX in-class quizzes were associated with significantly higher medical students’ academic performance in the anatomy course, students perceived that their self-directed learning abilities were enhanced, and fostered the development of effective learning habits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-09646-1.

Background

Anatomy is a basic compulsory course for every medical student. However, students always have difficulty in learning this course, because there are a lot of terminologies and detailed knowledge points in anatomy course [1–3]. Most medical colleges in China offer anatomy courses for freshmen, but Zhongshan School of Medicine of SYSU divides the anatomy course into two stages in order to reduce the learning pressure of students and establish a close connection between the practical operation of anatomy and clinical courses. In the first stage, 90 class hours of systematic anatomy course will be provided for freshmen; in the second stage, 72 class hours of regional anatomy courses will be set up for junior students majoring in clinical medicine. Although we hope that splitting the courses will alleviate some of the learning pressure, many freshmen still have learning difficulties, and even fail to pass the exam. The main reason is that freshmen lack the ability of self-discipline, self-learning and active learning.

In the context of China’s examination-based education and admission system, students are used to passively receiving knowledge rather than actively seeking it. The constant supervision by parents and teachers also results in low self-learning ability. Therefore, it is usually difficult for freshmen to quickly adapt to the new study and living environment and a large amount of medical knowledge. The maladjustment affects the students’ learning of anatomy courses, but also affects the students’ future learning of medical courses [4]. Some studies have shown that in-class quizzes can arouse students’ learning motivation, help teachers to master the teaching situation in time, enhance the interaction between teachers and students, and thus improve the quality of teaching [5, 6]. Therefore, we believe that using in-class quizzes to encourage students to learn independently, enhance their independent learning ability, improve their self-discipline and help them form good learning habits, which can help students learn anatomy courses and be beneficial to their future learning. However, it is not easy to organize in-class quizzes appropriately. After all, the annual enrollment of medical students in China is relatively large, so it will be difficult to set questions and correct papers frequently.

WJX website is a portal that can help create large-scale questionnaires and conduct online exams in China. Through this website, exam papers can be created freely, conveniently and efficiently. Each exam paper created on the WJX website corresponds to a QR code, and students can take the quiz on their mobile phones or computers by scanning the QR code through WeChat (the most popular social media platforms in China). After students submit their answers, the WJX system automatically corrects and grades them. This method does not require teachers to spend a lot of time and energy on correction, but can help teachers accurately find the problems in their teaching and deal with students’ confusions in a timely manner, making the teaching process efficient and convenient. University teachers are under great pressure of scientific research and heavy teaching tasks, so, using WJX website to conduct in-class quizzes improves teachers’ work efficiency. Teachers do not need to set up examination rooms or correct test papers. In addition, WJX can replace the registration process and help teachers avoid wasting time on roll call; it can also monitor students’ attendance to some extent.

Nowadays, in the context of “Internet plus education” models, new intelligent teaching modes such as MOOC (Massive Open Online Course) and digital virtual simulation teaching, and new teaching patterns such as problem-based learning (PBL), case-based learning (CBL), team- based learning ((TBL) and flipped classroom have developed rapidly. In general, putting students at the center and encouraging them to learn independently are at the core of these new teaching patterns. Students should play the most critical roles in the teaching process [7–9]. This study aims to find out how to reasonably apply the in-class quiz of WJX to the conventional teaching of anatomy course, thereby cultivating student’s independent study ability and promoting their learning.

