Continuing Medical Education Taking Test on Computer

Expanding the use of computer-based assessments in medical education

¹ Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
² Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission	08-Nov-2021
Date of Decision	19-Nov-2021
Date of Acceptance	25-Nov-2021
Date of Web Publication	04-Feb-2022

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME, Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_97_21

The employment of computers for facilitating learning in the field of medicine is a known identity. The purpose of the current review is to explore the role of computer-based assessment in medical education and the potential challenges and strategies that need to be adopted to overcome them. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 15 articles were selected based upon their suitability with the current review objectives and analyzed. The keywords used in the search include computer-based assessment and medical education. The mode of use of computers in assessment can be decided based on the purpose of the intended assessment and play an important role in helping predominantly the students to expedite their learning. Computer-based assessments offer a good option for the students to assess their knowledge and learning progression in a nonthreatening and noncompetitive environment. In conclusion, computer-based assessments can be acknowledged as an exciting prospect and have the potential to bring about reforms in the assessment in medical education. This calls for the need that each and every medical institution should gradually aim for the introduction of the same within their set-up and thus prepare students better for their future medical career.

Keywords: Assessments, computer, medical education

How to cite this article:
Shrivastava SR, Shrivastava PS. Expanding the use of computer-based assessments in medical education. Curr Med Issues 2022;20:44-7

Introduction

The employment of computers for facilitating learning in the field of medicine is a known identity.^[1] The computers have been used in a multiple number of ways to promote learning among medical students.^[1],[2] In fact, the use of computers ranges from adoption of simulation for the sake of training, inclusion of animations in the regular power-point presentations used by teachers as a stimulus variation, or in the form of three-dimensional graphics model, or even in the computer laboratories.^{[3],[4],[5],[6]} Further, computers have also been utilized in medical colleges to train medical students for their approach to treat emergency cases, as a part of emergency medicine training.^[7] A number of studies have been conducted to assess the knowledge, attitude, limitations, and suggestions for the better implementation of computer-based medical education in medical colleges.^[7],[8] The purpose of the current review is to explore the role of computer-based assessment in medical education and the potential challenges and strategies that need to be adopted to overcome them.

Methods

An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on research skills among medical students published in the period 2006–2021 were included in the review. A total of 17 studies similar to the current study objectives were identified initially, of which two were excluded due to the unavailability of the complete version of the articles. Overall, 15 articles were selected based upon their suitability with the current review objectives and analyzed. The keywords used in the search include computer-based assessment and medical education in the title alone only (viz. computer [ti] AND medical education [ti]; computer-based learning [ti] AND medical education [ti]; computer-based assessment [ti] AND medical education [ti]; computer-based assessment [ti]). The articles published in only the English language were included in the review [Figure 1]. The collected information is presented under the following sub-headings, namely computer-based assessments, nature of computer-based assessments, merits of computer-based assessments, necessity for computer-based assessments, identified challenges and potential solutions, lessons from the field, implications for practice, and implications for research.

Computer-Based Assessments

Computer-based assessments have been frequently employed in medical institutions across the European and American region; nevertheless, the emergence of coronavirus disease – 2019 (COVID-19) pandemic has made the use of computers as an established type of student assessment in the different parts of the world.^[8],[9],[10] Computer-based assessments should be looked upon as a paradigm shift from the conventional methods (paper-based test) to an alternative approach, wherein computers are being used to deliver, grade, and analyze the results of the assessment of students.^[9] The use of computers in assessments can be done either by feeding in their responses given in paper into a computer optical mark reader or by making the computers as the direct interface for students to enter their responses and receive a feedback in return.^[9],[10]

Nature of Computer-Based Assessments

The mode of use of computers in assessment can be decided based on the purpose of the intended assessment, which can vary from being diagnostic (to assess the knowledge of the student before initiating the topic), formative (to ensure that the students receive feedback about their performance and faculty members realize their teaching effectiveness), summative (to progress to the next level after achieving the set criteria), and self-assessment (to help the students understand how much they know and what are their learning needs).^{[9],[10],[11]} These varieties of assessment play an important role in helping predominantly the students to expedite their learning, and also the teachers as well as to some extent teachers.^{[10],[11],[12]}

Merits of Computer-Based Assessments

Computer-based assessments offer a good option for the students to assess their knowledge and learning progression in a nonthreatening and noncompetitive environment.^[13] The biggest advantage is that it provides immediate feedback to the students about their individual performance in a uniform manner, whereaas the teachers get feedback about their teaching-learning strategies.^[10] At the same time, these tests are convenient to be organized, can be delivered at the same time in different places, have a wide reach, and can be used for thousands of students, which is not the case with traditional paper-based assessments. From the teachers' perspective, these computer-based assessments save time and efforts and enable them to track the performance of individual students.^[13],[14]

Furthermore, the presence of a number of security features like proctoring, ensures that the test integrity is sustained and assessments can be done in a fair manner. Further, there is often an option to employ computer-adaptive tests, wherein based on the answers given by the students, the difficulty level of the question paper is being determined.^{[10],[11],[12],[13]} Moreover, the inclusion of a wide range of media on tests enables teachers to assess novel aspects of thinking. On administrative grounds, the tests can have a variety of randomly selected questions from the question banks, which enables the assessment of different aspects.^{[11],[12],[13],[14]} Moreover, considering the fact that the process is automated, it is a rapid strategy, which is free from human bias and also aids in automatic grading.

