Abstract
Asynchronous online graduate courses offer flexibility for learners, but also pose challenges for engagement and timely formative feedback. The muddiest point (MP) technique (a reflective formative assessment in which students identify concepts they find most unclear) is associated with improved learning, but its effectiveness as an optional, ungraded strategy in asynchronous settings is not well established. This retrospective cohort study examined whether participation in optional MP discussion boards was associated with academic performance and course engagement in a graduate-level asynchronous epidemiology course. De-identified learning management system data were analyzed across seven semesters (Spring 2023–Summer 2025), for 154 Master of Public Health students. Learners were categorized as actively engaged if they submitted at least nine discussion posts and viewed at least 21 posts. Outcomes included summative test scores, final exam performance, and proportion of course content completed. Wilcoxon rank-sum tests and modified Poisson regression with robust variance estimation were used to evaluate differences. Thirty students were classified as actively engaged and 124 as passive. Active engagement was associated with higher performance on assessments in Fall and Spring semesters, and greater likelihood of earning an A or B on the final exam (RR = 1.17, 95% CI: [1.06, 1.29],
p
= .002) and greater course completion (RR = 5.47 [3.58, 8.37],
p
< .001). No significant differences in test scores were observed during summer sessions. The MP technique may offer a feasible, low-stakes strategy for supporting student engagement and academic success while providing opportunities for formative feedback.