Methods

Overview

This study utilized a historical cohort comparison design. Data were collected from two cohorts of students enrolled in the systematic anatomy course during the academic years 2017 (pre-implementation) and 2018 (post-implementation). The experimental subjects were the 369 students majoring in clinical medicine from Class 4–15 of Grade 2018 who did in-class quizzes, while the control group consisted of the 386 students majoring in clinical medicine from Class 4–15 of Grade 2017 who did not have in-class quizzes. The 2017 and 2018 cohorts had comparable entry scores based on university admission records. Both cohorts followed the same curriculum syllabus, were taught by the same faculty team, and completed final examinations with equivalent difficulty levels. To objectively evaluate whether in-class quizzes help improve students’ grades, a retrospective analysis was conducted on the performance of the experimental group and the control group in the final exams of the systematic anatomy course. At the end of the course, we collected feedback from the students who participated in the systematic anatomy course ( students majoring in clinical medicine, stomatology, and public health) by sending survey questionnaires through WJX platform, and got 389 feedbacks(369 from clinical medicine majors), in order to know students’ evaluation of WJX in-class quizzes.

In-class quizzes

2017 control cohort: No in-class quizzes; final exam accounted for 50% of the total course grade. 2018 intervention cohort: Five WJX in-class quizzes (30%), sample test (30%), and final exam (40%). During the Systems Anatomy course, 5 in-class quizzes were given to students in the experimental group, with an average interval of 3 to 4 weeks. Students were informed in advance that the in-class quiz would count toward their final grade. To prevent students from cheating, the WJX system had many features such as randomizing the order of questions and options anti-screen cutting function and automatic submission function (if there was no corresponding operation within a certain period of time, the paper would be submitted automatically). All in-class quizzes were announced to students in advance and administered on time. Each in-class quiz typically contained 15 multiple-choice questions. Testing time varied depending on the complexity of the questions, but was usually limited to 15 min. The in-class quizzes usually consisted of key points of the courses, some anatomical analysis, clinical case analysis, and so on. Once the quizzes were submitted, the WJX backend would provide real-time feedback so that the instructors could master the average grades, score segmentation, accuracy rate, etc., and have a clear understanding of the problems during the teaching process. The results could also reflect the students’ deficiencies and encourage them to reflect on their learning processes. (Table 1).

Table 1.

Online test contents, time points and question type

No.	Test contents	Test time	Test format
1	Motor system	4th week	15 multiple choices
2	Digestive, respiratory, urinary, and reproductive systems	8th week	15 multiple choices
3	Cardiovascular, endocrine systems, and sensory organs	11th week	15 multiple choices
4	nervous system1	13th week	15 multiple choices
5	nervous system2	16th week	15 multiple choices

Questionnaire survey

An online questionnaire survey was conducted on grade 2018 students from all majors at Sun Yat-sen University to understand their attitudes, suggestions and opinions towards the WJX in-class quiz. The questionnaire survey was also generated through the WJX platform, consisting of two parts: fill in the blank questions and multiple-choice questions. The questionnaire was developed by the research team based on a review of relevant literature on formative assessment and self-regulated learning in medical education. Items were designed to capture students’ perceptions across three domains aligned with Zimmerman’s cyclical model of self-regulated learning: (1) forethought phase (e.g., ‘The quizzes helped me develop more suitable study plans’), (2) performance phase (e.g., ‘The quizzes helped me pay more attention when studying’), and (3) self-reflection phase (e.g., ‘The quizzes helped me understand my knowledge gaps’). The questionnaire underwent initial review by three anatomy educators with expertise in educational assessment to ensure content validity and clarity. Minor wording revisions were made based on their feedback before distribution. Among them, six questions about students’ subjective attitudes were measured by the Likert scale [10]. In this scale, the answers were divided into 5 levels, 1 point (very negative), 2 points (negative), 3 points (neutral), 4 points (positive), and 5 points (very positive). The survey was anonymous and on a voluntary basis.

Data analysis

We retrospectively analyzed the performance of the experimental group (all students from clinical majors in Class 4–15 of grade 2018) and the control group (all students from clinical majors in Class 4–15 of grade 2017) in the final exam of the systematic anatomy course. Both examination questions for grade 2017 and 2018 referred to the knowledge points in the teaching syllabus, including 30 multiple-choice questions, noun explanations, short answer questions, and Q&A questions. All statistical analysis was completed by the IBM SPSS 23.0 statistical software. We used independent sample T-test to analyze the final exam grades of the two groups of students, chi square test to analyze the number of students in different score ranges, Likert scale, and Cronbach’s alpha to analyze the results of the questionnaire survey.

