Tabriz University of Medical Sciences Research and Development in Medical Education 2322-2719 15 1 2026 01 01 Association Between Low-Stakes Formative Assessment Scores and High-Stakes Summative Examination Outcomes Among Undergraduate Pathology Students: A Cross-Sectional Study 33420 33420 10.34172/rdme.33420 EN Mohammed Abdul Rafi https://orcid.org/0009-0000-7960-826X Pranathi Mahankali https://orcid.org/0009-0007-2864-1132 Radhika C Sasturkar https://orcid.org/0000-0003-1414-6388 Anam Sughraa https://orcid.org/0009-0007-3305-7782 Journal Article 10.34172/rdme.33420 2026 02 06 2026 06 25 Introduction: Competency-Based Medical Education, introduced in India in 2019, emphasizes continuous assessment through formative evaluations. However, the association of formative assessments with medical students’ final summative examination performance, particularly in pathology, remains underexplored. This study aimed to examine the correlation between formative assessment scores and final summative results among second-year MBBS students in pathology and explore their perceptions of formative assessments. Methods: A cross-sectional study was conducted among 101 second-year MBBS students. Twelve formative assessments were administered over nine months, followed by feedback on student performance. Data from formative and summative assessments were analysed using descriptive statistics and Pearson’s correlation coefficient. The comparison was only between students’ formative and their own summative scores, not before/after. A self-administered survey measured students’ perceptions of the effectiveness of formative assessments, using a 5-point Likert scale. Results: The mean formative assessment score was 51.83% (Standard deviation=10.8), and the mean summative exam score was 61% (Standard deviation=6.5). A significant positive correlation (r=0.66, P<0.001) was found between formative and summative exam scores. In the perception survey, the majority of students agreed with statements indicating that formative assessments helped them identify focus areas, build confidence, and manage exam anxiety. Conclusion: Formative assessment scores demonstrated a strong positive correlation with summative examination outcomes among undergraduate pathology students. While students held favorable perceptions regarding the utility of formative assessments, causality cannot be inferred due to the cross-sectional, observational design. The observed association may reflect underlying student characteristics—such as baseline academic ability, consistent study habits, or intrinsic motivation—rather than a direct effect of formative assessments on performance. These findings support formative assessments as useful indicators of student progress and valuable tools for structured feedback within the CBME framework.