Multiple-true-false (MTF) assessments can provide granular feedback on course materials, which stems from the format of the MTF question and helps to enhance student understanding and illuminates misconceptions that can be hidden with other assessment types (Brassil & Couch, 2019). The purpose of this study was to document how students use and experience MTF based formative assessments, the feedback provided on the assessments, and subsequent reinstruction, to improve student conceptions of microbial cell biology over the course of three MTF based formative assessments. The context of the study was a first-year course covering microbiology in a physician assistant education program. The research design was a qualitative case study with item level frequency analysis and descriptive statistical analysis. Findings revealed that MTF based formative assessments uncovered student misconceptions and allowed for improvement of the conceptions of cell wall material of fungi, Gram staining, and bacterial cell wall composition. Students engaged in metacognitive reflection and reiterated via interviews that MTF based assessments helped to expose their non-expert understandings. Students' attitudes and experiences were also noted; there was near unanimous support for the MTF question type in formative assessment. This study suggests that there are numerous benefits for the use of MTF based formative assessments for addressing microbiology concepts, additionally, it contributes to the literature by documenting the voice of students to further understand MTF based assessments. Students expanded on the following traits of the MTF question type from the literature, the clear and concise nature and test taking strategies used on the assessments, as being significant in their metacognitive reflections. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]