Results

Comparison of final exam scores

The mean final exam score (75.79 ± 13.81, n = 369) of the 2018 students who participated in the WJX in-class quizzes in the Systems Anatomy course was better than the mean final exam score (67.52 ± 17.15, n = 386) of the 2017 students who did not participate in the in-class quizzes, which showing a significant difference between the two groups of students (Fig. 1A).Further analysis of score distributions (Fig. 1B; Table 2) revealed significant differences between cohorts across most score ranges (p < 0.05), with the exception of the 70–79 range. Notably, the pass rate of the 2018 cohort (88%) was significantly higher than that of the 2017 cohort (74%) (p < 0.05), and the proportion of students achieving high scores (≥ 80) increased substantially from 29% to 50%.Chi-square analysis of pass rates (χ²= 41.02, p < 0.001, Cramer’s V = 0.233) showed a small to moderate effect, reflecting practically significant gains in the proportion of students successfully mastering course content.

Fig. 1.

Comparing the performance of grade 2017 students (386) and grade 2018 students (369) in the final examination of anatomy courses; A. Compare the average grades of two groups of students; B. Compare the number of students in different grade ranges between two groups* P < 0.05 indicates a difference between the two groups

Table 2.

The Number of Student in Different score ranges

Grade	the Number of Students in Different score ranges
	0–59	60–69	70–79	80–89	90–100	Total
2017	102	81	91	95	17	386
2018	49	45	92	137	46	369

Range 1, 0–59; Range 2, 60–69; Range 3, 70–79; Range 4, 80–89; Range 5, 90–100

The results of the questionnaire survey

A total of 389 valid questionnaires were received from students of dentistry, public health, and clinical medicine. The third to eighth questions in the questionnaire were about the students’ subjective feelings about the “WJX” in-class quiz. Here the results of these 6 questions are presented and analyzed in the form of a five-component scale (Table 3). The six Likert-scale items demonstrated high internal consistency (Cronbach’sα = 0.932), indicating strong reliability. These items were designed to capture students’ perceived engagement with self-regulated learning processes as conceptualized in Zimmerman’s model, though we acknowledge they represent subjective perceptions rather than validated measures of self-regulated learning competency.

Table 3.

Likert scale

1 point (very negative), 2 points (negative), 3 points (neutral), 4 points (positive), and 5 points (very positive).Factor 1: attitudes to the online formative quizzes; Factor 2: obtained benefits

The results showed that more than 95% of the students had a positive attitude toward the WJX in-class quiz. Also, more than 95% of the students perceived improvement in the “WJX” in-class quiz helped them improve their self-learning ability. In addition, more than 90% of the students believed that the WJX in-class quiz helped them understand the knowledge (4.15 ± 0.99). More than 95% of the respondents believed that the WJX in-class quiz helped them to pay more attention when studying anatomy courses (4.35 ± 0.83). Students believed that the WJX in-class tests helped them develop appropriate study plans and cultivate better study habits (4.25 ± 0.89).

We have received feedbacks from some students. Message 1: I think this kind of WeChat in-class quiz is excellent and can urge us to review.Very good. Message 2: This teaching method is really good. On the one hand, it encourages students to study; on the other hand it reduces the pressure on students to prepare for the final exam, and helps students master the knowledge better. Thanks teachers. Message 3: Telling the truth, the in-class quizzes clearly improve my motivation for learning. Maybe I’m not the only one who feels like this.

Discussions

The teaching philosophy of university is to encourage students to enhance their self-learning ability, which is very different from that of high school education, emphasizing instilling knowledge. However, most freshmen still have not broken away from the high school learning mode, so their learning is relatively passive, with poor self-learning awareness. Having passed the college entrance examination just now, they are in a loose state and slacked off in their studies. Therefore, although teachers repeatedly emphasize the importance of self-directed learning and the difficulty of anatomy courses, it still makes little sense. It is necessary to find a way to cultivate and strengthen students’ self-directed learning abilities [11, 12].

