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

We applied the Integrated Online TBL (IO-TBL) model in teaching pathology because it combines synchronous meetings with flexible asynchronous engagement, giving teams time to work through application activities. This structure provides students with 1–2 weeks to explore the clinical relevance of foundational pathology knowledge. We introduced the Individual Post-Application Activity Test (iPAT) at the end of each IO-TBL topic to assess individual application of this knowledge following collaborative case analysis. This study examined whether iPAT scores were positively associated with Module Summative Test (MST) scores and whether this association remained after adjustment for Individual Readiness Assurance Test (iRAT) performance. We also explored whether the association between iPAT share and MST performance differed between two study years with different TBL assessment weightings. A retrospective, quasi-experimental design across two academic years included 297 preclinical medical students. In the second year, the grading weight of iPAT was increased and that of tRAT was decreased, while the overall contribution of TBL activities to the final course grade remained unchanged. Associations were analysed using linear mixed-effects models, and student perceptions were explored through anonymous feedback. iPAT scores were positively associated with MST performance after adjustment for iRAT performance (β = 0.64, p < 0.001). The association between iPAT share and MST performance did not differ significantly between the two study years ( p = 0.063). Students reported that anticipating iPAT motivated engagement with the learning materials; 61.0% selected iPAT over peer evaluation when asked which way they considered most objective for assessing participation in the case-based task. The positive association between iPAT and MST performance after adjustment for iRAT supports the potential value of iPAT as a complementary assessment within IO-TBL. It may help identify gaps in individual knowledge application following collaborative case analysis. Ethics approval No. 389/T-1 (granted by the Research Ethics Committee of the University of Tartu, in accordance with the Declaration of Helsinki).