Necessity for Computer-Based Assessments

It is a well-known fact that most of the students read-only before the examinations. Thus, considering the reality that computer-based assessments can be carried out frequently in comparison to conventional paper-based assessments, the number of assessments can be definitely increased.^{[12],[14],[15]} This will act as a motivating factor for the students to continue their learning and even augment their skills (namely critical thinking, clinical reasoning, and problem-solving). The introduction of computer-based assessments gives a wide range of variety of assessment tools for the teachers, and thus, we can better assess students in the different aspects.^{[9],[10],[11]} The nature of tests can vary from selecting the correct option (viz. true/false or yes/no or multiple-choice questions, etc.), completion type (viz. short answer question, essay question, and case studies), image-based questions, etc., and thus can test much more than what is being offered in conventional paper-based assessments.^[10],[11]

Further, it minimizes the load on the teachers to give feedback for an individual student, and at the same time ensures that no student is deprived of feedback about their performance. Moreover, these assessment methods play an important role in augmenting the objectivity of the examinations and maintaining consistency in assessing which is often not the case in paper-based assessments.^{[10],[11],[12],[13],[14]} Further, the basic challenge of manually correcting all the papers, which in itself is a time-consuming process, is also ruled out, upon the adoption of computer-based assessments. In addition, the introduction of these assessments also enhances the overall efficiency at the administrative level.^[11],[14]

Identified Challenges and Potential Solutions

Computer-based assessments are potentially expensive and require effort and time in the initial stages to set up the examinations. As these are technology-dependent, the process of training the concerned staff becomes indispensable.^[9] Moreover, there is a need for a significant amount of expertise to prepare the question banks and store a wide variety of questions. Further, we cannot ignore the fact that these tests might provide some form of additional advantage to the students who have better computer skills, than merely the knowledge of the subject.^{[9],[10],[11]} In addition, we will require reliable and secure test delivery system to conduct fair examinations, which in itself can prove to be a financial burden.

Subsequently, the possibility of plagiarism can also be not ruled out, if the students have simultaneous access to the internet and the proctoring system is not effective. Finally, as these are technology-driven interventions, a sort of backup examination also needs to be arranged in case there are any hardware or network interruptions.^{[8],[11],[12],[13]} All these challenges are bound to be there in the initial stages, but once the capacity building has been achieved and the question bank is ready with good proctoring support, these computer-based assessments can prove to be the investments for the future.^{[12],[13],[14]} Moreover, these initiatives require financial investments, but once again, it is a step for future betterment to improve the quality of assessments and subsequently minimize the administrative workload on teachers, so that they can focus more on other domains of quality teaching.^{[11],[12],[13],[14],[15]}

Lessons from the Field

At Shri Sathya Sai Medical College and Research Institute, a constituent unit of the Sri Balaji Vidyapeeth, Deemed-to-be University, Puducherry, a number of assessments have been carried out using computers. These include multiple choice questions and short answer questions through the Google Forms, proctored-assessments, software-based assessments (such as Zoom, Pear Deck, Kahoot, Poll Everywhere, Quiziz), and assessments done through the learning management system. The experience of using these computer-based assessments has been enriching for both the teachers and the students, and encouraging response has been obtained from the medical students about the same.

Implications for Practice

Acknowledging the wide scope of the computer-based assessments and the additional advantage which these assessments offer for facilitation of learning, it is the need of the hour that all medical colleges should look to incorporate the same within their setup. It is always good to carry out a need assessment among the faculty members to identify the areas in which they need exposure. Based on the findings of the need assessment, the Medical Education Unit of the institution can organize faculty development programs for empowering them in different tools of computer-based assessments. Subsequently, the faculty members can be assisted while they are planning assessments in their department to increase their confidence. It will be good if the faculty members can be given demonstration of free and simple computer-based applications, as many of them prefer the same.

Conclusion

Computer-based assessments can be acknowledged as an exciting prospect and have the potential to bring about reforms in the assessment in medical education. This calls for the need that each and every medical institution should gradually aim for the introduction of the same within their set-up and thus prepare students better for their future medical career.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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  [Figure 1]

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