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Prevalence and Impact of Backwash on Learning in Undergraduate Medical Students


avatar Afshan Sumera 1 , avatar Ankur Barua 2 , avatar Arshad Jawed 3 , *

1 Assistant Professor, Lecturer Faculty of Medicine, International Medical University, Kuala Lumpur, Malaysia

2 M.B.B.S,Lecturer Faculty of Medicine, International Medical University, Kuala Lumpur, Malaysia

3 Assistant Professor/Researcher, Research & Scientific Research Unit, College of Nursing and Allied Health Sciences, Jazan University, Jazan

How to Cite: Sumera A, Barua A, Jawed A. Prevalence and Impact of Backwash on Learning in Undergraduate Medical Students. J Med Edu. 2018;17(1):e105606.
doi: 10.22037/jme.v17i1.19712.


Journal of Medical Education: 17 (1); e105606
Published Online: June 03, 2018
Article Type: Research Article
Received: January 04, 2018
Accepted: February 27, 2018


Background: Backwash or washback is a common phenomenon that exists in almost all the educational institutes in the world. It directly correlates itself to teaching, learning and student assessment. It’s a prevailing conception that conducting exams / tests could drive teachers to teach and students to learn (also called as measurement-driven instruction).Methods: A questionnaire based tool was developed and named the Backwash Assessment Questionnaire (BAQ). It was validated to evaluate backwash among medical students in Malaysia.A preliminary version, consisting of 15 structured items was developed based on an exhaustive and focused group discussion with students, content experts and extensive literature reviews. Multi-stage refinement narrowed it down to 10 items after the process of testing. The final version was analyzed using reliability testing. For testing, refinement and review process, 90 students and 10 lectures were selected to assess the acceptability, time-management and reliability of this questionnaire. A fresh sample of 105 undergraduate medical students from semester three to five from the same university was used for the test of the final version.Results: The overall internal reliability (Cronbach’s alpha) of the final version of the BAQ was found to be 0.874. The test-retest reliability from kappa statistics was found to be high with k=0.92 with P=0.0001*.Conclusion: The study showed that the BAQ was a valid, powerful and reliable tool for measuring backwash effects on education and assessment process. We found a high prevalence of backwash among the medical students in the undergraduate course.


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© 2018, Journal of Medical Education. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.