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 Table of Contents  
Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 54-59

Face to face versus virtual assessment - A survey on Indian medical students' perception during COVID-19 pandemic: A cross-sectional study

1 Assistant Professor, Department of Anatomy, AIIMS, Kalyani, West Bengal, India
2 Professor, Department of Anatomy, AIIMS, Kalyani, West Bengal, India
3 Senior Resident, Department of Anatomy, AIIMS, Kalyani, West Bengal, India
4 Associate professor, Department of Anatomy, AIIMS, Kalyani, West Bengal, India

Date of Submission05-Aug-2021
Date of Decision19-Dec-2021
Date of Acceptance06-Jan-2022
Date of Web Publication01-Feb-2022

Correspondence Address:
Satabdi Sarkar
Department of Anatomy, 1st Floor, Medical Block, AIIMS, Kalyani Basantapur, Saguna, Nadia - 741 245, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/NJCA.NJCA_102_21

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Background: Assessment has a very important role in curricular development by motivating students and target setting, providing appropriate feedback and quality assurance. During COVID-19 pandemic-induced lockdown, most of the medical schools throughout the world including India had to undergo a paradigm shift from face to face to online mode in medical education and assessment. This study was planned to assess and analyze the perception and opinion of 1st-year medical students from all over the country regarding the online assessment (OA) process that emerged during the COVID 19 pandemic. We also tried to find out the preferred resources that the students wanted to access via online mode and any major hindrance they faced. Methodology: It was a cross-sectional, Internet based, online survey conducted on 1st year medical students from all over India. Result: Students preferred the traditional (face to face) examinations over the OA in terms of usefulness, motivation, answering long answer questions, adequacy of allotted time, and ease of performance. However, they favored OA in terms of examination anxiety, examiner bias, and answering the objective type of questions. The lack of good Internet connectivity was considered a major hindrance. Conclusion: This information might be helpful for respective authorities to establish an effective online platform which could deliver an authentic and valid OA in future during any crisis.

Keywords: Anatomy, COVID-19 pandemic, Indian medical students, online assessment, online survey

How to cite this article:
Ghosh A, Sarkar S, Ray B, Sarkar A, Dasgupta A. Face to face versus virtual assessment - A survey on Indian medical students' perception during COVID-19 pandemic: A cross-sectional study. Natl J Clin Anat 2022;11:54-9

How to cite this URL:
Ghosh A, Sarkar S, Ray B, Sarkar A, Dasgupta A. Face to face versus virtual assessment - A survey on Indian medical students' perception during COVID-19 pandemic: A cross-sectional study. Natl J Clin Anat [serial online] 2022 [cited 2022 May 20];11:54-9. Available from: http://www.njca.info/text.asp?2022/11/1/54/337037

  Introduction Top

Assessment has very important role in any curriculum to verify and confirm the efficacy of curriculum.[1] It helps the learners in target setting, motivation, quality checking, and effective learning by gaining the appropriate knowledge.

During the COVID 19 pandemic, the Indian medical education system was forced to temporarily replace the traditional way of teaching and assessment into online mode. Some of the challenges were lack of previous exposure and infrastructure in handling online education, stress and anxiety related to COVID pandemic, issues related to Internet connection, time management, lack of confidence to use technology, etc.[2] A drastic change of mode of assessment from face to face to online was never an easy task, especially for low-to-middle-income countries like India.[3] However, the crisis made the people find the solution, at least partially. Different faculty members and institutions innovated ideas to transit from face to face to virtual mode and prepared questionnaires and exam patterns accordingly.[4]

Most institutions used Google form-based online assessment (OA) for theory; digital spotter exam and video call-based viva voce examination for practical.[5],[6] In some institutions, the final examination was delayed until the students were called back for a traditional face to face examination when the first wave of the pandemic was over.

Though the use of online proctoring systems and computerized adaptive tests have been considered as very useful tools to make the OA authentic,[7],[8] most of the medical schools in India did not have the funding or expertise to implement those complex solutions. Still, the OA was initiated. Some positive aspects about OA included effective learner involvement and higher achievement in some problem-based learning models, enhancement of self-directed learning, automated formative feedback, documenting evidence, the satisfaction of staffs, etc.[9],[10],[11],[12],[13],[14] OA provided a scope of open-book examination (OBE) and open book, open web (OBOW) examination as well which helped the learners in the self-directed discovery of knowledge and its application.[6],[12],[15] However, the data regarding the perception of Indian medical students about OA are very limited.

Keeping the usefulness and limitations of OA in mind, we wanted to study the perception of 1st year MBBS students of Indian medical schools about OA in anatomy over the traditional method. The other objectives were to find out the preferred resources that the students wanted to access via online mode and any major hindrance they faced.