Researches have shown that high-density in-class testing can help improve students’ academic performance [13]. In-class quiz as an important part of formative assessment can give teachers effective feedbacks, help teachers master the students learning progress, and promote the teaching. Teachers in Chinese universities have heavy scientific research tasks and high teaching pressure [8]. Therefore, organizing written exams is a heavy burden for teachers; also, it cannot provide real-time feedback on teaching situations, and it’s not conducive to conducting formative evaluations. So there was almost no regular test for this course in the early stages, which gave rise to both teachers and students being largely unable to find the problems that arose during the teaching and learning processes. We hope that we can solve the problem through the combination of the WJX platform and WeChat.

The WJX platform provides technical support for creating and delivering electronic test papers, offering features such as QR code access and automated grading [14]. Teachers can see the feedback of each student, the distribution of accuracy for each question, and the average score of the entire class. Teachers can also find the problem in teaching by analyzing the questions with low scores, and explaining the corresponding knowledge. Besides, teachers can also pay more attention to students with poor scores, understanding their difficulties and helping them improve their learning methods. In addition, online quizzes also push students to attend classes, as students who are late or absent will have no grades in the online quizzes, which is equivalent to the roll calling. Teachers do not need to spend time on roll calling, which greatly improve teaching efficiency. At the same time, it can also prevent students from “proxy roll call”, so it is more accurate than traditional roll calling. The in-class testing method has many advantages such as convenience, efficiency, and real-time feedback, which can ensure the effectiveness of formative evaluation technologically to a certain extent.

In this study, we analyzed the final exam scores of two grades, which shown that the “WJX” in-class quizzes had a positive effect on students’ academic performance. Comparing the final exam scores of systematic anatomy courses, the average score and the pass rate of grade 2018 students who underwent the WJX in-class quizzes was higher than that of grade 2017 students who did not undergo the WJX in-class quizzes, both of which were statistically significant (P < 0.05). The moderate to large effect size (d = 0.53) for final exam scores provides evidence that the WJX quizzes contributed to educationally meaningful improvements in student performance, beyond mere statistical significance.

Further analyzed the scores of the two groups, we found significant differences in the number of students in the first, second, fourth, and fifth score ranges (Fig. 1B). The results shown that in the final assessment, the proportion of students with low grades decreased after underwent in-class quizzes; especially the number of students who fail the exam was significantly reduced, while the proportion of students with high grades was significantly increased. The small to moderate effect on pass rates (V = 0.233) further supports the practical value of this intervention for reducing failure rates—a key concern in anatomy education.”

As is well known, students who enter the same school and major perform similarly in the college entrance examination, which means that their learning abilities are at the same level, especially in the first year of university. So the lack of autonomous learning ability is the culprit of poor performance in final exams. The in-class quizzes could urge students with poor autonomous learning abilities to focus on their studies and get higher grades. That is, the external pressure prompted these students to review actively, so that they have shown significant progress in final exam.The different grading weighting between cohorts may constitute an alternative explanation for the observed score improvement. The 2017 cohort’s final exam accounted for 50% of the total grade, representing a high‑stakes single summative assessment, whereas the 2018 cohort’s final exam contributed only 40%, with 30% of the grade already determined by regular quizzes. This lower-stakes final exam may have reduced test anxiety and influenced examination performance independently of changes in self-regulated learning. We acknowledge this grading structure difference as an important methodological limitation of this historical cohort study.

