Background: Good performance in a summative assessment does not always equate to educational gain following a course. An educational programme may focus on improving student's performance on a particular test instrument. For example, practicing multiple choice questions may lead to mastery of the instrument itself rather than testing the knowledge…

Introduction: It was a challenge to design a feedback pathway for distance learning course that deals with complex and ambiguous clinical subject like organ transplantation. This course attracts mature clinicians (n = 117 spread over three modules) from 27 countries where in addition to the time and zone barriers; there are cultural, institutional…