  Materials and Methods Top

The study was an Internet-based cross-sectional survey conducted on 1st year medical students of various Indian Medical Colleges during July 2020–October, 2020 by the faculty members of our institution. Institutional Ethics Committee's (letter no-T/IM-NF/Kalyani/20/04 dated August 10, 2020) approval was sought before conduction of the study. The Questionnaire 1 (survey regarding online assessment during covid 19 Pandemic) was showing students opinions regarding the use of online resources for better performance in assessments. It was Google form-based self-administered, prevalidated questionnaire. The major part of the questionnaire was made by the literature search.[1],[5],[16],[17],[18] Validation was done by sending the questionnaire to three external experts and according to their suggestion, minor modifications were made by rephrasing some sentences. The reliability of this questionnaire was ascertained by conducting a pilot study in which five 1st year MBBS students were participated. They were chosen randomly from the 1st-year batch. Cronbach's alpha coefficient of the results of this pilot study was calculated at least 0.85 and subsequent actual study responses almost showed the same value.

The questionnaire had three parts

Part 1: An introductory section describing the purpose of the study and assuring anonymity and confidentiality of the participants. Informed consent was taken in this part.

Part 2: Basic demographic data (age, gender, type of device used).

Part 3: Question on different aspects of face to face and OA and assignment resources in a 4-point Likert scale (4-strongly agree, 3-agree, 2-disagree, 1-strongly disagree). “No opinion” option was removed to avoid neutral responses and to obtain the maximum number of opinions. Question on Types of hindrance faced in OA added.

The questionnaire link was shared to the 1st-year MBBS students of various medical colleges via their peers and teachers. The form was accessible via computer or smartphone. We considered the responses of those students who appeared for the first internal assessment examination (which was taken in traditional face to face method by most of the medical Institutions) and participated in online assignments and examinations. We did not include those responses who did not submit the consent.

All data were tabulated in Microsoft Excel sheet. Standard statistical analysis was performed using SPSS version 22 (IBM corp, Armonk, NY, USA), and EpiCalc 2000 (version 1.02: Brixton Health) (online software). To compare the opinion regarding traditional and OA, Chi-square test was used, P ≤ 0.05 was considered statistically significant.

  Results Top

We included 254 students for this survey after excluding 7 responses according to inclusion and exclusion criteria.

About 50.80% were female and 49.2% of the respondents were male. Their age varied between 17 and 23 years. About 80.3% of students used smart phone to take online examinations.

Most of the students (94.88%) agreed that regular assessment in the traditional way was useful in learning gross anatomy, whereas 61.41% believed that regular OA was helpful in learning anatomy [Table 1].
Table 1: Comparison between students' opinion regarding traditional versus online assessment

Click here to view

No statistically significant difference was found in responses favoring or disliking the traditional assessment (TA) system over OA system based on gender, age, or type of device used.

Regarding the type of question, they had various opinions. In TA, students believed short answer questions (SAQ) and long answer questions (LAQ) were more useful (as they were easy to write than type and were the most common question forms asked in final examinations) than multiple choice question (MCQs) in lesson preparation. In the case of OA 66% (approximately) students believed MCQ and SAQ were much useful than LAQ (55.51%). Students believed that examiners' bias in giving marks was more in traditional examination in comparison to the online examination which was statistically significantly high in traditional/face to face examination. Regarding motivation for the study, statistically significant higher number of students (93.31%) voted for traditional examination. Students expressed that examination anxiety was higher in the traditional examination (83,46%) than online mode (47.64%). Students (TA-79.13% and OA-54.33%) also preferred traditional examinations for ease of performance.

Majority of students (>65%) believed online tests, quizzes (were prepared and uploaded online by faculty members) were helpful and it was easier to get quick feedback on the submission of online assignments. Most of them (>60%) wanted to participate to access more to online study materials (books in pdf format, lecture slides), online practice tests, and online quizzes. Online clinical case-based questions were the most preferred resource material [Table 2].
Table 2: Students opinion regarding use of online resources for better performance in assessments

Click here to view

39.75% of students opined that network issue was the major hindrance to take online tests. The other challenges faced by students were technical issues (28.46%), lack of privacy (16.23%), typing speed (13.98%), and improper devices (1.58%).

  Discussion Top

The present study showed us that 1st-year medical students, who had to take the online mode of formative and internal assessments during the COVID 19 pandemic, preferred the TA system in terms of usefulness, motivation, answering LAQ, adequacy of allotted time and ease of performance. However, they favored OA in terms of examination anxiety, examiner bias, and answering the objective type of questions. They preferred online quizzes, practice tests and expressed that OA had less examiner bias, examination-related anxiety and was good for getting instant feedback. It indicates their disliking for OA could be due to other issues including lack of strong network connection, privacy at home, typing speed, technical challenges, lack of secured and proctored examination facility and especially the negative feeling associated with the ongoing pandemic.[16],[19]

In most of the previous studies, students preferred the online mode of examination where the online examination was implemented after adequate preparation and with proper infrastructure, in a secured website, using MCQ-based questionnaire within well-structured examination centers.[1],[17],[20],[21],[22]

In particular, the OA was preferred by students when it was conducted in the university's own server system or web-based learning management system; using randomized MCQ type questions, feedback and score with item analysis was provided immediately after the examination.[17],[21] Other reasons for preference of these types of online examination were-high security, support for computer glitches, appropriate Internet support and almost no provision of using unfair means.[18],[22] It has been believed that the authentic assessment process with adequate validity and reliability usually improves the learning process and are preferred by students.[1],[18]

Students of a business school preferred the OBOW exam than the closed book, invigilated traditional examinations as the final examination[23] as they preferred the flexibility of time and space to take the exam, the engaging and practical application-based questions.

