The effectiveness of implementing various audience response system (ARS) formats in large classes to engage students, positively influence academic outcomes, and align with their preferences for different types of activities lacked sufficient information. This study aimed to (1) evaluate students' perspectives on different ARS formats, including Kahoot for individual (Kahoot-I) and team (Kahoot-T) play, and Google Forms and Google Sheets for multiple-choice questions (Google-MCQ) and for open-ended questions (Google-OEQ) on different aspects with/without subgroup analysis of students into quartiles (Q1-lowest-Q4-highest) of summative scores, and (2) determine correlations between students' perspectives and academic outcomes. At the course's final class, a QR code for a 5-point Likert scale questionnaire was displayed for all enrolled medical students. 269/312 students (86.22%) provided written consent and completed the questionnaire constructed based on dimensions of student engagement. Across all ARS formats, students rated scores [greater than or equal to] 4 for almost all aspects, with participation in class receiving the highest scores. For each aspect, Kahoot-T was rated highest in various aspects and Google-MCQ for "understanding" and Google-OEQ for "asking/answering question". Higher academic achievers expressed more "enthusiasm" for Kahoot-I than lower achievers (P < 0.05). Formative and summative scores were positively correlated with many aspects. Students reported high engagement with all ARS formats, with higher academic achievers rating them with higher scores. Kahoot-T was the most favored for multiple aspects, Google-MCQ for "understanding" and Google-OEQ for interactive "asking/answering question". Thus, selecting ARS in alignment with learning objective could enhance students' engagement and learning outcomes.