The subjective evaluation of the questionnaire survey also proved the positive impact of the WJX in-class quizzes. Most students highly agreed with the WeChat in-class testing method, which helped them improve their performance, develop good learning habits and adjust their learning plans timely; encouraged them to learn autonomously and better adapted to future learning. Most students believed that they benefit from it and were in favor of applying the WJX in-class testing method to medical teaching. However, it is important to acknowledge that because the quizzes contributed 30% to the final grade, the observed improvements may reflect not only enhanced self-regulated learning behaviors but also increased assessment exposure and the motivational impact of grade incentives. Though it seemed like a passive learning behavior under the pressure of tests at the beginning, it would gradually become a good habit of active learning. It could also be seen that students highly affirmed the positive role of in-class quiz in promoting their learning.To further clarify the independent effects of the online quiz tool and grade incentives, future research could employ a low-stakes, ungraded version of the WJX quizzes to isolate the impact of regular formative assessment from that of grade-related motivation.

Limitations of the study

During the study, we found that there are still some bugs and weaknesses in this kind of in-class quiz. Students might make mistakes during the tests due to nervousness and cause flashback of electronic paper. Sometimes, unstable cell phone signals, system stutters or even crashes could also affect students answering questions.To ensure fairness during technical issues (e.g., stuttering or flashing), we suggest preparing a paper-based backup and a clear protocol. Affected students may pause the timer, report the issue, and switch to the supervised paper version if needed, preserving assessment continuity and equity. The paper-based backup plan was applied to a small number of individual students in the 2018 cohort who encountered technical issues with the online quiz system. For the vast majority of students, all quizzes were completed via the WJX online system under teacher supervision. At the same time, we strengthened the control and supervision. In order not to interfere with the lesson plan, the test time was controlled at about 20 min or even shorter. The paper consisted mainly of objective questions, not subjective questions, which meant that the test content and method were not comprehensive enough. More research is needed on the appropriate proportion of questions.

There were still some shortcomings in this study.Although the 2017 and 2018 cohorts had comparable college entrance scores, we cannot fully exclude potential unmeasured environmental or cohort differences, such as changes in campus academic atmosphere, concurrent curriculum adjustments, or variations in student motivation and learning habits across years. Several limitations related to academic integrity, learning environment control, and technological equity should be considered when interpreting our findings Although the two student cohorts exhibited similarities, it is not possible to completely rule out unmeasured cohort effects, such as differences in student motivation or other external factors. The assessment of self-regulated learning improvement relied on self-reported perceptions via Likert-scale questionnaires rather than validated objective measures. The “WJX” mini-program on WeChat was not perfect. It also had some instability problems such as stuttering and flashing. Although in-class quizzes were conducted under teachers’ regulation, students were guided to complete the tests independently and the order of questions was randomly generated, it was still impossible to prevent students from communicating with each other and cheating. Therefore, cheating could not be completely avoided, and the fairness and authenticity of the tests could not be fully guaranteed.

We propose technical and procedural optimizations. Technically, use biometric verification and lockdown browsers to prevent proxy test-taking and restrict unauthorized actions. Procedurally, enforce time limits, restrict access by device/IP, and log response data. Increase subjective questions and conduct post-quiz analysis to flag suspicious activity. This multi-layered system will enhance assessment rigor and credibility on WJX.

Conclusion

It is very convenient and efficient to organize in-class quiz, get real-time feedback on teaching and learning, strengthen formative evaluation, and change the traditional summative evaluation by combining “WJX” platform with WeChat. Students can also develop active learning habits and strengthen their active learning ability through in-class quiz, which lays a solid foundation for their future learning of medical course.

Authors’ contributions

L.T. ,L.M. ,and X.T. wrote the main manuscript text. L.Y. and W.Z were responsible for data collection and formal analysis. G.K. and L.T. supervised the study and co-wrote the manuscript. All authors critically reviewed the manuscript and approved the final version for submission.

Funding

The work was supported by the Teaching Quality and Teaching Reform Project Construction Fund of Undergraduate Colleges and Universities in Guangdong Province(2024, 2026); Teaching Quality and Teaching Reform Project Fund, Zhongshan School of Medicine, Sun Yat-Sen University༈2025, 2026༉.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding authors on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the Sun Yat-sen Ethics Review Board and the informed consent was obtained from the anatomy professors interviewed as well as from the students who participated in the feedback survey.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.