The present study was based on the online examinations that were arranged during COVID 19 Pandemic when in most institutions the preparations were inadequate, no online proctoring could be arranged mostly due to huge cost, most of the students had to use smartphones only and there were big network issues in most part of India. In the Indian system of traditional summative examination, various types of questions like essay type descriptive questions, short answer type, and objective types of questions are usually asked. Therefore, various types of questions like problem-based and image based MCQ, SAQ, structured LAQ were included in the online anatomy examination in most of the medical schools.[24] The Internet facility varied depending on the location of the residence, capability to pay for a stronger connection, and the quality of device students were using. Moreover, students felt demoralized and there was the question about examination integrity as there was scope for using unfair means in most cases.[25]

In another similar study, the 1st-year medical students from an Indian medical school,[5] during COVID 19 pandemic, expressed that viva voce examination taken by video conferencing was the most reliable and multiple choice-based questions were the most feasible to answer within limited resources. This result had some similarities with our findings.

Another study conducted on Indian medical students during COVID-19 pandemic[26] preferred offline mode of examination though they felt that it was easier to score in online examination like the present study. The study population of both these studies had demographic similarities with the present study regarding infrastructure for implementing online examination, devices used by the medical students. It is a complex decision to choose a perfect mode of effective assessment.[27]

Some authors recommended the inclusion of various activities including self-test Quiz, discussion forum, e-portfolio, interactive formative feedback engaging students at regular intervals, and using multiple small online tests rather than a single summative examination might improve the overall satisfaction.[1],[8] Moreover, the establishment of strong information technology set up in the institution as a back-up and appropriate training of the staff is recommended.[28],[29]

It can be said that comparison and evaluation of online and offline assessments is not a very easy task as many factors determine the successful implementation of assessments. A good approach may be a combination of both in appropriate proportion considering the feasibility and associated factors.

The study was conducted as an online survey among the 1st-year medical students of more than one institution which increased the representation of medical students from various regions of India. Maintenance of anonymity regarding the participants' name and institutions reduced the investigator bias. Future studies should be conducted on larger population size and should analyze various aspects of assessment including perception about proctoring, examination center-based online examination, OBE etc.

  Conclusion Top

Indian medical students preferred the traditional mode of assessment over OA in most aspects except examination-related anxiety and examiner bias during COVID 19 induced lockdown period. However, students showed their interest in accessing more clinical case-based questions, online practice tests, online quizzes and other resource materials to improve their performance. Network connectivity issue was regarded as the major hindrance for online participation. This information might be helpful for respective authorities to establish an effective online platform which could deliver an authentic and valid OA in future during any crisis.


We sincerely acknowledge the students who participated in the study and provided their valuable opinion and the persons who helped to share the questionnaire.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  Questionnaire Top

Questionnaire 1: survey regarding online assessment during covid 19 Pandemic [1],[5],[16],[17],[18]

1) What is your age?

2) What is your gender?

3) Did you appear for first semester examination?

  • Yes
  • No

4) Did you participate in online assessments?

  • Yes
  • No

5) Which device you used for online examination?

  • Smart Phone
  • Desktop
  • Laptop
  • Tablet

  • 6) Your opinion: Regular assignments are useful in learning gross anatomy

    7) Your opinion: Multiple choice questions are more useful in preparation of lessons of anatomy

    8) Your opinion: Short answer questions are useful in lessons preparation in anatomy

    9) Your opinion: Long answer questions are useful in preparation of lessons of anatomy

    10) Your opinion: There is bias among examiners affecting students score

    11) Your opinion: The time allotment was adequate

    12) Your opinion: The mode of examination motivated for better study

    13) Your opinion: Examination anxiety was very high and affected the score in

    14) Your opinion: It was easier to perform in the examination

    15) Your opinion: Practice objective structured practical examination helped to identify the structure/perform better during practical examination in gross and histology examination

    16) Your opinion: I would like to have access to more online Clinical case-based anatomy questions

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    17) Your opinion: I would like to access more online resources

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    18) Your opinion: I would like to participate in more online practice tests

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    19) Your opinion: It was convenient to answer online quizzes

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    20) Your opinion: I would like to have access to more online clinical case-based anatomy questions

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    21) Your opinion: Submitting the assignment and getting quick feedback was helpful in online learning methods

    • Strongly agree
    • Agree
    • Disagree
    • Strongly disagree

    22) What is the main hindrance you faced in online examination?

    • Network issue
    • Typing speed
    • Technical issues
    • Improper device
    • Lack of privacy

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      [Table 1], [Table 2]


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