Research report: Individual Post‑application Activity Test (iPAT) as an additional brief assessment for evaluating student learning in an integrated online TBL setting in pathology course

A brief individual test given after collaborative case work appears to capture something that traditional readiness quizzes miss, according to a retrospective study of preclinical medical students published in BMC Medical Education. Researchers at the University of Tartu found that scores on an Individual Post-Application Activity Test (iPAT) were positively associated with performance on the Module Summative Test (MST), even after accounting for how well students did on their initial individual readiness quizzes. The study examined an Integrated Online Team-Based Learning (IO-TBL) model used in a pathology course.

This format combines synchronous online meetings with flexible asynchronous engagement, giving student teams one to two weeks to work through application activities that explore the clinical relevance of foundational pathology knowledge. At the end of each topic, students completed the iPAT, a short assessment designed to measure individual application of knowledge after the team had collectively analysed clinical cases. The research team, led by Anastassia Kolde and colleagues, asked two main questions.

First, were iPAT scores positively associated with Module Summative Test scores, and did that association hold after adjusting for Individual Readiness Assurance Test (iRAT) performance? Second, did the relationship between the weight given to iPAT and summative performance differ between two academic years in which the assessment weighting changed? To answer these questions, the researchers used a retrospective, quasi-experimental design spanning two academic years and involving 297 preclinical medical students.

In the second year, the grading weight of the iPAT was increased while the weight of the team readiness test (tRAT) was decreased, with the overall contribution of team-based learning activities to the final course grade remaining unchanged. In practical terms, this suggests that a student's ability to independently apply knowledge after collaborative case analysis carries information about later summative performance that goes beyond what the initial individual readiness test reveals. Interestingly, the association between the iPAT share and summative performance did not differ significantly between the two study years, although the result sat close to the conventional threshold for statistical significance (p = 0.063).

This means the researchers could not confirm that changing the grading weight altered the strength of the relationship, and the finding should be interpreted with appropriate caution given the quasi-experimental design and the borderline nature of the comparison. Student perceptions added a complementary dimension to the quantitative results. In anonymous feedback, students reported that anticipating the iPAT motivated them to engage with the learning materials.

When asked which method they considered most objective for assessing participation in the case-based task, 61.0% selected the iPAT over peer evaluation, suggesting that many students viewed a brief individual test as a fairer measure of their own contribution than assessments based on classmates' judgements. The authors conclude that the positive association between iPAT and summative performance, after adjustment for iRAT scores, supports the potential value of the iPAT as a complementary assessment within the IO-TBL framework. Several limitations deserve emphasis.

The study was retrospective rather than randomised, so the findings describe associations within a single institution's pathology course rather than causal effects of the assessment format. The population consisted of preclinical medical students at one university, and the quasi-experimental comparison across two years with different weightings cannot fully isolate the effect of grading changes from other cohort differences. The study was approved by the Research Ethics Committee of the University of Tartu (No. 389/T-1) in accordance with the Declaration of Helsinki.

Subject of Research: Use of an individual post-application activity test to assess student learning in an integrated online team-based learning pathology course

Article Title: Individual Post‑application Activity Test (iPAT) as an additional brief assessment for evaluating student learning in an integrated online TBL setting in pathology course

Article References: Kolde, A., Uiboleht, K., Sarv, A., & Minajeva, A. (2026). Individual Post‑application Activity Test (iPAT) as an additional brief assessment for evaluating student learning in an integrated online TBL setting in pathology course. BMC Medical Education. https://doi.org/10.1186/s12909-026-10697-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10697-7

Keywords: team-based learning, iPAT, pathology education, medical education, assessment, online learning, summative testing, iRAT, quasi-experimental study, University of Tartu, BMC Medical Education, student motivation