Assessment design plays a pivotal role in shaping students’ learning behaviours, influencing both the depth and direction of study in higher education. This mixed-methods study examined perceptions of oral summative, written summative, and formative assessments among 33 students enrolled in three international master’s programmes at Karolinska Institutet—Translational Physiology and Pharmacology, Bioentrepreneurship, and Global Health—comprising learners from diverse geographic and disciplinary backgrounds.

Quantitative Likert-scale data indicated that written summative assessments were consistently perceived as more effective for consolidating factual knowledge (median = 4), whereas oral summative assessments received more varied ratings for supporting deeper understanding (median = 3) but were clearly valued for encouraging reflection (median = 4). Oral summative formats were moderately motivating (median = 3) and perceived as more stressful than written formats, although reported stress levels remained moderate overall (median = 3). Formative assessments demonstrated the strongest consensus across the cohort (median = 4), with students highlighting clarity, feedback, interaction, and a low-stakes structure as key drivers of engagement.

Qualitative findings reinforced these patterns, illustrating how oral summative assessments foster real-time reasoning and communication, written summative tasks promote clarity and precision, and formative activities cultivate confidence and continuous improvement. In the context of increasing use of Generative AI, oral assessment formats may also support academic integrity by enabling more authentic evaluation of student understanding. Subgroup analyses further indicated that engagement—but not stress—modulated perceptions of professional relevance, with highly engaged students more strongly recognising the authenticity of oral formative assessment practices.

Overall, the findings underscore the pedagogical value of integrating diverse assessment formats to support cognitive depth, emotional regulation, inclusive learning practices, and career preparedness in global biomedical higher education.