Formative self-assessment using multiple true-false questions on the Internet: feedback according to confidence about correct knowledge

In undergraduate clinical courses, students are often dispersed over several teaching sites. Traditional curricula do not have mechanisms that allow monitoring of an individual student's educational progress or that of a small group of students at a teaching site relative to that of the whole group. To address these issues, we have developed a web-based formative assessment system that consists of knowledge tests based on multiple true-false questions. During the test, in addition to marking true or false against each question, students indicate their level of confidence (doubt or certainty) about each answer. The feedback consists of whether the answer is correct or incorrect and the confidence with which the student had responded. Feedback to students assesses their own performance in relation to that of their peers. Feedback to tutors provides anonymized information about the level of achievement of students at their teaching site relative to that of students at other sites. This systems has the tools that students can use to direct their learning and tutors can use to tailor their teaching in the light of the instantaneously available comparative feedback.